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pred and racing heart

Posted , 6 users are following.

noninoni
noninoni

I have been on 7.5mg prednisone for PMR since mid October.  Well, right before Xmas my heart was racing. I thought I could ignore it, but after a couple of days I finally called the GP and they said "get thee to the hospital immediately", so I went.  I should have gone earlier!!  Anyway, they gave me a shock and my heart rate returned to normal and the next day, Christmas eve, I got on a plane and flew to see daughter, her spouse and grandkids.  

     My hopeful guess is that the cause of the episode was 2 diuretics on top of prednisone.  This made my potassium too low.  One of the docs said I should be on a potassium sparing diuretic.  If my guess is right I won't have a problem in the future if I get the diuretic he mentioned. They also put me on diltiazem to prevent the racing heart, and increased my thyroid medicine.  Nothing ever hurt by the way, but I have been more out of breath since then, which bothers me. 

     In January I will see a cardiologist for a  post hospital check, (my former cardiologist, who diagnosed my PMR, just moved to NY City) and, finally, my first visit with a rheumy. 

      So I am wondering if, in the regular monitoring you guys talk about, if potassium is one of the things they look at?  What other tests do they run for you in the UK? 

1 like, 11 replies

11 Replies

  • tina-uk_cwall
    tina-uk_cwall noninoni

    Posted

    Hi noninoni, for about a month now I 've also been experiencing from a sort of 'fluttering ' heart beat, that happened maybe 4 times a day, not for long and the flutter was definitely that and not a full blown palpitation. Went to see the gp yesterday and she was very through with examination but couldn't find anything. She asked me how much tea and coffees I drink a day, normally at least 8, she suggested cutting back because it could be caffeine overdose? She told me to cut back gradually otherwise I would suffer a crushing headache. I only had 1 tea and 1 coffee yesterday and I've just got up with a thumping head! I will keep an eye out and see how I fair.

    i don't know but could you also be drinking too much caffeine?

    christina

  • Nefret
    Nefret noninoni

    Posted

    I know my surgery here do checks - I was given a call by them two years ago to say both my potassium and magnesium levels were low, this following a routine blood test.

    I take a magnesium supplement anyway so took a higher dose for a while, and made sure I ate bananas and apricots - both high in potassium.  At the next test everything was back to normal and no further problems.

  • MrsO-UK_Surrey
    MrsO-UK_Surrey noninoni

    Posted

    Noninoni, I was prescribed the diuretic, Indapamide (Natrilix), recently and after just over 3 weeks, my blood tests, including potassium, creatinine and sodium levels were all over the place, some raised way above normal and others plummeted below normal.  I can't say it produced a racing heart, but I did feel rough (I came off steroids just over two years ago).  Were your diuretics checked for compatibility with steroids when being prescribed, and against any other drugs you were taking at the time (calcium for instance)?

    I have also taken Diltiazem (in my case prescribed for high blood pressure), and I believe in some people it can cause some breathlessness, especially at first but this can improve as the body gets used to it.

    As Christine has suggested, reducing caffeine intake might help - I suffer bouts of palpitations, and any caffeinated drinks definitely set them off, so I stick to decaf tea and just the very occasional decaf coffee.

    I do hope you continue to feel better but at least it will be reassuring to have the follow-up appointment shortly with the cardiologist.  

  • EileenH
    EileenH noninoni

    Posted

    Any half-decent GP should be checking "U&Es" every time they do a blood test - though a lot simply don't do them. Urea and electrolytes covers all those things you have mentioned and monitors all sorts of things, kidney function included. Everyting is done on an automated analyser these days but it is only what the doctor asks for that is reported usually - they need to request the test report rather than it being stuck onto the machine. Anyone on a non-potassium sparing diuretic should be monitored often.

    However - you ladies with fluttery hearts: don't just leave it at that. The autoimmune part of PMR can also damage the electrical cells in the heart that trigger it to beat. I would have occasional mild episodes but never thought much about it since my GP also insisted he couldn't find anything wrong, then it was blamed on the pred until I reacted badly to i.v. diazepam (valium) being used for severe back muscle problems. Proper investigation with a 24 hour monitor identified atrial fibrillation and I was immediately put on an anticoagulant and further investigations done. 

    Since I have been treated for the a/f those episodes have disappeared - and the cardiologist is confident it was due to damage caused by the underlying autoimmune disorder. A/f is known to be more common in rheumatoid arthritis patients although it is also fairly common in patients of our age anyway so when I asked rheumies I got the "we can't tell because your age group gets it anyway..." - not the attitude here, it is taken seriously because it is a major cause of stroke. What I do know is that I have come across quite a few PMR/GCA patients who have eventually been diagnosed with a/f.

    A single ECG and clinical examination won't identify it unless it happens to be happening at the time, and it rarely is. You need at least a 24 hour ECG monitor, preferably a longer one unless you are confident is is happening most days. 

    Insist on it being checked properly if stopping coffee doesn't reduce the episodes. Stopping drinking coffee isn't something they are likely to recommend here!

    Christina - don't reduce drastically like that. You need to reduce slowly, yes drink less caffeine but don't go from 8 to 1 per day. Cut one at a time! Same as pred!

    • tina-uk_cwall
      tina-uk_cwall EileenH

      Posted

      Hi Eileen, you are quite right re the tea and coffee reduction. I can't imagine what I was thinking of yesterday. It's now 12.30 and I'm only just beginning to feel ok, still abit if a headache but it's on the mend. So this morning I've  drank plenty of water and a ate a croissant. As soon as I feel much better I will have some tea /coffee but at the moment I simply couldn't face any. Christina
  • noninoni
    noninoni

    Posted

    Thank you thank you for all your replies!  I am intrigued by Eileen'

    s comment that the racing heart may be caused by the underlying autoimmune of PMR rather than pred, because I had an extremely slow heart 2 years ago and again last year which was fixed with a cardiac ablation.  So I could have had PMR at the time.  Of course a racing heart is just the opposite, but a similar type of thing.  

