Stereoids with bradycardia and few more questions.

[MatPatP]

Hi all,

I have already written this similar questions few days ago, but I posted them as a question, so I have no idea if it is visable at all, so I will repost it.

I hope you all are doing as fine as you can.

I have written here my story previously with strange episodes I have been experiencing for the last 2.5 years. It started with sudden arrythmias, extreme tiredness(i couldn't make 500 meters without calling ER), and a feeling of "fever" in my eyes. Also, I had stomac problems, nauseas etc...

The episode lasted cca month and a half and then It gradually got better, but never entirely fine since.

In last two and half years new simptoms appeared: Raynauds phenomenon, Dry eyes, dry nose channels, feeling of too little saliva in my mouth(but not entirely dry), legs numbness, lack of strength. Extreme tiredness that is better after rest, muscle aces, as if they are constantly inflamed and I get terrible muscle fevers after excercising simple excercises.

I have made following tests:

Schirmer test: 0mm tears in both eyes, disagnosis Conjuctivitis sicca

ANA titer highly positive: 1:1280, but all ENA negative and low(1,2,7...), only anti-RO 24(but that is still negative).

EMNG - made for legs numbness- showed mild positived for Myastenic syndrom and polymyositis.

I have another neurology exam at 28.02. I will probably have to do Prostigmin test and antibodys for Myasthenia.

Regarding Sicca I need to do Salivary Glands scyntigraphy at April.

Uf! It takes so looong to get dyagnosis. I am from Croatia and here if you go privately to Neurologist or Reumatologist and if you need to enter hospital(For Prostigmin test for example) you need to do all exams you did privately all over again at Hospital Neurologyst :(!

I also have arrythmias, bradyardia(50-55 bpm heart rate) and Mitral valve prolaps with regurgitation 2+..

So I wonder If I ever do need stereoids, can I even take them with Bradycardia and arrythmia? Does someone here has similar conditions?

Also, if someone did prostigmin test, how does that go with slower heart beats?

Thank you all!

[PMRpro]

I have been taking corticosteroids for the past 10+ years for polymyalgia rheumatica PMR). Early in the PMR I noticed palpitations, which were dismissed as "your age" by the GP, but they were paroxysmal and relatively rare. They improved with pred when I was finally diagnosed but never went away entirely. Nearly 7 years ago I had severe back problems due to spasmed muscles causing sacroiliac inflammation and was admitted for treatment where they use i.v. painkillers and steroids in the morning and i.v. diazepam at night as a muscle relaxant. Unfortunately, although it worked wonderfully well for the back muscles the second lot of i.v. diazepam caused atrial fibrillation, a rare but known adverse effect. They thought it was the steroids and stopped them but it happened again the following night. Once it was properly diagnosed and treated medically I realised that the episodes before had been due to the a/f, caused, the cardiologist is confident by the autoimmune part of PMR which has damaged the electrical cells in the heart that govern heart rate.

That has progressed with the vasculitis that causes PMR and I developed bradycardias, often below 40, after episodes of tachycardia/arrythmia. The bradys got worse but could not be caught on a monitor and eventually I collapsed as a result of one. In the ED they gave me i.v. diazepam because they didn't know the effect it has on me - more a/f and finally they saw the pauses which were up to 7 seconds! I was given a pacemaker and since then have had no problems because the bradys have been stopped. Initially I was able to manage the bradys better by increasing the steroid dose, it was under 10mg at first but as I flared I took it up to 15mg,

All this to say - there is often no reason why you shouldn't take steroids when you have arrythmia problems. That is something to discuss with a cardiologist and balance with any other medication.

[MatPatP in reply to PMRpro]

Hi PMRPro,

Thank you very, very much for your reply!

It is actually amazing that my episode(of whatever it is(they suspect sicca or Myasthenia now and I am doing tests now) 2.5 years ago started with sudden arrythmias and a horrible fatigue. Then cardiologyts also found bradycardia, but not so tertibly low in heart beets(46 sometimes at night time-60 at most at daytime, but in average 50-55) and didn't wish to give me beta blockers because of a low hearth rate.

Thanks a lot for claryfying regarding stereoids. I guess if arrythmia was caused by reumathic or whatever desease, they even might help as you say.

When my episode happened 2.5 years ago, I ended up on ER because I had such a horrible arrythmia walking from work to home, and I almost fainted, and a man on the street called ER.

There, they gave me Diazepam and let me go home thinking I had a pannic attack, because they only caught 1 or 3 extrasystolas on EKG, and all else was normal by the time I got to ER.

I exited hospital, diazepam started to work and again I almost fainted!

I don't handle any muscle relaxant well. They all make me a dizzy and invoke arrythmia, probably because of the low heart beats as you say!

Thanks again!

[PMRpro in reply to MatPatP]

Have you access to a external loop monitor perhaps? That is a heart monitor you wear for several days at least and if you have an "episode" you press a button and the previous few minutes of cardiac activity is transmitted to the hospital. It means that you don;t miss something because you can't predict it. I was about to ask for one when events overtook me - ordinary monitors don't look backwards - and in something like this it is important.

[MatPatP in reply to PMRpro]

Thank you a lot!

My heart is better now, is is not as in that "flare" I had 2.5 years ago. Soon I am going to cardio control and will definitely ask my cardio of such a device. Arrythmias are hard to monitor and strange episodes do not happen each day as you say.

I will ask also my doc if that intense arrythmia episode, "flare" I could have been linked with some possible autoimune condition they suspect I have(Like PMR for you triggered hearth problems).

Uf! I hope somehow all our problems can get minimalized!

Thank you very much for your advices!