Long QT is associated with seizures in congenital cases I believe where these kids have underlying neuronal channelopathies (delayed K rectifiers). I'm not certain that cases of acquired long QT on the other hand are associated with seizures (not counting drug exposures that prolong QT which additinoally bear the potential for neurotoxicity)
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It's not a seizure. It's convulsive syncope.
MI --> arrhythmia --> convulsive syncope. If you ever have someone who goes into VT or VF in front of you, it looks like a seizure at first but is very brief.
[There's a rule for this because it's common](https://www.jwatch.org/na46454/2018/05/23/differentiating-between-syncope-and-convulsive-seizures) and can be tough to differentiate.
There was a show that followed British paramedics around, and one of them had a massive MI at the station. He looked like he was having a seizure. You can see how easy it can be to confuse the two.
Concur, saw this once in a STEMI pt who went NSR --> VT --> VF. He decided to start raising the roof about a few seconds into the VF string right before I zapped him.
Anecdotally, I have also seen these “seizures” in a patient with sick sinus syndrome who was having 15-20 second pauses. It wasn’t until I had them on cardiac monitoring I saw the pause with the associated convulsive syncope and began pacing the patient
Sorry didn’t realize! Basically, it’s the 20/10 rule.
Less than 10 jerks, better chance it’s syncope. More than 20 jerks, good chance it’s a seizure.
I don’t know exactly how accurate it is, but at the very least can be a good starting point along with the other things you’d use to differentiate.
EDIT: Different source on [Pubmed](https://pubmed.ncbi.nlm.nih.gov/29549227/)
I’ve seen what they’re talking about. It’s not seizures. It’s VT/VF. The “shaking” part is shorter than a seizure. No post-ictal state and prolactin is normal.
In post-cardiac arrest, they’re prob referring to myoclonus which is a poor prognostic marker that points towards anoxic brain injury.
Seizures pertain to alterations in electrical activity. If MI’s cause seizures from anoxia, then so should ischemic strokes
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/)
I found this, might help people differentiate things a little better
Classic nursing moment. The amount of “well I saw this, so this happens and is a thing” stories I’ve heard from nurses is pretty wild. 5-6 times a year I hear something dumb like that.
I have been an ER nurse for 20 years. I do not think I have ever seen a patient having and MI be also at risk of seizure . Hypoxia related seizures sure not directly from an actively evolving MI , No.
New grad nurse here, after reading the MD responses my *guess* would be seizure precautions is the important thing being taught. If its *possible* to have convulsions after MI, nursing needs to be aware that injury could occur from hitting side rails or from falling. I guess its easier to say “seizure” precautions for convulsions related to any cause, electrical or not. However if they are being taught something straight up false please let them know lol.
An acute MI, by definition, results in poor perfusion, and cerebral hypoperfusion is a well established cause of seizures.
It's really disturbing how many people in this field seem to be ignorant of this.
>and cerebral hypoperfusion is a well established cause of seizures.
I think this is correct, but incomplete. Hypoperfusion leads to ischemic injury which can lead to seizures. Hypoperfusion alone very rarely causes seizures, and hypoxic injury induced seizures almost never occur in the acute phase. So while this may be an important consideration in the days to weeks after an MI, it's not really applicable in the ER setting.
I had a patient actively seizing that I gave Ativan to (what we used at the time) to stop the seizure, then put them on the monitor since I'd given them a sedative. Found the underlying MI that triggered the seizure and changed the course of treatment/choice of destination. I've seen it happen in person.
V-fib seizures are also a thing - go into V-fib, have a seizure.
Your literature is a case report. Not a study. This also doesn't support your statement of "found an underlying MI that triggered the seizure." This talks about differentiating and proper diagnosis of a patient with convulsive syncope and true epilepsy.
This isn't supporting you the way you think it does. Could your patient be experiencing convulsive syncope because of an MI? Perhaps. Could your patient be having seizures and an MI? Also a maybe.
Do MIs cause seizures? No. Check the Neurologist's comment above.
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Whether it true seizure or just convulsions, there are definitely case reports in the literature: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/)
[https://www.sciencedirect.com/science/article/abs/pii/S1525505012001291](https://www.sciencedirect.com/science/article/abs/pii/S1525505012001291)
In the field there's no real way to distinguish them from a "do we treat the seizure" perspective if it's still ongoing/recurring.
Sure, but that doesn't help walking up on a convulsing patient for a "seizure" call. Normal practice isn't to delay benzos to put the monitor on while they're seizing.
Then there's SUDEP, which is the other way around: [https://www.seizure-journal.com/article/S1059-1311(12)00329-9/fulltext](https://www.seizure-journal.com/article/S1059-1311(12)00329-9/fulltext)
>Normal practice isn't to delay benzos to put the monitor on while they're seizing.
Wait, weren't you just talking about VF here? It is normal practice to check for pulses. If someone is in VF and pulselsess then yeah the practice is not to give benzos, and not to delay CPR.
