Cardiac irregularities during labour in paraplegic women

Guttmann, Ludwig; Frankel, H L; Paeslack, Volkmar

doi:10.1038/sc.1965.14

Cited by 44 publications

(15 citation statements)

References 7 publications

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“…However, there is some evidence to indicate, as reported in the present study, that autonomic dysreflexia may be associated with cardiac arrhythmias, particularly atrial fibrillation (4,5,28), which may require pharmacologic conversion to restore the normal rhythm (5). Furthermore, a case report in a young woman with SCI at the level of T5 describes profound cardiac irregularities during autonomic dysreflexia triggered by uterine contractions during labor, in which there was a clear relationship between the severity of autonomic dysreflexia and the arrhythmia (29). Certainly it is known that cardiovascular mortality is greater in individuals with SCI than in able-bodied persons (1,30), and these data indicate that the incidence of both ECG abnormalities and autonomic dysreflexia in individuals with chronic SCI may be underestimated.…”

Section: Cardiovascular Control During Vibrostimulationsupporting

confidence: 71%

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Claydon

Elliott

Sheel

et al. 2006

The Journal of Spinal Cord Medicine

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Background/Objective: Cardiovascular abnormalities and arrhythmias are common in individuals with spinal cord injury (SCI) who are undergoing vibrostimulation for sperm retrieval. The study aimed to examine cardiovascular control in men with SCI undergoing this procedure.Methods: Individuals with chronic cervical (n ¼ 8; age: 33.1 6 1.9 years) and upper thoracic SCI (n ¼ 5; age: 35.2 6 2.9 years) volunteered for vibrostimulation, with continuous blood pressure (Finometer) and electrocardiographic monitoring. Patients were characterized further by sympathetic skin responses (SSR) to assess descending autonomic spinal pathways and American Spinal Injury Association (ASIA) scores to assess motor and sensory pathways.Results: All but one subject with cervical SCI were ASIA A or B and were negative for SSR in the hands and feet. All subjects with upper thoracic SCI were ASIA A or B and were positive for SSR in the hands. Systolic blood pressure was lower in men with cervical injury at rest. Vibrostimulation induced an increase in systolic blood pressure .20 mmHg in all patients with cervical SCI (range ¼ 125/65-280/152; median ¼ 167/143 mmHg) and in 2 thoracic subjects (151/104 and 170/121 mmHg). During ejaculation, 6 cervical and 3 thoracic subjects developed arrhythmias (5 with bradycardia, 6 with premature atrial contractions, 4 with ventricular excitation, 1 with junctional rhythm, and 1 with heart block). Conclusion:The vibrostimulation procedure induced electrocardiographic abnormalities and autonomic dysreflexia in subjects with either cervical or high thoracic SCI.

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Section: Cardiovascular Control During Vibrostimulationsupporting

confidence: 71%

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Claydon

Elliott

Sheel

et al. 2006

The Journal of Spinal Cord Medicine

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“…Tachycardia 2,6 and re¯ex bradycardia 1,2,4,6 are most commonly observed in this setting, and are attributed to heightened noradrenergic sympathetic activity and re¯ex vagal responses, respectively. Electrocardiographic abnormalities observed during an attack of autonomic hyperre¯exia include premature atrial and ventricular contractions, 1,8 sinus tachycardia and bradycardia, 1 alterations in T-wave and U-wave amplitudes, 1 atrial ®brillation, 9,10 bigeminy 8 and conduction block. 8 We are unaware of any reports of ventricular ®brillation in association with autonomic hyperre¯exia.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,4,6,7 Cardiac abnormalities described in association with episodes of autonomic hyperre¯exia include bradycardia 1,4,6,7 and tachycardia, 2,6,7 premature atrial and ventricular contractions, 1,8 atrial ®brillation 9,10 and conduction block. 8 Despite the occurrence of these arrhythmias associated with autonomic hyperre¯exia, they are seldom recognized as a cause of cardiac arrest in individuals with traumatic spinal cord injury.…”

Section: Introductionmentioning

confidence: 99%

Autonomic hyperreflexia associated with recurrent cardiac arrest: Case Report

Colachis

Clinchot

1997

Spinal Cord

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Autonomic hyperre¯exia is a condition which may occur in individuals with spinal cord injuries above the splanchnic sympathetic out¯ow. Noxious stimuli can produce profound alterations in sympathetic pilomotor, sudomotor, and vasomotor activity, as well as disturbances in cardiac rhythm. A case of autonomic hyperre¯exia in a patient with C6 tetraplegia with recurrent ventricular ®brillation and cardiac arrest illustrates the profound e ects of massive paroxysmal sympathetic activity associated with this condition.

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“…A person with an injury at or above T6 would be expected to have a baseline blood pressure between 90 and 110 mmHg. Guttman et al 10 described an autonomic dysre¯exia episode occuring when the systolic blood pressure reached 20 ± 40 mmHg above baseline. Nevertheless the Autonomic Dysre¯exia Guideline Development Panel 11 decided to adopt 150 mmHg systolic pressure as the value at which pharmacological treatment should be considered.…”

Section: Methodsmentioning

confidence: 99%

Autonomic dysreflexia during urodynamics

et al. 1998

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Autonomic dysre¯exia (AD) is an acute syndrome characterised by inappropriate and massive autonomic response that occurs in patients with spinal cord injury above the T6 level. Aims: to evaluate the incidence of AD during cystometry and the relationships with clinical and urodynamic features. Patients and methods: Forty-eight spinal cord injury patients were studied by neurological and urological examination and urodynamic evaluation with concurrent recording of blood pressure, heart rate and symptoms and signs of AD. Patients were considered to have AD if blood pressure reached values higher than 150/100 mmHg. Results: All the patients showed a signi®cant increase of both systolic and diastolic blood pressure, although only 20 showed pressure values higher than 150/100 mmHg (in seven of them without AD symptoms). AD was more frequent in cervical patients (P=0.034), but did not correlate with any other clinical features: sex ratio, age, disease duration, completeness of lesion, incidence of detrusor hyperre¯exia/are¯exia and detrusor-sphincter dyssynergia, voiding modalities, usage of anticholinergic drugs. In three patients blood pressure increase began when uninhibited contraction started, in 11 it was coincident with unhibited contraction peak and in the other six it appeared at maximum bladder capacity. Conclusions: (1) during urodynamic evaluation all the patients with lesion level above T6 showed signs of sympathetic stimulation, although only some showed dangerous blood pressure values; (2) the relationship between urodynamic data and dysre¯exia crisis shows that both the presence of detrusor uninhibited contractions and bladder distension are able to stimulate the crisis; (3) treatment with anticholinergic drugs is not sucient to prevent autonomic dysre¯exia starting from the bladder, unless it induces detrusor are¯exia. These patients are at risk of developing autonomic dysre¯exia following bladder distension.

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Cardiac irregularities during labour in paraplegic women

Cited by 44 publications

References 7 publications

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Autonomic hyperreflexia associated with recurrent cardiac arrest: Case Report

Autonomic dysreflexia during urodynamics

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