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Heart Arrhythmia

About 12 years ago I had a brief incident with heart arrhythmia.  It felt like my heart was actually skipping beats and made me feel lightheaded at times.  I had all the tests (ECG, heart holter, stress test) and it turned out to be benign PAC's and PVC's (premature atrial and ventricular contractions).  Soon after, they disappeared and did not recur until about 2 months after I started taking Tasigna  in October 2016.  For about 4 or 5 months, I suffered pretty badly from these heart palpitations.  Some days would be almost non-stop and I could feel thousands of them throughout the day.  I took zanax when they were real bad and it seemed to help for a while. I had the same battery of tests and again and again got the same Dx.  I started dose reduction soon thereafter and things improved considerably.  Then about 9 months ago, they started again and I had a more comprehensive set of tests at Mayo Clinic (ECG, heart holter, echocardiogram, nuclear stress test).  The cardiologist that I saw told me I scored the highest he had ever seen on the stress test (17.5 mets) and that I had the cardiovascular system of a 30 year old (I am 65 and do 2 miles a day on the treadmill).  Soon after, the palpitations subsided and I went 7 - 8 months without any significant episodes.  About 6 weeks ago, they started again and I have had some pretty bad days since.  When I have a lot of them, my back starts to hurt and I just get plum exhausted. So I called my GP and he prescribed metroprolol.  I have been on that for 5 days now and no noticeable change.

I was wondering if anyone else here has experienced this since starting Tasigna or any other TKI for that matter, and if so, is there some treatment I haven't tried that might help.  I have been on 150 mg/day (very low dose) of Tasigna since September 2017 and PCR has been <.003% since April of 2017.  Any thoughts or suggestions would be much appreciated.

Hi Jax,

I think when I started Sprycel last year at 100mg/day the same thing was going on with me.  Here's what my PCP wrote, "EKG shows either a PAC or PVC."  He said I should drink less coffee.  I decided to take less Sprycel.  I haven't had any arrhythmia since then.

My resting heart rate is around 45 to 50 bpm.  What's your normal resting bpm?

Do you think 20mg Sprycel would be an option for you to try?  There might be merit to the idea of changing/rotating TKIs in order to reduce side effects.

Here's a link to a brief discussion about the concept: https://communityview.lls.org/statuses/5137

Good luck,

Kirk

I've had arrhythmia issues before, during, and after Sprycel. I was on beta blockers 3 years before my CML diagnosis, although I now wonder what was going on in my blood back then. After about 4 months on/off Sprycel, I do think it irritates my already existing issues. And abnormal heart rhythm is one of the side effects listed on the Sprycel page, unfortunately, so it would come as no surprise. Here's my only suggestion... Electrolytes play a key role in heart rhythm, and my suspicion is that Sprycel does something metabolic that impacts either the electrolyte balance or something electrolyte adjacent. One thing that I've found helps somewhat--not a miracle cure--is easing back on salt and having a bit more fruits and vegetables. That will improve your sodium/potassium ratio. Potassium is involved with heart rhythm (sodium is too, but there's almost nobody who doesn't get enough salt). Don't overdo potoassium though, because you can get too much and that can be seriously bad. Basically when you eat, just incorporate things like bananas, spinach, avocados, cantaloupe, etc. Also consider taking magnesium, another key electrolyte and one that has unfortunately faded out of our standard food supply. 

Thanks Bill and RC: Update after being on Metroprolol for a week now, the quantity of PAC's/PVC's had diminished. but I don't know if it's the new medicine or just the "normal" cycle.  I changed my diet after Dx and it includes many of the food you suggest plus I am a very low salt consumer.  I also take 1,250 mg of magnesium taurate before bed each night.  I hate to start another TKI when Tasigna works so well, but that is one of my options if this doesn't improve.  I am also considering a 2 week drug break to see if that resets things.  My resting heart rate before taking metroprolol was 68 - 72, now it's about 10 points lower. I really don't want to stay on this new drug, so I might go off for a week and see what happens to the palpitations.

Another thing to consider is anemia. Over the past few weeks I’ve dropped from 11.7 into the 10s, then 9s, then 8s, and now 7s for HGB. When I was in the 10s and 11s I was usually not having palpitations, but as I dipped lower and lower I became much more sensitive to electrolyte imbalances, I think simply because there was less blood to moderate things. I can’t do much about it now other than be really careful about hydration and a favorable ratio of electrolyte intake. The littlest salt spike and my heart gets super pissed. The slightest neglect of potassium is the same. Just a thought.

Thnaks for the additional thought Bill.  My HGB has been between 15 - 16 for over 2 years now.  It did drop to 13 once during early treatment in late 2016, but onyl stayed there briefly.  K levels have always been around 4 - 4.5, so mid-normal range.  Throughout this time, my PAC/PVC's have ebbed and flowed, so I don't think these are root causes.  I really think it's the TKI combined with a predilection for this condition that predates my TKI days.  The last 2 -3 days have shown some improvement, so I'm hoping that this latest cycle may be waning a bit.