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Can Remicade And Methotrexate Cause Increased Heart Rate?
Question: I had an echo that revealed a mildly dilated left ventricle with normal EF (55-60%) 18 months ago. My BMI is 21, I have never smoked and have been very athletic since my teens. I do have unpredictable arrhythmias at times, but most of the time I am in sinus rhythm (had an incident of bigeminy for about 5 minutes during a doctor's visit, a few times of tachycardia, a couple of incidents of bradycardia in the last year; but when I was placed on a monitor, I stayed in sinus rhythm). I will be 55 soon, am female, and was just diagnosed with seronegative erosive RA over the summer, and have just started remicade infusions. Should we get another echo before getting any more infusions, (I have had two to date and have notices my heart rate goes up with less exertion when I exercise since starting the infusions).
Thank you in advanced!
XXXXXXX
I forgot to add, my normal BP is anywhere from 100/65 to 90/55; resting ht rt is between 50 and 60. I trained for the Olympics at one time back in the days when we over trained, and I wonder if the history of over training could be tied to the arrhythmias when they happen.
On more thing ... only meds I take are the remicade and methotrexate for the RA, before this summer I did not need medication for anything.
Thank you in advanced!
XXXXXXX
I forgot to add, my normal BP is anywhere from 100/65 to 90/55; resting ht rt is between 50 and 60. I trained for the Olympics at one time back in the days when we over trained, and I wonder if the history of over training could be tied to the arrhythmias when they happen.
On more thing ... only meds I take are the remicade and methotrexate for the RA, before this summer I did not need medication for anything.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would like to explain that your mildly dilated left ventricle may be related to what is called "athlete's heart", a frequent finding in highly trained elite athletes.
Intermittent ectopic beats may be also explained in this context, as you have a sustained normal sinus rhythm and only boats of isolated ectopic beats or bigeminy, it doesn't seem to be a serious or life threatening arrhythmia.
So relax and don't worry about it!
Nevertheless I would like to directly review your cardiac ultrasound and Holter monitor reports.
Please could you upload those reports for me to review?
From the other side RA is a well known risk factor for cardiovascular disease, leading to high rates of morbidity and mortality. It may affect valvular, myocardial tissue components and leading to increased rate and premature appearance of (silent or not) myocardial ischemia, myocardial infaction, heart failure, etc.
Anti RA drugs like remicade, though have been shown to improve endothelial function in the first couple of weeks from the therapy start, after this period they have been shown to increase vasoconstriction, wall shear stress and high-density lipoproteins. Other potential side effects may be also myocardial ischemia or even infarction during an infusion.
Anyway, if properly monitored in hospital settings this therapy seems to be safe and beneficial for your RA.
I would recommend having frequent follow ups with resting ECG, cardiac ultrasound. An exercise cardiac stress test would be also advisable to rule out a myocardial ischemia component.
I would also strongly encourage you to keep under control the traditional cardiac risk factors:
- treat your dyslipidemia
- monitor your blood pressure
- avoid close smoking contacts
- keep being physically active
- follow a healthy diet (Mediterranian diet is recommended), etc.
Remember that a low level of PCR and other inflammatory markers are not good only for your RA, but also for preventing potential cardio vascular complications.
So they may be good targets for your medical follow up.
Hope to have been helpful!
Feel free to ask any other questions, whenever you need!
Greetings!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would like to explain that your mildly dilated left ventricle may be related to what is called "athlete's heart", a frequent finding in highly trained elite athletes.
Intermittent ectopic beats may be also explained in this context, as you have a sustained normal sinus rhythm and only boats of isolated ectopic beats or bigeminy, it doesn't seem to be a serious or life threatening arrhythmia.
So relax and don't worry about it!
Nevertheless I would like to directly review your cardiac ultrasound and Holter monitor reports.
Please could you upload those reports for me to review?
From the other side RA is a well known risk factor for cardiovascular disease, leading to high rates of morbidity and mortality. It may affect valvular, myocardial tissue components and leading to increased rate and premature appearance of (silent or not) myocardial ischemia, myocardial infaction, heart failure, etc.
Anti RA drugs like remicade, though have been shown to improve endothelial function in the first couple of weeks from the therapy start, after this period they have been shown to increase vasoconstriction, wall shear stress and high-density lipoproteins. Other potential side effects may be also myocardial ischemia or even infarction during an infusion.
Anyway, if properly monitored in hospital settings this therapy seems to be safe and beneficial for your RA.
I would recommend having frequent follow ups with resting ECG, cardiac ultrasound. An exercise cardiac stress test would be also advisable to rule out a myocardial ischemia component.
I would also strongly encourage you to keep under control the traditional cardiac risk factors:
- treat your dyslipidemia
- monitor your blood pressure
- avoid close smoking contacts
- keep being physically active
- follow a healthy diet (Mediterranian diet is recommended), etc.
Remember that a low level of PCR and other inflammatory markers are not good only for your RA, but also for preventing potential cardio vascular complications.
So they may be good targets for your medical follow up.
Hope to have been helpful!
Feel free to ask any other questions, whenever you need!
Greetings!
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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