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31 Cards in this Set
- Front
- Back
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What are the sympathetic innervations to the heart?
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T1-T5 synapsing with the thoracic and cervical chain ganglia.
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where is the stellate ganglia located and what does it do
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located anterior to TP of C7 and head of rib1 and sometimes rib 2
aka cervicothoracic ganglia contributes to sympathetics to the heart |
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talk about the path the RIGHT sympathetic fibers take to the heart
Increased sympathetic tone to right sided heart --> ????? |
Right sympathetic fibers Right deep cardiac plexus to innervate the right heart and SA node.
Increased sympathetic tone to right sided heart Predisposition for supra-ventricular tachyarrhythmias IMPORTANT** |
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Left sympathetic fibers Left deep cardiac plexus AV node
Increased sympathetic tone ???? |
Increased sympathetic tone predisposition for ectopic beats and ventricular fibrillation.
2nd'ary syndromes Increased sympathetic tone to the coronary vessels has been linked to coronary vasospasm. Prolonged increased sympathetic tone to the heart decreases the heart’s ability to form collateral circulation. An imbalance between the right and left stellate ganglioionic sympathetic impulses to the heart has been postulated as being the mechanism for causing some ventricular arrhythmias in some long Q-T syndromes. |
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Decreased sympathetic tone to the heart will lead to:
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Decreased venous return
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right vagus nerve innervates what
left vagus nerve innervates... |
Right Vagus n. innervates the SA node
Left vagus innervates the AV node. |
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Increased parasympathetic tone to the right vagus -->
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predisposes heart to bradyarhythmias
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Increased parasympathetic tone to the left vagus (AV node) predisposes the heart to ?????.
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Increased parasympathetic tone to the AV node predisposes the heart to AV block.
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Somatic dysfunctions at what areas could have an effect on the vagus nerve?
KNOW THESE |
Somatic dysfunctions at the OM suture, OA, AA and / or C2 can affect the vagal reflexes.
Jugular foramen (occiput & temporal bones) C2 has a branch feeding the vagus KNOW THIS SLIDE |
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Vagus exits the skull through the ____
Basi-occiput & petrous portion of the temporal bone are borders of the ____ |
Treatment of the O-A is an often-cited method for optimizing the Vagal Supply to the Viscera
JUGULAR FORAMEN |
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you want to ___ the parasympathetics
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YOU WANT TO NORMALIZE THEM
as opposed to increasing or decreasing the sympathetics |
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talk about autonomics of the circulatory system
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Sympathetics to circulation are generally unopposed:
Except: submaxillary gland, parotid, blush region of the face, the tongue and the penis. Note: Increased sympathetics to T10-11 and its relationship to HTN. (think renal!) |
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increased sympathetic tone at T10-T11 can lead to what
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KIDNEY STIM --> incr. peripheral resist --> decr glomerular filtration --> incr ADH --> incr aldosterone --> retained fluids and electrolytes --> INCR BP
ADRENAL --> release catecholamines --> Incr CO and peripheral resistance --> INCR BP! KNOW THESE PATHWAYS |
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The endocardium, myocardium and epicardium drain primarily through the
KNOW THIS AND KNOW WHERE IT IS |
right lymphatic duct
runs above apex of right lung. Drains into the right subclavian v. |
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The pericardium drains primarily through the
KNOW THIS AND KNOW WHERE IT IS |
thoracic duct
runs above apex of left lung. Drains into the left subclavian v. |
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Thoracic duct runs from below diaphragm on right at the Cysterna Chyli and crosses to the left around the level of
KNOW THIS AND KNOW WHERE IT IS |
T5-T6.
Restriction here can cause decreased lymph drainage |
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Thoracic duct drains into the
KNOW THIS AND KNOW WHERE IT IS |
eft subclavian v
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The thoracic duct and large lymphatic vessels are under
KNOW THIS AND KNOW WHERE IT IS |
sympathetic control
Therefore: increased sympathetics can increase pumping of lymph. This effect is theorized to be more to modify immune response rather than increase flow through vessels. |
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If lymphaticovenous systems fail to function...
