Seizure-associated Takotsubo cardiomyopathy
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Published on: November 28, 2025
Claudia Stöllberger1, Christian Wegner, Josef Finsterer
1Krankenanstalt Rudolfstiftung, Wien, Österreich, Austria. claudia.stcllberger@chello.at
Insights
Seizure-associated takotsubo cardiomyopathy is distinct, occurring in younger males and presenting with less chest pain but more cardiogenic shock and recurrence. This condition can manifest as sudden hemodynamic deterioration, potentially causing death.
Area of Science:
- Cardiology
- Neurology
Background:
- Takotsubo cardiomyopathy (TTC) is a stress-induced heart condition mimicking acute coronary syndrome.
- Seizures are recognized triggers for TTC, but differences from other triggers remain unclear.
Purpose of the Study:
- To investigate if seizure-associated takotsubo cardiomyopathy (SATC) differs from TTC triggered by other factors.
- To compare characteristics of SATC cases with larger TTC cohorts.
Main Methods:
- Literature review of 36 SATC cases.
- Comparison of SATC patient demographics, clinical presentation, and outcomes with a control group of 974 TTC patients from existing series.
Main Results:
- SATC patients were younger (61.5 vs. 68.5 years) and more frequently male (17% vs. 9%) than other TTC patients.
- SATC presented with less chest pain (6% vs. 76%) but higher rates of cardiogenic shock (25% vs. 8%) and recurrence (14% vs. 3%).
- Neurologic and psychiatric disorders were common comorbidities in SATC patients.
Conclusions:
- Seizure-associated takotsubo cardiomyopathy exhibits unique clinical features compared to other TTC forms.
- SATC often manifests as rapid hemodynamic compromise, highlighting its severity.
- Sudden unexpected death in epilepsy may be linked to SATC.
Abstract:
Takotsubo cardiomyopathy is characterized by chest pain, dyspnea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall-motion abnormalities without identifiable coronary culprit lesion explaining the wall-motion abnormality. Takotsubo cardiomyopathy occurs frequently after emotional or physical stress. Seizures have been reported as triggers of takotsubo cardiomyopathy. It is unknown if seizure-associated takotsubo cardiomyopathy differs from takotsubo cardiomyopathy associated with other triggers. Seizure-associated takotsubo cardiomyopathy cases from the literature were compared with takotsubo cardiomyopathy series comprising 30 or more patients. Thirty-six seizure-associated takotsubo cardiomyopathy cases (6 male, mean-age 61.5 years) were found. Seizure-type were tonic-clonic (n = 13), generalized (n = 5), status epilepticus (n = 6), grand mal (n = 2), or not reported (n = 13). Twelve patients had a history of epilepsy, in 15 patients takotsubo cardiomyopathy-associated seizure was the first or the information was not given (n = 9). In 17 patients takotsubo cardiomyopathy occurred immediately after the seizure, in 9 patients 1-72 h postictally, and in 10 patients, the interval was not reported. In 20 patients neurologic disorders were reported and in 14 psychiatric disorders were reported. There were medical comorbidities in 17 patients, arterial hypertension (n = 11), hyponatremia (n = 2), and cancer (n = 2). Compared with 974 patients reported in takotsubo cardiomyopathy -series, patients with seizure-associated takotsubo cardiomyopathy were younger (61.5 vs. 68.5 years, p < 0.0001), more frequently males (17 vs. 9%, p = 0.004), had less frequent chest pain (6 vs.76%, p < 0.005), more frequent cardiogenic shock (25 vs. 8%, p = 0.003), and more frequent recurrency (14 vs. 3%, p = 0.004). Seizure-associated takotsubo cardiomyopathy manifests frequently as sudden hemodynamic deterioration, which could result in death in the absence of adequate help. Probably some cases of sudden unexpected death in epilepsy are attributable to takotsubo cardiomyopathy.
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