Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

Abstract

Spinal cord injury (SCI) disrupts autonomic circuits and impairs synchronistic functioning of the autonomic nervous system, leading to inadequate cardiovascular regulation. Individuals with SCI, particularly at or above the sixth thoracic vertebral level (T6), often have impaired regulation of sympathetic vasoconstriction of the peripheral vasculature and the splanchnic circulation, and diminished control of heart rate and cardiac output. In addition, impaired descending sympathetic control results in changes in circulating levels of plasma catecholamines, which can have a profound effect on cardiovascular function. Although individuals with lesions below T6 often have normal resting blood pressures, there is evidence of increases in resting heart rate and inadequate cardiovascular response to autonomic provocations such as the head-up tilt and cold face tests. This manuscript reviews the prevalence of cardiovascular disorders given the level, duration and severity of SCI, the clinical presentation, diagnostic workup, short- and long-term consequences, and empirical evidence supporting management strategies to treat cardiovascular dysfunction following a SCI.

A comprehensive review of respiratory, autonomic and cardiovascular responses to intermittent hypoxia in humans

“…Patients with spinal cord injuries are known to have autonomic, cardiovascular, pulmonary and motor dysfunction ( Schilero et al, 2009 ; Wecht et al, 2020 ; Williams et al, 2019 ). Therapeutic intermittent hypoxia might lead to improvements in these outcome measures.…”

The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury

“…[ 121 ] Cardiovascular autonomic dysfunction in spinal cord injury: epidemiology, diagnosis, and management Wecht et al. [ 124 ] Autonomic neuromodulation New approaches for treating atrial fibrillation: focus on autonomic modulation Sohinki et al. [ 125 ] Neuromodulation for the treatment of heart rhythm disorders Waldron et al.…”

“…Clinical trials are underway evaluating SCS in recovering lower extremity, bladder, bowel, and sexual function [ 122 , 123 ]. Additionally, both transcutaneous and implanted SCS have been shown to improve autonomic cardiovascular dysfunction that occurs after SCI [ 124 ].…”

Characteristics of Official Wheelchair Basketball Games in Hot and Temperate Conditions

“…Whereas Mason et al [15] and Croft et al [33] described a mean HR of around 155 beats per minute, the present study reported a value of 118 beat per minute, which is associated with a much lower exercise intensity. Since some athletes with SCI may have a disturbed HR regulation [34], and in other studies often other disabled athletes were included without SCI, this comparison has to be taken with caution.…”