Is prednisone (a corticosteroid) used to treat bradycardia (abnormally slow heart rate)?

Prednisone is Not Recommended for Bradycardia Treatment

Prednisone is not indicated for the treatment of bradycardia and may actually cause bradycardia as a side effect in some patients. 1, 2

Standard Treatment Options for Bradycardia

According to the 2019 ACC/AHA/HRS guidelines on bradycardia management, the recommended treatments include:

First-line Approach

1. Identify and treat reversible causes 1
   • Review medications (beta blockers, calcium channel blockers, digoxin)
   • Check for electrolyte abnormalities
   • Evaluate for hypothyroidism
   • Rule out acute myocardial ischemia
   • Consider infections (especially Lyme disease)

Acute Management of Symptomatic Bradycardia

For patients with symptomatic bradycardia or hemodynamic compromise:

1. Atropine (Class IIa recommendation)

   • 0.5-1 mg IV, may repeat every 3-5 minutes to maximum 3 mg 1

2. Beta agonists (Class IIb recommendation) if low likelihood of coronary ischemia:

   • Isoproterenol: 20-60 mcg IV bolus followed by 1-20 mcg/min infusion
   • Dopamine: 5-20 mcg/kg/min IV
   • Epinephrine: 2-10 mcg/min IV or 0.1-0.5 mcg/kg/min IV 1

Corticosteroids and Bradycardia

Contrary to being a treatment for bradycardia, multiple case reports indicate that corticosteroids including prednisone can actually induce bradycardia:

• Oral prednisone at doses of 40-80 mg has been documented to cause sinus bradycardia 3, 4
• Bradycardia appears to be dose-dependent and resolves after discontinuation or dose reduction 5
• This adverse effect can occur with both intravenous and oral administration 6, 7

Clinical Considerations

• Bradycardia from corticosteroids may be asymptomatic or present with symptoms like dizziness, fatigue, or syncope 4, 6
• The mechanism is not fully understood but may involve altered sodium and potassium transport across cell membranes
• Patients receiving corticosteroids should be monitored for cardiac effects, especially those with pre-existing cardiac conditions 7

Management Algorithm for Bradycardia

1. Assess hemodynamic stability

   • If unstable: immediate intervention with atropine or temporary pacing
   • If stable: proceed with evaluation

2. Identify and address reversible causes

   • Review medication list (discontinue offending agents if possible)
   • Check thyroid function, electrolytes, and screen for infection

3. For symptomatic patients requiring intervention:

   • First-line: Atropine
   • Second-line: Beta agonists (isoproterenol, dopamine, epinephrine)
   • Consider temporary transcutaneous or transvenous pacing if medications fail

4. For persistent symptomatic bradycardia:

   • Evaluate for permanent pacemaker implantation

Important Cautions

• Atropine should not be used in heart transplant patients without evidence of autonomic reinnervation (Class III: Harm) 1
• Corticosteroids should be considered as a potential cause rather than treatment for bradycardia 3, 4, 5
• Monitor patients on high-dose steroids for bradycardia, especially those with cardiac comorbidities 7

In summary, prednisone has no role in treating bradycardia according to current guidelines, and clinicians should be aware that it may actually cause bradycardia as an adverse effect.