Oral or I.V. steroid use and episodes of tachycardia

Can oral or IV steroid use during asthma treatment initiate episodes of tachycardia?  I seem to be experiencing an odd side-effect of oral and (some) I.V. steroids.  During my last hospitalization for asthma (12/07) I developed some short episodes of profound tachycardia.  These were documented and appropriately followed-up with during my hospital stay (I was there for 8 days that time) and afterward, but I noticed that the episodes continued at home during the months that I was tapering my prednisone dose.  With subsequent prednisone doses, I also had episodes of tachycardia, and during the times that I have been off of prednisone or I.V. steroids I have not had any episodes of tachycardia.  I have not found anything helpful in the general medical literature with regard to prednisone, so I wondered if it is a condition that any of you have heard of?  I know that many of the other asthma medications can cause this side-effect, but it has not been problematic for me with any of my other medications as long as I am not taking prednisone.  The problem does seem to be somewhat dose-related, too, although my evidence is certainly anecdotal at best.  My suspicions at this point, from a patient's point of view, is that the effect is causal, rather than simply coincidental, due to the number of episodes that I have documented and the absence of them sans prednisone or IV steroid therapy.

I try to stay off of prednisone as much as possible (especially now, as the episodes are uncomfortable when they are sustained longer than a few hours), and I've managed to avoid it for several months, but a recent respiratory infection has prompted the need for a short course of prednisone and I did notice the return of this condition today when I initiated therapy.  The episodes are self-limiting and not severe (120-140 range usually) and I have discussed them with my pulmonologist and my internist. 

I have severe asthma so I am often on multiple medications for my asthma, but I even tried discontinuing all of them with the exception of prednisone (with my healthcare provider's permission) and the tachycardia did not fully resolve until I had discontinued the prednisone (this was in early 2008).  I do not have any cardiac issues, other than a PFO (patent foramen ovale) which was diagnosed 4 years ago, just after the birth of my third child.  That was also the first time that I/my pulmonologist noted the episodes of profound tachycardia.

Any information that you could provide on this subject would be helpful.  I am currently on 8 medications for my asthma and I added prednisone to those today.  I was not experiencing any episodes of tachycardia prior to the addition of the prednisone, and I have had one episode that was short-lived since I added prednisone.  The episodes appear to by typical, in that they sometimes begin with a thump in the chest.  The interesting thing for me with regard to these episodes, is that my heartrate does not respond to controlled or modified breathing.  I am a professional flutist and I am trained in several methods of breath-control (a necessity in my profession), many of which have effects upon the heartrate (usually a significant reproducible lowering of the heartrate).  While I can perform the exercises in the normal fashion when I am experiencing episodes of tachycardia, my pulse rate does not respond as usual, if at all. I have been doing these exercises for many years and they are as second nature to me, as they are part of my training.  I do not feel anxiety during the episodes of tachycardia, although it is a rather uncomfortable feeling and the episodes do make me tired after a bit.  I usually just feel as though I want to lie down and rest when they occur.

Thank you!

Issy

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