Cardiovascular Lecture 2 Omm Lecom

Front 1

Sympathetics fibers from the right heart tend to pass to the

Back 1

right deep cardiac plexus to innervate the right heart and the sinoatrial (SA) node.

Front 2

Hypersympathetic activity of the right heart side predisposes to

Back 2

supraventricular tachyarrhythmias

Front 3

The fibers from the left sympathetic heart tend to innervate the

Back 3

left deep cardiac plexus and the atrioventricular (AV) nodes

Front 4

Hypersympathetic activity of the left heart side predisposes to

Back 4

ectopic foci and ventricular fibrillation.

Front 5

Right- sinoatrial (SA) node and right deep cardiac plexus– predisposes to

Back 5

supraventricular tachyarrhythmias

Front 6

Left-atrioventricular (AV) node and left deep cardiac plexus- predisposes

Back 6

to ectopic and ventricular fib

Front 7

Right vagus-via SA node and hyperactivity predisposes

Back 7

sinus bradyarrhythmias

Front 8

Left vagus- via AV node where hyperactivity predisposes to

Back 8

AV blocks

Front 9

What parasympathetics viceral afferent has strongest influence on the heart?

Back 9

Pulmonary branches

Front 10

Dysfunction of occipitomastoid suture, OA, AA, and C2 presumably produces effects through afferent activation of

Back 10

vagal reflexes

Front 11

What does the right lymphatic duct drain?

Back 11

Heart, parts of lung, R upper limb, head & neck

Front 12

Lymph nodes are innervated by the ___?_

Back 12

Sympathetic NS

Front 13

The Left Lymphatic Duct drains what?

Back 13

THORACIC DUCT: Rest of Body

Front 14

Diameter of Thoracic Ducts is under what control?

Back 14

Sympathetic Control

Front 15

Basically any change, new onset angina, angina at rest for first time, increasing severity or duration or frequency

Back 15

Unstable angina

Front 16

___ and ___ articulations are the most common sites for Musculoskeletal Chest Pain

Back 16

Costochondral and costosternal

Front 17

Direct pressure at ____ will reproduce pain and is essential part of CP workup

Back 17

articulations
"Musculoskeletal Chest Pain"

Front 18

Pain may be darting, last a few seconds, or a dull ache lasting hours or days

Back 18

Musculoskeletal Chest Pain

Front 19

redness and swelling with pain at the costosternal junction

Back 19

Tietzes Syndrome: type of Musculoskeletal Chest Pain

Front 20

Chapman reflex points =

Back 20

tender point in myofascial tissue with hyper-irritability, increased sweat gland activity, spasm and vasoconstriction

Front 21

What is usually underlying CAD.

Back 21

Coronary artery thrombosis

Front 22

What is the Compensatory response in MI?

Back 22

increased sympathetic tone, BP, HR, myocardial workload. Arrhythmias commonly associated

Front 23

What can a inappropriate parasympathetic tone in MI cause?

Back 23

blocks and bradycardia

Front 24

Why is there arm pain in MI?

Back 24

Visceral afferents facilitate the spinal cord segments resulting in pain, arm pain (due to dorsal root), and tissue texture changes.

Front 25

In an MI, what V-lvls are the Ventricular involvement?

Back 25

C8-T3

Front 26

In an MI, what V-lvls are the Atrial involvement?

Back 26

T4-6

Front 27

In an MI, what V-lvls are the Anterior infarct

Back 27

T2-3 on the LEFT

Front 28

In an MI, what V-lvls are the Inferior wall?

Back 28

T3-5 on LEFT, C2

Front 29

What is the Right pectoralis major trigger point associated with in a MI?

Back 29

supraventricular tachyarrhythmias due to sympathetics

Front 30

How can abnormal gait affect a person in Ischemic Heart Disease?

Back 30

increase cardiac work up to 300%

Front 31

In Ischemic Heart Disease, what is the OMM treatment for T1-6 Left?

Back 31

Indirect techniques to attenuate facilitation (esp. T2-3 Left in anterior wall MI)

Front 32

In Ischemic Heart Disease, what is the OMM treatment for OA?

Back 32

vagal normalization (esp. inferior wall MI)

Front 33

In Ischemic Heart Disease, what is the OMM treatment forChapman points?

Back 33

myocardium, renals, lungs

Front 34

What V lvls has shown a correlation with HTN for OMT?

