The patient required continuous ventricular pacing at a rate of 60bpm for the next four days, after which his intrinsic rate increased to 60—70bpm without further episodes of asystole.
He did not require any more pacing support over the next three days and on hospital day 17 the pacemaker was discontinued. The patient did well from a cardiac standpoint at follow-up four weeks after the injury, with no further documented episodes of bradyarrythmias, syncope, or pre-syncope.
There are an estimated 10,—12, spinal cord injuries every year in the US. A quarter of a million Americans are currently living with spinal cord injuries. Cervical spine injuries constitute nearly half of all these injuries. Fifty-five percent of spinal cord injury victims are between 16 and 30 years of age.
Cardiovascular complications are a leading cause of death in patients with CSCI. Neural pathways play an important role in the dynamics of cardiovascular physiology. The heart receives both sympathetic and parasympathetic innervation. The parasympathetic fibers travel from the pre-ganglionic neurons in the medulla nucleus ambiguus and dorsal motor nucleus of the vagus with the vagus nerve to supply the heart.
The sympathetic fibers travel from neurons in the intermediolateral columns of the spinal cord at the T1—T4 levels and synapse in the stellate cervical ganglia, and from here the post-ganglionic sympathetic neurons reach the heart.
Parasympathetic neurons have an inhibitory effect on heart rate and the conduction, excitability, and contractility of myocardial cells, while the sympathetic stimulation has the opposite effect. Sinoatrial and atrioventricular nodes and the atrioventricular conduction system have abundant parasympathetic innervation. The arteries and veins of the systemic circulation are innervated primarily by the sympathetic system.
In normal circumstances there is parasympathetic predominance in the heart physiology. The autonomic nervous system receives its sensory input from the baroreceptors located in the major vessels, and this forms part of the arterial baroreflex feedback mechanism, which ultimately regulates the heart rate and blood pressure.
Severe bradycardia and hypotension as a complication of acute CSCI are common as a result of post-injury imbalance in the autonomic nervous system caused by dissociation of spinal cardiac and vasomotor sympathetic fibers, while the parasympathetic fibers that travel with vagus nerve remain intact. There is experimental evidence suggesting two mechanisms by which these patients may develop bradycardias. One mechanism is that of autonomic imbalance with predominance of the parasympathetic nervous system due to anatomic sympathetic denervation.
Hopefully, this article helped you better understand how bradycardia can affect your day-to-day life after spinal cord injury. There are many risks associated with bradycardia after spinal cord injury, so be sure to seek medical assistance and get the treatment you need to optimize your health.
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Skip to content No products in the cart. Last updated on April 13, Spinal Cord Injury and Bradycardia Your autonomic nervous system controls many body functions that do not require have conscious thought, like heart rate, temperature, digestion, and blood pressure.
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I want this! Like What You Learned? More Ways to Recover with Flint Rehab:. Sign me up! Discover Award-Winning Neurorehab Tools. Use digital stimulation to empty your bowel. Check your skin for red spots that mean you might have a pressure injury. If possible, check your blood pressure every 5 minutes to see if it improves.
Call your doctor, even if symptoms go away and your blood pressure is decreasing. If the symptoms return, repeat the above steps and go to the emergency room or call emergency services.
Overfull bowel or constipation Gastrointestinal problems such as gallstones , stomach ulcers , or gastritis Follow your bowel management program. Eat fibre and consume fluids as your doctor suggests. Pressure injuries Ingrown nails Other skin problems Check your skin daily. Make sure all clothing or devices fit correctly. Sexual activity Be aware that sexual activity can cause the condition. Discuss this with your doctor.
Broken bones or other injuries Tight clothing or devices Extreme temperatures or quick temperature changes Be aware that these can cause the condition. Make sure all clothing and devices fit correctly. Credits Current as of: August 4, Top of the page Next Section: Related Information. Previous Section: Related Information Top of the page. Current as of: August 4, Overfull bladder Urinary tract infections UTIs. Overfull bowel or constipation Gastrointestinal problems such as gallstones , stomach ulcers , or gastritis.
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