NEWBIE: My very first post: Can PMR and/or Prednisolone cause reduced heart rate?

[JanetRosslyn]

I am a 60 year old female and my GP suspects I have PMR. (Pain, immobility, raised ESR and CRP.) I have my first Rheumatology appointment due in February 2017. Never having heard of PMR before, I am SO PLEASED to have found this amazing and informative forum!!!

I reluctantly started taking the dreaded steroids (15mg Prednisolone every morning) ten days ago, with amazing results... I can once again roll over in bed, get out of bed, get dressed, get in the shower, walk up the stairs, etc., all without assistance, and I can sneeze without thinking my head was going to snap off!!! . I still have some pain and stiffness, but things have improved dramatically so I'm not complaining.

However, I have noticed that my resting heart rate (normally 60 beats per minute during the day and 54 during the night) has gradually been dropping and is now 48 during the day and as low as 38 during the night. I also get a slight 'pressure' feeling in my chest and light-headed if I stand up too quickly, neither of which I've had before. I'm seeing my GP in three days time, so will raise this issue then, but I was just wondering if anyone else had experienced this with PMR/Prednisolone as everything I've read so far seems to discuss increased heart rate.

Regards, JR.

[PMRpro Ambassador]

Yes - pred is usually blamed for increasing heart rate although bradycardia (slow) has been noted in rare cases with high dose steroids, especially when given as an infusion. 15mg is NOT high dose though!

BUT - I developed atrial fibrillation at about the same time the first signs of PMR appeared. I went to the GP repeatedly about the PMR symptoms - blood tests were fine so I couldn't be ill (!). I also reported the palpitations I noticed on occasions - he couldn't hear anything, the ECG was fine, there couldn't be anything wrong. The fact the palpitations never happened when I was at the doctor was immaterial it seemed. So I plugged on and tried to ignore them. Eventually the PMR got so bad I did a lot of online investigation and came up with "PMR" - and he referred me to a rheumy. 15mg pred - miracle!

It wasn't until I had severe sacroiliacitis and was admitted to the local hospital here for treatment that the atrial fibrillation was identified for what it was. I had a drug reaction to iv valium and had a 5 hour episode of a/f. When that was diagnosed and treated - the palpitations were gone! The cardiologist was of the opinion that the autoimmune part of PMR had damaged the electrical cells in the heart that govern heart beat. Depending on the damage done the type of arrythmia can vary.

Do you check your BP as well? Pred can lead to a fall in BP if the PMR inflammation has badly restricted blood flow - the arteries widen again and that leads to a fall in BP. But those heart rates are not really ideal and if they fall further or you feel unwell do go to A&E if you can't get to see your GP quickly.

However - don't accept your GP just checking your pulse and doing a one-off ECG. That will show nothing unless it is actually happening at the time. You need a 24-hour Holter monitor ECG at the very least.

[JanetRosslyn in reply to PMRpro]

Thanks for that PMRpro. Much appreciated.

I'm glad to hear your palpitations were sorted - it must have been really scary - and very interesting to hear the Cardiologist's opinion about PMR and arrhythmia.

I don't have the equipment to check my own BP (and if my husband reads this, I do NOT want any for Xmas... ha ha). My GP specifically chose NOT to check my BP when I last saw her as I was in so much pain and distress she said it would not be a true reading, but she said she would check it, along with various other things (which she listed) when I see her next, which is only three days away from now. What you say makes a lot of sense, so when I see her I'll ask for the 24 hour Holter monitor ECG as you suggest. Meanwhile, I'm talking plenty of rest and keeping my mobile phone close, 'just in case' and will go to A&E immediately if there's any real chest 'pain' or if my heart rate keeps dropping.

Thanks again for your response. Much appreciated.

[PMRpro Ambassador in reply to JanetRosslyn]

Perhaps the biggest risk with severe bradycardia is that you can feel faint in precarious situations - like at the top of the stairs or while handling something hot in the kitchen - and be injured as a result. That is my concern - and if you have any close shaves, don't ignore them! I don't want to sound scary - but I do want to be realistic.

No, a BP device would be a bit like being given a pressure cooker for xmas wouldn't it. I have had a lot of treasured domestic appliances as presents though...

[JanetRosslyn in reply to PMRpro]

Thanks for your concern. I promise, I won't ignore any close shaves. In fact, if my heart rate drops further tonight I think I'll give my GP a call in the morning, just to be safe, especially as I'm home alone at the moment as hubby has just flown off to work in Luxembourg for a few days.

