I've been having problems with my heart rate staying high after exercise and not returning to normal for nearly 24 hours sometimes. I'm on predisolone for GCA (and also Tocilizumab) and have come down to 20mg/day from 80mg/day in July. I can go out for a walk with normal heart rate and then occasionally when I stop my heart rate goes up and stays high for an extended period of time hovering around the 90-100bpm range. Spoke to my GP yesterday who has now prescribed Propranolol (beta blocker). Would be interested to hear if anyone else is also taking this and if this has helped or caused any further problems. Slightly reluctant to add yet another drug to my daily dosage but also keen to resolve my heart rate issues so that I can continue my normal exercise routine. Thanks for taking the time to read this.
Has anyone got any experience of taking beta bloc... - PMRGCAuk
Has anyone got any experience of taking beta blockers whilst on prednisolone?
You were on a very high dose of Prednisalone initially. I wonder if your heart rate just needs time to settle? 20 mgs is still a significant dose. I would feel happier if I was referred for cardiology checks in your place. I have been prescribed Atenolol ( beta blocker) for steroid induced hypertension along with Doxazosin. A fast heart rate wasn’t part of my symptoms though. I haven’t noticed any adverse effects from the Beta Blocker but was disappointed to be left on it without explanation when Doxazosin was introduced as my blood pressure remained on the high side. You have reminded me to question this. I would be on a stunning amount of drugs had I not refused some of them.
Many thanks for the reply. Have had a couple of ecg's recently which have been normal so not unduly concerned about other heart problems at this point. I am also on lisinopril (10mg) for blood pressure which has kept my blood pressure on the acceptable range but perhaps the propranolol will help keep it at a lower level. Have been hoping the reduction in prednisolone dosage would improve the heart rate issues but incidences have increased over the last couple of weeks.
I was on Atenolol for high blood pressure before and during GCA (so initially on high steroid doses) - no adverse affects.
Please to say, not on either any more.
did find this on drugs.com - interactions checker -
Interactions between your drugs
Moderate -
propranolol prednisoLONE
Applies to: propranolol, prednisolone
PrednisoLONE may reduce the effects of propranolol in lowering blood pressure. The interaction is most likely to occur when prednisoLONE is used for more than a week, since prolonged use can cause sodium and water retention. Let your doctor know if you experience sudden, unexplained weight gain or swelling of the hands, ankles, or feet.
You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Thanks for your reply. Good to know you didn't have any side effects. I can't find any serious adverse reactions reported on using the two and as the primary reason for the propranolol is to keep the heart rate lower and not to lower my blood pressure I hope I will be alright to take both whilst monitoring BP to make sure it doesn't get too low.
nd also same age and activity except golf and slightly higher dose than you stil on 27.5 although started in june, so you have tapered fast from 80 to 20 in3 months. I'm sorry you lost the sight in one eye through misdiagnosis. I have the fast heart rate issue and not on betablockers. It lasted a whole day but now back to normal. I'm due for 5 days 24/7 wiring up to see what the heart is doing before going on any extra drug regime. I think your problem is that you are trying to get back to your normal and reducing too fast. It is too much for your heart to handle. Slow down, you can't get back to your old exercise regime so park that and take stock.
Thanks and good to hear from you. I think the quick taper regime is partly because I'm also on Tocilizumab which should also be tackling the inflammation from GCA. It's slowing up a bit now as staying on 20mg for 3 weeks before going to 15mg. I've pretty much accepted I can't go running and cycling at the same level as before but golf is fairly sedate in comparison so worrying if my heart rate issues prevent me from continuing that in the short term. Good luck with your recovery and hope you can get back to cycling. Have always wanted to go the the Dolomites but it won't be on a bike, hopefully skiing 😀
hi and interested to hear of your trip with TCZ. My rheum. wants to use it but I'm not sure. Got enough issues with what I'm already taking. I don't think the drop from 20/15 or whtever to near zero is going to be quick. Thanks for the well wishes..we have hopes still.
I've had no issues at all as yet with the the Tocilizumab so if it helps getting me off Prednisolone sooner then all well and good but understand your reluctance to add another drug as pretty much what I feel about adding the Propranolol. Due to go down to 10mg in early December then, yes, much slower after that, 1mg reduction every 4 weeks. That's almost another year 😞
My resting heart rate was between 90-100 bpm from 60mg to somewhere below 20mg. It went down with dose from there to my normal 58-60bpm when I stopped Pred after 3.5 years.
