Cardiac arrhythmias associated with spinal cord injury

Hector, Sven Magnus; Biering‐Sørensen, Tor; Krassioukov, Andrei V.; Biering‐Sørensen, Fin

doi:10.1179/2045772313y.0000000114

Cited by 41 publications

(27 citation statements)

References 42 publications

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“…Specifically, bradycardia has been reported in 64-77% of patients with cervical SCI (being most severe for up to 5 weeks after injury). [104][105][106][107][108] When SCI occurs in the mid-thoracic region or caudally, bradycardia is typically less severe, secondary to the preservation of supraspinal influences over cardiac sympathetic neurons. Neurogenic shock has the potential to significantly impact long-term recovery from SCI, by delaying acute surgical management of the injury itself, 109 and the arrhythmias that present during this phase of injury can require the implantation of a cardiac pacemaker.…”

Section: Acute Cardiovascular Changesmentioning

confidence: 99%

“…Neurogenic shock has the potential to significantly impact long-term recovery from SCI, by delaying acute surgical management of the injury itself, 109 and the arrhythmias that present during this phase of injury can require the implantation of a cardiac pacemaker. 107,108 It is important to differentiate the terms "neurogenic shock" and "spinal shock", both of which can occur during the acute phase of SCI, but represent two different conditions altogether. 36,110 Although these terms are often used interchangeably, neurogenic shock describes the clinical outcomes of changes in autonomic blood pressure control after SCI, while spinal shock describes the clinical outcomes of changes in motor/sensory/reflex function after SCI (i.e., flaccid paralysis and areflexia).…”

Section: Acute Cardiovascular Changesmentioning

confidence: 99%

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Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Phillips

Krassioukov

2015

Journal of Neurotrauma

158

136

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Cardiovascular (CV) issues after spinal cord injury (SCI) are of paramount importance considering they are the leading cause of death in this population. Disruption of autonomic pathways leads to a highly unstable CV system, with impaired blood pressure (BP) and heart rate regulation. In addition to low resting BP, on a daily basis the majority of those with SCI suffer from transient episodes of aberrantly low and high BP (termed orthostatic hypotension and autonomic dysreflexia, respectively). In fact, autonomic issues, including resolution of autonomic dysreflexia, are frequently ranked by individuals with high-level SCI to be of greater priority than walking again. Owing to a combination of these autonomic disturbances and a myriad of lifestyle factors, the pernicious process of CV disease is accelerated post-SCI. Unfortunately, these secondary consequences of SCI are only beginning to receive appropriate clinical attention. Immediately after high-level SCI, major CV abnormalities present in the form of neurogenic shock. After subsiding, new issues related to BP instability arise, including orthostatic hypotension and autonomic dysreflexia. This review describes autonomic control over the CV system before injury and the mechanisms underlying CV abnormalities post-SCI, while also detailing the end-organ consequences, including those of the heart, as well as the systemic and cerebral vasculature. The tertiary impact of CV dysfunction will also be discussed, such as the potential impediment of rehabilitation, and impaired cognitive function. In the recent past, our understanding of autonomic dysfunctions post-SCI has been greatly enhanced; however, it is vital to further develop our understanding of the long-term consequences of these conditions, which will equip us to better manage CV disease morbidity and mortality in this population.

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Section: Acute Cardiovascular Changesmentioning

confidence: 99%

Section: Acute Cardiovascular Changesmentioning

confidence: 99%

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Phillips

Krassioukov

2015

Journal of Neurotrauma

158

136

View full text Add to dashboard Cite

show abstract

“…Данные по нарушениям ритма сердца у людей с ТСМ противоречивы. Ряд авторов утверждает, что для людей с хронической ТСМ из нарушений ритма сердца наиболее характерны брадикардия, которая встречается у 26−50% лиц с шейным и 13−60% лиц с грудным уровнем повреждений спинного мозга [10−12], и желудочковая экстрасистолия [13]. Однако М. Prakash и соавт., проведя сравнение 654 участников исследования с хронической ТСМ с 26 734 здоровыми людьми, пришли к выводу, что как риск желудочковых экстрасистол, так и риск развития фибрилляции предсердий у лиц с хронической ТСМ аналогичен группе контроля [14].…”

Section: нарушения ритма сердцаunclassified

Disturbances of Cardiovascular System in Persons With Chronic Spinal Cord Injury During Exercise and Participation in Paralympic Sports

et al. 2018

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Spinal cord injury (SCI) is a devastating condition that affects mostly young and active individuals but also impacts their family members and results in significant challenges for medical care and social integration. In addition to obvious motor impairment (tetraplegia/paraplegia), these individuals also suffer from a variety of less obvious but devastating autonomic nervous system dysfunctions that negatively impact their health and affect various aspects of daily living. Physical training and sports are essential components of rehabilitation and leaser activities for people with disabilities. Number of individuals with SCI who run an active lifestyle is increasing. Physical activity puts an additional stress on various organs and body systems. The presented manuscript describes in detail cardiovascular dysfunctions in physically active individuals with a SCI, including those engaged in Paralympic sports: low resting blood pressure, orthostatic hypotension, arrhythmias, and the phenomenon of «autonomic dysreflexia». We also address issues related to self-induced episodes of autonomic dysreflexia in order to improve athletic performance ― a phenomenon known as «boosting». Boosting may improve sports performance in short term but is associated with the risk of serious cardiovascular disorders and even sudden death. This practice is considered as anti-doping rule violation by the International Paralympic Committee and thus prohibited. Understanding of the changes occurring in the body of a physically active individual after SCI is necessary for general practitioners, neurologists, rehabilitation specialists, sports medicine physicians, as well as for specialists of adapted physical education and sports.

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“…A prevalência de lesões acima de T6 que podem apresentar disautonomia varia entre 48 e 90% dos casos, sendo a trombose venosa profunda e o tromboembolismo pulmonar complicações potencialmente fatais, em especial, nos primeiros 7 a 10 dias após o trauma. 1,2,[9][10][11] Neuroanatomia e Fisiopatologia Diversas regiões supratentoriais, tais como o córtex da ínsula, córtex medial pré-frontal, hipotálamo, e núcleos do tronco encefálico, são responsáveis pelas funções autonômicas. Didaticamente representadas pelo sistema nervoso autônomo simpático e parassimpático, estas fibras controlam os sinais vitais, adequando-os conforme a demanda ambiental.…”

Section: Desenvolvimento Epidemiologiaunclassified

Neurogenic Shock: Clinical Management and Particularities in an Emergency Room

Damiani

2016

Arq Bras Neurocir

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Neurogenic shock has a strong impact in traumatology. It is an important condition, associated with lesions in the neuraxis and can be medullar and/or cerebral. In the last years, its pathophysiology has been better understood, allowing a reduction in the morbimortality with more precise and efficacious interventions taking place in the emergency room. In this review article, the author presents the current aspects of the management of neurogenic shock, highlighting the neuroprotective measures that improve the outcome. Many pharmacologic interventions are still questionable and need more prospective studies to accurately assess their real value. The best moment for neurosurgical intervention is also debatable. Quite clearly, the initial proceedings in the emergency room are fundamental to guarantee the adequate conditions for neuroplasticity and neuronal rehabilitation.

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Cardiac arrhythmias associated with spinal cord injury

Cited by 41 publications

References 42 publications

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Disturbances of Cardiovascular System in Persons With Chronic Spinal Cord Injury During Exercise and Participation in Paralympic Sports

Neurogenic Shock: Clinical Management and Particularities in an Emergency Room

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