Although the most obvious joint pain symptoms associated with RA have been under control for a while now, I've been struggling with occasional symptoms that include: weakness, fatigue, short of breath, heart palpitations, nausea, dizziness, cough, and tightness in my chest...not all the time, usually lasts a few hours then goes away. My doctor has performed several heart related tests; EKG, blood metabolism, and a 24 hr halter test, all have been normal. I am now scheduled to start a 30 day heart monitor test next week. In the mean time I've been researching the topic and have found a couple of interesting facts that are new to me...though I'm sure others are aware of them. First, RA sufferers have a factor of 2 to 3 higher risk for heart disease than the normal population. The most likely cause seems to be inflammation of the blood vessels and in rare cases, the heart itself, though there are other risk factors, like lack of exercise, that probably contribute. Interestingly enough, one of the possible culprits is excess TNF, which is exactly what the new biologics are targeted to reduce. Most of the reports recommend agressive treatment of inflammation to reduce the risk of heart disease...something else to consider when you're weighing the risk of medications...and more frequent heart testing, such as an EKG. The other fact I discovered is that about 60% of RA sufferers have anemia. It's the most common side effect of RA. The symptoms are very similar to what I described at the beginning, including heart palpitations (rapid heart beat and irregular heart beats). There's a type of anemia called chronic illness anemia. It's probably caused by inflammation as well. There's also a folate deficiency anemia that may be caused by MTX. The good news is that anemia is treatable. I intend to talk to my doctor about it next time I visit. It might explain what I've been experiencing. If anyone else has any insights on this topic I'd love to hear from you.
Happy Thanksgiving,
Alan
Alan,thanks for your comments
I know what you mean about it being difficult to sort out what is due to RA and what is due to another cause. One of the articles I read observed that people with RA tend to have more "silent" heart attacks...that is, no noticeable symptoms, but can apparently be diagnosed with an EKG after the fact. The speculation was that people with RA are more conditioned to deal with pain and just don't notice the small stuff. That's one reason why they recommended having a routine EKG periodically. I think the same is true of me. When the RA was flaring, the joint pain masked everything else. Now that it's under control for me (...with Humira, now), I've noticed other symptoms that were probably there before too.
Alan
Alan,
I'm not sure what heart papitations feel like but what I've been experiencing for the last month or so feels like my heart is skipping beats. You know the feeling of being suddenly scared? Your heart jumps? It happens to me many times a day,every day. It's really starting to bother me and I'm going to mention it to my rheumy next week when I see him. Do you think this is what you're talking about?
Thanks.
I had heart problems right from the beginning and it really scared me. I found myself in the Cardiac ward of two different hospital within the course of a couple of weeks. It turned out to be Pericarditis which is inflammation of the heart muscle caused by RA. It is very painful, can cause rapid heart beats and hurts really bad. You think you are having a heart attack.
That's one problem that can occur. They regularly do echocardiograms on me and the stress tests. Over the years, they have found some thickening of the heart wall. The constant inflammation of RA can damage your vessels, leading to early problems with your heart that we usually associate with aging like clogging of the arteries. Your cholestrol and blood pressure can rise, a result of prednisone for instance.
So, regular checkups and adding a cardiologist to your team of doctors is very reasonable if you have any problems.
Added to my situation is a history of heart problems in my family. I have Mitral Prolapse Valve as does my sister. My younger brother has had two heart attacks, the first at the age of 40. My mom and grandmother had pacemakers. My paternal grandmother had angina.
I regularly use Toprol XL for heart palpitations. It works really well. I also am on blood pressure medication (also runs in my family) and use Nitroglycerin tablets when needed. It's hard to distinguish heart problems from Costochronditis and when I have chest pain, I have to guess whether it requires a trip to the ER or not.
Regardless, the problems that you are experiencing are scary and I find them very stressful when I am having problems.
It is extremely vital to tell the ER doctors that you have RA if you go there for any problem. Sometimes something small is an early warning sign that we can indeed overlook.
I hope you feel better and they find some easy answers for you, Alan. I know it is very distressing especially when you are feeling symptoms but the tests are coming back negative. Just keep a sharp eye on it and trust your instincts as to when it becomes an emergency. Other than diet and exercise, in the end, that is about all you can do. Your body may actually be sending out warning signals early before the doctors really can detect something. So, your carefulness is fully justified.
I see my cardiologist on a yearly basis now. He has told me a couple of times that we didn't need to see each other any more (he's the sweetest man), but then the problems would all resurface again. I just go by my instincts and put a lot of trust in God to take care of me.
Kahil, for me the palpitations start as a rapid heart beat, usually around 100 beats per minute, sometimes a little higher. When it slows down I also get skipped beats a lot. The skipped beats, if fairly infrequent, can be normal and not cause any problems.
Deanna, thanks for sharing your experience. At this point, my doctor doesn't think there's any underlying heart problem, and is more likely a chemical imbalance of some sort. But he's being cautious and hopefully the 30 day test will be able to catch a few events so they can see what's going on. I'm also wondering now about anemia. I was very anemic a few months ago with similar symptoms. Of course, stress and anxiety can also cause similar symptoms.
Alan
Let me know what you find out about the anemia. I've been told for a couple of years that I have that problem, but they don't address it in any way. If your doctor does, I'd like to know what they are doing about it. I've read that the kind of anemia we have cannot be treated in some places and the opposite in others.Thought this link might be of interest to people. It's from the National Anemia Action Council and provides some good information about RA and anemia.
http://www.anemia.org/patients/educationsheets/arthritis.pdf
Thanks for the info, Alan. I guess my doc thinks the multivitamin I take is enough. I'm going to ask specifically about this because I could use anything that decreases the fatigue.
It was very sweet of you to look up the info. It gives me something specific to address and I needed that. Thanks again.
I have cardiomyopathy and was in severe heart failure a while ago. I see my cardiologist twice a year and pay close attention to what's going on. I can't take pred because any dose higher than 5 mg causes nasty palpitations, and then chest pain.
Its a real catch 22 I have chostrochronditis (sp) right now which hurts in my sternum like crazy, but pred would just make my heart flop around like a fish out of water.. arrrgh.