Can coronary artery disease (CAD) cause seizures?

Can Coronary Artery Disease Cause Seizures?

Coronary artery disease (CAD) itself does not directly cause seizures, but seizures can occur as a rare complication (<1%) in patients undergoing procedures for CAD such as carotid artery stenting (CAS). 1

Relationship Between CAD and Seizures

Primary Mechanisms

CAD primarily affects the heart's blood supply and does not directly impact brain function in a way that would trigger seizures. However, there are several indirect pathways through which CAD-related conditions might lead to seizures:

1. Cerebral Hypoperfusion

   • Seizures during carotid artery stenting procedures are related predominantly to hypoperfusion of brain tissue 1
   • When severe CAD leads to heart failure or arrhythmias, resulting in decreased cardiac output, cerebral blood flow may be compromised

2. Cerebrovascular Disease Overlap

   • Patients with CAD often have concurrent cerebrovascular disease due to shared risk factors 1
   • In the REACH registry, 57% of patients with peripheral arterial disease also had CAD 1
   • This atherosclerotic burden increases stroke risk, which can subsequently lead to seizures

Procedural Complications

The clearest evidence for seizures in relation to CAD comes from patients undergoing interventional procedures:

• During carotid artery stenting (CAS), seizures occur in less than 1% of cases 1
• These seizures are primarily related to cerebral hypoperfusion during the procedure 1
• The 2011 AHA/ASA guidelines specifically note this as a recognized complication 1

Special Considerations

Epilepsy in Patients with CAD

Patients with epilepsy have been found to have increased atherosclerotic cardiovascular disease (ASCVD) risk:

• A 2021 study showed that epilepsy was associated with a 52% increase in ASCVD risk 2
• This association was primarily related to health behaviors rather than direct physiological connections
• Patients with epilepsy reported poorer diet, less physical activity, and increased frequency of cardiovascular conditions 2

Diagnostic Challenges

Cardiac symptoms can sometimes be misattributed when the true cause is epilepsy:

• A case report described a 74-year-old man with temporal lobe epilepsy who was initially misdiagnosed with CAD due to recurrent chest discomfort 3
• The patient underwent repeated cardiac angiography before video EEG monitoring confirmed that his "chest discomfort" episodes were actually seizures

Clinical Implications

1. For CAD patients:

   • Routine seizure prophylaxis is not indicated for patients with stable CAD
   • During procedures like CAS, clinicians should be aware of the small risk (<1%) of seizures 1
   • Patients with risk factors for cerebrovascular disease should be monitored more closely

2. For patients with both conditions:

   • Management should address both cardiovascular risk factors and seizure control
   • Antiepileptic drugs can interact with cardiovascular medications, requiring careful medication management 1

Conclusion

While CAD itself does not directly cause seizures, there is a small risk (<1%) of seizures during procedures like carotid artery stenting due to cerebral hypoperfusion. Patients with CAD often have concurrent cerebrovascular disease, which increases stroke risk and subsequent seizure potential. The relationship between these conditions is complex and requires attention to both cardiovascular and neurological aspects of care.