Cardiac arrhythmia

[Swizzly]

Does anyone know the problem with cardiac arrhythmia on Pred? Specially at night?

I am currently on 15mg, started with 20mg.

[PMRpro Ambassador]

Did you have the arrythmia pre pred? I had atrial fibrillation which started about the same time as the PMR symptoms and is adjudged by the cardiologists here to be due to the underlying autoimmune cause of PMR symptoms having damaged the sinus node which governs heart rate. It had been controlled with medication for years but the Covid bivalent booster 18 months ago made it far worse, up to 12 hours and almost every day rather than short episodes once or twice a week, and I eventually had an ablation in January which has cured the afib.

It often FEELS worse at night because you notice it more but you need it investigated, with a longterm cardiac monitor first, at least a 24 hour ECG but it must include an episode or it is worthless so it if is less frequent it will need a monitor until they see it to be able to identify what type of arrythmia it is. The most important medication for an arrythmia may just be an anticoagulant to reduce the risk of stroke but if it is bothering you, other meds can be very successful.

[Bluey-1 in reply to PMRpro]

This is interesting. I had a TIA Aug 23 which was linked to Afib. I had been on Pred for over a year at this point. I was put on Edoxaban (30mg now) and Bisoprolol (2.5mg now) and thought that was that, meds will do the job. Bouts of fatigue I put down to adrenals following Syncathen test results. Now I wonder. I updated my smart watch to the latest Apple one which does an ECG and notes Afib events. Less than a week in but two days showed constant Afib - I’m taking 3 ECGs a day. The last 3 days it just says sinus rhythm, so normal. The Afib days were wipe out ones, so exhausted. The last few days I feel a lot lighter. Hard to work out what is causing fatigue. I intend to build up the data over a couple of weeks before I see a GP. Disappointed as I thought once I was on the meds it’s sorted. How naive. It feels like I have to learn about another condition that at the moment doesn’t seem to be fully under control. It needs someone to join the dots as well. When I see the endo in June it might be a more complex picture. Is it all connected with GCA? I’ve never had problems before?

[PMRpro Ambassador in reply to Bluey-1]

No, 'fraid not, they just help. How effective they are varies. When I had afib episodes I felt as if I'd run a 10km the next day. For nearly 10 years the original medication had worked pretty well, the odd short episode but nothing earth-shattering. Until that Covid jab - within 3 hours the afib ramped up and was then almost daily and 3-4 hours long after a week or two. Over time it increased. At Christmas I ate smoked salmon and the like with salad - I couldn't stand long enough to cook without being SO dizzy. I live alone so no-one to help. On the 25th I intended to go for pizza, family tradition, I wasn't well enough to walk into the village.

When I eventually saw the electrophysiologist he wouldn't have the vaccine connection, he said that the medications usually only last a max of about 5 years, I'd been on propafenone for 10! But it was working fine the day before ... He switched me to Flecainide - like night and day but still far from perfect - and I was on the waiting list for ablation, 3 or 4 months he said, in the end it was 9 months. But it has worked. The lady electrophysiologist who actually did the ablation agrees with me it was the vaccine that made it worse. She was amazing at the post-op appointment.

But the other thing has been that a few weeks after the ablation I had to have a bisphosphonate infusion after a ?spinal compression fracture. That has caused atrial tachycardia - arrythmias are a known adverse effect. So if you are on alendronic acid that is also a possibility.

[Bluey-1 in reply to PMRpro]

I didn’t know that either. I had my first zoledronate infusion for osteoporosis March 22, a few months before GCA hit me. Second one in Dec 23. My gut feeling is that the Afib is causing most exhaustion now. I’ve been on 3mg pred since February. My cortisol scores were low despite the kick to the adrenals so told to stay on 3mg until endo appointment. It’s the getting the story right when I see the GP, endo then rheumi appointment in Aug. Thanks PMRpro.