         When the doctors were talking to each other, not to me, I could just  make out something about butterflies- they were saying atrial flutter not butterflies but it made me laugh.  They seemed to think it might be difficult to control, so I am thinking I should get a fitness band so I know for sure when it is happening.  I am to report back to the hospital if it returns.

         And, YEA, Mrs. O is quite right that diltiazem can cause shortness of breath which will go away with time.  I would not have thought of that. That is most encouraging because it is scarry when a few steps in the morning cause difficult breathing.  It does get better in the afternoon.

         And on coffee- yes I drink too much of it and it is a very good idea to taper off rather than stop it completely.  So I am trying to drink a glass of water inbetween cups of coffee, at least after the first two in the morning.

    • EileenH
      EileenH noninoni

      Posted

      Damage to the sinus node could cause any form of arythmia - and bradycardia (slow beat) or tachycardia (fast) . I had tachycardia followed by periods of bradycardia (which is common, the heart slows down a bit too much after being fast)  but also had atrial fibrillation which is irregular in pattern - flutter is almost the same in terms of causes and symptoms but is regular and more predictable. Ablation is best for flutter but medication is usually tried first for fibrillation. 

      Mine is paroxysmal - it happens and then stops after a bit but the length of the episodes varied. I rarely noticed them - didn't feel my heart racing but if it went on for long I felt sick and dizzy. The doctors couldn't believe I didn't feel anything! Even with a heart rate of 200! Never thought of a fitness band - would it register the a/f? We have a BP machine - you get ones that still work even if the patient has an irregular heart beat. Most of the time now my pulse is below 50! Hasn't gone below 40 yet that I have seen - happened all the time in hospital after a tachy episode so the alarm went off, drove me up the wall at night! Poor ladies sharing my room :-(

    • tina-uk_cwall
      tina-uk_cwall EileenH

      Posted

      Hi Eileen, PMR and all its associated medical 'free riders'! I had no idea that the heart can sometimes sustain damage from PMR. Tell me please, if a patient is unlucky enough to get this damage, at what point would this occur, pre diagnosis and treatment, post diagnosis and treatment or at any point throughout the 'live' episode. Also, how long would it take before someone would be alerted to any such damage, ie, fluttering, palpitations.

      thanks christina

    • EileenH
      EileenH tina-uk_cwall

      Posted

      I don't really know Christina. It is the autoimmune disorder that does the damage, causing the immune system to attack its own body and damage cells leading to the inflammation which we all know is the cause of the pain and stiffness in PMR. But it isn't just that - in some people it will attack other cells in the cardiovascular system and damage can be done to the arteries all over the body. It isn't entirely clear what other cells are involved. RA is an autoimmune disorder - and it IS known that RA patients have higher rates of arrythmias than patients in the general population, plus there is likely to be a higher rate amongst women than usual because a/f usually is found more in men.

      Patients who have been diagnosed with GCA are at an increased risk of several cardiovascular problems - but it is very rarely mentioned by our medics. For example, it is recommended we are monitored for aortic aneurysm, a chest x-ray is advised every couple of years as follow-up. I have seen it alleged they don't do it because it is difficult to treat and not knowing is better than worrying about something that can't be "cured" - except this is something that in this day and age would be a candidate for a stent if found early enough and it won't be found early if it isn't looked for - and a popped aneurysm is a quick death. It was a very different matter even a few years ago but things in cardiac surgery have changed! We are also at a higher risk of peripheral arterial disease. These are also examples of why we need to be on enough pred to control the inflammation - because that does long term damage too. 

      I honestly have no idea of the point at which damage would be done - I imagine no one does for sure. In some ways it could be a bit like a slow puncture, you never know WHEN the nail got in the tyre, you just find out when you have a flat tyre.

      The incidence of a/f in the UK is under 1% in people in their late 50s, 18% in over 85 year olds. The rate of PMR in over 80s is about 1 in 2. Is there an association? There are a lot of suspected underlying causes so the possibility of it being the autoimmune disorder causing damage is just one of course. 

      What I want to push though is that when you have such symptoms it should never be dismissed as "it'll be the pred". It is the same with high blood sugars or high blood pressure being blamed on pred. It doesn't matter if it IS the pred - it still needs to be diagnosed properly and then treated or the long term consequences may be severe.

      a/f is one of the leading risk factors for stroke if the patient isn't on warfarin or something similar as an anticoagulant - having a/f increases your risk of stroke by 5 times. 15% of stroke patients have a/f, 80% of strokes in a/f patients can be prevented. It is often asymptomatic - to a great extent it was for me and it was luck it was identified. Now I realise what was suggesting it beforehand I jump up and down when I hear PMR patients describing the symptoms I had and them being dismissed by their GPs. 

       

    • tina-uk_cwall
      tina-uk_cwall EileenH

      Posted

      Hi Eileen, thanks for all the info. And how right you are I,ve never read any info relating to heart issues and PMR. Thanks, christina 
  • noninoni
    noninoni

    Posted

    Hi again, I am still thinking about the idea of a fitness watch.  I already have an oximeter and just got new batteries for it.  It  is much the same thing except I don't wear it.  I like the idea of something I can wear and check at any time.

          When I had the bradycardia, my pulse went down to 36 fairly often. 

         When I had the tachycardia last week, the pulse was 150 for most of two days I guess. This caused the enzymes that measure heart damage to go up, troponin, but the cardiologist decided it was nothing to worry about but often happened after cardioversion (the electric shock).  

          

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