Can steroids cause cardiac palpitations?

From the Guidelines

Steroids can cause heart palpitations, and the risk is particularly elevated in patients with pre-existing heart conditions or those taking high doses of corticosteroids. The relationship between steroid use and heart palpitations is supported by recent studies, including a 2024 narrative review of drug-induced atrial fibrillation, which highlights the potential of corticosteroids to increase the risk of atrial fibrillation, particularly in new users and those with respiratory diseases such as asthma and COPD 1. Key factors that contribute to this risk include:

• Fluid retention and electrolyte imbalances caused by corticosteroids, which can lead to heart rhythm disturbances 1
• Increased blood pressure, which is a known risk factor for atrial fibrillation 1
• Direct effects of anabolic steroids on the heart muscle, alteration of cholesterol levels, and increased blood pressure, all of which can potentially cause palpitations
• The risk is dose-dependent, with higher doses and longer durations of use associated with a greater risk of heart palpitations It is essential for individuals taking steroids to be aware of these potential risks and to consult their healthcare provider immediately if they experience palpitations or any other concerning symptoms. The evidence suggests that the risk of atrial fibrillation associated with corticosteroid use is significant, particularly in certain patient populations, and highlights the need for careful consideration and monitoring when prescribing these medications 1.

From the FDA Drug Label

Cardio-Renal Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. The FDA drug label does not answer the question.

From the Research

Steroids and Heart Palpitations

• Steroids, specifically corticosteroids, can have various effects on the cardiovascular system, including changes in heart rate and rhythm 2, 3, 4.
• The study published in Chest in 1992 found that the administration of prednisone potentiated the acute biochemical effects of high-dose inhaled beta-agonist drugs, but did not significantly alter the cardiovascular responses, including heart rate and QTc interval 2.
• However, a case report published in the Arab journal of nephrology and transplantation in 2012 described a case of bradycardia that developed after the use of oral corticosteroids, suggesting that cardiac arrhythmias may occur even with standard doses of oral prednisone 3.
• Another study published in The Canadian journal of cardiology in 2000 reviewed the potential adverse effects of glucocorticoid therapy on the cardiovascular system, including dyslipidemia, hypertension, and left ventricular free wall rupture after myocardial infarction, but did not specifically mention heart palpitations 4.
• It is worth noting that the relationship between steroids and heart palpitations is complex and may depend on various factors, including the type and dose of steroid, individual patient characteristics, and underlying medical conditions 2, 3, 4.

Mechanisms and Risk Factors

• The mechanisms of steroid-induced cardiovascular effects are complex and not fully understood, but may involve changes in lipid metabolism, systemic vascular resistance, and cardiac contractility 4.
• Certain risk factors, such as high doses and prolonged courses of corticosteroid therapy, may increase the risk of cardiovascular complications, including heart palpitations 4.
• Patients with underlying cardiovascular disease or other risk factors for cardiovascular disease may be more susceptible to the adverse effects of corticosteroids on the cardiovascular system 4.

Clinical Implications

• Clinicians should be aware of the potential cardiovascular effects of corticosteroids, including heart palpitations, and monitor patients closely for signs and symptoms of cardiovascular complications 2, 3, 4.
• The use of corticosteroids should be judicious and tailored to the individual patient's needs, with attention to risk modification and minimization of adverse effects 4.