Type 2 myocardial infarction following generalized tonic-clonic seizure

Cardiovascular complications of epileptic seizures

Seizure disorders are associated with multisystem complications. Cardiovascular complications account for a significant proportion of morbidity and mortality in these patients. As such, particular attention must be paid to the incidence of cardiovascular complications especially in populations at increased risk. The background for cardiac dysfunction lies in the interplay of genetic/molecular, autonomic, and iatrogenic factors that contribute to its onset. The purpose of this review was to summarize the state of literature in the last decade with regard to cardiac complications of epileptic seizures in order to increase awareness of short- and long-term debilitating cardiac complications as well as facilitate informed clinical decision-making. Taken together, the evidence provided in this review suggests that cardiac dysfunction following seizures should not be viewed as a separate entity but as an important complication of epileptic seizures. Appropriate cardiac therapy should be instituted in the postictal medical management of epileptic seizures. In acute states, postictal cardiac troponinemia (elevated cTn) should be worked up. Longer-term, monitoring for the development of cardiac structural and functional abnormalities is prudent.

Type 2 Myocardial Infarction: A Geriatric Population-based Model of Pathogenesis

Distinction between type 2 myocardial infarction (T2MI), defined as an imbalance between oxygen supply and demand without atherothrombosis, and type 1 myocardial infarction (T1MI), due to plaque disruption, is often a clinical challenge in frail elderly patients. We aimed to identify the characteristics and underlying causes of T2MI using a comprehensive geriatric approach. From a multicentre population-based prospective study in coronary care units, we adjudicated 4572 consecutive patients hospitalized for an acute T1MI or T2MI, according to the 3^rd universal definition and a prespecified geriatric model of T2MI pathogenesis. In total, 3710 (81%) had T1MI and 862 (19%) T2MI. Patients with T2MI were 10 y older (77 vs 67 y, p<0.001), more frequently female (44 vs 26%, p<0.001) and had more frequent comorbidities. In multivariate analysis, acute heart failure, tachycardia and C-reactive protein elevation at admission were associated with a higher risk of T2MI vs T1MI, whereas chest pain, troponin I peak > 10 µg/L and ST-segment elevation were associated with a lower risk. Underlying mechanisms leading to T2MI highlighted 3 main patterns: 1) Age-related physiological cardiovascular decline 2) chronic predisposing factors including chronic anaemia (10%) and severe aortic stenosis (7%), 3) acute triggering factors, the most common being acute infection (39%), mainly respiratory tract infection, followed by tachyarrhythmia (13%) and acute heart failure (10%). 122 (14%) patients had combined predisposing and triggering conditions for T2MI. In our large population-based survey of T2MI, chronic anaemia and severe aortic stenosis increased predisposition to T2MI and acute respiratory infection was by far the most frequent trigger. Our data shed new light on the age-related pathophysiological basis for discrepancies in oxygen supply and demand leading to MI.

Serum levels of cardiac troponin I in patients with status epilepticus and healthy cardiovascular system

BACKGROUND AND AIMS

Status epilepticus (SE) is accompanied by acute and intense activation of the sympathetic nervous system, which might result in myocyte damage. However, there is insufficient evidence to assess cardiac biomarkers in SE patients. As a highly specific and sensitive biomarker of acute myocardial infarction, serum concentration of cardiac troponin I (cTnI) has been assessed in this study in a sample of SE patients without evidence of previous cardiovascular diseases.

METHODS

In this analytical cross-sectional study, a total number of 30 patients with SE and no history of baseline cardiovascular disorders, aged between 12 and 60 years have been evaluated. Baseline, demographic characteristics and laboratory measurements including cTnI, creatine kinase (CPK) and CPK-MB were recorded for all of patients. cTnI was quantified using ELISA method with the precision of 0.01 ng/mL.

RESULTS

All cases had a cardiac troponin level <0.01 ng/mL except for one 60- year-old female with a history of seizure 3 years prior. The last seizure was 60 days prior and the patient had a reported cTnI level as 0.04 ng/mL, within normal limits. The mean serum levels of CPK and CK-MB were 202.20 (SD = 14.46) μg/l and 14.54 (SD = 1.49) ng/mL, respectively.

CONCLUSIONS

This investigation is one of the few to evaluate serum concentration of cTnI in generalized convulsive SE patients where no detectable elevation was observed in serum concentration of cTnI following SE episode. However, it is very important to take into account that all recruited SE patients included in this study had a healthy cardiovascular system.