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Spinal cord series and cases v.2, 2016년, pp.16030 -   

Coronary vasospasm in intractable autonomic dysreflexia

Tan, See Wei (Department of Rehabilitative Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia ) ; Rahman, Zafefe BA (Department of Rehabilitative Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia ) ; Fauzi, Aishah A (Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ) ; Latif, Lydia A (Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ) ; Hasnan, Nazirah (Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ) ;
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    Introduction:Coronary vasospasm is a transient sudden vasoconstriction of one of the coronary arteries that can lead to myocardial ischaemia, myocardial infarction, fatal arrhythmia and sudden death. Most patients with coronary spasm have underlying cardiac pathology.Case Presentation:This paper presents a rare case of intractable autonomic dysreflexia in a 36-year-old patient with chronic C5 paraplegia with silent myocardial ischaemia secondary to coronary vasospasm in the absence of underlying cardiac pathology. The MRI perfusion study revealed normal left ventricular contractility and no evidence of coronary artery occlusion.Discussion:This case highlights the cardiac complications associated with paroxysmal heightened sympathetic nervous system and proposes that autonomic dsyreflexia can predisposes to coronary vasospasm via uncontrolled sympathetic nervous system. The disruption of sensory input from the myocardium to the brain in patient with SCI predisposes them to asymptomatic myocardial ischaemia. The challenges in the diagnosis and management of coronary vasospasm associated with autonomic dysreflexia are described.


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