Physical injury can have adverse effects on the body that may be evident months or years later after the injury. Physical injury consists of the trauma caused to the body by objects, heat, cols electricity, pressure or radiation. The injury can be done caused by a crush, blow or cut to the body. The complications resulting from the trauma are usually due to the bleeding that may result, fracture or even an infection. It is always recommended that after physical injury of any nature a doctor should conduct a thorough medical analysis to ensure that no vital internal organs have been damaged or injured. This is because physical injuries to internal organs are not usually evident just from outward analysis and may remain hidden for some time. Physical injuries occur every day, for instance in the U.S it is reported that about a third of all emergency department admissions are due physical injuries. In Australia about 10.5% of the population suffers some form of physical that require emergency admission every year. (O'Donnell, 2004). According to WHO (World Health Organization) cardiovascular diseases are the world largest killers claiming the lives of 17.1 million people every year. According to WHO, cardiovascular diseases occur mostly in low and middle income countries and occurs almost equally in both men and women. However the diseases increase in women after menopause. The same report by WHO lists the major causes of cardiovascular diseases. Among the causes include: use of tobacco, unhealthy diet, physical inactivity, heart attacks and strokes. The report goes on to explain that cardiovascular diseases can be prevented by engaging in physical activities and eating healthy diet. (World Heart Day, 2009).
Cardiovascular diseases include complications that lead proper lack of function of the arteries and veins that supply oxygen and circulate blood to and from vital organs of the body. The dysfunction may also involve the valves that prevent the mixing of the deoxygenated blood and the oxygenated blood further impeding the capacity of the heart to supply oxygen. The heart is also a special kind of muscle that is able to initiate its own contractions, therefore disease may be as a result of the inability of the heart to contract effectively therefore reducing its capacity to pump blood to organs of the body including itself because the heart also needs blood. Lack of blood supply to vital organs will definitely cause the death of that organ.
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Ischemia is one disease of the heart which is a general term used to refer to conditions caused by obstruction of blood flow to the heart. This may be as a result of a number of reasons which include excess fat deposits or plaque which lead to narrowing of the veins that supply the heart with oxygenated blood. High blood pressure or hypertension is also another heart disease resulting from excess fat and build up of plaques in veins and arteries around the body.
This conditions causes the heart to work extra hard to overcome the barriers presented by the narrowing of these vessels. This condition offers much danger because it is not always evident during its earlier stages as the body will attempt to overcome it. However after sometime the body becomes tired and an individual gets a surprise heart attack or angina. In some instances the heart attack may be so severe and consequently fatal. This is one of the deadliest heart diseases because the first warning sign may provide the killing blow. Other conditions such as kidney disorders that leave extra fluids and some toxins in the body, obesity, diabetes, birth control pills, pregnancy and excessive stress may also lead to high blood pressure.
Infections to the heart which include carditis and endocarditis also cause the heart to become diseased. These conditions arise when the immune system has been compromised; the liver has complications, after heart surgery or as a result of an autoimmune disorder such as rheumatism or lupus. Endocarditis is for instance very common in persons with HIV or AIDS and it can cause excessive damage to the heart if not treated early enough. Surprisingly there are only little literature that correlates cardiovascular diseases and physical injuries.
Injuries to the Spinal Chord
In the United States alone incidences involving injuries to the spinal cord are approximately 11,000 persons per year. 53 percent of the affected individuals suffer from tetreplegia which are injuries to one of the eight cervical segments of the spinal cord. 42 percent of the affected individuals also suffer from paraplegia which include lesions to the thoracic, lumbar, or sacra; regions of the spinal cord. Research conducted on the relationship between cardiovascular diseases and spine injuries have shown that of the patients with motor complete cervical injuries most develop bradycardia, 68 percent become hypotensive while 16 percent develop cardiac arrest. However for those persons with incomplete cervical injuries 35-71 percent develops bradycardia, however these patients do not always develop cardiac arrest. Deep vein thrombosis also develops in 47-90 percent of the patents according to the severity of the prophylaxis. Spinal injury is also characterized by other conditions such as physical inactivity, obesity, hyperlipidemia, insulin resistance and diabetes. Most of these conditions become more severe after spinal injuries. Research in the United States has established that close to 20 percent of the deaths in relation to spine injury occurs as a result of cardiovascular complications.
Spinal cord injury for instance may cause significant clinical complications to the heart some of which may be long term and others short term. Some of the complication may involve the impairment of the control of the autonomous nervous system which is mostly known to occur in individuals with injuries in high thoracic or cervical.
Injuries to the spinal cord may also lead to a number of complications ranging from hypotension to conditions such as bradycardia and autonomic dysreflexia. Some injuries to the spinal cord may also result in complications cush as deep venous thrombosis and coronary heart disease. Injuries to the spinal cord have very well been correlated to cardiovascular diseases due to the effect such injuries have on the nervous system. Although the heart generates contractions via the sinu arterio node and arterio ventricular node the heart rate is still under significant control by the autonomous nervous system. It is for this reason that such conditions such as bradycrdia may arise when there is damage to the spinal cord especially in the high thoracic or cervical.
It is well known that the communication involving the brainstem and the autonomous nervous system is important in controlling the cardiovascular system and the communication can be severed during spinal injury leading to cardiovascular complications. For instance vasoconstriction and heart contraction is controlled by the neurons of the sympathetic nervous system form the intermediolateral cell column. Therefore in the instance that an individual suffers spinal injury of the upper thoracic and cervical from an accident, the individual loses the ability to control some or all of their sympathetic nervous system.