[PMRpro Ambassador in reply to JanetRosslyn]

[JanetRosslyn in reply to PMRpro]

An update... just in case you were wondering... My resting heart rate has steadily increased and for the last five days has remained at 54 beats per minute. However, most days I get brief intermittent feelings of pressure on my chest, at which point my heart rate drops into the low 40s. My GP tells me my ECG looks 'normal' and that my blood pressure is 'perfect' at 100/60. He's said he's 99% certain that what I'm experiencing is a side-effect of the Pred and that he is going to report it as such as it has not been reported before. He has also got me an 'Urgent Rapid Access' appointment at the Cardiology Department of my local hospital... 10th January.... 'just to be on the safe side'.

And I didn't get a BP monitor for Xmas - hooray!

[PMRpro Ambassador in reply to JanetRosslyn]

I can't speak for the UK - but here that would trigger investigation! 100/60 is not perfect, it is low (only the UK thinks that is wonderful!) and those bradycardias are possibly OK at present - if they get lower they may not be! Even the 54 is bradycardic!

"For most people, a heart rate of 60 to 100 beats a minute while at rest is considered normal. If your heart beats less than 60 times a minute, it is slower than normal.

A slow heart rate can be normal and healthy. Or it could be a sign of a problem with the heart's electrical system .

For some people, a slow heart rate does not cause any problems. It can be a sign of being very fit. Healthy young adults and athletes often have heart rates of less than 60 beats a minute.

In other people, bradycardia is a sign of a problem with the heart's electrical system. It means that the heart's natural pacemaker isn't working right or that the electrical pathways of the heart are disrupted. In severe forms of bradycardia, the heart beats so slowly that it doesn't pump enough blood to meet the body's needs. "

However - if you are feeling better that is great!

[JanetRosslyn in reply to PMRpro]

Thank you for your reply. Perhaps I'm very fit? Ha ha, it doesn't feel like it right now! Pre-PMR I ran or walked about 40 miles a week (I've run seven marathons, not fast, 4hrs 15mins) and also went to Zumba classes, Pilates classes, Aquarobics, Swimming lessons and Gym. My heart rate was never this low before though, so I'm glad I've been referred to the Cardiology Unit, even though I'm feeling much better than I was.

Here's wishing you a happy and healthy New Year.

[PMRpro Ambassador in reply to JanetRosslyn]

That could account for the low pulse and BP if you are really fit - but not really the dips into the 40s...

[JanetRosslyn in reply to PMRpro]

You're right, of course. Here's hoping all goes well when I get to see the cardiologist in 2 weeks.

[JanetRosslyn in reply to JanetRosslyn]

An update: No change in symptoms. I was seen at the Cardiology Unit, where my heart rate actually dropped while I was being examined. (What were the chances of that happening as it only happens 2 or 3 times a day!) An echocardiogram, 24 hour Holter monitor and a CT coronary calcium scoring test are now being scheduled (6 - 12 weeks).

After 6 weeks of Pred (15mg) I am due to make my first reduction (to 12.5mg) tomorrow. It will be interesting to see if it makes any difference to my heart rate.

[PMRpro Ambassador in reply to JanetRosslyn]

I suspect you would have been kept in here! Just in case - though the situation here isn't quite winter pressures!

[JanetRosslyn in reply to PMRpro]

It's certainly wintery here today, and they're forecasting snow later. Brrrrr. I'm envious of my Australian relatives who are currently reporting temperatures in the mid-30s.

I'm glad they didn't keep me in hospital as I'm currently the sole carer for my daughter (adult) who has uncontrolled epilepsy and who was recently discharged from an 11 week stay in hospital. She's still having an average of 10 seizures a day, bless her, but it's an improvement on the 20 to 30 a day she was having.

Looking on the bright side of things... as one has to I guess... getting PMR now has enabled me to take time off work to look after her.

[PMRpro Ambassador in reply to JanetRosslyn]

It's an ill wind that blows nobody any good!

Have they ever tried the high fat diet for her? It seems to achieve miracles for some young epileptics. Bless her - and you. What a responsibility.

[JanetRosslyn in reply to PMRpro]

Thanks PMRpro. We asked about the high fat diet but they've said the ketogenic diet is not usually recommended for adults (she's 35) as the restricted food choices make it hard to follow. It may be something we should reconsider. Her new drugs seem to making a difference though, so as we continue their gradual increase we're hoping to get the seizures under control.

There's always someone having a worse day than us, so the plan is to smile, remain positive and just be thankful for what we have.

[PMRpro Ambassador in reply to JanetRosslyn]

An awful lot of people manage strange diets when it works and they feel better - but it has to be up to her of course.

I just had a quick look - and it points out it isn't so different from the Atkins approach and a lot of people manage that

I have to say - if you told me I had to eat loads of butter and cheese I wouldn't object if it stopped me being ill!!!!! I already eat a very low carb diet most of the time - just to control pred weight. It seems to work.