Back 34

C6,T2,T6 somatic dysfunction pattern

Front 35

What is the OMM goal in HTN?

Back 35

Break the sympathicotonia cycle and delay stage of fixed HTN

Front 36

Chapman points in HTN

Back 36

posterior adrenal points T11-12- rotary stimulation

Front 37

Inability of heart to pump enough blood to meet oxygen requirements of body

Back 37

CHF

Front 38

Causes of CHF?

Back 38

MI, valvular disease, HTN, cardiomyopathies

Front 39

Arrhythmias with the right vagus

Back 39

SA node and sinus bradyarrhythmias

Front 40

Arrhythmias with the left vagus

Back 40

AV node and AV blocks

Front 41

____ branches of vagus produce the strongest inhibitory influence on the heart.

Back 41

Pulmonary

Front 42

Irritation of ___, ___, ___ will slow heart via visceral afferents that activate the vagal efferents

Back 42

larynx, carotid body pressure, oculocardiac reflex

Front 43

Sympathetic effects in Arrhythmias

Back 43

Increase tone results in increased heart rate and vasoconstriction. This leads to increase in cardiac irritability and subsequent arrhythmias.

Front 44

Right sided irritation in arrhythmias predisposes to ?

Back 44

SA node influence and supraventricular tachyarrhythmias (Travell’s pectoralis triggerpoint)

Front 45

Left sided irritation in arrhythmias predisposes to ?

Back 45

AV node and ventricular tachyarrhythmias or fibrillation

Front 46

Flattened thoracic kyphosis or crossover points in the upper thoracic area tend to periods of tachyarrhythmia with stress.Trigger point in the right pectoralis muscle is noted

Back 46

Structural diagnosis Arrhythmias

Front 47

What is the treatment goal in Post Sternotomy Patient “S/P CABG

Back 47

Increase movement of ribs, respiratory dynamics, increase lymphatic drainage

Front 48

What are the overall OMM Treatments for Post Sternotomy Patient “S/P CABG”

Back 48

Rib raising, BLT, Lymphatic Pump, Clavicular releases, Diaphragmatic release, OA release, MFR of the sternum

Front 49

What is Facilitation driven by

Back 49

nociception

Front 50

_____ is a loop within the interneuron network that lowers the threshold so that less nociceptive stimulus will cause the interneuron to fire

Back 50

Facilitation

Front 51

_____ synapse with an interneuron in the spinal cord

Back 51

Pain fibers (nociceptors)

Front 52

In CABG, The ____ is the pivot point and does not suffer strain.

Back 52

Costo-transverse junction

Front 53

In CABG, The rib heads are ___ into the vertebral bodies causing the most strain.

Back 53

compressed

Front 54

What ligaments can be damaged in CABG?

Back 54

Lateral costotransverse ligament, Superior costotransverse ligament, Radiate ligament

Front 55

What is the idea of treatment in CABG?

Back 55

restore normal motion in the mediastinum while it heals to prevent the development of a restrictive scar.

Front 56

What soft tissue is affected in CABG?

Back 56

parietal pleura, The phrenic nn. also supplies the abdominal diaphragm.

Front 57

Key Areas to Diagnose and Treat Cervical spine

Back 57

"Parasympathetics
Phrenic nerve"

Front 58

Key Areas to Diagnose and Treat Thoracic spine

Back 58

"Sympathetics
Chapman"

Front 59

Key Areas to Diagnose and Treat Thoracic Outlet

Back 59

Lympathics

Front 60

Key Areas to Diagnose and Treat Rib cage

Back 60

"Sympathetics
Lymphatics
Mechanical
Venous"

Front 61

Key Areas to Diagnose and Treat TA diaphragm

Back 61

"Lymphatics
Venous
Ventilatory Mechanics"

Front 62

"Sympathetics
____with synapses in upper thoracic and cervical chain ganglia."

Back 62

T1-6

Front 63

What is the Parasympathetic Innervation to the Heart?

Back 63

"Cranial Nerve X (Vagus)
Jugular foramen, OM suture, OA, AA, C2
Right and Left sided distribution
Right side= SA node
Left side= AV node
"

Front 64

"Weight reduction
Physical Activity
Smoking
Pharmacological
Diet
Stress reduction"

Back 64

Management of Cardiac Patient

Front 65

"Presentation: heaviness, pressure, burning, squeezing, smothering, choking
Typically caused by exertion, or emotion, and relieved by rest or sublingual Nitroglycerin"

Back 65

Stable angina

Front 66

"Radiating upper half of left chest
referral out and down the inner surface of arm and hand to the tips of fingers
refer up the neck and into the jaw"

Back 66

VS Reflex pain from coronary arteries

Front 67

"Palpatory findings
Areas of acute facilitation =

Back 67

acute, warm, boggy, edematous, T1-T6 Left"
Viscerosomatic Reflex physical findings Angina vs. Musculoskeletal CP

Front 68

What are the treatment goals in MI?

