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Bradycardia and cardiac arrest are known complications of acute spinal cord injuries and are usually temporary. If the general measures of correcting hypoxia and using atropine fail, placement of a temporary followed by a permanent pacemaker is typically considered. We describe 2 very interesting cases of severe symptomatic bradycardia resistant to atropine, where we were able to obviate the use of pacemaker placement by the simple use of intravenous aminophylline. Aminophylline had been used in the past for treating resistant bradycardia in settings such as acute inferior wall myocardial infarction, cardiac transplantation, and so on, but has never been used in the setting of acute spinal cord injuries. Aminophylline probably works in this setting by increasing cyclic adenosine monophosphate (cAMP) and activating the sympathoadrenal system.

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Recent reports support the role of a valve-sparing procedure in ascending aortic dissection in patients with Marfans syndrome. A 49-year-old woman with Marfans syndrome and prior aortic aneurysm repaired with a composite graft presented with sudden-onset chest pain. Following an initial negative computed tomographic (CT) scan, a long dissection involving the descending thoracic and abdominal aorta was discovered on a repeat CT scan a few hours later. Symptoms improved gradually with optimal medical management and the patient was discharged home on anticoagulant therapy. Although no direct cause-and-effect relationship can be established, chronic anticoagulant therapy may accelerate the progression of recurrent dissection in these patients. A valve-sparing procedure should be considered in eligible patients with Marfans syndrome who need operative correction to avoid possible future untoward effects of long-term anticoagulant therapy.

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