Background Individuals with Spinal Cord Injury (SCI) experience various types of cardiovascular dysregulation depending on the level of their cord lesion. The recognition and management of cardiovascular dysfunction following SCI represent challenging clinical issues. Moreover, cardiovascular disorders are among the most common causes of death in individuals with SCI.
Objective To raise awareness that persons, athletes included, with SCI may develop cardiac arrhytmia without any obvious underlying cause or discernable symptoms.
Design Case report of atrial fibrilation (AF) in asymptomatic tetraplegic athlete diagnosed on routine pre-op ECG.
Setting North West Regional Spinal Injuries Centre at Soutport UK and British Wheelchair Athletics Association.
Case report 37 year old, C6 complete (Abbreviated Injury Scale A) traumatic tetraplegic was diagnosed with AF during routine ECG for elective replacement of intrathecal baclofen pump. He is a full time athlete, medallist at Paralympic and World Games and held at one time the world record in his category (F51) in the Discus.
There were no symptoms, no recent history of infection or alcohol excess and no past history suggestive of underlying cardiac pathology, as his previous ECG, echocardiography, thyroid function test and electrolytes were normal. After anticoagulation, cardioversion was successfully carried out after failure of treatment with amiodarone and flecainide for 4 months. Currently, 1 year after initial diagnosis, he is in sinus rhythm, not taking any medication and resumed normal physical activity and competitive sports. In his subjective opinion, he feels he can train harder than before cardioversion.
Conclusion First, SCI may contribute to increase risk of developing arrhythmia (AF in this case), which will have negative effect on cardiac performance and if left untreated can increase the risk of cerebrovascular events that could further impair the patient's (athlete in this case) functional status and reduce his life expectancy. Second, we feel that more diligent preparticipation athletic screening and diagnosis is recommended in persons with SCI.
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