Epileptic Heart

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Sahar Memar Montazerin, M.D.[3]


Chronic epileptic episodes and the subsequent catecholamine surges and hypoxic events may affect the heart and coronary vessels and result in the dysfunction of the heart. This condition is known as the "epileptic heart." This concept was first described by Dr. Richard L. Verrier and his colleagues in 2020.

Historical Perspective

  • Absence of cardiac activity during epileptic seizure was first described by Dr. A.E. Russell, an English physician, in 1906.[1]
  • The epileptic heart was first described by Drs. Verrier, Pang, Nearing, and Schachter, in 2020.[2]


  • There is no established system for the classification of the epileptic heart.


  • The exact mechanisms involved in the development of the epileptic heart are still being elucidated. However, the conceptual framework below provides helpful information on the development of heart disease in patients with epilepsy.[3]
Chronic epilepsy
Repeated hypoxia and subsequent myocardial ischemia
Accelerated atherosclerosis
Myocardial stunning
Vacuolization of myocytes and fibrosis
Catecholamine-induced cardiotoxicity
Epileptic Heart

Cardiac electrical instability
T wave alternans

Epilepsy and Cardiac Arrhythmia

Cardiac arrhythmias have long been observed in patients with epilepsy. Three different mechanisms explain this association:[4]

Epilepsy and Structural Heart Disease

Three mechanisms have been suggested to explain the association between epilepsy and structural heart disease:[4]


Epileptic heart may be caused by the following:

Differentiating epileptic heart from other Diseases

Epileptic heart Sudden unexpected death in epilepsy SUDEP Convulsion syncope Epileptic seizure

Epidemiology and Demographics



  • Males are more commonly affected with the epileptic heart than females.


  • There is no racial predilection for epileptic heart.

Risk Factors


Currently, there is no guideline statement that recommended routine cardiac evaluation of patients with epilepsy. However, a resting 12-lead EKG and/or ambulatory EKG patch recording may be useful in identifying the patients at risk of cardiac pathology and further follow the progression of their cardiac pathology. [2]

Natural History, Complications and Prognosis


Diagnostic Criteria

  • The diagnosis of the epileptic heart is made when the following diagnostic criteria are met:

Hisory and Symptoms

Physical Examination

  • Physical examination associated with epilepsy include:

Laboratory Findings

Common laboratory findings related to epileptic heart may include:


An ECG may be helpful in the diagnosis of epileptic heart. Findings on an ECG suggestive of effects of seizure on the heart include: [32][33][34]


A Chest-x-ray may be helpful in the diagnosis of atherosclerosis associated with chronic epilepsy. Findings on an CXR suggestive of heart involvement in epilepsy include:

Echocardiography or Ultrasound

Echocardiography may be helpful in the diagnosis of epilectic heart. Findings on an echocardiography diagnostic of epileptic heart include: [32]

CT scan

Coronary CT angiography may be helpful in the diagnosis of ischemic heart disease in chronic epilepsy. Findings on coronary CTangiography suggestive of ischemic hear disease include:[40]


Cardiac magnetic resonance angiograpgy (MRA) may be helpful in the diagnosis of ischemic heart disease in chronic epilepsy. Findings on MRA suggestive of high-risk patients include: [41]

Other Imaging Findings

There are no other imaging findings associated with epileptic heart.

Other Diagnostic Studies

Holter ECG 24-48 hours may be helpful in the diagnosis of the arrhythmia-related epileptic heart. Findings suggestive the probability of the occurrence of ventricular fibrillation include: [42]

  • Other diagnostic studies for epileptic include ECG patches which are worn for 14 days with a higher chance for detection of tachyarrhythmia compared with Holter ECG.


Medical Therapy



  • 12 lead ECG
  • Holter ECG 24-48 hours
  • Wireless ECG patches(patient-friendly tool, worn for 14 days, increased chance for detection of arrhythmia compared with Holter ECG)


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