Cardiovascular complications of spinal cord injury.

ABSTRACT

BACKGROUND: The aim of this paper is to provide an overview of the autonomic innervation of the cardiovascular system and the cardiovascular sequelae of spinal cord injuries. METHOD: A literature search was carried out in the PubMed database, with the search phrases "traumatic spinal cord injury"/"traumatic spinal cord injuries" together with "autonomic dysfunction", "autonomic dysreflexia" and "cardiovascular disease". RESULTS: The most important cardiovascular complications in the acute phase are bradyarrhythmia, hypotension, enhanced vasovagal reflexes, supraventricular/ventricular ectopic beats, vasodilation and venous stasis. Important in the chronic phase are orthostatic hypotension and impaired regulation of blood pressure, blood volume and body temperature. Tetraplegia is frequently accompanied by autonomic dysreflexia, impaired transmission of cardial pain, loss of muscle mass in the left ventricle and pseudoinfarction. Patients with injuries above the sixth thoracic vertebra have a predisposition for autonomic dysreflexia. This is a condition characterised by sudden, uncontrolled sympathetic response accompanied by a rise in blood pressure. Autonomic dysreflexia usually leads to headaches and erythema on the upper chest. The condition may cause cerebral haemorrhage and is potentially life threatening. Patients with spinal cord injuries have an increased risk of atherosclerotic disease due to overweight, lipid disorders, metabolic syndrome and diabetes. They are predisposed to thrombotic emboli due to venous stasis and hypercoagulopathy, particularly immediately after the injury. INTERPRETATION: Knowledge of cardiovascular sequelae after spinal cord injuries and assessment of these is important for correct diagnostics, planning of preventive measures and optimal treatment.