An Adult Patient with Seizure and Supraventricular Tachycardia (SVT) - Occam’s Razor or Hickam’s Dictum

This is a case report describing a young lady presenting with both seizure and supraventricular tachycardia (SVT) to the emergency department (ED). She was previously well, asymptomatic with no risk factors for both conditions. A 33-year-old lady presented to the emergency department (ED) with her first episode of seizure. She was found in the kitchen with up rolling of eyes, jerking of all four limbs which self-aborted after two minutes. Electrocardiogram (ECG) performed showed supraventricular tachycardia, which reverted to sinus rhythm after administration of intravenous adenosine. Post conversion ECG showed normal sinus rhythm, absence of pre-excitation and normal QTc. Laboratory tests and computed tomography of the brain were normal. This case highlights the complex relationship between seizure and cardiac arrhythmia. SVT and seizure occurring at the same time is unusual. Clinicians need to rule out hypoxic convulsions. Epilepsy and seizures could also have a profound effect on cardiac function. Drug therapy for epilepsy is not without influence on heart rhythm. Both alcohol and illicit drugs could also precipitate concurrent seizure and SVT. Is this a case of Occam’s razor or Hickam’s dictum?