Coronary Slow Flow and Acute Coronary Syndrome in a Patient with Spinal Cord Injury

Texas Heart Institute Journal, 2011 · DOI: · Published: August 1, 2011

Spinal Cord Injury Cardiovascular Science

Simple Explanation

The study discusses a case where a patient with a recent spinal cord injury experienced acute coronary syndrome (ACS) due to a condition called coronary slow flow. Coronary slow flow is when blood flow is delayed in the heart's arteries, even without blockages. This is thought to be related to issues with how blood vessels expand and contract. The authors suggest that the spinal cord injury led to an overactive parasympathetic nervous system, causing blood vessel dilation and contributing to the coronary slow flow and ACS.

Study Duration

Not specified

Participants

A 55-year-old man with paraplegia

Evidence Level

Level 4, Case Report

Key Findings

1
The patient presented with chest pain and ECG changes after a recent spinal cord injury, leading to a diagnosis of unstable angina pectoris.
2
Coronary angiography revealed decelerated coronary flow velocity without significant stenosis, with specific TIMI frame counts indicating slow flow in the LAD, RCA, and LCx arteries.
3
Treatment with a calcium-channel blocker and warfarin, along with routine anti-ischemic agents, resolved the patient's angina and ST-segment alterations.

Research Summary

This case report highlights the potential for acute spinal cord injury (SCI) to cause coronary slow flow and consequent acute coronary syndrome (ACS) due to increased parasympathetic activity. The authors emphasize the importance of recognizing this phenomenon in the differential diagnosis of chest pain in patients with recent SCI. They suggest that parasympatholytic agents might be beneficial in treating coronary slow flow and ACS in SCI patients, while angiotensin-converting enzyme inhibitors should be avoided.

Practical Implications

Diagnostic Awareness

Clinicians should consider coronary slow flow as a potential cause of chest pain in patients with recent spinal cord injuries.

Treatment Strategies

Parasympatholytic agents might be a beneficial treatment option for coronary slow flow and ACS in this patient population.

Medication Avoidance

Angiotensin-converting enzyme inhibitors should be avoided in SCI patients experiencing coronary slow flow due to potential prolonged activation of the renin-angiotensin-aldosterone system.

Study Limitations

1
Single case report limits generalizability.
2
Data regarding the causes and clinical manifestations of coronary slow flow are inconclusive.
3
Further research is needed to confirm the role of the autonomic nervous system.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury