Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and
Lauren Rietchel1, Andrea L Ramirez1, Shea Hocaloski1,2
1International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada.
Study Design:
Secondary data analysis.
Objectives:
To characterize autonomic dysreflexia (AD) associated heart rate (HR) changes during penile vibrostimulation (PVS) and urodynamic studies (UDS).
Setting:
University-based laboratory.
Methods:
We analyzed blood pressure (BP) and HR data, recorded continuously, from 21 individuals (4 females; median age 41 years [lower and upper quartile, 37; 47]; median time post-injury 18 years [7; 27]; all motor-complete spinal cord injury (SCI) except one; cervical SCI = 15, thoracic [T1-T6] SCI = 6), who underwent PVS (11/21) or UDS (10/21).
Results:
Overall, 47 AD episodes were recorded (i.e. PVS = 37, UDS = 10), with at least one AD episode in each participant. At AD threshold, bradycardia was observed during PVS and UDS in 43% and 30%, respectively. At AD peak (i.e., maximum increase in systolic BP from baseline), bradycardia was observed during PVS and UDS in 65% and 50%, respectively. Tachycardia was detected at AD peak only once during UDS. Our study was limited by a small cohort of participants and the distribution of sex and injury characteristics.
Conclusions:
Our findings reveal that AD-associated HR changes during PVS and UDS appear to be related to the magnitude of systolic BP increases. Highly elevated systolic BP associated with bradycardia suggests the presence of severe AD. Therefore, we recommend cardiovascular monitoring (preferably with continuous beat-to-beat recordings) during PVS and UDS to detect AD early. Stopping assessments before systolic BP reaches dangerously elevated levels, could reduce the risk of life-threatening complications in this cohort.
Related Concept Videos
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...
01:19Urodynamic Studies: Uroflowmetry
01:17Male Sexual Response: Erection & Ejaculation
The blood filling the erectile tissues compresses the veins, which helps to prevent blood from leaving...
01:20Regulation of Pulse
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
01:31Regulation of Heart Rates
The SNS increases heart rate through the release of norepinephrine and epinephrine, which act on beta-1 adrenergic receptors in the heart. This action increases the rate of depolarization in the sinoatrial (SA) node, the heart's...