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There may be an increased risk of Coronary Heart Disease and atherosclerosis following SCI. PCPs should continue to address any modifiable risk factors and educate any chronic spinal cord injured patient on preventive measures.

Prevention Considerations Assessment Considerations
  • Patient with SCI above T5 may have an atypical presentation of atypical symptoms and abnormal perceived chest pain with angina. Diagnostic evaluation usually involves a pharmacological stress test and echocardiogram (ekg).
    • Unexplained autonomic dysreflexia, jaw pain, shoulder pain nausea, syncope, and worsening spasticity can be the initial presentation
    • Lower baseline blood pressure is common following SCI
  • Hypertension should be distinguish from high blood pressures related to Autonomic Dysreflexia, which has a specific etiology.
    • Although Hypertension is generally treated similarly as in the able body population, diuretics must been used with caution in patients performing intermittent catheterization.
  • Patients with SCI may have an atypical presentation for peripheral arterial disease.
    • Monitor for risk factors such as increased lipids, smoking, history of atherosclerosis or diabetes mellitus.
  • Blood Panal
    • Decreased glucose tolerance and insulin resistance is common in patients with SCI
  • On clinical examination, inspect the skin for changes and check pedal pulses.
    • Skin color changes and cool temperature in the feet can sometimes be seen after SCI without any peripheral arterial disease.
      • May order arterial dopplers and check ankle-brachial indices.
      • A vascular specialist my also need to be involved.
      • Amputation can be a complication for patient with severe vascular disease.
  • Orthostatic Hypotension
  • Venous Thromboembolism



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The University of Alabama at Birmingham Spinal Cord Injury Model System provides this website as an auxiliary resource for the primary care of patients with spinal cord injury.The contents of this website were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SIMS0020). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.