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Alterations in Cardiac Electrophysiology After Spinal Cord Injury and Implications for Exercise

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The Physiology of Exercise in Spinal Cord Injury

Part of the book series: Physiology in Health and Disease ((PIHD))

Abstract

When the spinal cord is injured at or below thoracic level 5 (T5), cardiovascular control is markedly unbalanced as the heart and blood vessels innervated by upper thoracic segments remain under brain stem control, whereas the vasculature of the lower body is affected by unregulated spinal reflexes. As a result, mid-thoracic spinal cord injury (SCI) results in chronic arterial pressure and cardiac volume unloading due to a rapid and sustained reduction in arterial pressure, venous return and end-diastolic volume, secondary to the loss of sympathetic vasoconstrictor tone below the level of the injury. The resulting hypotension and reduced cardiac filling initiates a dramatic and immediate reflex increase in sympathetic outflow and decrease in parasympathetic outflow to the heart. These high levels of sympathetic outflow and reduced parasympathetic outflow following mid-thoracic SCI have been reported to induce calcium overload, left ventricular dysfunction, cardiac injury and ST-segment elevation. The myocardial damage also promotes nerve growth factor-induced sympathetic sprouting, hyper-innervation of the heart and pathological neuroplasticity in the autonomic ganglia, spinal cord and autonomic centers within the brainstem. Pathological neuroplasticity following SCI is associated with many lingering complications such as chronic pain, spasticity, neurogenic bladder, and autonomic dysreflexia. Pathological neuroplasticity is also associated with changes in cardiac electrophysiology and an increased susceptibility to life-threatening ventricular arrhythmias. These complications are exacerbated by the sedentary lifestyle of the typical individual with SCI. Regular exercise may exert a protective effect via an increased plasma volume, increased venous return and a subsequent volume loading of the heart, which in turn maintains contractile function, arterial pressure and reduces sympathetic sprouting, hyper-innervation and pathological neuroplasticity.

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  1. Department of Physiology, School of Medicine, Wayne State University, 540 E. Canfield Ave., Detroit, MI, 48201, USA

    Heidi L. Lujan & Stephen E. DiCarlo

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  1. Heidi L. Lujan
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  2. Stephen E. DiCarlo
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Correspondence to Stephen E. DiCarlo .

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  1. Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Hospital Cambridge, Cambridge, Massachusetts, USA

    J. Andrew Taylor

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Lujan, H.L., DiCarlo, S.E. (2016). Alterations in Cardiac Electrophysiology After Spinal Cord Injury and Implications for Exercise. In: Taylor, J. (eds) The Physiology of Exercise in Spinal Cord Injury. Physiology in Health and Disease. Springer, Boston, MA. https://doi.org/10.1007/978-1-4939-6664-6_5

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