Cheyne-Stokes respiration, periodic circulation, and pulsus alternans in spinal cord injury patients.

STUDY

DESIGN

Case reports.

OBJECTIVES

To describe Cheyne-Stokes respiration (CSR) and associated circulatory abnormalities in three patients with spinal cord lesions.

SETTING

Veterans Administration Hospital, USA.

SUBJECTS: One paraplegic patient with coronary artery disease in congestive heart failure, one tetraplegic patient with alcoholic cardiomyopathy and postural hypotension, and one tetraplegic complete patient with cardiomegaly, severe aortic atherosclerosis, and postural hypotension.

METHODS

Breathing activity was measured with a nasal thermistor or abdominal stretch transducer. Cardiac activity was estimated with a photoelectric sensor for cutaneous blood flow placed on the forehead or a piezoelectric transducer for pressure positioned over an artery or the cardiac apex. Tracings were drawn on a strip chart recorder. The subjects were at rest in semireclining positions.

RESULTS

Survey times were 17-21 min, and cycling periods were 41-72 s. Periodic changes in the depth of breathing were accompanied by periodic changes in amplitude of forehead cutaneous pulse, blood pressure, or apical cardiac impulse in all patients. Peak circulation occurred at or following peak respiration. In addition, cyclical pulsus alternans occurred in two patients.

CONCLUSION

Three spinal cord injury patients sustained CSR and circulatory periodicity associated with cardiac disease and postural hypotension.