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80 Cards in this Set
- Front
- Back
Sympathetics fibers from the right heart tend to pass to the
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right deep cardiac plexus to innervate the right heart and the sinoatrial (SA) node.
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Hypersympathetic activity of the right heart side predisposes to
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supraventricular tachyarrhythmias
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The fibers from the left sympathetic heart tend to innervate the
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left deep cardiac plexus and the atrioventricular (AV) nodes
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Hypersympathetic activity of the left heart side predisposes to
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ectopic foci and ventricular fibrillation.
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Right- sinoatrial (SA) node and right deep cardiac plexus– predisposes to
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supraventricular tachyarrhythmias
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Left-atrioventricular (AV) node and left deep cardiac plexus- predisposes
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to ectopic and ventricular fib
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Right vagus-via SA node and hyperactivity predisposes
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sinus bradyarrhythmias
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Left vagus- via AV node where hyperactivity predisposes to
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AV blocks
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What parasympathetics viceral afferent has strongest influence on the heart?
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Pulmonary branches
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Dysfunction of occipitomastoid suture, OA, AA, and C2 presumably produces effects through afferent activation of
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vagal reflexes
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What does the right lymphatic duct drain?
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Heart, parts of lung, R upper limb, head & neck
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Lymph nodes are innervated by the ___?_
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Sympathetic NS
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The Left Lymphatic Duct drains what?
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THORACIC DUCT: Rest of Body
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Diameter of Thoracic Ducts is under what control?
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Sympathetic Control
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Basically any change, new onset angina, angina at rest for first time, increasing severity or duration or frequency
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Unstable angina
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___ and ___ articulations are the most common sites for Musculoskeletal Chest Pain
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Costochondral and costosternal
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Direct pressure at ____ will reproduce pain and is essential part of CP workup
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articulations
"Musculoskeletal Chest Pain" |
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Pain may be darting, last a few seconds, or a dull ache lasting hours or days
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Musculoskeletal Chest Pain
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redness and swelling with pain at the costosternal junction
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Tietzes Syndrome: type of Musculoskeletal Chest Pain
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Chapman reflex points =
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tender point in myofascial tissue with hyper-irritability, increased sweat gland activity, spasm and vasoconstriction
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What is usually underlying CAD.
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Coronary artery thrombosis
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What is the Compensatory response in MI?
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increased sympathetic tone, BP, HR, myocardial workload. Arrhythmias commonly associated
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What can a inappropriate parasympathetic tone in MI cause?
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blocks and bradycardia
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Why is there arm pain in MI?
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Visceral afferents facilitate the spinal cord segments resulting in pain, arm pain (due to dorsal root), and tissue texture changes.
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In an MI, what V-lvls are the Ventricular involvement?
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C8-T3
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In an MI, what V-lvls are the Atrial involvement?
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T4-6
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In an MI, what V-lvls are the Anterior infarct
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T2-3 on the LEFT
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In an MI, what V-lvls are the Inferior wall?
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T3-5 on LEFT, C2
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What is the Right pectoralis major trigger point associated with in a MI?
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supraventricular tachyarrhythmias due to sympathetics
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How can abnormal gait affect a person in Ischemic Heart Disease?
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increase cardiac work up to 300%
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In Ischemic Heart Disease, what is the OMM treatment for T1-6 Left?
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Indirect techniques to attenuate facilitation (esp. T2-3 Left in anterior wall MI)
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In Ischemic Heart Disease, what is the OMM treatment for OA?
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vagal normalization (esp. inferior wall MI)
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In Ischemic Heart Disease, what is the OMM treatment forChapman points?
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myocardium, renals, lungs
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What V lvls has shown a correlation with HTN for OMT?
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C6,T2,T6 somatic dysfunction pattern
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What is the OMM goal in HTN?
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Break the sympathicotonia cycle and delay stage of fixed HTN
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Chapman points in HTN
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posterior adrenal points T11-12- rotary stimulation
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Inability of heart to pump enough blood to meet oxygen requirements of body
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CHF
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Causes of CHF?
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MI, valvular disease, HTN, cardiomyopathies
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Arrhythmias with the right vagus
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SA node and sinus bradyarrhythmias
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Arrhythmias with the left vagus
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AV node and AV blocks
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____ branches of vagus produce the strongest inhibitory influence on the heart.
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Pulmonary
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Irritation of ___, ___, ___ will slow heart via visceral afferents that activate the vagal efferents
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larynx, carotid body pressure, oculocardiac reflex
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Sympathetic effects in Arrhythmias
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Increase tone results in increased heart rate and vasoconstriction. This leads to increase in cardiac irritability and subsequent arrhythmias.
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Right sided irritation in arrhythmias predisposes to ?
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SA node influence and supraventricular tachyarrhythmias (Travell’s pectoralis triggerpoint)
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Left sided irritation in arrhythmias predisposes to ?
