Atrial Fibrilation after SCI

Atrial Fibrilation after SCI

Posted by AskNurseLinda on Nov 19, 2018 11:39 am

A reader recently asked about atrial fibrillation after spinal cord injury. The reader noted that there is extensive information about the number of individuals who have SCI that develop atrial fibrillation but there is scant information about why this occurs. They are correct. The information in scientific literature is less than helpful about the cause, and more importantly, what to do about it. Let’s break it down.

Atrial fibrillation is a situation with the heart when the typical pattern of heart beat becomes out of sync. Usually, people’s hearts beat in a lub dub sound pattern. There are four chambers in the heart muscle. The top two chambers are the atria. The bottom two chambers are the ventricles. The heart beats by an impulse that causes the atria to contract which pushes blood through the first atria and then to the second atria. That is the lub. Then the blood is pushed down to the two ventricles. That is the dub.

An impulse misfire in the atria leads to atrial fibrillation. It is the misfire of the atrial heart stimulation node that is of concern for individuals with SCI although either ventricle or atrial fibrillation can occur to anyone. In either case, blood flow is not effective through the heart because the stimulus to the cause the heart to beat is not effective, not in pattern or both.

Messages for the heart to beat is sent through the autonomic nervous system. This is the part of the nervous system that works automatically or without your thinking about it. Sympathetic nerves speed the heart. The vagus nerve works to slow your heart. These nerves can be affected, although still functioning after spinal cord injury. Many individuals with spinal cord injury have slow heart beats depending on the level of injury and effects on the sympathetic and vagus nerves.

Individuals with higher level of spinal cord injuries have a higher incidence of bradycardia or slowing of the heart, arrythmias and cardiac instability especially earlier after trauma. In spinal cord injury from disease, the onset is slower or in relationship to the progression of disease. Individuals with lower level injuries do not appear to have as significant cardiac issues.

Another possibility is the effects of Autonomic Dysreflexia (AD). Although only a small number of studies have been conducted using small sample sizes, there could be a relationship between AD and atrial fibrillation as recharging of the atrial heart stimulation node might not be complete in episodes of AD. This is more apparent in typical and noticeable episodes of AD but also occurs with less typical or even silent episodes of AD. Since the events of atypical and silent AD are not readily apparent, it is more difficult to assess therefore not often correlated even if present.

Over time, after a spinal cord injury, the body becomes used to a slower pulse, but cardiac fibers want to work. This allows the opportunity for the heart beat to become out of sequence. The main atrial heart stimulation node might lose command of the organization of cardiac muscle contraction which leads to multiple smaller sites attempting to organize the heart contraction instead of a unified group. This creates a chaotic heartbeat.

Symptoms of atrial fibrillation are palpitations (a feeling like butterflies in your chest), weakness, fatigue, less ability to exert energy as for exercise or just daily movement, tiredness, lightheadedness, dizziness, confusion, shortness of breath, chest pain. As an individual with spinal cord injury or paralysis, some of these symptoms can appear for other reasons.

With spinal cord injury, lightheadedness or dizziness can appear as symptoms of orthostatic hypotension (OA) or low blood pressure when raising your head or upper body. Weakness is a symptom of spinal cord injury especially at the zone of transition where you body changes from movement and sensation to less function. For those who have had spinal cord injury for a while, sudden changes or dropping blood pressure when you did not do so before can be the differentiation between OA and atrial fibrillation. A change in tiredness, weakness or fatigue is another way of noticing atrial fibrillation in the absence of other symptoms.

It is important to note that some people do not have any symptoms of atrial fibrillation even when it is present. This is the same for individuals with spinal cord injury, paralysis or individuals without these conditions. Sometimes, atrial fibrillation is not noticed until physical exam at your regular checkup. If you monitor your pulse or blood pressure, you might notice changes in the quality of these physiologic measurements. For example, you might feel an irregularity in your pulse or blood pressure, if you monitor blood pressure with a stethoscope.

Causes of atrial fibrillation for those with or without spinal cord injury include advancing age, obesity, alcohol use, or family history (genetics). Heart disease is another risk factor. Heart disease includes valve problems, coronary artery disease, heart attack, heart surgery or congestive heart failure. Diseases such as thyroid disease, kidney or lung disease can lead to atrial fibrillation.

Metabolic disease, and diabetes which have a higher incidence in individuals with spinal cord injury can lead to atrial fibrillation. High blood pressure is a risk factor for atrial fibrillation. After spinal cord injury, individuals tend to have a blood pressure that is lower than that of the general population. It is important to know your average blood pressure because a general population normal blood pressure will be a high blood pressure for you after spinal cord injury. Having any of these or other secondary complications of spinal cord injury puts you at a higher risk for atrial fibrillation.

Caught early, you can prevent complications of atrial fibrillation which are stroke and/or heart failure. It is critically important that you tell your health care provider if you feel butterflies, palpitations or have any of the symptoms of atrial fibrillation mentioned above. Your healthcare professional should listen to your heart at every visit. If you have symptoms, you might need an EKG (measurement of the heart function including effective beats). Some people will wear an Holter Monitor which is a long-term EKG, for a day or two. This gives a picture of your heart function over time and with different activities.

Atrial fibrillation appears in different ways. You might have some symptoms that appear and then just go away. Persistent atrial fibrillation does not resolve but can be controlled with medication or cardioversion. Cardioversion is a procedure where you are anesthetized, and a jolt or shock is applied to your skin over your heart. That will put your heart back into a regular rhythm. Long standing, persistent atrial fibrillation does not resolve in 12 hours. Permanent atrial fibrillation is present for an even longer time. Both are treated with cardioversion and long-term medication.

All of this sounds dismal, but there are preventions that you can take to avoid or at least stall the start of atrial fibrillation. Eat a healthy diet to maintain your body and weight. There is a site online called https://www.choosemyplate.gov/ which can help you modify your diet for general wellbeing. This will help you avoid obesity, metabolic syndrome and diabetes. Also, adding activity, even if passive will do the same. Activity will help the circulation in your extremities. Assisting circulation assists the heart functioning.

Stop smoking. Smoking greatly affects oxygenation of the blood which reduces the amount of oxygen in your body. Limit caffeine and alcohol intake. Avoid cold and cough medications which can increase your blood pressure.

Find ways to reduce stress and anger. You might need some outside help to deal with issues of frustration. It is always good to have a check with a mental health professional to get on top of stress and anger issues. These can creep into your life before you are aware of them. Meditation exercises are helpful as well.

Why individuals with spinal cord injury have a higher incidence of atrial fibrillation is an unanswered question. It might be because of the nature of the affected function of the nerves, especially the Vagus nerve as well as lack of movement, which is common to everyone. Keeping track of your general health can possibly avoid development of ineffective heart beating. It will be interesting to see if the incidence of atrial fibrillation is reduced with the movement of activity added to recovery treatments. Nurse Linda
 

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