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Semin Neurol 2020; 40(05): 550-559
DOI: 10.1055/s-0040-1713885
Review Article

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

Jill M. Wecht
1   VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
2   Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York
3   Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York
,
Noam Y. Harel
1   VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
3   Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York
4   Department of Neurology, The Icahn School of Medicine, Mount Sinai, New York, New York
,
James Guest
5   The Miami Project to Cure Paralysis, Miami, Florida
6   The Miller School of Medicine, University of Miami, Miami, Florida
,
Steven C. Kirshblum
7   Kessler Institute For Rehabilitation, West Orange, New Jersey
8   Kessler Foundation, West Orange, New Jersey
9   Department of Physical Medicine and Rehabilitation, Rutgers Medical School, Newark, New Jersey
,
Gail F. Forrest
7   Kessler Institute For Rehabilitation, West Orange, New Jersey
8   Kessler Foundation, West Orange, New Jersey
,
Ona Bloom
10   The Feinstein Institute for Medical Research, Manhasset, New York
11   Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
,
Alexander V. Ovechkin
12   Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky
13   The University of Louisville, Department of Neurosurgery, Louisville, Kentucky
,
Susan Harkema
12   Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky
13   The University of Louisville, Department of Neurosurgery, Louisville, Kentucky
14   Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky
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Abstract

Spinal cord injury (SCI) disrupts autonomic circuits and impairs synchronistic functioning of the autonomic nervous system, leading to inadequate cardiovascular regulation. Individuals with SCI, particularly at or above the sixth thoracic vertebral level (T6), often have impaired regulation of sympathetic vasoconstriction of the peripheral vasculature and the splanchnic circulation, and diminished control of heart rate and cardiac output. In addition, impaired descending sympathetic control results in changes in circulating levels of plasma catecholamines, which can have a profound effect on cardiovascular function. Although individuals with lesions below T6 often have normal resting blood pressures, there is evidence of increases in resting heart rate and inadequate cardiovascular response to autonomic provocations such as the head-up tilt and cold face tests. This manuscript reviews the prevalence of cardiovascular disorders given the level, duration and severity of SCI, the clinical presentation, diagnostic workup, short- and long-term consequences, and empirical evidence supporting management strategies to treat cardiovascular dysfunction following a SCI.

Keywords

parasympathetic - sympathetic - blood pressure - heart rate - tetraplegia - paraplegia

Disclosure

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (e.g., NIH or NHS grants) and work are clearly identified in the title page of the manuscript.




Publication History

Article published online:
09 September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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