Tan See Wei, Rahman Zafefe Ba, Fauzi Aishah A, Latif Lydia A, Hasnan Nazirah
Department of Rehabilitative Medicine, University Malaya Medical Centre , Kuala Lumpur, Malaysia.
Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.
Spinal Cord Ser Cases. 2016 Dec 22;2:16030. doi: 10.1038/scsandc.2016.30. eCollection 2016.
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.
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.
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.
冠状动脉痉挛是冠状动脉之一的短暂性突然血管收缩，可导致心肌缺血、心肌梗死、致命性心律失常和猝死。大多数冠状动脉痉挛患者有潜在的心脏病变。
本文介绍了一例罕见的顽固性自主神经反射异常病例，患者为36岁慢性C5截瘫患者，在无潜在心脏病变的情况下，继发于冠状动脉痉挛的无症状心肌缺血。MRI灌注研究显示左心室收缩功能正常，无冠状动脉闭塞证据。
该病例突出了与阵发性交感神经系统亢进相关的心脏并发症，并提出自主神经反射异常可通过不受控制的交感神经系统导致冠状动脉痉挛。脊髓损伤患者心肌向大脑的感觉输入中断使他们易患无症状心肌缺血。文中描述了与自主神经反射异常相关的冠状动脉痉挛的诊断和管理挑战。
