### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have been on prednisolone continuously for almost 15 years and apparently my natural cortosol production is reduced. Ive had multiple bypasses and it seems there is one artery virtually closed at the junction with the back of my heart. I developed asevere AF after my heart operation 9 years ago, and had RF Ablations because a pacemaker was not optimal (My immune system was/is consequently suppressed). I have finally been able to reduce prednisolone to 3 mg/day after several years of oscilating between 15-5 mg (with occasioinal bursts about 3/yr 50 mg for a period then reduced. For 5 years I have been able to walk 5-8 Km every day. QUESTION: I am getting occasional missing heart beat/palpitations... but find if I gently walk 5 Km, have a cup of coffee, then walk 2 Km to home I start to feel good (heart regular, lungs clearer), but need a sleep later.  QUESTION... ought I continue with the gradual reduction of prednisolone? Has the prednisolone been assisting with coping with the remaining blocked artery?

### output:

Hi, It looks like you have been coping up well with the gradual reduction of prednisolone. If the prednisolone would not have been enough for you then you would have low blood pressure, or any abnormalities in your electrolytes. The atrial fibrillation can sometimes happen all of a sudden which is known as paroxysmal aphid. As long as it does not cause any dizziness, shortness of breath or chest pain it's fine. I would advise you to see your cardiologist.1. Do 48 hours holder monitoring2. Do an ECHO3. Check morning cortisol level at 7 am (would tell you if cortisol is enough)I hope it helps. Regards.