Treatment Strategies for Cardiovascular Management of Patients with Cervical Spinal Cord Injury

Abstract

Cardiovascular function is altered in individuals with cervical spinal cord injury and it is important to understand the pathophysiology and provide appropriate treatment for each conditions. Autonomic dysfunction plays a major role in altered cardiovascular function and leads to hypotension, bradycardia, and autonomic dysreflexia. Bradycardia and autonomic dysreflexia can be life-threatening in severe cases, so prevention and immediate management of these conditions are important.The tracheal stimulation during suctioning can cause unopposed vagal stimulation and lead to bradycardia especially in acute state in patients with complete tetraplegia. Close monitoring of heart rate during suctioning is recommended. When autonomic dysreflexia appears, it is important to quickly lower blood pressure. Bladder distention, the most common cause, is first examined, and short-acting antihypertensive drugs are used when necessary. As patients with cervical spinal cord injuries reach the chronic stage, the risk of cardiovascular disease increases due to the occurrence of dyslipidemia and insulin resistance.Despite the decreased response to exercise, upper extremity aerobic and strengthening exercises and exercises utilizing functional electrical stimulation have a positive effect on cardiovascular fitness in individuals with cervical spinal cord injury. As a spinal cord injury becomes more chronic, individuals become more susceptible to cardiovascular diseases, including coronary artery disease. To prevent this, it is advisable to regularly engage in moderate to vigorous aerobic and strength training exercises using the upper body, practice weight control, and actively manage dyslipidemia and blood glucose level.