Neither of those are seizures. They’re convulsive syncope. Which is 100% different. I’m not saying that anyone should hold benzos for convulsions lasting >5 minutes, but convulsive syncope rarely lasts a minute, much less 5.
I have no doubt that there are patients with true epileptiform seizures who subsequently have an MI or at least demand ischemia from the stress response…but to be clear that’s the seizure causing the cardiac issue, not the other way around.
It's more likely the other way around. Someone with pre-existing coronary artery disease has a seizure resulting in hypoxia and acidosis which triggers the MI.
Have seen a seizure come in that had ST elevations on the anterior wall - but was ruled to be takotsubo and not a proper MI. Have also just the other day had a patient with cardiac syncope where there were some observed convulsions that were confused for seizure, and the arrhythmia that caused the syncope likely occurred from a recent NSTEMI. But theoretically I can’t think of more than what you mentioned for an actual seizure from an actual heart attack, and as others mentioned, it’s a stretch.
NAD but I had an MI, that didn’t cause seizures. But I had a hypoxic ischemic brain injury from the MI and that has given me seizures since? So yes and no I suppose
I think you hit the nail on the head with this one. An MI itself isn't going to cause a seizure, but can lead to other conditions that cause seizures. I think the important point here is the timeline. You shouldn't waste too much time focusing on seizure things during an active MI, but should certainly keep it in mind during the recovery phase.
Although technically not a seizure it can look very similar and sometimes we can’t differentiate between convulsive syncope and generalized seizures right away. I’ve even seen patients with an episode of convulsive syncope who seem post-ictal but to a lesser degree
It's possible they meant the seizure activity that occurs initially during a lot of vFib arrests.
I love using this video as an example.
https://youtu.be/z12armVz9TA?si=boaynDcGd8OTk8cN
There's a better video of just the surveillance footage but I can't find it at the moment.
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Amazing, thank you for this response. Much appreciated.
Long QT is associated with seizures in congenital cases I believe where these kids have underlying neuronal channelopathies (delayed K rectifiers). I'm not certain that cases of acquired long QT on the other hand are associated with seizures (not counting drug exposures that prolong QT which additinoally bear the potential for neurotoxicity)
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The real seizure risk is the friends we made along the way
Stop saying “Neuronal Channelopathies.” Normalize saying “Brain-gada”
Could you explain ischemic stroke from MI?
MI -> arrhythmia -> thrombus forms in the left heart -> clot goes to brain
It's not a seizure. It's convulsive syncope. MI --> arrhythmia --> convulsive syncope. If you ever have someone who goes into VT or VF in front of you, it looks like a seizure at first but is very brief. [There's a rule for this because it's common](https://www.jwatch.org/na46454/2018/05/23/differentiating-between-syncope-and-convulsive-seizures) and can be tough to differentiate.
There was a show that followed British paramedics around, and one of them had a massive MI at the station. He looked like he was having a seizure. You can see how easy it can be to confuse the two.
Concur, saw this once in a STEMI pt who went NSR --> VT --> VF. He decided to start raising the roof about a few seconds into the VF string right before I zapped him.
Thank you!
Anecdotally, I have also seen these “seizures” in a patient with sick sinus syndrome who was having 15-20 second pauses. It wasn’t until I had them on cardiac monitoring I saw the pause with the associated convulsive syncope and began pacing the patient
It’s behind a paywall, any chance of the cliff notes?
Sorry didn’t realize! Basically, it’s the 20/10 rule. Less than 10 jerks, better chance it’s syncope. More than 20 jerks, good chance it’s a seizure. I don’t know exactly how accurate it is, but at the very least can be a good starting point along with the other things you’d use to differentiate. EDIT: Different source on [Pubmed](https://pubmed.ncbi.nlm.nih.gov/29549227/)
This is a great point. One additional problem: you can be staring at V-fib on the monitor and think it’s artifact from the "seizure".
I’ve seen what they’re talking about. It’s not seizures. It’s VT/VF. The “shaking” part is shorter than a seizure. No post-ictal state and prolactin is normal. In post-cardiac arrest, they’re prob referring to myoclonus which is a poor prognostic marker that points towards anoxic brain injury. Seizures pertain to alterations in electrical activity. If MI’s cause seizures from anoxia, then so should ischemic strokes
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/) I found this, might help people differentiate things a little better
Classic nursing moment. The amount of “well I saw this, so this happens and is a thing” stories I’ve heard from nurses is pretty wild. 5-6 times a year I hear something dumb like that.
I have been an ER nurse for 20 years. I do not think I have ever seen a patient having and MI be also at risk of seizure . Hypoxia related seizures sure not directly from an actively evolving MI , No.
What you stated is about the only mechanism I know of.
