From the Research
ST abnormalities on an ECG in a patient with a seizure typically indicate seizure-induced cardiac changes, which are often transient and resolve once the seizure activity ends. The most common ST abnormalities include ST-segment depression or elevation, which occur due to autonomic nervous system activation during seizures, causing a surge in catecholamines that affects cardiac repolarization 1. This sympathetic overdrive can lead to tachycardia, hypertension, and these ECG changes. No specific treatment is needed for these seizure-related ECG changes themselves; instead, focus should be on seizure management with appropriate antiepileptic medications. However, it's essential to distinguish these transient changes from true cardiac ischemia, especially in patients with risk factors for coronary artery disease. If ST changes persist after the seizure has resolved, or if the patient has chest pain or other cardiac symptoms, further cardiac evaluation is warranted, including cardiac enzymes and possibly cardiology consultation.
Some key points to consider:
- Seizure-induced cardiac changes can occasionally be severe enough to cause takotsubo cardiomyopathy or even sudden unexpected death in epilepsy (SUDEP), highlighting the importance of optimal seizure control 2.
- The relationship between epilepsy and myocardial channelopathies has been proposed, and post-ictal ECG changes may indicate underlying channelopathies or arrhythmic cardiomyopathies 3.
- A recent study found that post-ictal ECGs showed a higher prevalence of Brugada ECG pattern, abnormal QTc interval, early repolarization pattern, and right precordial abnormalities compared to basal ECGs 3.
- The 12-lead ECG after an epileptic seizure may show disease-related alterations otherwise concealed in a population at a higher incidence of sudden death and channelopathies 3.
In terms of management, the focus should be on seizure management with appropriate antiepileptic medications, and further cardiac evaluation is only necessary if ST changes persist or if the patient has cardiac symptoms. It's also important to note that polytherapy with sodium channel-blocking antiepileptic drugs may be associated with arrhythmogenic ST-T abnormality in patients with epilepsy 4. Overall, the management of ST abnormalities in patients with seizures should prioritize seizure control and distinguish between seizure-induced cardiac changes and primary cardiac disease.