Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OPP III Exam 1 > 9-2 CV Cases > Flashcards

9-2 CV Cases Flashcards

1
Q

What are the limits of Osteopathy?

A

No one knows the limits of Osteopathy.”

John Martin Littlejohn

(except peer-reviewed literature)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

—Is Osteopathy only useful for treating musculoskeletal pain and injuries?

A

No - viscerosomatic reflexes, and somatovisceral input

Also, use of lymph techniques and other circulatory enhancing tachniques to improve venous return, possibly preload if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

—Where does the sympathetic innervation of the heart have its origins? Where are the synapses?

A

—Cord segments T1-5(6)
—Synapses occur in the upper thoracic and/or cervical chain ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Does SNS fiber distribution to the heart have something unusual about it? Is it perfectly symmetrical?

A

—Sympathetic fibers to the heart do have a right- and left-sided distribution

—Right sided fibers pass to the right deep cardiac plexus - innervate the right heart and sinoatrial (SA) node
—Left sided fibers pass to left deep cardiac plexus – innervate left heart and atrioventricular (AV node)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

—What is the result of hypersympathetic activity (tone) to the right side of the heart (SA node)?

A

—Supraventricular tachyarrhythmias
—Sinus tachycardia
—Paroxysmal supraventricular tachycardia (PSVT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

—What is the result of hypersympathetic activity (tone) to the left side of the heart (AV node)?

A

—Ectopic foci
—Ventricular tachycardia
—Ventricular fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

—What type of somatic dysfunction can increase sympathetic activity (tone) to the heart?

A

—Upper thoracic dysfunction (especially extended segments)
—Upper rib dysfunction, many times associated with upper thoracic dysfunction
—Cervical dysfunction – affecting the superior, middle and inferior cervical ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

—Where does the parasympathetic innervation of the heart have its origins?

A

—Vagus nerves (cranial nerve 10)

—Also have ipsilateral distribution:
—Right vagus – innervates the sinoatrial (SA) node
—Left vagus – innervates atrioventricular (AV) node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

—What is the result of hyperparasympathetic activity (tone) to the right side of the heart (SA node)?

A

Sinus Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

—What is the result of hyperparasympathetic activity (tone) to the left side of the heart (AV node)?

A

—AV Blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

—What is the course of the vagus nerve (cranial nerve 10)?

A

—Originates on the medulla
—Exits the skull via the jugular foramen between the occipital and temporal bones
—Has connections with the first 2 cervical somatic nerves
—Enters the chest via the thoracic inlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

—What types of somatic dysfunction can affect the vagus nerves?

A

—Occipitomastoid compression affecting the jugular foramen

—Occiput, atlas and axis (upper cervical spine)

—Thoracic inlet:
—Upper thoracics
—Upper ribs
—Clavicles
—Lower cervicals
—Cervical fascia
—ECT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is lymph drainage from the heart and lungs taken care of? Where does it drain, and what is the course of the lymph vessels? What drives this movement?

A

—Lymphatic drainage from heart and lungs primarily carried back to the heart via the right lymphatic duct
—Courses through the thoracic inlet on the way back into the heart
—Driven by synchronized diaphragmatic function and muscle activity – overall body movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the relative dist of the body in terms of what each lymph vessel drains:

right lymphatic duct

left lymphatic duct

A

right lymphatic duct

  • heart and lungs, right half of neck and head, right arm and shoulder

left lymphatic duct

  • everything else
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What 2 treatment modalities (other than drugs) that can improve lymph flow, and by how much?

A

—OMM, in dog studies, can improve lymphatic flow by 4-5 times
—

Exercise can improve lymphatic flow by 30+ times
—

We can combine both for the benefit of the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

—What are some areas of somatic dysfunction that can negatively affect lymphatic flow?

A

—Thoracic inlet
—Respiratory diaphragm
—Lower thoracics
—Lower ribs
—Upper lumbars (psoas major muscle)
—Sympathetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are Chapman’s reflexes?

