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Epilepsy and pseudo-heart disease.

Send a doctor a patient complaining of irregular heartbeat or chest pains, and the physician will most likely diagnose heart disease. But in some cases, the problem is centered far above the heart.

The culprit? The neural activity that accompanies seizures has long been known to affect cardiac functioning. But in patients with nonconvulsive types of epilepsy, these secondary symptoms may be misread as the primary illness.

Five specific cardiac problems have been linked to epilepsy: irregular heartbeat, anginal chest pain, pulmonary edema, symptoms of pheochromocytoma -- a tumor linked to hypertension -- and sudden death. This is because the areas of the brain affected by epileptic episodes are linked to the hypothalamus, the section of the brain that affects the autonomic nervous system.

Cardiac arrhythmia -- irregular heartbeat -- is not widely recognized as a symptom of epilepsy. In one study, 90% of patients showed rapid changes in heart rhythm. Yet this symptom is often misread.

Doctors have known that epilepsy can cause chest pain but often miss the connection between the supposed angina and a seizure. It is rare for angina to occur during seizures. Still, physicians should pursue the connection if other factors, such as a history of epilepsy or mind-body dissociation during an anginal attack, exist.

Pulmonary edema occurs for a number of reasons, including a redistribution of bodily fluid that changes capillary permeability and increases pulmonary blood volume. Most patients recover rapidly after being treated for symptoms of edema. Some die suddenly.

Symptoms of pheochromocytoma, too, are at times indistinguishable from the effects of certain types of epilepsy. Headache, hypertension, a flushed complexion, apprehension and tremors can be warning signs both of seizures and of this type of tumor.

Epileptics are two to three times more likely to suffer sudden death than the general population. Up to 30% of those deaths cannot be explained. Doctors suspect epilepsy-related cardiac troubles as a major cause, and autopsies in many unexplained deaths of epileptics have shown evidence of myocardial necrosis -- death of the muscular tissues in the heart.

By understanding the link between epilepsy and these particular cardiac problems, doctors will probably gain insight that could lead to accurate diagnoses.
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Publication:Nutrition Health Review
Date:Jan 1, 1991
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