Thanks for the reply. My problem is that my resting heart rate is around 50 most of the time and hasn't changed much on prednisolone except when I get one of these episodes. Good that yours has returned to normal on lower doses and I'm hoping these issues are purely down to the steroids and mine will also get back to normal as the dosage is reduced.
Come to think of it I did find my heart rate did go high disproportionately when I went up stairs for example. I didn’t pay attention to how long it stayed there. It’s difficult isn’t it because slow return to normal can also be a sign of problems. Is it possible for you to have a 24 hour ecg?
mine was 51 and 64 at end of day before this. Now it is whatever it decides each day although it has stabilised lately.
Hi My resting heart rate sometimes is 49
I had HA 2 and half years ago only symptom was feeling unwell but nothing I could pinpoint and a racing heart .
Put on cocktail of drugs including 1.25 Bisoprolol
Lost two stone and try to excersise more not easy with PMR
Then 4 weeks ago Heat beat 103 spent night in hospitals and told if it happens again due to history to call ambulance .
Bisoprolol increased to 2,5
Have had loads of ECG and 24 hour Halter Monitor all ok
I've been on a low dose of bisoprolol for several years alongside my pred. No problems I'm aware of. For a long time I was also on Losartan (an angiotensin receptor blocker), also at a low dose. The thought is 2 different drugs at low doses reduces the adverse effects of each while achieving better control. I also need a bit more pred at times because the arrythmia problem is worse during a flare. My problem is almost certainly due to the autoimmune part of PMR having damaged the sinus node.
I assume you have had all the appropriate cardiology investigations? It sounds as if you haven't - and having plain ECGs isn't that useful unless an episode occurs while it is being done as they are snapshots - you need the film version!!!
Hi and thanks for the reply. No, not really had anything much in terms of cardiology investigations and I have pointed out to my GP that the ECG's don't really show up much whilst my heart is normal. Had one done yesterday, but typically, my heart had settled down on the way to the surgery. I will be following it up but don't hold out much hope of getting a hospital appointment in the short term under the current circumstances, especially given that my "urgent" referal to the eye clinic in July for my double vision problem ( two days before I lost sight in one eye) took 3 months to come through!!! In the meantime, from what I can gather, a low dose of Propranolol doesn't seem to carry too much risk so hopefully it will help with the heart rate.
How long do the episodes last? The twice I have bothered going to A&E by the time I saw a doc it had calmed down! Though since the ambo crew had done a 3 lead they knew something had been going on! When I went to my GP in the UK about palpitations he suggested calling 999 when it happened - on the grounds the ambos have a 12-lead ECG machine - and will get there quicker than you going to the doctor.
The episodes can last for hours (yesterday about 20 hours) but with heart rate generally below 100 bpm. The emergency services here are not really interested unless your heart rate is above 100 continuously and the 111 service tell you to go through your GP.
Up to 100 is the top end of normal - though I have to say, I'm not too pleased when it gets to that level. If mine starts to speed up I take a dose of magnesium supplement and it usually cuts it.
Yes, 100 is much too high for me too especially as resting HR is usually under 50. Will look into the magnesium supplement option if it continues.
Hi sequeluk,I've been on pred for 2½yrs and propanolol for last 2yrs. I've a history of rapid heartbeat (not AFib) and had several bouts of investigations over the years which have always shown nothing more than ectopic beats... uncomfortable but not dangerous.
It's important to mention that my most recent tests carried out before being prescribed the propanolol again involved a small adhesive ecg monitor that I wore for two weeks because as PMRPro said...a regular or 24hr ecg may not capture an episode. Unfortunately this 'gadget' is not available on NHS and it was organised privately. I also had some scans.
Having had several years free of them, the pred definitely seemed to contribute to the re-emergence of them but the propanolol has thankfully sorted them out again. I started on 40mg bd and now take 40mg daily. I've not experienced any side effects or issues related to taking the propanolol so far.
Hope this was helpful.
Hi Kendrew, thanks and that's very useful to know. I'll look into the longer term ecg device. Had one many years ago from the NHS but didn't show anything much up at the time. I've been given 40mg tablets to take 1-3 times/day but have only taken the one today and intending on sticking to that and seeing how the next 7 days go. Sorry to read you had to give up your teaching and best wishes for recovering from the GCR.
