The Connection Between SCI, Surgery, and Heart Problems and Why Does it Matter?

This is a true story and one The Rollin’ RNs wanted to explore. This event unfolded when a friend of ours with a spinal cord injury (SCI) was being prepped for a scheduled bladder/bowel surgery. She developed goosebumps and her normal heart rate became very fast and irregular (known as atrial fibrillation or AFib). This heart rate is unsafe at any time as it can lead to blood clots, stroke, heart failure, and other complications. Needless to say, her surgery was canceled. What made this occurrence unusual is that this person had no other underlying health conditions besides having an SCI (T4 complete) and she’s only in her early 40’s. So, what caused her to go into an irregular heart rhythm? First, a little background. When an SCI occurs, the autonomic nerves in the spinal cord can be damaged. These nerves make up what is called the autonomic nervous system (ANS) and control several basic functions of the body that are automatic including:

• heart rate

• body temperature

• breathing rate

• digestion

• sensation

We don’t have to think consciously about these systems for them to work.

Damage to the ANS can also be a setup for autonomic dysreflexia (AD) for those people with SCI usually at level T6 or higher. AD often occurs when your body experiences pain or discomfort below the injury level. When the pain or discomfort message does not get to the brain because of the SCI, the body activates a reflex that causes a rise in blood pressure. The brain recognizes this rise in blood pressure and attempts to correct the problem but is unable to send the message below the level of injury. The body remains confused and unable to sort out the situation and blood pressure continues to rise. This can cause all sorts of seemingly unrelated signs and symptoms including a pounding headache, sweating, goosebumps, stuffy nose, change in heart rate, blurred vision, or red splotchy skin. If the cause of the pain or discomfort is not found and remedied quickly, serious complications such as stroke, seizure, and even death may occur. For our friend, it was hard to sort out the culprit that caused her AD and irregular heart rate that day. Could it be because she hadn’t eaten anything coupled with having done a bowel cleanse for surgery? Maybe her bladder was irritated by the foley catheter. What about her body experiencing discomfort from positioning? The list for a reason goes on. Regardless, AD is a potentially life-threatening medical emergency. For most people, AD can be easily treated as well as prevented. The key is knowing your baseline blood pressure, triggers, and symptoms. Because many health professionals are not familiar with this condition, it is important for people who are at risk for AD, including the people close to them, to recognize the symptoms and know how to act. For more information on Autonomic Dysreflexia (AD) check out The Rollin’ RNs article here. For our friend, labs completed after the occurrence revealed an abnormal potassium lab value and that can have an impact on heart activity. Fortunately, after getting something to eat and drink, her heart rate got back into a normal rhythm without any other intervention. And it was concluded the bowel prep and resulting potassium level may have been the source of her AD and AFib.

The takeaway here is to be prepared anytime a planned surgery is in your future. Especially if you have an SCI with a higher injury level that could predispose you to AD. Every person with an SCI will have their own unique response with AD. Is your doctor familiar with SCI, AD, and how to treat it? Be familiar with your baseline blood pressure, AD triggers, and symptoms. Have an advocate who can speak on your behalf about these things if and when you can’t. Have a physical document about AD and how to treat it on hand should you need to educate anyone, such as the one found here. It’s all good, so keep on rollin’.

Roberta, RN and Patty, BSN, RNC The Rollin’ RNs ™

References: https://www.healio.com/news/cardiology/20160204/spinal-cord-injury-may-elevate-risk-for-af https://www.sciencedaily.com/releases/2011/10/111024084628.htm https://emedicine.medscape.com/article/321771-overview#a3 https://www.healthline.com/health/autonomic-dysfunction https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624 https://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/autonomic-dysreflexia