Cortisone, a type of corticosteroid medication, is widely used as a potent anti-inflammatory treatment, typically administered via injection to target localized pain and swelling. These injections are commonly used for conditions affecting joints, tendons, and the spine, delivering medication directly to the source of inflammation. Because this treatment involves a powerful hormone-like substance, patients often express concern about potential systemic side effects. A frequent question is whether a cortisone injection can trigger heart palpitations. This article addresses the connection between this common procedure and the experience of a racing or fluttering heart rhythm.
The Link Between Cortisone Injections and Palpitations
Cortisone injections can cause heart palpitations in some individuals, although this is generally considered an uncommon side effect. The experience is often described as the heart fluttering, pounding, or skipping beats in the chest. These changes in heart rhythm are typically a transient reaction to the medication, lasting only a short period.
Palpitations are usually short-lived, beginning shortly after the injection and resolving within 48 to 72 hours. While these episodes can be disconcerting, they often pass without requiring medical intervention. The experience of a racing heart (tachycardia) or other rhythm disturbances depends on the amount of drug that enters the systemic circulation from the injection site.
How Corticosteroids Affect Heart Rhythm
Corticosteroids influence the body’s physiological system because they are structurally similar to natural stress hormones. Their presence can amplify the body’s “fight or flight” response, primarily mediated through the cardiovascular system’s adrenergic pathways.
Corticosteroids potentiate the effects of catecholamines, such as epinephrine (adrenaline). This means the body becomes more sensitive to its own natural adrenaline, leading to an increase in heart rate and the force of contraction. Systemic absorption of the injected drug drives this stimulant-like effect on the heart.
A second mechanism involves the drug’s influence on the balance of electrolytes, which are electrically charged minerals essential for stable heart function. Corticosteroids can sometimes cause sodium retention and increase the excretion of potassium from the body. Low potassium levels (hypokalemia) are known to interfere with the heart’s electrical signaling. This shift in electrolyte levels, coupled with the potential for fluid retention and a temporary rise in blood pressure, creates a physiological environment that is more prone to palpitations.
Patient and Procedure Factors That Increase Risk
The likelihood of experiencing palpitations is modulated by the patient’s health profile and the specifics of the procedure. One major factor is the injection site itself, which dictates the rate and amount of drug absorbed into the bloodstream. Injections into highly vascularized areas, such as epidural spaces or large joints, allow for faster and greater systemic absorption compared to a superficial soft-tissue injection.
The specific type and total dose of the corticosteroid used also play a role. Higher doses are associated with a greater chance of developing cardiovascular complications, including rhythm disturbances. Furthermore, some corticosteroid formulations have higher mineralocorticoid activity, which may increase the propensity for sodium retention and electrolyte shifts.
Pre-existing medical conditions significantly increase susceptibility. Patients with a history of arrhythmias, hypertension, or underlying cardiovascular disease are more vulnerable to the heart-related effects. Individuals with kidney disease are also at higher risk, as their bodies may have difficulty regulating electrolyte or fluid changes. Anxiety disorders or sensitivity to stimulant medications can also predispose a patient to palpitations. Patients should communicate any such pre-existing conditions to the prescribing physician before the procedure.
Recognizing Symptoms and Seeking Medical Advice
When palpitations occur, it is important to distinguish between a mild, temporary awareness of the heart beating and more concerning symptoms. Mild fluttering that resolves within a couple of days after the injection is common and usually only requires monitoring.
However, certain signs should prompt immediate medical attention. If palpitations are accompanied by chest pain, significant shortness of breath, or sudden severe dizziness, emergency care should be sought immediately. Other red flags include feeling faint, fainting, or prolonged episodes of a very rapid heart rate. Patients should inform the prescribing physician about any new or worsening symptoms. Diabetic patients should also monitor their blood sugar closely, as corticosteroids can temporarily cause a rise in glucose levels.