Table of ContentsView AllTable of ContentsPrednisone UsesCardiac Side EffectsProtect Your HeartWho Is at Risk?Before Taking Prednisone

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Table of Contents

Prednisone Uses

Cardiac Side Effects

Protect Your Heart

Who Is at Risk?

Before Taking Prednisone

Prednisone, a steroid drug used to treatinflammation, can causeheart palpitations(skipped, pounding, or racing heartbeats) as well as other cardiac side effects likebradycardia(slowed heartbeats),tachycardia(rapid heartbeats), andatrial fibrillation(irregular heartbeats).

Prednisone can cause an imbalance ofelectrolytesthat helps regulate heartbeats, including potassium, calcium, sodium, and magnesium. People given large doses of prednisone or intravenous doses (delivered into a vein) are at greatest risk. Severe cases have been known to causesudden death.

This article explains what prednisone is, how it affects the heart, and what can be done to avoid side effects. It also explains when it is time to see a healthcare provider.

Luis Alvarez / Getty Images

Female doctor examining patient. Medical professional checking woman’s back with stethoscope in clinic.

Why Prednisone Is Prescribed

But there are times when too much inflammation can do more harm than good, such as withinflammatory diseases(that end up damaging tissues with inflammation) andautoimmune disorders(in which the immune system attacks its own cells and tissues).

Some of the conditions prednisone can help treat include:

A Word From VerywellThe use of steroids, though helpful for many conditions, may be associated with the risk of having abnormal heart rhythms (arrhythmias). This risk usually increases with higher doses of steroids. The most important thing I tell my patients is to pay attention to your symptoms while you are taking steroids. Make sure to speak with your healthcare team on strategies to help mitigate the risk of unintended side effects.—CHRISTOPHER LEE, MD, MEDICAL EXPERT BOARD

A Word From Verywell

The use of steroids, though helpful for many conditions, may be associated with the risk of having abnormal heart rhythms (arrhythmias). This risk usually increases with higher doses of steroids. The most important thing I tell my patients is to pay attention to your symptoms while you are taking steroids. Make sure to speak with your healthcare team on strategies to help mitigate the risk of unintended side effects.—CHRISTOPHER LEE, MD, MEDICAL EXPERT BOARD

The use of steroids, though helpful for many conditions, may be associated with the risk of having abnormal heart rhythms (arrhythmias). This risk usually increases with higher doses of steroids. The most important thing I tell my patients is to pay attention to your symptoms while you are taking steroids. Make sure to speak with your healthcare team on strategies to help mitigate the risk of unintended side effects.

—CHRISTOPHER LEE, MD, MEDICAL EXPERT BOARD

Christopher Lee, MD

Side Effects Involving Heart Rate

Electrolytes are minerals in your blood that carry an electric charge. Several of these electrolytes—most notablypotassium,sodium,calcium, andmagnesium—help regulate electrical impulses that make the heart beat. An imbalance of electrolytes, either high or low, can interfere with electrical signaling and lead to irregular heartbeats.

This can happen when prednisone is taken in large doses or for a prolonged period of time.Depending on which electrolytes are affected, the heart rhythm may slow down, speed up, or become erratic.

Bradycardia

Bradycardia, also known assinus bradycardia, is an abnormally slow resting heart rate, usually under 60 beats per minute (BPM). Electrolyte imbalances are one of the possible causes of bradycardia.

The electrolyte most commonly linked to bradycardia is potassium. When levels are either too high (hyperkalemia) or too low (hypokalemia), the heart rate can slow significantly.

Prednisone is known to cause potassium deficiency. This can lead to hypokalemia and the onset of bradycardia.

In addition to an abnormally slowed heart rate, symptoms of bradycardia include:

In severe cases, bradycardia can causesyncope(fainting),cardiac arrest, and sudden death.

Tachycardia

Tachycardia is an abnormally fast heart rate, generally faster than 100 BPM when resting. There are many causes of tachycardia, but it commonly occurs when electrical impulses to theSA (sinoatrial) nodeare accelerated.

The SA node, considered the “pacemaker of the heart,” is the structure that generates electrical impulses that are conducted to the AV node. Potassium and sodium are electrolytes that regulate how effectively the SA node works.

In addition to an abnormally fast heart rate, tachycardia can cause:

Severe cases can lead to fainting and unconsciousness. A potentially life-threatening form of tachycardia affecting the lower chambers of the heart (calledventricular tachycardia) has been known to occur with high-dose intravenous prednisone.

