PMR, steroids and atrial fibrillation.

[Mack100]

I was diagnosed with PMR exactly 2 years ago and apart from heading towards non-diabetic hyperglycaemia (which I avoided through diet) I've had a very easy ride thus far compared with many. DSNS tapering and being given control of my steroid dosage by my GP have been key factors. I'm now down to 5mg prednisolone daily without any real pain anywhere.

I've had occasional ectopic heart beats for many years mainly when training for marathons in my 30's and 40's but also when I've drunk a little more alcohol than I really should have. About 6 weeks after PMR diagnosis, when my PMR was still poorly controlled with pred I experienced my first bout of atrial fibrillation which may also have a stress component.

I spoke to 111 after 20 minutes of rapid heart beat and while I was on the phone the heart gradually returned to normal so any trip to the local ED was no longer discussed. Over the past 2 years I have had several episodes of ectopic beats usually only lasting a minute or so and not particularly fast, only irregular. 10 days ago in the evening after a meal I began to have irregular rapid beats which did not disappear and after an hour of these I spoke to 111 and paid a visit to my local ED where they diagnosed atrial fibrillation, gave me medication and when the rate came down to 100 bpm I was discharged with a hospital script for anticoagulants.

So I've done some research and now find myself between a rock and a hard place, it seems that steroids and inflammation both have a relationship with cardiovascular disease in respect of steroids and atrial fibrillation in respect of inflammation.

tctmd.com/news/even-low-dos...

journals.plos.org/plosmedic...

frontiersin.org/articles/10...

So having reached 5mg what is my next step? Do I continue with my DSNS tapering and run the risk of a flare with it's attendant inflammation or stick with my present dose, keep the inflammation under control but increase my risk of CVD because of my steroid medication.

Given that my previous AF episode was at 15mg pred and poorly controlled PMR inflammation then that episode could be due to either. But what caused this latest and more serious episode of AF with low dosage of pred and being pain free? I'm minded to stick with 5mg pred for the time being to keep the inflammation under control as I believe a flare could be more serious.

My hypertension is well controlled at about 117/76 with a resting heart rate of about 50 and my blood lipid profile is very good probably due to Dr.Michael Mosleys work on cider vinegar! I have been given a non-urgent appointment with the arrhythmia nurse at my local hospital in January.

Apologies for the long post.

[SheffieldJane]

This is is a decision to be taken with an experienced cardiologist. I would be very interested in what your final decision is. Your own research will be invaluable.

[PMRpro Ambassador]

The risk of CVD is a long term one. I've been on pred for over 12 years - it hasn't caused cardiac problems yet that we know of. In the meantime, the a/f is clearly linked to the inflammation, being notably worse when I flare and the dose of pred is also helpful in managing the a/f since the cardiologist reckons she is doing what she can realistically with drugs.

I also have a/f, almost certainly entirely due to the PMR - the underlying autoimmune disease damaged the cells in the sinus node that controls heart rate. I also have what is called paroxysmal a/f, relatively short episodes that rarely last more than an hour or so at most and usually dissipate with an oral dose of magnesium (used in our local hospital and really quite effective!). Mostly they are preceded by some intermittent tachycardias and if I take the magnesium then, it seems to stop it in its tracks. I have only got as far as A&E once because an episode lasted longer than I was comfortable with - and it had gone by the time I got there. even with an ambo.

I did develop bradycardic episodes where the pauses got rather long - up to 7 seconds it seems. It was found when I fainted after one and hit my head and I was agitated at hospital so they gave me i.v. diazepam which I react to with severe a/f lasting some hours (it is a relatively adverse common effect). But at least they found the cause of the dizzy spells! I was given a pacemaker and been fine since - just the intermittent tachys and a/f.

[Mack100 in reply to PMRpro]

Thanks to both of you for your replies. I shall investigate the feasibility of oral magnesium both as daily supplementation or taken in response to an attack of AF at home. I too have paroxysmal AF and have not had any problems since the episode 10 days ago. I have also completely avoided caffeine and alcohol by way of elimination and will gradually introduce small amounts of both to gauge the effect.

Curiously my heart is not producing any ectopic phenomena since the recent episode of AF, this could of course be due to eliminating alcohol and caffeine.

I was prescribed bisoprolol, a beta blocker, by the hospital but as my BP was 94/66 with HR 42 the following morning I did not take any! These very low readings were probably due to the intravenous magnesium I was given still exerting an influence, my GP is happy with this and agrees for me not to take the beta blocker as my BP and HR are now normal.

After reading your response it does seem that the inflammation produced by PMR is the main culprit here so I will not taper any further for the time being.

[PMRpro Ambassador in reply to Mack100]

I am on 2.5mg bisoprolol plus propafenone as an antiarrythmic and most of the time it works pretty well. OH is just on an even lower dose of bisoprolol for the a/f but his is almost continuous. The most important thing is the anticoagulant though to reduce the risk of stroke.

I was devastated to discover last summer that G&T was triggering a lot of a/f! Wine doesn't I am relieved to report! Total abstinence didn't seem to make it any better. I rarely drink coffee but do drink loads of tea. Stress is a b*%%"r - and obviously doesn't help the PMR either.I can go days and not feel anything and them get a run of several days with episodes and very often about midnight which is a pain as I can't get to sleep and am very reluctant to even think of going to A&E as then I have to get home again!

[Rugger in reply to PMRpro]

Please would you say what dose of magnesium you take? I know you've mentioned it before. 💓

[PMRpro Ambassador in reply to Rugger]

It's magnesium pidolate - which doesn't appear to be available in the UK so I don't know how it compares to other magnesium salts. It is 1.5g in the10ml.

[Rugger in reply to PMRpro]

Thank you. I was just wondering if it's worth taking my 'regular' Mg supplement if I have a run of a/f! I'll have a look at the figures!

[PMRpro Ambassador in reply to Rugger]

"Small studies have found that magnesium in the aspartate, citrate, lactate, and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate"What makes a big difference is the amount you absorb = mag oxide is only 4% apparently!! At one time I could have worked it out but I fear those days are long gone!!!

This discusses why using it rather than other salts seems a good idea:

Headaches and Magnesium - MDPI mdpi.com › pdfPDF

by JA Maier · 2020 · Cited by 5 — Keywords: magnesium; pidolate; deficiency; headache; migraine; BBB. 1. Background. A large body of literature suggests a relationship ..

It's a download of a pdf

And the Summary and Conclusion of this

ncbi.nlm.nih.gov/pmc/articl...

discusses ways of improving Mg absorption.

[Rugger in reply to PMRpro]

Thank you again for all your delving! 🌻

[PMRpro Ambassador in reply to Rugger]

I spend a lot of time down rabbit holes. I think it keeps me relatively sane .. I THINK ...

[nuigini]

This post has been of great interest to me as I've been experiencing AFIB on a pretty consistent basis. I will be getting hooked up to a 48 hour Holter monitor next month and have been referred back to cardiology. A 24 hour monitor didn't reveal any issues a couple of years ago.

[Mack100 in reply to nuigini]

Have you only been getting these episodes since you were diagnosed with PMR or have you had them prior to that?

[nuigini in reply to Mack100]

I'm 7+ years with PMR. Started getting episodes a couple of years ago, but they're occurring more often now.