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Europa Medicophysica 2002 June;38(2):73-87

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

The cardiovascular system in individuals with spinal cord injury

Occhi E., Pedrini D., Brambilla M.

From the Spinal Unit E. Morelli Hospital, Sondalo (Sondrio)


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Spinal ­cord inju­ry (­SCI) ­with resul­tant par­a­ple­gia ­and tet­ra­ple­gia is ­often asso­ciat­ed ­with sig­nif­i­cant alter­a­tions of ­the car­di­o­vas­cu­lar (CV) ­system ­due to ­the ­loss of sym­pa­thet­ic con­trol, immo­bil­ity ­and hor­mo­nal-meta­bol­ic dys­reg­u­la­tion. The ­main alter­a­tions relat­ed to sym­pa­thet­ic dys­func­tion ­are: ­low rest­ing ­blood pres­sure, ­reflex brad­y­car­dia, orthos­tat­ic hypo­ten­sion, periph­er­al ede­ma, ­reduced ­venous ­return, ­altered ­response to phys­i­cal exer­cise, auto­nom­ic dys­re­flex­ia ­and, rare­ly, car­diac ­arrest. These alter­a­tions ­occur in ­patients ­with tet­ra­ple­gia or ­high par­a­ple­gia as a con­se­quence of ­the ­loss of supras­pi­nal con­trol of ­the sym­pa­thet­ic ner­vous ­system direct­ed to ­the ­heart ­and cer­vi­co-tho­rac­ic ves­sels. Immobility ­and hor­mo­nal-meta­bol­ic dys­reg­u­la­tion ­are respon­sible ­for a ­series of com­pli­ca­tions ­such as ­deep ­vein throm­bo­sis (some­times com­pli­cat­ed by pul­mo­nary embo­lism), obes­ity, ­altered lip­id pro­file, hyper­ten­sion ­and ath­ero­scler­o­sis. All ­these com­pli­ca­tions ­reduce ­the exer­cise capac­ity of ­many indi­vid­u­als ­with ­SCI ­and ­are respon­sible ­for a ­high mor­tal­ity ­rate ­from CV dis­ease. Regular aero­bic phys­i­cal exer­cise, in ­some cas­es asso­ciat­ed ­with ­FES ergom­e­try pro­gram, ­diet ­and peri­od­ic ­check up of CV ­system, ­seem to ­improve CV fit­ness ­and ­reduce com­pli­ca­tions.

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