Atrial Fibrillation and Heart Palpitations

Cardiac arrhythmiadescribes any type of irregular heart rate, including bradycardia and tachycardia. When the heart is beating erratically, it may be due to a specific type of arrhythmia known as atrial fibrillation (AFib).

AFib is oftenasymptomatic(without symptoms). When AFib is symptomatic, heart palpitations are one of the most common symptoms.

Other symptoms of AFib include:

Possible complications of AFib includemyocardial infarction(heart attack) and stroke, generally in those with underlying heart disease,

How to Lower the Risk of Cardiac Side Effects

Generally speaking, the risk of prednisone-induced arrhythmia is dose-dependent, meaning that you are more likely to get bradycardia, tachycardia, AFib, or palpitations at higher doses.

Some studies have shown that a daily 7.5-milligram (mg) oral dose of prednisone was associated with a six-fold increase in the risk of atrial fibrillation.

By reducing the dose or using prednisone for a shorter period, you may be able to lower your risk of cardiac side effects. But this isn’t always possible, particularly with chronic diseases like multiple sclerosis.

In such cases, your healthcare provider will likely prescribe daily supplements like calcium, potassium, and magnesium to help you avoid electrolyte imbalances.Most experts recommend supplements like these for anyone taking 2.5 mg or more of prednisone daily for more than three months.

You may also be advised to reduce your dietary salt intake to avoid hypernatremia.

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 orkidney 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 ofcardiac arrhythmia(abnormal heartbeat). This can range from mild to life-threatening.

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 undergoheart monitoringbefore receiving prednisone. This includes people with:

People with these heart conditions may be able to use prednisone, but that’s not always the case. Your healthcare provider 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.

When to Call 911Call 911 or seek emergency care if you are on prednisone and experience sudden changes in your heart rhythm or symptoms of bradycardia, including:Chest painDizziness or lightheadednessSudden extreme fatigueShortness of breathConfusionFainting

When to Call 911

Call 911 or seek emergency care if you are on prednisone and experience sudden changes in your heart rhythm or symptoms of bradycardia, including:Chest painDizziness or lightheadednessSudden extreme fatigueShortness of breathConfusionFainting

Call 911 or seek emergency care if you are on prednisone and experience sudden changes in your heart rhythm or symptoms of bradycardia, including:

Summary

Prednisone is a steroid drug used to treat inflammatory conditions and autoimmune diseases. While effective, the drug can cause bradycardia (slowed heartbeats), tachycardia (rapid heartbeats), atrial fibrillation (irregular heartbeats), and palpitations.

Those at greatest risk are people who have pre-existing heart or kidney disease, as well as those given high-dose oral prednisone or intravenous (IV) prednisone.

Managing Prednisone Side Effects

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stroeder J, Evans C, Mansell H.Corticosteroid-induced bradycardia: case report and review of the literature.Can Pharm J (Ott).2015;148(5):235-240. doi:10.1177/1715163515597451MedlinePlus.Prednisone.Olivero JJ.Cardiac consequences of electrolyte imbalance.Methodist Debakey Cardiovasc J.2016 Apr-Jun;12(2):125–6. doi:10.14797/mdcj-12-2-125Choudhury M.Biology of the sinus node and its disease.Arrhythm Electrophysiol Rev.2015 May;4(1):28–34. doi:10.15420/aer.2015.4.1.28lshansky B, Sullivan R.Inappropriate sinus tachycardia.EP Eurospace. 2019 Feb;21(1):194-207. doi:10.1093/europace/euy128Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30January CT, Wann LS, Calkins H, et al.2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation.2019;140(2). doi:10.1161/CIR.0000000000000665Rafaqat S, Rafaqat S, Khurshid H, et al.Electrolyte’s imbalance role in atrial fibrillation: pharmacological management.Int J Arrhythm.2022;15. doi:10.1186/s42444-022-00065-zHox V, Lourijsen E, Jordens A, et al.Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper.Clin Transl Allergy. 2020 Jan 3;10:1. doi:10.1186/s13601-019-0303-6Lupsa BC, Insogna KL, Micheletti RG, Caplan A.Corticosteroid use in chronic dermatologic disorders and osteoporosis.Int J Womens Dermatol.2021 Dec;7(5Part A):545–51. doi:10.1016/j.ijwd.2021.07.014National Heart, Lung, and Blood Institute.Arrhythmias.

