Epileptic Heart
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
Chronic epileptic episodes and the subsequent catecholamine surges and hypoxia events may affect the heart and coronary vessels and result in the dysfunction of the heart, this condition has known as the epileptic heart. This concept first described by Dr. Richard L. Verrier and his colleagues in 2020.
Historical Perspective
- The Absence of cardiac activity during epilepsy, first described by Dr. A.E.Russell, an English physician, in 1906.[1]
- The epileptic heart was first discribed by Dr. Richard L. Verrier and his colleagues, in 2020.[2]
Classification
- There is no established system for the classification of the epileptic heart.
Pathophysiology
- The exact mechanisms involved in the epileptic heart is still should be elucidated. However, the algorithm below provides beneficial information on the development of heart disease in the context of epilepsy.[3]
| Epilepsy | |||||||||||||||||||||||||||||||||||||||
| Cardiac effects | |||||||||||||||||||||||||||||||||||||||
| Repeated hypoxia and subsequent myocardial ischemia | Cathecholamines-induced cardiotoxicity | ||||||||||||||||||||||||||||||||||||||
| Accelerated atherosclerosis | Myocardial stunning | Vacuolization of myocytes and fibrosis | |||||||||||||||||||||||||||||||||||||
Epilepsy and Cardiac Arrhythmia
Cardiac arrhythmia have long been observed in patients with epilepsy. There are three different mechanisms that explain this association:[4]
- Direct (casual) pathway
- Co-existence of epilepsy and cardiac arrhythmia in the context of genetic disorders:
- Resultant association:
- The anti-epileptic medications have been known to cause arrhythmia.
- Seizure may also causes arrhythmia.
- Ictal phase may be associated with tachycardia, asystole, bradycardia, and AV block.
- Postictal phase may be associated with asystole, AV block, atrial flutter or fibrillation, and ventricular fibrillation.
Epilepsy and Structural Heart Disease
Three mechanisms have been suggested to explain the association between epilepsy and structural heart disease:[4]
- Direct (casual) pathway
- Direct (casual) pathway in which structural heart disease may result in stroke and subsequent epilepsy.
- Common risk factors contribute to the development of both epilepsy and structural heart disease.
- Resultant pathway:
References
- ↑ Russell, A.E. (1906). "CESSATION OF THE PULSE DURING THE ONSET OF EPILEPTIC FITS,". The Lancet. 168 (4325): 152–154. doi:10.1016/S0140-6736(01)30477-4. ISSN 0140-6736.
- ↑ Verrier, Richard L.; Pang, Trudy D.; Nearing, Bruce D.; Schachter, Steven C. (2020). "The Epileptic Heart: Concept and clinical evidence". Epilepsy & Behavior. 105: 106946. doi:10.1016/j.yebeh.2020.106946. ISSN 1525-5050.
- ↑ Verrier, Richard L.; Schachter, Steven C. (2018). "Is heart disease in chronic epilepsy a consequence of seizures or a fellow traveler?". Epilepsy & Behavior. 86: 211–213. doi:10.1016/j.yebeh.2018.06.027. ISSN 1525-5050.
- ↑ 4.0 4.1 Shmuely, S.; van der Lende, M.; Lamberts, R.J.; Sander, J.W.; Thijs, R.D. (2017). "The heart of epilepsy: Current views and future concepts". Seizure. 44: 176–183. doi:10.1016/j.seizure.2016.10.001. ISSN 1059-1311.