Cardiac Conditions

Posted by Nurse Linda in Daily Dose on August 26, 2022 # Health

heart A secondary complication of paralysis is cardiovascular disease. Paralysis can lead to cardiac conditions from a variety of factors. Two factors stand out, which are lack of movement and Autonomic Dysreflexia (AD). Lack of movement in the body heightens risk factors of obesity, lipid disorders, diabetes, and metabolic syndrome. If there is dysfunction in the autonomic nervous system (ANS, the part of the nervous system that controls automatic functions such as heart functions), cardiovascular issues can be affected due to blood pressure effects, heart rate variability, arrhythmias, and poor cardiac response to challenges such as physical activity and stress responses.

Advances in treatments of sepsis, renal failure, and pneumonia have dropped the occurrence and deaths from these health issues. Improvement in overall healthcare allows individuals with paralysis to live longer. Unfortunately, although there are increased treatments and options for individuals with cardiac conditions and paralysis, improvements in other areas have pushed cardiac issues into the top spot for the cause of death. With understanding and treatments, you can help lower your risks for cardiac disease.

Lack of movement is a concern for individuals with paralysis. Maintaining cardiac health is a challenge for individuals with and without paralysis. Movement can assist with maintaining a healthy weight. Individuals who cannot exert energy in moving their bodies can easily take in more calories through food than what is needed. Fats can collect in the blood. These are cholesterol and triglycerides. LDL cholesterol causes fat deposits on artery walls which can clog the arteries, as well as make the artery walls stiff or without elasticity for blood to pass or pump power. Triglycerides are fats that can make arteries stiff or hard, as in atherosclerosis. Diabetes prevents the body’s ability to turn blood glucose into energy and leads to damage or organs, nerves, and tissues.

Metabolic syndrome is a condition that is a combination of other health issues, including high blood pressure, diabetes, and high cholesterol. Individuals with fat accumulation in the waist are susceptible to metabolic syndrome. It is a chronic condition that is usually not noticed except for the expanding waistline. Laboratory blood testing for each element and diagnosis by a healthcare provider is required.

You can help yourself avoid cardiac conditions due to lack of movement. The first step is to move your body or have someone move it for you twice a day. This not only helps with cardiac function but also keeps your joints subtle, reduces tone (spasticity), improves your bowel program, decreases urinary tract infections, and even can make you feel better mentally. Often, individuals give up a daily range of motion or stretching exercises due to time constraints or finding someone to do the movements, but those that keep up with it or restart activity find better, overall health with fewer complications.

If you have the option to go to an adapted gym, having a coach or therapist that can assist with adaptations is helpful. There are heated pools in most areas that have adaptive swimming. Look online for wheelchair exercise videos. There are many video options. Before you begin moving, be sure to check with your healthcare professional to ensure your body is ready for activity. Hidden issues such as blood clots can be affected by movement, so be sure it is safe for you.

Functional electrical stimulation can really help with movement, but it can be difficult to find a payor source. Prices of FES equipment have radically lowered with different options, so look for something in your or your payor’s financial range.

If you are thinking, I do not have time or desire for activity, welcome to the club of every single human. Individuals both with and without paralysis have difficulty finding time and desire to exercise. This is a worldwide human issue. Therefore, changing your mindset and lifestyle to commit to the endeavor is necessary. Work with a group or within your own family, as having movement partners helps encourage your dedication.

Follow a healthy diet to avoid lipid disorders, diabetes, and metabolic syndrome. Eating can become a habit or the thing you look forward to during the day. Be mindful of your food choices. If you are not sure about how many calories you need or what kind of diet to follow, ask your healthcare provider for a nutrition consult. That will get you started on an eating plan that is right for you.

There are some basics to eating healthy. Avoid processed foods, anything with sugars and salt added, saturated fats, trans fats, and cholesterol. Stick to foods that include fruits, vegetables, and whole grains. Moderate your protein intake. The specifics of a diet for the uniqueness that is you should be worked out with a healthcare professional. For instance, you may require more protein while healing a pressure injury or other specialization issue.

Eliminate alcohol and other drugs as well as smoking, vaping, e-cigs, etc. These all affect your breathing, keeping nutrients from entering your body at a cellular level, as well as other costly effects on your body and wallet. Alcohol is a huge factor in weight gain due to its high sugar content.