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the rate of edema of limbs and organs in congestive heart failure may be increased or resolution may be impeded.
Impaired lymphatic drainage from the heart is known to severely compromise homeostasis and has been implicated in reduced collateral circulation and increased morbidity and mortality from ischemia and infection. |
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Impaired flow of lymphatics can lead to
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Increased central venous pressure
Increased tissue congestion decreased O2 and nutrients to the myocardium Increase the size from an MI Increase the risk of subacute bacterial endocarditis |
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Where would you expect to find palpable changes relating to viscerosomatic reflexes from the heart?
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Viscerosomatic reflexes at T1-5 on left (heart)
Acute viscerosomatic reflexes Warm, moist, boggy, edematous Chronic viscerosomatic reflexes firm, dry sponginess, joint is “really stuck” , rubbery end-point Chapman’s reflexes at the left second intercostal space (between ribs 2 & 3) near the sternum and posteriorly between the transverse processes (TPs) T2 and T3 |
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a chapman point is
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a neurolympathic reflex
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where are chapman's points for HTN (1st the kidney then adrenal)
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Adrenal Function Chapman’s Point
Anterior: 1 inch lateral & 2 inches superior to umbilicus Posterior: Intertransverse space between T11 & T12 Kidney Chapman’s points Posterior: Intertransverse space between L1 & L2 Anterior: 1 inch superior and 1 inch lateral to the umbilicus. Viscerosomatic reflexes from the kidneys at T10 and T11 |
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Pectoralis Major Trigger point on right has been associated with
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supraventricular tachyarrhythmias
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Pectoralis Trigger Point for Arrhythmias
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Right Pectoralis Major, below the Right Rib 5 margin, half way between the sternal margin & the nipple line
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Left sided Pectoralis Major trigger point
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Trigger Points of the Left Pectoralis Major May (somewhat) Resemble “Referred” Pain Pattern of Heart
Hallmark of a Trigger Point is that the pain travels from the site of Tenderness in a characteristic pattern Reproducible Muscular Pain and characteristic pattern may aid clinical Dx & Tx |
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osteopathic findings in mitral valve prolapse
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MVP
Systolic murmur with click at the apex of the heart. Associated with a Flattened thoracic kyphosis |
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tx of MI (osteopathic)
long list - use soft gentle indirect techniques! |
Treat T2-3 on left, rib raising (reducing sympathetics.)
Post-chest compressions- ribs/sternum-indirect C2 & Cranial base dysfunction (vagal…parasymp) Use indirect if you can Paraspinal inhibition to decrease the total peripheral resistance and cardiac workload (sympathetics) Thoracic inlet (lymphatics, stellate ganglion) Hyoid fascial connection to mediastinum (lymphatics) Pectoral traction to increase lymphatic return Doming of diaphragm (better motion; lymphatics) CV4 fluid homeostasis, decrease stress levels (parasympathetics) |
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tx of HTN pt
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T1-T5 (sympathetics to heart)
T10-11 (sympathetics to kidneys) Treat All sympathetics (rib raising, chain ganglia) to decrease total peripheral resistance Chapman’s points for the adrenal glands and kidneys. OMT should be slow, gentle augment rest and relaxation, promote autonomic balance and release fascial contractures. OA, OM (parasympathetics) CV4, Fascia- Lymphatics, body fluids Ribs, gentle OMT- ANS, stress reduction/relaxation T-L junction/chapman’s – ANS, balance rennin-angiotensin |
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tx of arrhythmias
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Decrease sympathetic tone
Cervical ganglion, rib raising T1-T5 Modify vagal tone ocular pressure, carotid massage, valsalva maneuver treat occiput, OA-AA, C2 Tx pectoral trigger point |
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Treating Congestive Heart Failure
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Lymphatics- lymphatic pump, effleurage
Help to decrease inefficiency of the dilated Thoracic Duct Restore lymph flow to more physiologic levels Treat the diaphragm and thoracic cage Optimal respiratory function is vital for the maintenance of treatment effects directed at lymphatic and venous return. |
