Nandan Patel, MD
PM&R PGY3
University of Alabama at Birmingham Spain Rehabilitation Center
Birmingham, Alabama, United States
Tanvee Sinha, BS
Medical Student
University of Alabama at Birmingham
Birmingham, Alabama, United States
Cassandra Renfro, DO
Assistant Professor
University of Alabama Spain Rehabilitation Center
Birmingham, Alabama, United States
Traumatic Spinal Cord Injuries (SCI) at or above the sixth thoracic level often leads to autonomic dysfunction, which manifests as autonomic dysreflexia (AD). AD is typically triggered by stimuli related to the bladder or bowel and is characterized by hypertension, bradycardia, and symptoms such as headaches, sweating, and flushing. These vascular network changes are prone to cardiac effects, specifically cardiac contractile dysfunction, arrhythmias, and conduction blocks; however current literature lacks a clear consensus on how this develops.
Case Description:
This case report details a 33 year old male with a C4 SCI who presented with recurrent AD, leading to the discovery of new onset hypertrophic obstructive cardiomyopathy (HOCM) following episodes of paroxysmal atrial fibrillation with rapid ventricular response. Despite various treatments for his neurogenic bladder and spasticity, the patient experienced persistent AD episodes, which were eventually linked to a newfound cardiac condition that was not present the year prior to his injury.
Discussions:
The case highlights the interplay between autonomic dysregulation and cardiovascular pathology in SCI patients, attenuating the importance of monitoring for potential cardiac complications in this population. Abnormalities in responses to catecholamines likely due to altered adrenergic receptor sensitivity from AD, and reduced norepinephrine reuptake further adds to the role of the SNS dysfunction. The blood pressure variations preceding ventricular fibrillation and various cardiac defects with no other recognized etiology indicates a relationship between the dysreflexia and eventual HOCM that was diagnosed in this patient.
Conclusions:
Given the high risk of sudden cardiac death associated with HOCM, early detection and appropriate cardiological management are crucial. This case emphasizes the need for vigilant cardiovascular monitoring in patients with high-level SCI and recurrent AD, where ECG and echocardiograms may serve as valuable tools for early diagnosis and prevention of severe outcomes.