An issue that some individuals with paralysis from spinal cord injury and some brain injuries is autonomic dysreflexia (AD). Individuals with spinal cord injury have been known to have this condition if their injury is in the cervical (neck) or thoracic (rib cage) area. Those with brain injury may have this condition depending on the part of the brain affected. This is an issue with blood pressure and heart rate. It can lead to stroke, seizure, and cardiac arrest. Emergency treatment should be provided. This wallet card, available through the Christopher and Dana Reeve Paralysis Foundation, provides quick information about the condition and treatment for you, your family, and caregivers, as well as for healthcare providers: https://www.christopherreeve.org/living-with-paralysis/free-resources-and-downloads/wallet-cards.

AD effects of extremely high variability in blood pressure over a short period of time, challenges to heart rate both in too fast or too slow beats, arrhythmias, and poor cardiac response when needed can affect the overall cardiac and vascular (blood vessels) system. Episodes of AD can be controlled by learning about and therefore avoiding triggers.

The primary trigger of an AD episode is an overfilled bladder due to a catheter clog or kink, drinking too much fluid too quickly overfilling the bladder, or ignoring bladder program emptying times. The second most common trigger is an overfilled bowel from not performing a bowel program in a timely manner, constipation, impaction, or diarrhea. The third most common cause is pressure on the skin from pressure injury, too tight clothing, or wrinkles in your sheets or clothes. Other triggers exist that can be almost anything, temperature changes internally or from the environment, bright light or sunlight, breezes, infections, literally anything that affects the body’s reactions by the autonomic nervous system.

If you have an episode of AD, it is important to treat it immediately by relieving the trigger. That means catheterizing, doing manual stool removal, adjusting anything touching the skin, or any other issue. If you cannot find the trigger, call 911 because the elevated blood pressure will then need be relieved with medication. Other tests can be performed to check for an infection or to locate the trigger.

To avoid AD episodes, monitor your blood pressure. After a neurological injury, your blood pressure can lower over time. AD diagnosis is an elevation of blood pressure by 20mm Hg systolic (top number) in adults and 15mm Hg systolic (top number) in children. Your blood pressure may be naturally low due to your injury, so an elevation may put you in the normal blood pressure range, which would not alert someone that there is a problem if they are not familiar with AD.

In addition, check your blood pressure during different activities to look for an issue called ‘silent AD’. This is an AD episode with elevated blood pressure that you cannot feel but without an outward sign of AD such as headache, change in heart rate (pulse), vision, nasal congestion, sweating, goose bumps, flushing, or tingling sensations. Untreated, silent AD can impact your cardiovascular health.

Treatments can be used to avoid triggers such as lidocaine inserted into the urethra prior to catheterizations and catheter changes. Botulinum toxin bladder injections reduce irritations to the bladder. Sphincterotomy (a small surgical incision to open the internal urinary sphincter) and suprapubic catheters have reduced bladder triggers of AD. Rectal analgesics can be used to reduce rectal triggers during bowel programs. Keeping clothing loose and sheets without wrinkles helps reduce skin triggers.

If AD cannot be managed by control of triggers, medications can be used. Nitroglycerin 2% paste is used in an AD emergency to lower blood pressure quickly. Be sure to remove it with soap and water when pressure is within the individual’s normal, so the blood pressure does not go too low. Other emergency medications include nifedipine, captopril, and clonidine.

Cardiac risks can be reduced through the movement of the body and control of autonomic dysreflexia. There is new research demonstrating external electrical stimulation can reduce AD episodes. These are challenges that can be met through thoughtful care and concern for your well-being. The benefits are far-reaching even beyond cardiac function.

Pediatric Consideration:

Autonomic Dysreflexia is a frightening situation when it first appears. Having knowledge about the situation can help families deal with the issue. A pediatric AD card is also available from the Christopher and Dana Reeve Foundation at the same site: https://www.christopherreeve.org/living-with-paralysis/free-resources-and-downloads/wallet-cards.

Be sure to have a pediatric-sized blood pressure monitor that you can use if you suspect AD is occurring. Check blood pressure periodically to assess for changes and with different activities to monitor for silent AD. Listen carefully to your child and observe symptoms. Record blood pressures so you can identify an AD episode.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.