In a situation where spinal injury occurs, an individual's blood pressure rises instantly. This is due to the body's release of norepinephrine by the adrenal glands. Norepinephrine may also be released as he body responds to mechanical disruption of the vaso-active neurons and tracts of the cervcal and upper thoracic spinal cord. Due to the interruptions on the descending sympathetic tracts the response is usually followed by moments of reduced sympathetic nervous activity. Consequently input by the supraspinal is reduced leading to the cutaneous vasodlation, inability of the sympathetic nervous system to initiate vasoconstriction and eventually the lack of sympathetic activity to the heart. Clinically a patient suffering from spinal injury may develop complications such as hypothermia, hypotension and bradycardia due to the inability of the sympathetic nervous system to initiate it regulatory role and the resulting uncontrolled vagal tone.
The autonomic nervous system functions to regulate the electrophysiology of the heart and complications may lead to ventricular arrhythmias. This can mostly occur during parsympathetic input to the heart which may result in bradycardia especially in injuries involving cervical spinal cord. Studies have established that there exists close association between bradycardia and cardiac arrest in individuals who have spinal injury. Bradycardia always develops as a result of tracheal stimulation for instance during suctioning and hypoxia. Treatment is usually achieved by administration of Atropine and in severe cases cardiac pacemakers are used. The complication usually disappears two to six weeks after the spinal injury.
It has also been observed that individuals with tetraplegia or high paraplegia experienced reduced compensatory vasoconstriction which results from changes in sympathetic activity that in most instances occur in the large vascular bed in the skeletal muscle and splanchic regions. This condition together with the venous pooling in the lower extremities and reduced mascular activities reduced venous blood return, stroke volume and blood pressure. Nitric Oxide the powerful vasodilator may also be increased in circulation. Autonomic dysreflexia leading to dangerously high blood pressure may also be caused by the inability of the body to regulate the hyperreflexic sympathetic nervous activity. This situation or condition usually occurs as a result of the loss of control by the supraspinal over the sympathetic nerves which usually occur as a result of injury above the major splanchic outflow. Furthermore, due to the decreased functions of the autonomic nervous system there is a subsequent reduced blood flow and circulations to the lower extremities of the body. The conditions that lead to individuals with severe spine I jury to develop a complication such as deep vein thrombosis is due to the lack of movement to in the secondary muscles and paralysis which lead to reduced fibrinolytic activity together with increased activity of factor VIII.
Coronary heart diseases have been shown to occur in higher prevalence in older people than younger people who have both suffered from spinal injuries. It is thought that the higher prevalence in older people may be related conditions related to higher occurrences of metabolic dysfunctions related to obesity, dyslipidemia, hypertension, insulin resistance, increased prothrombic and pro-inflammatory mostly experienced in older generations. Conditions resulting from abnormal lipid levels caused by increase in the levels of cholesterol and low density lipoprotein followed by a subsequent decrease in the levels of high density lipoproteins are usually common in individuals who have suffered from severe spinal injury. This puts them at higher risks of developing cardiovascular diseases. The actual cause for the decrease in the protective high density lipoprotein has not been well substantiated experimentally but likely conditions include the poor diet, adrenergic dysfunction and lack of physical activities characteristic of people who have suffered from spinal injury. Thus in the management and treatment of people who have suffered from spine injury includes optimizing cholesterol management and use of lipid lowering drugs which is aimed at tackling dyslipidemia. However optional pharmacological agents have been discovered.
Mostly physical exercise is always recommended for persons at risk of suffering from most cardiovascular diseases.
The major objectives of physical activities in this case include reduction of blood pressure, increased lipid sensitivity and to prevent accumulation of lipids in the walls of blood vessels. However for persons who have suffered from severe spinal injury physical activities becomes a limitation due to conditions such as paralysis, reduced muscular mass and adrenergic dysfunction. However these conditions are not just limited to spinal injury but may also be observed in most other accidents that may lead to immobility. The reduced movement in such cases is not able to meet the daily requirements for physical exercise. The lack of enough exercise can further place these individuals at even higher risks of developing cardiovascular diseases due to inefficient cardiac output and stroke volume. People who have suffered from spinal injury in areas above the sympathetic output elevation of the heart rate are due to withdrawal of vagal inhibition. When the patients are placed under regular exercise the rates of their heart and oxygen uptake increases moderately but does not reach levels that are recommended and that can cause significant change.
Although this paper has concentrated a lot on the injuries that are mostly caused to the spinal cord and how they are related to cardiovascular diseases, it is also apparent that some other physical injuries may also lead to situations such as paralysis, reduced muscular mass and generally immobility. As outlined in the introduction cardiovascular diseases already cause around 17.1 million deaths each year. The WHO recommends that persons should engage in physical activities, avoid sedentary life and eat healthily to avoid the risks of developing cardiovascular diseases. However this also presents a challenge to persons who have been condemned to sedentary life and physical exercise becomes impossible after severe physical injuries to the spinal cord or other physical injuries that cause immobilization of the patients. Physical injuries that lead to complications in the autonomic nervous system or the sympathetic nervous system or both generate conditions that may cause or worsen an already existing cardiovascular disease.
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