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55 Cards in this Set
- Front
- Back
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Which sympathic levels are affected by heart dysfunction?
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T1-6
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SA node sympathetics
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right T1-6
hyperactivity predisposes to supraventricular tachyarrhythmias |
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AV node sympathetics
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left T1-6
hyperactivity predisposes to ectopic and Vfib |
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In a healthy heart, what does increased sympathetic tone do?
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increases force of contraction
shortens the time of systole increases ventricular output increases rate of contraction raises BP |
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Consequences of increased sympathetic tone
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constricts blood vessels throughout the body
vasospasm increases morbidity following myocardial infarction predisposes to arrhythmias inhibits development of collateral circulation adversely affects degree of recovery post MI |
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Vasculature of the arms receives sympathetic supply from which levels?
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T2-8
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Vasculature of the arms receives sympathetic supply from which levels?
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T11-L2
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SA node parasympathetics
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Right vagus
hyperactivity predisposes to sinus bradycardia |
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AV node parasympathetics
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Left vagus
hyperactivity predisposes to AV blocks |
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From which nerve roots does the vagus root receive fibers?
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C1 and C2 nerve roots
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Which other organ visceral afferents have the greatest affect on reflex bradycardia of the heart?
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pulmonary branches have the strongest influence
oculocardiac reflex, carotid body pressure and laryngeal irritation will reflexively slow rate |
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Parasympathetic innervation to the heart
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Cranial nerve X (vagus)
(jugular foramen, OM suture, OA, AA, C2) |
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Parasympathetics cause peripheral arteriolar innervation in which situations?
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Vessels of:
Face blush submax glands parotid glands tongue penis and clitoris (erection and engorgement) |
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Do parasympathetics usually cause vasodilation?
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only rarely
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What viscerosomatic reflex findings are found in ischemic myocardial disease?
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palpable soft tissue changes in the upper thoracic paraspinal region
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Heart anterior chapman points
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close to the sternum in the 2nd intercostal space BILATERALLY
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Heart posterior chapman points
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midway between the SP and the tips of the TP in the space between the TP of T2 and T3 BILATERALLY
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Adrenals posterior chapman points
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intertransverse spaces of T11 and T12 midway between the SP and the TP BILATERALLY
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Adrenals anterior chapman points
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lateral aspect of the rectus abdominus at the level of the inferior margin of the costal margin
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What happened in one study when posterior chapman's points to the adrenals were treated in hypertensive patients?
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BP dropped 15 mmHg systolic and 8 mmHg diastolic
serum aldosterone levels decreased 36 hours post-OMT |
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What does rotary stimulation of the posterior adrenal Chapman's points do?
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lowers BP and decreases serum aldosterone levels
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Pts with flattening of the thoracic kyphosis or postural crossovers in the upper thoracics tend to develop _______ when subjected to other stressors
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tachyarrhythmias
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What is the trigger point for supraventricular tachyarrhythmias?
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right pectoralis muscle just below the 5th rib in the midclavicular line
**treatment of this trigger point makes dysrhythmia disappear |
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What does abnormal gait do to cardiac work
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increase cardiac work by 300%
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To where does the heart usually drain lymphatics?
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predominantly to the right lymphatic duct
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What does hypersympathetic activity do to the lymphatics?
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can reduce lymphatic flow
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Which body parts does the right lymphatic duct drain?
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heart, lungs, liver, right upper limb, head and neck
**80% to the right brachiocephalic turnk |
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What does the right jugular trunk drain and to where does it go?
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drains head and neck and goes to the right lymphatic duct
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What does the right bronchomediastinal trunk drain and to where does it go?
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drains heart, lungs and liver and goes to the right lymphatic duct
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What does the right subclavian trunk drain and to where does it go?
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drains the right upper limb and goes to the right lymphatic duct
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What are the different trunks that drain to the left lymphatic (thoracic) duct?
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left jugular, left subclavian, left bronchiomediastinal
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Which autonomic NS system innervates the lymph nodes?
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sympathetics
**diameter of the thoracic duct is under sympathetic control |
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Faciliation
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When the a pool of neurons or preganglionic sympathetic neurons are maintained in a state of partial or subthreshold excitation; in this state, less afferent stimulation is required to trigger the discharge of impulses
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Which techniques/areas can you work to treat sympathetics in a cardiac pt?
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cervical ganglion
rib raising T1-6 Chapman's reflexes T10-L1 (Adrenal and Kidney) |
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Which techniques/areas can you work to treat parasympathetics in a cardiac pt?
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OA
AA Cranial **All vagus nerve |
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Which techniques/areas can you work to treat lymphatics in a cardiac pt?
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thoracic inlet
abdominal diaphragm rib raising lymphatic pump |
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Management of Acute MI
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NO FORCEFUL DIRECT ACTION
Do not over treat may need to treat in semi-recumbent position "pumps" are too vigourous |
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Management of Chronic MI
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upper thoracic motion
diaphragm OA and C2 Fascia thoracic inlet |
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HTN Osteopathic treatment
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Reduce stress (decrease facilitation)
decrease sympathetic tone encourage parasympathetic tone improve lymph drainage address chapman's reflexes for kidney's and adrenals |
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CHF osteopathic treatment goals
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improve venous return
improve lymphatic return = diaphragm, pectoralis lift, lymphatic pump (but not in acute phase) decrease abnormal workload due to structural problems improve thoracic cage compliance--improves autonomic tone |
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Arrhythmias osteopathic treatment
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decrease sympathetic tone
remove trigger points involved in arrhythmias removed postural factors involved in arrhythmias |
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Post Sternotomy (S/P CABG) treatment
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increase movement of ribs, respiratory dynamics, increase lymphatic drainage
OMT txs: Rib raising BLT Lymphatic Pump Clavicular releases Diaphragmatic release OA release MFR of sternum |
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What drives facilitation?
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nociception = pain fibers (nociceptors) synapse with an interneuron in the spinal cord. A signal strong enough to overcome the minimum threshold will be relayed to the brain as pain. Becomes a loop that lowers the threshold of a nociception stimulus. Normal stimulus = perceived as painful and causes hypersympathetonia
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CABG
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Post-Coronary Artery Bypass Graft
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BLT
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Balanced Ligamentous Tension (Bilateral Posterior thoracic cage release)
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Sibson's Facia Release
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Direct myofacial release
used in Post-CABG |
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What was OMT Post-CABG proven to do for pts?
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provided decreased central blood volume suggesting peripheral circulation
mixed venous oxygen sat increased improvement in cardiac index |
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Hypertension reflex
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C6, T2,T6
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What are the goals of rib raising?
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normalize sympathetic activity
improve lymphatic return encourages maximum inhalation--more effective negative intrathoracic pressure |
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treatment of posterior cervical tender points
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extend and SARA
EXCEPT: C1 (inion) = Flex only C3 = Flex and STRAw |
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treatment of anterior cervical tender points
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flex and SARA
EXCEPT: C1 (inion) = rotate away C7 = Flex and STRAw |
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Anterior T1 Tender point
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location = midline episternal notch
tx = flexion |
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Anterior T2 tender point
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location = midline, junction of manubrium and sternum (angle of Louis)
tx = flexion |
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Anterior T3-5 tender point
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midline at level of corresponding rib
tx = flexion |
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Anterior T6 tender point
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midline xiphoid-sternal junction
tx = flexion |
