From the Guidelines
Troponins can elevate after a seizure, as indicated by the universal definition of myocardial infarction, which lists acute neurological disease, including stroke or subarachnoid haemorrhage, as a condition that can cause elevations of troponin in the absence of overt ischemic heart disease 1.
Conditions that can cause troponin elevation
Some of the conditions that can cause troponin elevation, as listed in the study, include:
- Cardiac contusion, or other trauma including surgery; ablation, pacing, etc
- Congestive heart failure, acute and chronic
- Aortic dissection
- Aortic valve disease
- Hypertrophic cardiomyopathy, heart block
- Tachy- or bradyarrhythmias
- Apical ballooning syndrome
- Rhabdomyolysis with cardiac injury
- Pulmonary embolism, severe pulmonary hypertension
- Renal failure
- Acute neurological disease, including stroke or subarachnoid haemorrhage
- Infiltrative diseases e.g: amyloidosis, haemochromatosis, sarcoidosis and scleroderma
- Inflammatory diseases of endo- pericarditis e.g. myocarditis or myocardial extension
- Drug toxicity or toxins
- Critically ill patients especially with respiratory failure or sepsis
- Burns, especially if affecting 30% of body surface area
- Extreme exertion
Diagnosis of myocardial infarction
The diagnosis of myocardial infarction requires a measurement of troponin exceeding the 99th percentile of a normal reference population, and the demonstration of a rise and/or fall of the measurements is essential to the diagnosis 1.
Troponin elevation after seizure
While the study does not specifically mention seizure as a cause of troponin elevation, it does mention acute neurological disease, which includes conditions such as stroke or subarachnoid haemorrhage, and it is reasonable to assume that a seizure could cause a similar elevation.
Clinical implications
In clinical practice, a troponin elevation after a seizure should be interpreted with caution, and other causes of the elevation should be considered, particularly if the levels are significantly high or persist beyond 48 hours 1.
Additional cardiac workup
Additional cardiac workup may be warranted in patients with risk factors for coronary artery disease, chest pain, ECG changes, or hemodynamic instability.
Monitoring
Most post-seizure troponin elevations are likely to be benign and do not require specific cardiac intervention beyond monitoring.
From the Research
Troponin Elevation After Seizures
- Troponin levels can be elevated after a seizure, as shown in a case study where a patient had troponin I values as high as 5.5 ng/mL and 6.3 ng/mL after a grand mal seizure 2.
- However, not all studies agree that seizures alone can cause troponin elevations. One study found that solitary seizures do not evoke elevations in troponin T 3.
- A study published in 2014 found that troponin elevation after generalized tonic-clonic seizures occurs more frequently in patients with cardiovascular risk factors, such as older age and coronary heart disease 4.
- Another study found that troponin I levels were higher in patients with complicated seizures compared to those with uncomplicated seizures, although none of the patients had troponin levels higher than the normal value 5.
- A recent case study reported an enigmatic elevation of troponin in a patient with seizures, with troponin levels found to be 34.71 ng/mL after a seizure, although no evidence of myocardial infarction was found 6.
Risk Factors for Troponin Elevation
- Older age: Patients 60 years of age and older were more likely to have elevated troponin levels after a generalized tonic-clonic seizure 4.
- Cardiovascular risk factors: Patients with coronary heart disease and other cardiovascular risk factors were more likely to have elevated troponin levels after a seizure 4.
- Complicated seizures: Patients with complicated seizures had higher troponin I levels compared to those with uncomplicated seizures 5.
Clinical Implications
- Elevated troponin levels after a seizure should not be automatically attributed to myocardial infarction, as other factors such as demand ischemia during sympathetic overactivity may be responsible 4.
- A thorough diagnostic workup, including cardiac catheterization and echocardiography, may be necessary to rule out myocardial infarction in patients with elevated troponin levels after a seizure 2, 6.