Last week I told you about the night I woke up at 2am and the three months I waited for a cardiologist to review the Holter monitor results.
What I didn't tell you, because I didn't know the connection yet, was what happened the day after my cardiologist recommended Coreg.
In late August, my dermatologist prescribed prednisone.
Not for my heart. For a skin condition on my legs that had been misdiagnosed twice — first as a bacterial infection, then as staph … before anyone figured out it was eczema.
Six weeks of antibiotics that didn't work. Then prednisone. Week one: 60 milligrams. Week two: 40. Week three: 20.
Most people take a steroid taper and think nothing of it. It's one of the most commonly prescribed medications in the world. You take it, the inflammation goes down, you move on.
My dermatologist warned me about elevated blood sugar and blood pressure. Standard precautions for a cardiac patient on steroids. Nobody mentioned heart rate. Nobody mentioned autonomic function. Nobody mentioned what a steroid taper might do to a post-MI nervous system that's already running on edge.
But I am not most people.
I am a cardiac survivor with two permanently scarred coronary arteries, and a resting heart rate that my cardiologist already wants to medicate.
I also have a personal chest-strap monitor I use every morning to measure my autonomic nervous system, and a device on my wrist that tracks my sleep.
So I watched.
Here's what the data showed.
My autonomic data across five phases — pre-flu baseline through post-prednisone. RHR, HRV, and wake times tell the story the clinic never saw.
My pre-flu baseline — before any of this year's health challenges began — had me at a resting heart rate of 80.1 beats per minute and an HRV of 48.4. Those were my numbers when things were stable.
During the 60mg week, my resting heart rate actually dropped slightly to 79.9. The drug was suppressing inflammation so effectively that some of the chronic cardiovascular strain temporarily reduced. My recovery scores stayed relatively stable.
I thought: maybe this isn't so bad.
Then I started tapering.
By the 40mg week, my HRV had dropped to 41.7 — down from my baseline of 48.4. My heart rate variability is the measure of how adaptable my autonomic nervous system is. It took five years of deliberate work to build that number. It was moving in the wrong direction.
By the 20mg week, my evening pulse was running at 86.3. My wake times had climbed to 7.1 per night. My sleeping heart rate was elevated.
And then I stopped the prednisone entirely, as scheduled.
That's when things got interesting.
My resting heart rate hit 90.0 beats per minute. My evening pulse hit 91.3. My HRV dropped to 39.3 — the lowest it had been since before I started tracking seriously. My Morpheus workout recovery score went negative for the first time.
The drug was gone. The disruption to my autonomic baseline wasn't.
Here's where it gets complicated.
My primary care doctor had ordered a Holter monitor, which I wore for 1 week in June — capturing my heart rate and cardiac rhythm around the clock.
Unfortunately, it took more than 3 months before a cardiologist could review the results with me.
Finally, on August 24 — the day before I started prednisone — my cardiologist recommended Coreg to bring my heart rate down. He was concerned about what he saw.
On September 16 — one day after I finished the taper — I had my ECHO test. I asked the lab tech whether the timing was a problem. She said no. She was right about the structural measurements — the ECHO captures anatomy, not autonomic function.
But my heart rate during the scan was 91 beats per minute.
Dr. Senske reviewed those results. He saw the 91 BPM. He now has two data points: August 24 and September 16, both showing elevated heart rate, both informing his recommendation for Coreg.
What he doesn't have is what happened in between.
A 60 milligram prednisone taper. Three weeks. My autonomic data showing RHR climbing to 90 post-prednisone — higher than anything he saw in his office. My HRV dropping to its lowest point in years.
I didn't connect those dots until after the ECHO test. Until I was sitting with my own spreadsheet, looking at the timeline, and realizing that the heart rate my cardiologist wants to medicate may have been significantly shaped by a steroid taper for a skin rash.
That's a conversation I still need to have with him.
I also plan to ask him specifically about a Coronary Artery Calcium scan — a direct imaging of arterial plaque that costs about $100-150. I've never had one. A man with two blocked arteries and six stents has never had a direct image of his arterial plaque burden. That conversation is overdue.
I’m also waiting for a home sleep study.
My primary care doctor suspects my elevated heart rate may be related to sleep apnea — a condition that can significantly raise resting heart rate and suppress HRV by triggering repeated autonomic surges throughout the night.
If that's what's driving my numbers, then Coreg may not be the right first step, because it wouldn't address the root cause. That's a decision I'll make with my cardiologist.
More on that in a future letter.
I'm not telling you to avoid prednisone. Sometimes it's exactly what the body needs — and for my skin condition, it helped.
I'm telling you that if you're a cardiac survivor and your doctor prescribes a steroid taper for anything — it's worth asking what it might do to your heart rate and autonomic function. And it's worth tracking it if you can.
Because your cardiologist probably won't connect those dots for you. Especially if, like mine, he's working with incomplete information through no fault of his own.
I connected them myself. Three weeks after the fact, staring at a spreadsheet of my own data.
That's what five years of tracking everything has taught me. The data tells a story. You just have to be willing to read it.
The skin condition, by the way, is close to be being resolved. I started a topical treatment as a followup to the prednisone.
Dennis
Cardiac Survivor · Your Friend in Recovery
Spokane, Washington
P.S. On Thursday, I'll show you what that seven-day heart monitor actually recorded — six heartbeats at 4:19 AM that I never felt — and why my two doctors read the same report so differently.
P.P.S. New here? The glossary has plain-English definitions of every cardiac and metabolic term I use: newsletter.cardiacsurvivor.org/p/glossary