Do seizures increase troponin levels?

From the Guidelines

Seizures can indeed raise troponin levels in some patients, as evidenced by various cardiac pathologies that result in cardiomyocyte injury and troponin elevations, including acute neurological diseases such as seizures 1.

Key Points to Consider

• Troponin elevation following seizures typically occurs without evidence of coronary artery disease or myocardial infarction, representing what is known as non-cardiac troponin elevation.
• The mechanism behind seizure-induced troponin elevation likely involves increased oxygen demand during the seizure, catecholamine surge causing cardiac stress, and possibly direct neurogenic cardiac injury.
• Clinicians should be aware that troponin elevation following seizures does not necessarily indicate a heart attack, though cardiac evaluation may still be warranted, especially in patients with risk factors for coronary artery disease.
• When evaluating a post-seizure patient with elevated troponin, it's essential to consider other clinical features, electrocardiogram findings, and the pattern of troponin rise and fall to distinguish between seizure-related elevation and actual acute coronary syndrome.

Relevant Evidence

• A study published in the European Heart Journal in 2021 highlights that many cardiac pathologies, including acute neurological diseases, can result in cardiomyocyte injury and troponin elevations 1.
• Another study published in Circulation in 2007 lists acute neurological disease, including stroke or subarachnoid hemorrhage, as a condition that can cause elevations of troponin in the absence of overt ischemic heart disease 1.
• The 2015 ESC guidelines for the management of acute coronary syndromes also mention that other life-threatening conditions, including acute neurological diseases, may result in elevated troponin levels and should be considered as differential diagnoses 1.

Clinical Implications

• It is crucial to consider the clinical context and other diagnostic factors when interpreting troponin elevations in patients with seizures, as the elevation may not necessarily indicate a cardiac event.
• Clinicians should be aware of the potential for non-cardiac troponin elevation in patients with seizures and take a comprehensive approach to diagnosis and management.

From the Research

Seizures and Troponin Levels

• Seizures can raise troponin levels, as evidenced by several studies 2, 3, 4, 5.
• A study published in 2014 found that 28.6% of patients with generalized tonic-clonic seizures had elevated troponin levels, with older patients and those with cardiovascular risk factors being more likely to have elevated levels 2.
• Another study from 2011 found that patients with complicated seizures had higher troponin levels than those with uncomplicated seizures, although none of the patients had troponin levels above the normal range 3.
• A 2019 study found that 10% of patients with generalized convulsive seizures had elevated cardiac troponin I levels, and 26% had elevated high-sensitive troponin T levels, with higher dopamine levels associated with troponin elevations 4.
• A 2015 study found that temporal seizure focus and status epilepticus were associated with high-sensitive troponin I elevation after epileptic seizures, with older patients and those with temporal seizure focus being more likely to have elevated troponin levels 5.

Factors Associated with Troponin Elevation

• Older age is associated with troponin elevation after seizures, as found in studies published in 2014 2 and 2015 5.
• Cardiovascular risk factors, such as coronary heart disease, are associated with troponin elevation after seizures, as found in a study published in 2014 2.
• Temporal seizure focus is associated with troponin elevation after seizures, as found in a study published in 2015 5.
• Status epilepticus is associated with troponin elevation after seizures, as found in a study published in 2015 5.

Clinical Implications

• Troponin elevation after seizures may indicate minor ischemic cardiac injury related to demand ischemia during sympathetic overactivity 2.
• The use of more sensitive biomarkers, such as high-sensitive troponin T, may suggest that signs of cardiac stress occur in about 25% of patients with generalized convulsive seizures without apparent clinical symptoms 4.
• Selected patients, such as those with temporal seizure focus or status epilepticus, may benefit from closer monitoring for cardiac complications 5.