Thankyou ❤
Who did you get your ecg monitoring through? Just found a company which offers something similar at £300 for 7 days.
My husband has private medical cover through his workplace so in this instance we used it.
I think we are pretty much on our own to use our intelligence and resolve our problems because the NHS is nearly a busted flush and can't cope with the immediate needs of an inflammatory disorder they don't understand
Is your salt level healthy - neither too high nor too low, as either can affect heart rate and /or blood pressure? Pred can influence our electrolyte levels so I hope that was looked into before another medication was prescribed.
Thanks for the reply and yes they are fine. Blood test done last week. Best wishes.
shall be interested to see mine from yesterday.
I am also on bisoprolol, have been since 2017. No issues as far as I know but I'm new to all this having been diagnosed and started on 40mg pred 3 weeks ago. My palpitations came back big time at first, but it seems to have settled down now. I had a heart monitor for a week in 2017 via the local NHS hospital which diagnosed me with suspected AF but it's never been confirmed. I have to be on blood thinners and bisoprolol forever. If you're in the UK you should be able to ask your GP for a referral for a heart monitor like I did.
Hi Broseley, Thanks for the reply. Going to follow up the hr monitor route with the GP. I had an ultrasound scan to confirm my diagnosis rather than a biopsy. Might be worth asking about as less invasive. Best wishes.
I did ask about ultra sound but they said it's not used in the UK as it's not reliable yet until developed further. I had my biopsy. Wasn't bad at all.
I would take the beta blocker and hold off on exercise. Maybe just lift weights for now? Also consider checking with a cardiologist to make sure you don’t have atrial fibrillation. Even a little atrial fibrillation is serious.
I was on all three and had no problems. My high heart rate turned out to be hyperthyroid. Definitely ensure they seek to find out the cause and not just assume it’s cardiac in nature. Good luck.
Hi sequelae,I have been taking Bisoprolol (beta blocker) since Nov 2018 after having a stress heart attack. I have been on Pred since 2015 now down to 7/6mg. Only thing I have noticed is return of hot flushes especially after a hot drink .
I have been taking Propranolol (Beta blocker) and HCTZ (diuretic) for over 30 years, long before I was diagnosed with PMR. The addition of prednisone has had no effect on my blood pressure or produced any side effects. Propranolol isn't cheap but it has worked very nicely on me with no side effects that I have ever noticed.
It fascinates me how timely topics appear on this site in terms of my immediate situation. At the moment I'm wearing a Holter monitor for 48 hours, returning it to the Cardiology Dept this morning and having an echocardiogram.
Prednisone sent my BP through the roof and for the last 7 years it's been kept under control with an appropriate amount of Losartan. Over the past few months I've been experiencing heart palpitations, AFIB readings on my home BP monitor (not necessarily AFIB, but something unusual) and 'unclassified' readings on a mobile Kardia ECG monitor. For all these reasons the GP referred me for further testing. A daily dose of 100 mg of Losartan for the past 3 months hasn't brought it to the 'required' 120/80.
When I met with the Cardiology NP yesterday she was somewhat dismissive of the situation (I actually felt like she had more important places to be and couldn't wait to get there) until listening to my heart and concluding a echocardiogram was needed after hearing a couple of heart murmurs.
Whatever the findings, which hopefully won't be of major concern, I'm looking at an additional BP medication so the comments a few of you have made on the various types will be useful. Over the years I've had candesartan and amlodipine added alongside the losartan and haven't handled the side effect well. Even with losartan I have to split the dose due to the fuzzy head and dizziness if I talk the full dose.
And strange how we are all different in how certain drugs affect us. I've been on Lisinopril for blood pressure for years and before my GCA diagnosis had gone up from 10mg to 20mg/day. I expected it to rise further after going on to Prednisolone but it seems to have had the opposite affect and I have recently gone down again to 10mg/day. I have never had any side affects from the Lisinopril. I suspect the Propranolol will also lower it so I'm keeping it closely monitored. I've got no experience of the other drugs you are on as I've stayed on this one since starting medication but good luck with getting yours under control.
I've woke up in the night many times with my heart rate up to 120.Scares me but doesn't last long.Iam assuming it's Prednisone.
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