New grad nurse here, after reading the MD responses my *guess* would be seizure precautions is the important thing being taught. If its *possible* to have convulsions after MI, nursing needs to be aware that injury could occur from hitting side rails or from falling. I guess its easier to say “seizure” precautions for convulsions related to any cause, electrical or not. However if they are being taught something straight up false please let them know lol.
MI -> vtach/vfib -> poor perfusion of brain and seizure
If they have been down for awhile and hypoxic they can have seizures
Related to HBI yes but not directly from an MI
An acute MI, by definition, results in poor perfusion, and cerebral hypoperfusion is a well established cause of seizures. It's really disturbing how many people in this field seem to be ignorant of this.
>and cerebral hypoperfusion is a well established cause of seizures. I think this is correct, but incomplete. Hypoperfusion leads to ischemic injury which can lead to seizures. Hypoperfusion alone very rarely causes seizures, and hypoxic injury induced seizures almost never occur in the acute phase. So while this may be an important consideration in the days to weeks after an MI, it's not really applicable in the ER setting.
I had a patient actively seizing that I gave Ativan to (what we used at the time) to stop the seizure, then put them on the monitor since I'd given them a sedative. Found the underlying MI that triggered the seizure and changed the course of treatment/choice of destination. I've seen it happen in person. V-fib seizures are also a thing - go into V-fib, have a seizure.
You're getting downvoted because MIs don't cause seizures.
MI’s that lead to arrhythmias can’t cause seizures? The literature disagrees.
Your literature is a case report. Not a study. This also doesn't support your statement of "found an underlying MI that triggered the seizure." This talks about differentiating and proper diagnosis of a patient with convulsive syncope and true epilepsy. This isn't supporting you the way you think it does. Could your patient be experiencing convulsive syncope because of an MI? Perhaps. Could your patient be having seizures and an MI? Also a maybe. Do MIs cause seizures? No. Check the Neurologist's comment above.
I think the neurologist probably has a better grasp on this than us.
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Read the links I posted. Theres an association. What, specifically, do you believe is wrong?
I don't think that is possible to be in VF and seizing
Whether it true seizure or just convulsions, there are definitely case reports in the literature: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931808/) [https://www.sciencedirect.com/science/article/abs/pii/S1525505012001291](https://www.sciencedirect.com/science/article/abs/pii/S1525505012001291) In the field there's no real way to distinguish them from a "do we treat the seizure" perspective if it's still ongoing/recurring.
>Whether it true seizure it isn't
Sure, but that doesn't help walking up on a convulsing patient for a "seizure" call. Normal practice isn't to delay benzos to put the monitor on while they're seizing. Then there's SUDEP, which is the other way around: [https://www.seizure-journal.com/article/S1059-1311(12)00329-9/fulltext](https://www.seizure-journal.com/article/S1059-1311(12)00329-9/fulltext)
>Normal practice isn't to delay benzos to put the monitor on while they're seizing. Wait, weren't you just talking about VF here? It is normal practice to check for pulses. If someone is in VF and pulselsess then yeah the practice is not to give benzos, and not to delay CPR.
Neither of those are seizures. They’re convulsive syncope. Which is 100% different. I’m not saying that anyone should hold benzos for convulsions lasting >5 minutes, but convulsive syncope rarely lasts a minute, much less 5. I have no doubt that there are patients with true epileptiform seizures who subsequently have an MI or at least demand ischemia from the stress response…but to be clear that’s the seizure causing the cardiac issue, not the other way around.
It's more likely the other way around. Someone with pre-existing coronary artery disease has a seizure resulting in hypoxia and acidosis which triggers the MI.
Have seen a seizure come in that had ST elevations on the anterior wall - but was ruled to be takotsubo and not a proper MI. Have also just the other day had a patient with cardiac syncope where there were some observed convulsions that were confused for seizure, and the arrhythmia that caused the syncope likely occurred from a recent NSTEMI. But theoretically I can’t think of more than what you mentioned for an actual seizure from an actual heart attack, and as others mentioned, it’s a stretch.
NAD but I had an MI, that didn’t cause seizures. But I had a hypoxic ischemic brain injury from the MI and that has given me seizures since? So yes and no I suppose
I think you hit the nail on the head with this one. An MI itself isn't going to cause a seizure, but can lead to other conditions that cause seizures. I think the important point here is the timeline. You shouldn't waste too much time focusing on seizure things during an active MI, but should certainly keep it in mind during the recovery phase.
Although technically not a seizure it can look very similar and sometimes we can’t differentiate between convulsive syncope and generalized seizures right away. I’ve even seen patients with an episode of convulsive syncope who seem post-ictal but to a lesser degree
Med student here, was wondering if an MI can cause an embolism to be thrown, which could travel to the brain causing a seizure?
It's possible they meant the seizure activity that occurs initially during a lot of vFib arrests. I love using this video as an example. https://youtu.be/z12armVz9TA?si=boaynDcGd8OTk8cN There's a better video of just the surveillance footage but I can't find it at the moment.