PMR & ARRYHMIAS

[Pusph]

Hi, I have recently been diagnosed with PMR in April 2022 and started off on 15mg Prednisone. I also have SVT which is a heart arrhythmia for which I take beta blockers statins and aspirin. Just lately I have been getting palpitations more often - 5 lots yesterday alone. Just wondering if anyone else has any experience of this and whether it is down to the steroids. Also the PMR pain went pretty quickly but I now have a very slight stiffness in between shoulder blades seeming to be returning. Thanks.

[PMRpro Ambassador]

I don't have SVT, I have atrial fibrillation and I find it is worse if I have a flare so need more pred rather than less. The cardiologist is confident the damage to the sinus node was due to the autoimmune disorder. However, pred does have a reputation for causing palpitations so it could be that.

You say you "started on 15mg" - have you already started to taper the dose? Was the arrythmia related to a change in dose? And the back stiffness?

[Pusph in reply to PMRpro]

No still on 15mg and not due to start tapering for another 2 weeks. May put it off though until I've spoken to my doctor. Out of interest do you have to really push to be referred to a rheumatologist/specialist for PMR or should we be automatically referred on?

[PMRpro Ambassador in reply to Pusph]

You are unlikely to be referred on automatically - and if there is no question over diagnosis and response to pred AND you have a good GP it may not be worth it - can be months to see a specialist and a bad specialist is far worse than a good GP. It is said 75% of PMR patients never see a consultant or if they see one for confirmation of the diagnosis they are just sent back for GP management - they prescribe the pred anyway.

Being on pred and the symptoms improving isn't a signal you can go back to normal life - if you did that may be contributing to the back problem. Or you have myofscial pain syndrome affecting the triangle of muscle from the shoulders down towards the waist, the trapesius and the underlying muscles.

youtube.com/watch?v=lfiorcW...(Not working as expected?)

[Cobalt2sister]

I'm thinking its the prednisone. I have GCA and am presently on 40 mg prednisone. I'm in mild tachycardia with it a lot of the time. (110). I too have SVT tho mild. And yes, having palpitations with it too. I'm wearing a loop recorder and they haven't picked up anything bad so I'm not worried. All this to say I think all is prednisone related...but of course I'm not a doctor...good luck to you. Did you check with your dr?

[Pusph in reply to Cobalt2sister]

I had to have routine blood pressure/heart rate test which showed slow heartbeat of 52 per minute and Dr mentioned reducing my beta blockers but I said I didn't really want that as was getting increased palpitations, but shall mention it again as it's got worse lately. Thanks.

[Kendrew]

Hi Pusph,

I have suffered with episodes of ectopic beats (palpitations) on and off for most of my life. Higher doses of Pred definitely have coincided with a re-emergence of them! Now I'm on a lower dose, they're not so much of a problem.

[Pusph]

Same here, had them for years and ended up having to go to hospital a couple of times for adenosine injections. Hopefully if I can begin to taper they might fizzle out or st least go back to how they were! Thank you.

[Chris_1236 in reply to Pusph]

Adenosine is the most wonderful thing... The first time I had an injection of it, I was warned that I would think I was dying. Heh... I told the ER doc I already felt like I was doing just that so get on with it. Turned out to be the most wonderful feeling. Dropping from 230+ back to 90 was such a relief that I must have missed the "bad" feeling along the way.

I'm very grateful for the wonderful folks at the ER we attend when necessary. They are world class.

[Chris_1236]

I have had problems with PSVTs for years. Heart rates exceeding 230 have been common for me.

Since being overtaken by PMR and beginning my Prednisone journey, I have not had an episode of PSVT. (Holding my breath as I type... 😜) I'm currently at 18 mg pred recovering from a flare due to a missed dose and a bit more physical activity than was prudent.

My "normal" heart rate is ~90... All of my life. On pred, it will eventually rise to ~110. I have had good success maintaining ~80 titrating Atenolol to about 12mg daily with my 1 am dose of pred.

Like you, I do have episodes of palpitations. A dose of ~6mg Atenolol usually corrects it in about 30 min.

This is what has worked for me. I have a wonderful cardio and GP who both are very flexible and responsive to the uniqueness of each of their patients.

As always: Your mileage may vary and always consult with your doctor(s).

[Mcdurmott]

Hi Pusph— I had atrial tachycardia and PVCs for years before I was diagnosed with GCA and PMR. I started on 60 mg of prednisone in May 2020 and I’m now down to 8 mg. I didn’t notice any increase in the arrhythmias due to prednisone. They just came and went as before – not more, not less. Then I was diagnosed with severe atrial valve stenosis in May 2021, and in September had a valve replacement via TAVR, a minimally invasive method to correct this condition. For a couple of months before TAVR, my arrhythmias were very strong.

Now (I’m almost afraid to say this in fear of changing my luck), the arrhythmias have virtually stopped—this after years of putting up with them. BTW, I was tested annually for a few years to monitor a mild case of aortic stenosis. The prednisone accelerated the condition, shocking even my cardiologist at how fast it moved ahead. Anyway, I seem to be better now than I’ve been in years, and just had cataract surgery. Pretty soon, I’ll have all new parts. Things could be worse. Good luck to you!

[Duketta]

Trazadone gave me heart issues