Sammanfattning
Background. The aim of this paper is to provide an overview of the autonomic innervation of the cardiovascular system and the cardiovascular complications of spinal cord injury.
Method. A literature search was conducted in the PubMed database using the search terms «traumatic spinal cord injury»/«traumatic spinal cord injuries» combined with the search terms «autonomic dysfunction», «autonomic dysreflexia» and «cardiovascular disease».
Results. The most important cardiovascular complications in the acute phase are bradyarrhythmia, hypotension, increased vasovagal reflexes, supraventricular/ventricular ectopic beats, vasodilation and venous stasis. Important in the chronic phase are orthostatic hypotension and impaired regulation of blood pressure, blood volume and body temperature. Tetraplegia is frequently accompanied by autonomic dysreflexia, reduced transmission of cardiac pain, loss of muscle mass in the left ventricle and pseudoinfarction. Patients with injuries above the sixth thoracic vertebra have a predisposition to autonomic dysreflexia. This is a condition characterised by sudden, uncontrolled sympathetic response accompanied by a rise in blood pressure. Autonomic dysreflexia usually causes headaches and erythema on the upper chest. The condition may cause cerebral haemorrhage and is potentially life-threatening. Patients with spinal cord injury have an increased risk of atherosclerotic disease due to overweight, lipid disorders, metabolic syndrome and diabetes. They are predisposed to thromboembolism due to venous stasis and hypercoagulopathy, especially immediately after the injury.
Interpretation. Knowledge and assessment of cardiovascular complications after spinal cord injury are important for correct diagnostics, planning of preventive measures and optimal therapy.