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AV node and ventricular tachyarrhythmias or fibrillation
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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
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Structural diagnosis Arrhythmias
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What is the treatment goal in Post Sternotomy Patient “S/P CABG
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Increase movement of ribs, respiratory dynamics, increase lymphatic drainage
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What are the overall OMM Treatments for Post Sternotomy Patient “S/P CABG”
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Rib raising, BLT, Lymphatic Pump, Clavicular releases, Diaphragmatic release, OA release, MFR of the sternum
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What is Facilitation driven by
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nociception
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_____ is a loop within the interneuron network that lowers the threshold so that less nociceptive stimulus will cause the interneuron to fire
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Facilitation
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_____ synapse with an interneuron in the spinal cord
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Pain fibers (nociceptors)
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In CABG, The ____ is the pivot point and does not suffer strain.
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Costo-transverse junction
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In CABG, The rib heads are ___ into the vertebral bodies causing the most strain.
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compressed
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What ligaments can be damaged in CABG?
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Lateral costotransverse ligament, Superior costotransverse ligament, Radiate ligament
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What is the idea of treatment in CABG?
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restore normal motion in the mediastinum while it heals to prevent the development of a restrictive scar.
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What soft tissue is affected in CABG?
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parietal pleura, The phrenic nn. also supplies the abdominal diaphragm.
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Key Areas to Diagnose and Treat Cervical spine
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"Parasympathetics
Phrenic nerve" |
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Key Areas to Diagnose and Treat Thoracic spine
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"Sympathetics
Chapman" |
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Key Areas to Diagnose and Treat Thoracic Outlet
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Lympathics
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Key Areas to Diagnose and Treat Rib cage
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"Sympathetics
Lymphatics Mechanical Venous" |
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Key Areas to Diagnose and Treat TA diaphragm
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"Lymphatics
Venous Ventilatory Mechanics" |
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"Sympathetics
____with synapses in upper thoracic and cervical chain ganglia." |
T1-6
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What is the Parasympathetic Innervation to the Heart?
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"Cranial Nerve X (Vagus)
Jugular foramen, OM suture, OA, AA, C2 Right and Left sided distribution Right side= SA node Left side= AV node " |
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"Weight reduction
Physical Activity Smoking Pharmacological Diet Stress reduction" |
Management of Cardiac Patient
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"Presentation: heaviness, pressure, burning, squeezing, smothering, choking
Typically caused by exertion, or emotion, and relieved by rest or sublingual Nitroglycerin" |
Stable angina
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"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" |
VS Reflex pain from coronary arteries
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"Palpatory findings
Areas of acute facilitation = |
acute, warm, boggy, edematous, T1-T6 Left"
Viscerosomatic Reflex physical findings Angina vs. Musculoskeletal CP |
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What are the treatment goals in MI?
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"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" |
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"What are the Management issues
Acute MI" |
"NO FORCEFUL DIRECT ACTION
Do not over treat May need to treat in semi-recumbent position “pumps” are too vigorous" |
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"What are the Management issues
Chronic MI" |
"Upper thoracic motion
Diaphragm OA and C2 Fascia- thoracic inlet" |
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"Hyper activity to sympathetic stimuli
Prolonged sympathetic stimuli to kidneys creates functional retention of water and salt plus elevated arterial pressure Inappropriate increased SVR" |
Essential Hypertension
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"HTN OMM Treatment
OA Release: _____ Rib Raising:_____ Cervicals: _____ Thoracolumbar junction: _____ Chapman’s Reflexes:_____ CV4: ______ Myofascial Trigger Points: _____" |
"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" |
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Treatment goals in HTN for OMM?
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"Treatment goals
Decrease excess sympatheticotonia Decrease systolic and diastolic pressures Stress reduction- facilitation response to decrease sympathetic stimulation" |
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"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 " |
Pathophysiology of CHF
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Treatment goals of CHF
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"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 " |
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Management ISSUES in CHF
Things not to do or take note of! |
"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." |
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"OMM treatment for CHF
Lymphatic Pump: ______ Diaphragmatic Techniques: ______ Effluerage: _____ Clavicular releases: _____ CV4: _____ Release ___ ligament of course: OA, thoracics, lumbar, Chapman pts, fascia, sternum " |
"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" |
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Treatment goals in Arrhythmias
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"Decrease sympathetic hypertonicity
Remove trigger points involved in arrhythmias Remove postural factors involved in arrhythmias" |
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What are the Initial OMM Treatments for Post Sternotomy Patient “S/P CABG”
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"Improve breathing- scalenes and cervicals
Paraspinal tissues- gentle Improve lymph-Indirect fascial for thoracic inlet Diaphragm- indirect" |
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What are the Long term OMM Treatments for Post Sternotomy Patient “S/P CABG”
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"Improve respiratory function
Improve ADLs" |