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Silent cardiac ischemia in cervical spinal cord injury: case study
1Department of Rehabilitation Medicine, Medical College of Virginia, Richmond 23298-0677.
Insights
Silent myocardial ischemia is a concern in aging patients with spinal cord injury (SCI). This case highlights the need to screen for asymptomatic cardiac ischemia in individuals with cervical SCI.
Area of Science:
- Cardiology
- Neurology
- Rehabilitation Medicine
Background:
- Ischemic heart disease management in aging patients with chronic spinal cord injury (SCI) is a growing concern.
- Silent myocardial ischemia is under-recognized, particularly in relation to cervical SCI.
- A literature review found no documented cases of asymptomatic cardiac ischemia in SCI patients.
Observation:
- A 65-year-old male with chronic C7 incomplete SCI presented with coronary artery disease risk factors and an abnormal ECG.
- Despite being asymptomatic, the patient exhibited significant myocardial ischemia during atrial pacing thallium scintigraphy.
- The diagnosis led to the postponement of a planned elective surgery.
Findings:
- This case report documents significant asymptomatic myocardial ischemia in a patient with chronic cervical SCI.
- The findings underscore the potential for silent cardiac ischemia in this population.
- Atrial paced thallium scintigraphy effectively identified ischemia under minimal stress.
Implications:
- Clinicians should consider screening for silent myocardial ischemia in patients with cervical SCI, especially those with cardiac risk factors.
- Early detection and management of cardiac ischemia are crucial for preventing adverse cardiovascular events in SCI survivors.
- This case emphasizes the importance of a comprehensive cardiovascular assessment in individuals with SCI undergoing medical or surgical procedures.
Abstract:
The management of ischemic heart disease in patients with chronic spinal cord injury (SCI) will become an increasingly major concern as this population ages. Although silent ischemia has become an important topic in the medical literature, the relationship with cervical SCI has not been adequately explored. A literature search revealed no case reports of documented asymptomatic cardiac ischemia in SCI patients. This is a case report of a 65-year-old patient with chronic C7 incomplete SCI who had multiple risk factors for coronary artery disease and an abnormal electrocardiogram. Despite being completely asymptomatic, the patient was found to have significant myocardial ischemia induced by minimal stress using atrial paced thallium scintigraphy. This finding led to the cancellation of an elective surgical procedure. This case illustrates the importance of suspecting silent myocardial ischemia in cervical SCI patients.