Aggressive heart pacing may work best in some spinal cord patients

Patients with recurring problems with the heart slowing or stopping after a neck injury damages their cervical spinal cord may need aggressive therapy to avoid further cardiovascular problems and even death, Medical College of Georgia researchers say.

A study subset of newly injured quadriplegics showed that less aggressive therapies, such as drugs and a pacemaker placed on top of the chest, simply were not sufficient, says Dr. Andres F. Ruiz-Arango, cardiology fellow and corresponding author of the article in the July/August issue of Cardiology in Review.

"There is a group of these patients who are not going to survive acute hospitalization but you don't want them to die just because they need a pacemaker," says Dr. Ruiz-Arango.

Although the heart has an intrinsic pacemaker, its rate is affected by two systems: the sympathetic nervous system to speed it up and the parasympathetic nervous system to slow it down, says Dr. Gyanendra K. Sharma, noninvasive cardiologist and study co-author.

With a cervical spinal cord injury, the influence of the sympathetic nervous system called the fight or flight system because it responds to stress by enabling an increase in heart rate can be injured or lost while the impact of the parasympathetic system continues, he says.

The result can be a dangerously slow heart rate, called bradycardia, which causes blood pressure to fall, organs to get insufficient blood and oxygen and can progress to heart stoppage, says Dr. Vincent J.B. Robinson, nuclear cardiologist and study co-author.

"It's the balance between sympathetic and parasympathetic nervous systems that keeps your heart rate in the normal range," says Dr. Ruiz-Arango. When patients lose this balance and start having dangerously slow rates, doctors typically try drugs, such as atropine and epinephrine, to increase heart rate and a transcutaneous pacemaker on the chest.

Their retrospective survey of

Contact: Toni Baker
Medical College of Georgia

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