[PMRpro Ambassador in reply to Bluey-1]

The e-physiologist immediately blamed the zolendronate infusion for the atrial tachycardia, no doubt in her mind. So there are 3 possible contributors: PMR/GCA itself. Covid vaccine and zolendronate.

[Bluey-1 in reply to PMRpro]

Thanks a lot PMRpro. I had a Moderna booster on the 8th May as well, so the full house! So difficult to work out what’s going on. The only awareness I’ve had of Afib has been during the night if I lie on my left side in bed. I can feel my heart pumping away. Since taking ECG recordings this week the contrast is stark comparing total fatigue on the Afib days and the normality on days when there are no Afib events.

[PMRpro Ambassador in reply to Bluey-1]

If you have smartwatch recordings even cardiologists will take them seriously. I had no problem at all after the Covid jab this winter - I was a bit apprehensive but it was fine. Oh - and low cortisol can also contribute to arrythmias.

[Bluey-1 in reply to PMRpro]

I only had a sore arm after the latest jab. Not aware of the arrhythmia at that point. It’s the data recorded on the watch that has helped me recognise total exhaustion linked to those Afib days. As you say low cortisol will have a part to play with fatigue but I didn’t know it contributed to arrhythmias. Have to say, this smart technology is a game changer. Thanks again. Your knowledge and experience is such an amazing support.

[PMRpro Ambassador in reply to Bluey-1]

Been there. done that, got the t-shirt and read the book!!!

[Karenjaninaz in reply to PMRpro]

I was told, after my ablation April 15, that it takes the heart 3 months to heal. It is common to have afib or extra beat episodes during that time. Its common to have "heartburn" after the ablation but its really from the surgery-which is near the esophagus.

[PMRpro Ambassador in reply to Karenjaninaz]

I had none for the first 3 weeks - until the bisphosphonate! Then it showed up as atrial tachycardia the cardiologist said. A bit more bisoprolol has sorted it so far. Hopefully I'll be able to lower the dose again over time.

[Karenjaninaz in reply to PMRpro]

But it was in the 3 month, what they call, the "blanking period". More sensitive to triggers.

I was put on a medication, Azithromycin(Zpak in the US) for a fever during a recent viral. Unfortunately, though I was doing very well, this stimulated assorted abnormal or rapid heartbeats. It turns out that drug can cause arrythmias in susceptible people. even though, its only given for 5 days, it has such a long half life that drug action continues for 2 more weeks after stopping. Between that and my asthma inhaler I had an episode of rapid pulse and feeling terrible. It looked like atrial flutter on my watch. I reported this to the team and took a flecainide. I'm discontinuing the asthma inhaler and taking one without a LABA-long acting beta agonist.

[Swizzly in reply to PMRpro]

Thank you PMRpro 🌷

Thinking back, it started with the onset of PMR last year, although not yet diagnosed. Thyroid was suspected.

I will discuss it with my rheumatologist.

[Hopeful424]

Since I got PMR and started Prednisone I have afib. However, I had PVCs prior to any of this. Apparently PMR can damage the sinus nodes. I am on Eliquis and have not experienced but one afib occurrance since Sept of 23, that I notice. No anti-arrhythmic drugs currently. Eliquis is not a great drug either, but I am unsure about having the Watchman inserted. Anyone had that procedure?

[PMRpro Ambassador in reply to Hopeful424]

If you want info about anyone with a Watchman you will have to repost this question as a new thread - probably only the author of this thread, DL and I will see it here and she and I haven't had one!!!

[Hopeful424 in reply to PMRpro]

I don't know how to do that, sorry.

[PMRpro Ambassador in reply to Hopeful424]

Scroll up to the top of the page and at the top right is a blue box with Write in it. Click/tap on that and a new page will come up for you to write your own post. The upper box is for a title "Has anyone had a Watchman fitted?" for example in this case. Then write what you said here in the lower box and post it by clicking where it says Post (I think)

[DorsetLady PMRGCAuk volunteer in reply to Hopeful424]

See this

healthunlocked.com/pmrgcauk...

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Nor me!