From the Guidelines
Prednisone can cause tachycardia, particularly at higher doses, due to its effects on the heart and fluid balance, as evidenced by a recent study published in 2024 1. The relationship between corticosteroids, such as prednisone, and cardiac effects like tachycardia is complex and multifaceted. Key factors include the dose and duration of corticosteroid therapy. According to the study, the risk of atrial fibrillation (AF), which can be associated with tachycardia, increases with the use of oral corticosteroids, especially at the beginning of therapy, with short-term use, and in those treated with high doses (≥ 7.5 mg of prednisone equivalents) 1. Some of the proposed mechanisms for corticosteroid-induced cardiac effects include a direct increase in cellular K+ efflux, which shortens atrial action potential duration (AAPD) and atrial effective refractory period (AERP), and an increase in plasma volume due to a mineralocorticosteroid-like effect, leading to elevation of atrial pressures and atrial enlargement 1. Patients on prednisone who experience symptoms such as rapid heartbeat, palpitations, chest pain, or shortness of breath should seek medical attention promptly. It is crucial for individuals with pre-existing heart conditions, hypertension, or those taking other medications that affect heart rate to be vigilant about these potential side effects. The risk of tachycardia associated with prednisone use may decrease with lower doses and could resolve upon tapering or discontinuing the medication, although any changes to prednisone dosage should be made under medical supervision to avoid withdrawal symptoms. In clinical practice, monitoring for signs of tachycardia and other cardiac effects is essential when prescribing prednisone, especially in vulnerable populations or at higher doses, as highlighted by the 2024 study 1.
From the Research
Corticosteroid-Induced Cardiac Arrhythmias
- The use of corticosteroids, such as prednisone, has been associated with various cardiac arrhythmias, including bradycardia and tachycardia 2, 3.
- A study published in the Arab journal of nephrology and transplantation found that oral prednisone can cause bradycardia, even at standard doses 2.
- Another study published in the Journal of the neurological sciences found that high-dose intravenous methylprednisolone can cause various cardiac arrhythmias, including sinus tachycardia and bradycardia, in patients with multiple sclerosis 3.
Tachycardia and Corticosteroids
- While there is evidence that corticosteroids can cause bradycardia, there is also evidence to suggest that they can cause tachycardia, particularly at high doses 3, 4.
- A study published in Transplantation found that high-dose intravenous methylprednisolone can cause supraventricular tachycardia in humans 4.
- However, another study published in Cardiovascular research found that prednisone can prevent atrial fibrillation promotion by atrial tachycardia remodeling in dogs, suggesting that corticosteroids may have a complex effect on cardiac rhythm 5.
Clinical Implications
- The evidence suggests that corticosteroids, including prednisone, can cause various cardiac arrhythmias, including tachycardia, particularly at high doses or in certain patient populations 2, 3, 4.
- Clinicians should be aware of the potential for corticosteroid-induced cardiac arrhythmias and monitor patients accordingly, particularly those with preexisting cardiovascular disease 4.
- Further research is needed to fully understand the effects of corticosteroids on cardiac rhythm and to determine the optimal management strategies for patients at risk of corticosteroid-induced arrhythmias 6.