Recent developments in the management of spinal cord injury have reduced mortality while prolonging the life span of quadriplegic patients. It is important to remember that even a simple urinary tract infection or constipation can cause fatal outcomes in quadriplegic patients via autonomic dysreflexia. A 40-year-old C3-C4 quadriplegic Caucasian male presented to the emergency room with palpitations. On examination his blood pressure was 211 /133 mm Hg with a heart rate of 99 beats/min. The patient had no cardiac risk factors and no history of hypertension. Blood work was normal except for leukocytosis (WBC 18,100/mm). During his hospital stay, the patient’s blood pressure was very labile, ranging from 50 /30 to 220 /110 mm Hg. Gross hematuria resolved following bladder irrigations and empiric antibiotic treatment for possible hemorrhagic cystitis. Bowel cleaning was initiated for severe constipation. An echocardiogram revealed severely impaired left ventricular systolic function with an ejection fraction (EF) of 10–15%. A repeat echocardiogram on the 3rd day, when he was hemodynamically stable following the above interventions, showed normalization of left ventricular systolic function (EF 55–60%). The patient was discharged from the hospital in good condition without any further cardiac work-up.