Despite its usefulness, prednisone is known to cause side effects, one of which is a change in heart rate.
This article explains how prednisone can affect the rate and rhythm of the heart. It also takes a closer look at who is at particular risk for this and if prednisone needs to be avoided by certain people.
Why Prednisone Is Prescribed
Prednisone works by suppressing the immune system to reduce inflammation. Inflammation is the body’s response to anything it considered harmful, but there are times when too much inflammation can do more harm than good.
Prednisone is used to treat many inflammatory conditions and autoimmune disorders (which occur when the body attacks its own cells and tissues).
Among the conditions for which prednisone may be prescribed are:
Addison’s disease (adrenal insufficiency) Asthma Certain cancers, including acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), and lymphoma Chronic obstructive pulmonary disease (COPD) Inflammatory forms of arthritis, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease Lupus Multiple sclerosis Pericarditis Sarcoidosis Severe allergic reactions Scleroderma Sjögren syndrome Tuberculosis
Side Effects Involving Heart Rate
One of the side effects of prednisone is bradycardia, an abnormally slowed heart rate. Prednisone causes this by decreasing the amount of potassium, calcium, magnesium, and phosphate in the blood.
All of these minerals play a role in the rhythm and rate of heartbeats. Calcium in particular helps stimulate contractions of the heart, while magnesium relaxes the heart after contractions. The depletion of these minerals can cause the heart rate to slow, in some cases to dangerous levels.
How often heart problems in prednisone users occur is unclear, but some studies have found that people who take corticosteroids like prednisone for a long time have higher rates of heart attack, heart failure, or stroke.
Prednisone can also sometimes cause atrial fibrillation (rapid, erratic heartbeats), atrial flutter (rapid rhythms in the heart’s upper chambers), and ventricular tachycardia (rapid rhythms in the heart’s lower chambers).
These side effects are most commonly seen with prednisone delivered through a vein (IV). Even so, they have been known to occur with the long-term use of prednisone taken by mouth, particularly at higher doses.
Who Is at Risk?
Although research has shown that bradycardia can affect anyone taking prednisone, some people are at greater risk. This includes people with pre-existing heart disease or kidney disease.
In people given IV prednisone, the rate of infusion also plays a role. When the infusion rate is fast (30 minutes or less), the risk of bradycardia and other heart rhythm problems increases.
As many as 82% of people given high doses of prednisone may experience some form of cardiac arrhythmia (abnormal heartbeat). This can range from mild to life-threatening.
Before Taking Prednisone
If your healthcare provider is suggesting prednisone, be sure they are aware of your medical history.
People who are at risk of bradycardia or other heart rhythm problems should undergo heart monitoring before receiving prednisone. This includes people with:
Congestive heart failure Unstable angina Heart valve disease Atrial fibrillation Aortic aneurysm Hypotension (low blood pressure) History of heart attack or stroke
People with these heart conditions may be able to use prednisone, but that’s not always the case. Your doctor will weigh the benefits and risks of treatment and, if needed, explore other drug options.
Bradycardia is a serious concern as it can cause frequent fainting and other complications, including heart failure, cardiac arrest, and sudden death.
Summary
Prednisone is a steroid drug used to treat inflammatory conditions and autoimmune diseases. While effective, the drug can cause bradycardia (slowed heartbeats) and other heart rhythm problems in some people.
Chest painDizziness or lightheadednessSudden extreme fatigueShortness of breathConfusionFainting
Those at greatest risk are people who have pre-existing heart or kidney disease, as well as those given prednisone into a vein.
Bradycardia is a serious medical concern as it can lead to frequent fainting, heart failure, cardiac arrest, and sudden death.
