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Figure 2.0 Constelation of Signs and Symptoms of Autonomic Dysreflexia Runny Nose Flushed Sweating Headache Chest Tightness Orthostatic Hypotension Orthostatic hypotension (OH) results in lightheadedness, dizziness, headache or fainting in response to an inadequate adaptation of blood pressure to changes in posture, typically when changing position from lying to sitting, or sitting to standing. OH is defined by a sudden 20mmHg drop in systolic blood pressure or a 10 mmHg drop in diastolic blood pressure, associated with changes in posture and altered cognition. This condition may be asymptomatic, and is often aggravated by exposure to hot conditions (weather, hot showers, or prolonged seating in a wheelchair). Current Canadian Practice - CVD Prevention and Management Current available guidelines to scren and manage CVD risks in individuals with SCI It is widely held that best practice involves the quantitative assessment of absolute CVD risk, followed by management, with therapeutic lifestyle changes (TLC) and pharmacotherapy. TLC are effective therapies used to reduce CVD risks or improve cardiovascular integrity, and include increases in physical activity, optimization of dietary intake and weight management strategies. Assessment of CVD risk becomes a critical link to achieve guideline-based primary and secondary disease prevention. Although current strategies for reducing CVD risk have not been customized for individuals with SCI, it is likely that the strategies designed for able-bodied individuals may be used or adapted for individuals with SCI. Current guidelines (for clinical practice and consumers) and currently available risk assessment tools are listed in Tables 2.0 to 4.0. Table 2.0 Guidelines for Prevention and Management of Lifestyle-Related CVD Risk Factors CVD • Cragg JJ, Stone JA, Krassioukov AV. Management of cardiovascular disease risk factors in individuals with chronic spinal cord injury: an evidence-based review. J Neurotrauma. 2012;29(11):1999-2012. Obesity • Lau DCW, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ. 2007;176(Suppl. 8):S1-13. http://www. cmaj.ca/cgi/content/full/176/8/S1/DC1. Accessed August 20, 2012. Lipid Disorders • Genest J, McPherson R, Frohlich J, et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult 2009 recommendations. Can J Cardiol. 2009; 25(10):567-79. Diabetes • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2008;32(Suppl. 1):S1-S201. Metabolic Syndrome • Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539-53 • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97 • Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-52 • International Diabetes Federation (IDF). The IDF consensus worldwide definition of the metabolic syndrome. Brussels, Belgium: International Diabetes Federation; 2006. http://www.idf.org/webdata/docs/IDF_ Meta_def_final.pdf. Accessed August 20, 2012. Hypertension • Daskalopoulou SS, Khan NA, Quinn RR, et al. The 2012 Canadian Hypertension Education Program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Card. 2012; 28(3):270-87. Peripheral Vascular Disease • 2005 Canadian Cardiovascular Society Consensus Conference. Peripheral Arterial Disease. http://www.ccs.ca/download/consensus_ conference/consensus_conference_archives/CCFinalPre_CJC_Pub.pdf. Accessed August 20, 2012. Deep Vein Thrombosis • Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(Suppl. 2):e351S-418S. CARDIOVASCULAR INTEGRITY | BODY STRUCTURE AND FNUCTION 129


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