From the Research
Palpitations in a 58-year-old wheelchair-bound patient with nerve transection are most likely caused by a combination of cardiac arrhythmias, autonomic dysreflexia, and physical deconditioning, and should be evaluated with a thorough history, physical examination, ECG, and assessment for triggers of autonomic dysreflexia, as recommended by the most recent study 1. The patient's condition can lead to various complications, including cardiac arrhythmias, such as atrial fibrillation, premature ventricular contractions, or supraventricular tachycardia, which can be triggered by autonomic dysreflexia, a condition that can occur after spinal cord injuries, causing sudden increases in blood pressure and heart rate 2. Some key points to consider in the evaluation and management of palpitations in this patient include:
- A thorough medication review to identify potential contributing factors, such as anticholinergics, beta-agonists, and certain pain medications 3
- ECG and Holter monitoring to detect cardiac arrhythmias 4
- Electrolyte panel and thyroid function tests to rule out underlying electrolyte imbalances or thyroid disorders 5
- Assessment for triggers of autonomic dysreflexia, such as bladder distension or pressure sores, and management of these conditions to prevent further episodes 2 The treatment of palpitations in this patient will depend on the underlying cause, but may include medication adjustments, treatment of electrolyte abnormalities, or management of specific cardiac conditions, and should be guided by the most recent and highest quality evidence, such as the study by 1.