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. 2016 Dec 22:2:16030.
doi: 10.1038/scsandc.2016.30. eCollection 2016.

Coronary vasospasm in intractable autonomic dysreflexia

See Wei Tan  1 , Zafefe Ba Rahman  1 , Aishah A Fauzi  2 , Lydia A Latif  2 , Nazirah Hasnan  2
Affiliations

Coronary vasospasm in intractable autonomic dysreflexia

See Wei Tan et al. Spinal Cord Ser Cases. .

Abstract

Introduction: Coronary vasospasm is a transient sudden vasoconstriction of one of the coronary arteries that can lead to myocardial ischaemia, myocardial infarction, fatal arrhythmia and sudden death. Most patients with coronary spasm have underlying cardiac pathology.

Case presentation: This paper presents a rare case of intractable autonomic dysreflexia in a 36-year-old patient with chronic C5 paraplegia with silent myocardial ischaemia secondary to coronary vasospasm in the absence of underlying cardiac pathology. The MRI perfusion study revealed normal left ventricular contractility and no evidence of coronary artery occlusion.

Discussion: This case highlights the cardiac complications associated with paroxysmal heightened sympathetic nervous system and proposes that autonomic dsyreflexia can predisposes to coronary vasospasm via uncontrolled sympathetic nervous system. The disruption of sensory input from the myocardium to the brain in patient with SCI predisposes them to asymptomatic myocardial ischaemia. The challenges in the diagnosis and management of coronary vasospasm associated with autonomic dysreflexia are described.

Keywords: Acute coronary syndromes; Diseases.

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Figures

Figure 1
Figure 1
An ECG done during an episode of autonomic dysreflexia showing ST elevation at leads II, III, aVF, V4–6 and T-wave inversion on V1, V2.
Figure 2
Figure 2
A normal ECG after the abortion of autonomic dysreflexia.
See this image and copyright information in PMC

References

    1. Krassioukov AV, Karlsson AK, Wecht JM, Wuermser LA, Mathias CJ, Marino RJ et al. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev 2007; 44: 103–112. - PubMed
    1. Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary artery spasm–clinical features, diagnosis, pathogenesis, and treatment. J Cardiol 2008; 51: 2–17. - PubMed
    1. Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. J Spinal Cord Med 2014; 37: 2–10. - PMC - PubMed
    1. Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol 2009; 169: 157–164. - PubMed
    1. Teasell RW, Arnold JM, Krassioukov A, Delaney GA. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil 2000; 81: 506–516. - PubMed

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