Autonomic dysreflexia and myocardial ischemia
1International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
Spinal Cord
|February 4, 2010
Summary
Individuals with spinal cord injury (SCI) may experience silent myocardial ischemia, particularly during autonomic dysreflexia (AD). This condition can occur due to altered sensory input and increased sympathetic activity, even without coronary artery disease.
Area of Science:
- Cardiology
- Neurology
- Spinal Cord Injury Research
Background:
- Spinal cord injury (SCI) can alter cardiovascular regulation.
- Autonomic dysreflexia (AD) is a common complication in individuals with SCI, characterized by exaggerated sympathetic responses.
- Myocardial ischemia, a condition of reduced blood flow to the heart muscle, is a serious concern in this population.
Observation:
- A case report details a 45-year-old male with C5 complete SCI experiencing an episode of autonomic dysreflexia (AD).
- The patient denied typical symptoms of myocardial ischemia, presenting with silent ischemia.
- Despite AD management, elevated blood pressure persisted, leading to further cardiac investigation.
Findings:
- Electrocardiogram revealed horizontal ST depression in lateral leads, and elevated troponin levels indicated myocardial injury.
- Cardiac angiography and MIBI scan showed normal left ventricular function and no coronary artery occlusion.
- This suggests myocardial ischemia occurred without underlying coronary artery disease.
Implications:
- Individuals with SCI may have a higher risk of asymptomatic myocardial ischemia due to impaired sensory feedback.
- Autonomic dysreflexia (AD) can precipitate myocardial ischemia through sympathetic overactivity and coronary artery constriction.
- Clinicians should consider silent myocardial ischemia in SCI patients, especially during AD episodes, even in the absence of traditional cardiac risk factors.
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