Back 68

"Decrease sympathetic hyperactivity
Decrease parasympathetic hyperactivity
Decrease lymphatic congestion
Consider- paraspinal inhibition, thoracic inlet,indirect to sternum/ribs, pectoral traction, diaphragm, C2, OA, CV4 for homeostasis and decrease stress"

Front 69

"What are the Management issues
Acute MI"

Back 69

"NO FORCEFUL DIRECT ACTION
Do not over treat
May need to treat in semi-recumbent position
“pumps” are too vigorous"

Front 70

"What are the Management issues
Chronic MI"

Back 70

"Upper thoracic motion
Diaphragm
OA and C2
Fascia- thoracic inlet"

Front 71

"Hyper activity to sympathetic stimuli
Prolonged sympathetic stimuli to kidneys creates functional retention of water and salt plus elevated arterial pressure
Inappropriate increased SVR"

Back 71

Essential Hypertension

Front 72

"HTN OMM Treatment
OA Release: _____
Rib Raising:_____
Cervicals: _____
Thoracolumbar junction: _____
Chapman’s Reflexes:_____
CV4: ______
Myofascial Trigger Points: _____"

Back 72

"OMM Treatment
OA Release: increase Vagal output
Rib Raising: inhibitory (attenuate facilitation)
Cervicals: carotid baroreceptors, cervical ganglions
Thoracolumbar junction: renals and RAS
Chapman’s Reflexes: myocardium, adrenals
CV4: fluid homeostasis and decrease stress
Myofascial Trigger Points: mobilize fluids"

Front 73

Treatment goals in HTN for OMM?

Back 73

"Treatment goals
Decrease excess sympatheticotonia
Decrease systolic and diastolic pressures
Stress reduction- facilitation response to decrease sympathetic stimulation"

Front 74

"Preload and afterload issues
Poor cardiac pump function with inadequate perfusion
Liver
Kidney
Brain
Problem filling the ventricles with “backward effect”
Consider autonomic innervation of large lymph channels
"

Back 74

Pathophysiology of CHF

Front 75

Treatment goals of CHF

Back 75

"Improve venous return
Improve lymphatic return
Diaphragms
Pectoralis lift
Lymphatic pump (NOT IN ACUTE PHASE)
Decrease abnormal workload due to structural problems
Improve thoracic cage compliance- improves autonomic tone
"

Front 76

Management ISSUES in CHF
Things not to do or take note of!

Back 76

"Do not treat in supine position during acute phase.
No forceful direct technique- acute
Do not over treat- acute
Care to liver and spleen due to friability from congestion."

Front 77

"OMM treatment for CHF
Lymphatic Pump: ______
Diaphragmatic Techniques: ______
Effluerage: _____
Clavicular releases: _____
CV4: _____
Release ___ ligament
of course: OA, thoracics, lumbar, Chapman pts, fascia, sternum
"

Back 77

"OMM treatment
Lymphatic Pump: fluid mobilization
Diaphragmatic Techniques: abdominal, thoracic, UG, popliteal fascias
Effluerage: mobilize peripheral fluid
Clavicular releases: promote thoracic duct drainage
CV4: fluid homeostasis and decrease stress
Release coronoid ligament
of course: OA, thoracics, lumbar, Chapman pts, fascia, sternum"

Front 78

Treatment goals in Arrhythmias

Back 78

"Decrease sympathetic hypertonicity
Remove trigger points involved in arrhythmias
Remove postural factors involved in arrhythmias"

Front 79

What are the Initial OMM Treatments for Post Sternotomy Patient “S/P CABG”

Back 79

"Improve breathing- scalenes and cervicals
Paraspinal tissues- gentle
Improve lymph-Indirect fascial for thoracic inlet
Diaphragm- indirect"

Front 80

What are the Long term OMM Treatments for Post Sternotomy Patient “S/P CABG”

Back 80

"Improve respiratory function
Improve ADLs"