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stroeder J, Evans C, Mansell H.Corticosteroid-induced bradycardia: case report and review of the literature.Can Pharm J (Ott).2015;148(5):235-240. doi:10.1177/1715163515597451MedlinePlus.Prednisone.Olivero JJ.Cardiac consequences of electrolyte imbalance.Methodist Debakey Cardiovasc J.2016 Apr-Jun;12(2):125–6. doi:10.14797/mdcj-12-2-125Choudhury M.Biology of the sinus node and its disease.Arrhythm Electrophysiol Rev.2015 May;4(1):28–34. doi:10.15420/aer.2015.4.1.28lshansky B, Sullivan R.Inappropriate sinus tachycardia.EP Eurospace. 2019 Feb;21(1):194-207. doi:10.1093/europace/euy128Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30January CT, Wann LS, Calkins H, et al.2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation.2019;140(2). doi:10.1161/CIR.0000000000000665Rafaqat S, Rafaqat S, Khurshid H, et al.Electrolyte’s imbalance role in atrial fibrillation: pharmacological management.Int J Arrhythm.2022;15. doi:10.1186/s42444-022-00065-zHox V, Lourijsen E, Jordens A, et al.Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper.Clin Transl Allergy. 2020 Jan 3;10:1. doi:10.1186/s13601-019-0303-6Lupsa BC, Insogna KL, Micheletti RG, Caplan A.Corticosteroid use in chronic dermatologic disorders and osteoporosis.Int J Womens Dermatol.2021 Dec;7(5Part A):545–51. doi:10.1016/j.ijwd.2021.07.014National Heart, Lung, and Blood Institute.Arrhythmias.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Stroeder J, Evans C, Mansell H.Corticosteroid-induced bradycardia: case report and review of the literature.Can Pharm J (Ott).2015;148(5):235-240. doi:10.1177/1715163515597451MedlinePlus.Prednisone.Olivero JJ.Cardiac consequences of electrolyte imbalance.Methodist Debakey Cardiovasc J.2016 Apr-Jun;12(2):125–6. doi:10.14797/mdcj-12-2-125Choudhury M.Biology of the sinus node and its disease.Arrhythm Electrophysiol Rev.2015 May;4(1):28–34. doi:10.15420/aer.2015.4.1.28lshansky B, Sullivan R.Inappropriate sinus tachycardia.EP Eurospace. 2019 Feb;21(1):194-207. doi:10.1093/europace/euy128Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30January CT, Wann LS, Calkins H, et al.2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation.2019;140(2). doi:10.1161/CIR.0000000000000665Rafaqat S, Rafaqat S, Khurshid H, et al.Electrolyte’s imbalance role in atrial fibrillation: pharmacological management.Int J Arrhythm.2022;15. doi:10.1186/s42444-022-00065-zHox V, Lourijsen E, Jordens A, et al.Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper.Clin Transl Allergy. 2020 Jan 3;10:1. doi:10.1186/s13601-019-0303-6Lupsa BC, Insogna KL, Micheletti RG, Caplan A.Corticosteroid use in chronic dermatologic disorders and osteoporosis.Int J Womens Dermatol.2021 Dec;7(5Part A):545–51. doi:10.1016/j.ijwd.2021.07.014National Heart, Lung, and Blood Institute.Arrhythmias.

Stroeder J, Evans C, Mansell H.Corticosteroid-induced bradycardia: case report and review of the literature.Can Pharm J (Ott).2015;148(5):235-240. doi:10.1177/1715163515597451

MedlinePlus.Prednisone.

Olivero JJ.Cardiac consequences of electrolyte imbalance.Methodist Debakey Cardiovasc J.2016 Apr-Jun;12(2):125–6. doi:10.14797/mdcj-12-2-125

Choudhury M.Biology of the sinus node and its disease.Arrhythm Electrophysiol Rev.2015 May;4(1):28–34. doi:10.15420/aer.2015.4.1.28

lshansky B, Sullivan R.Inappropriate sinus tachycardia.EP Eurospace. 2019 Feb;21(1):194-207. doi:10.1093/europace/euy128

Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30

January CT, Wann LS, Calkins H, et al.2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation.2019;140(2). doi:10.1161/CIR.0000000000000665

Rafaqat S, Rafaqat S, Khurshid H, et al.Electrolyte’s imbalance role in atrial fibrillation: pharmacological management.Int J Arrhythm.2022;15. doi:10.1186/s42444-022-00065-z

Hox V, Lourijsen E, Jordens A, et al.Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper.Clin Transl Allergy. 2020 Jan 3;10:1. doi:10.1186/s13601-019-0303-6

Lupsa BC, Insogna KL, Micheletti RG, Caplan A.Corticosteroid use in chronic dermatologic disorders and osteoporosis.Int J Womens Dermatol.2021 Dec;7(5Part A):545–51. doi:10.1016/j.ijwd.2021.07.014

National Heart, Lung, and Blood Institute.Arrhythmias.

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