This 35-year-old mid-level executive had an active lifestyle, exercised hard, ate clean and had no comorbidities or habits to warrant a heart health warning. In fact, the day she rushed to the emergency, she didn’t have any conventional signs of a heart attack like breathlessness, sweatiness or pain anywhere. She had a seizure, fainted and came back to her senses. She said she had been having such periodic bouts for a while and till then no doctor had been able to come up with a diagnosis. Understandable, because the fleeting nature of seizures means they often stop before medical evaluation. But her pattern was repetitive.
Yes, seizures or seizure-like activity can indicate a severe cardiac event, including a heart attack or cardiac arrest, as they are often triggered by a lack of oxygen to the brain due to heart dysfunction. These episodes can appear as shaking or convulsions, resembling epilepsy, but are caused by issues like arrhythmia or irregular heartbeats and asystole or the heart stopping. Not a traditional symptom but significant nevertheless.
What seizures can mean for the heart
On examination, we found that our patient had a blockage in the Left Main Coronary Artery (LMCA). This is considered a critical, high-risk cardiac condition where plaque narrows the vessel supplying oxygen-rich blood to the left side of the heart, which is responsible for pumping blood throughout the body. It is considered one of the most dangerous forms of coronary artery disease, often requiring immediate intervention like bypass surgery or stenting to prevent heart failure, severe heart attack or sudden death.
What triggers blockage in this artery?
Nowany buildup of plaque, which is made up of fat, cholesterol, calcium and other substances, is easily attributable to high LDL (low density lipoprotein or bad) cholesterol, smoking, high blood pressure, obesity and diabetes.
So why did plaque build up in my patient with healthy habits, a non-smoker and a non-alcoholic?That’s because plaque can build up in seemingly healthy peopledue to silent, underlying factors like chronic inflammation, genetic predisposition to LDL or stress. Even without obesity or smoking, let’s look at the risk factor we tend to underplay.
A performance-oriented individual, my patient admitted to having chronic stress.High cortisol levels increase inflammation, damaging artery walls silently, making it easier for the plaque to sit on them. A family history of heart disease can make individuals more susceptible, regardless of diet or exercise. Given that she was into intense workout routines, a sudden exercise could have even caused a stable, pre-existing plaque to rupture, leading to a blood clot that blocked her artery. Luckily, we opened up her blockage with a stent, a mesh device that widens the artery and keeps it that way.
The road to recovery
All her seizure episodes stopped immediately after the procedure and the pumping function of the heart normalised. Given that she was a fit and disciplined person, she did not need much cardiac rehab, a monitored protocol of exercise, lifestyle reorientation and counselling. But what she continues to follow is lifestyle discipline.
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While stents are designed to prevent scar tissue from clustering, they still require proper care to prevent blood clots from forming. You should never stop blood-thinning medications without consulting a cardiologist, as stopping too early is the leading cause of stent thrombosis. Avoid all tobacco and second-hand smoke to reduce the risk of clot formation and further artery damage.
Although my patient did not have any underlying conditions, since she already had an episode, she is particular about keeping her blood pressure, cholesterol and blood sugar within target levels to prevent new plaque buildup. Although a clean eater, she now checks food labels for sodium and has stopped saturated and trans fats. She continues with modern intensity exercises.
But what she does most diligently is keep to her follow-upsto monitor the stent’s function and manage potential complications.
(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)