A

—Chapman’s Reflexes
—A viscerosomatic reflex mechanism
—Associated with palpable nodules deep to skin and subcutaneous tissue
—Can be used for diagnosis and treatment
—Can be used to affect heart, renal and adrenal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can take a patient closer to threshold of sx and disease?

A

Allostatic load

  • SD anywhere affects the individual locally and globally

—Stressors/imbalance that takes them closer to the threshold of symptoms and disease-activates SNS-HPA couple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SD is frequently associated with what type of activity?

A

Hypersympathetic activity

—Example – upper thoracic dysfunction may be associated with local hypersympathetic tone to innervated structures but also a global increase in sympathetic tone throughout the body

—Overall, the entire individual is closer to their threshold for firing , more susceptible to imbalance and closer to the threshold for symptoms and disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is increased allostatic load associated with?

A

—Increased allostatic load may contribute to breakdown of the cardiovascular, immune, renal, gastrointestinal and central nervous systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How should osteopaths treat allostatic load - what is the philosophy?

A

—Our job – to work knowingly with the system to allow health to manifest itself
—As a result, multiple layers of dysfunction are removed to allow the underlying health to shine through

—It is not a sequence of wresting holds to mindlessly apply to disease conditions
—Osteopathy is art and science integrated into one

—The overall result of a competently applied Osteopathic treatment is to improve the health, function and motion of the individual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Do our genes/DNA just randomly think for themselves?

A

—Probably not! Epigenetics look at the genes as responding to multiple environmental signals that go into them

—Positive signals may produce positive epigenetic expression and vice versa
—Epigenetic abnormalities may be passed on for multiple generations unless the environmental signals are altered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

—What are some negative environmental signals that may have a negative impact on gene expression?

A

—Poor nutrition
—Toxic thoughts/mental stress
—Physical stress
—Environmental toxins
—Somatic dysfunction
—Others???

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How common is HTN? What is it a risk factor for?

A

—Affects a significant amount of the US population

—Is a risk factor for:

coronary heart disease,

congestive heart failure,

ischemic and hemorrhagic stroke,

renal failure and

peripheral arterial disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

—What determines arterial pressure?

A

Cardiac output

and

peripheral resistance

26
Q

What determines cardiac output?

A

stroke volume

heart rate

27
Q

What determines peripheral resistance?

A

vascular structure

vascular function

28
Q

—What is the most common cause of hypertension?

A

—Essential
—We don’t know what causes it

—Harrison’s Principles of Internal Medicine describes multiple contributing factors including increased sympathetic activity
—Some antihypertensive medications work by reducing sympathetic effects

—Renin-angiotensin-aldosterone system – involved in the regulation of arterial pressure via:
—Angiotensin II (vasoconstrictor)
—Aldosterone (sodium retention)

29
Q

Renin is synthesized by what in response to?

A

synthesized by juxtaglomerular cells

In response to:
—Decreased pressure or stretch within the renal afferent arteriole (baroreceptor mechanism)
—Sympathetic nervous system stimulation of renin-secreting cells

30
Q

—How can somatic dysfunction contribute to elevated blood pressure and hypertension?

A

—Upper thoracic dysfunction can facilitate increased sympathetic tone to the heart
—Increased heart rate
—Increased stroke volume

31
Q

What SD can affect the kidneys?

A

Somatic dysfunction in the thoracic and lumbar regions (especially T6-L2) can facilitate increased sympathetic tone to the adrenal gland and kidney

32
Q

HTN and SD can work together to make each other worse. How is this done?

A

—Will facilitate catecholamine release from adrenals – resulting in increased cardiac output and peripheral resistance

—Will activate renin-angiotensin-aldosterone system – resulting in vasoconstriction (increased vascular resistance) and sodium and fluid retention via aldosterone

33
Q

What techniques can reduce sympathetic tone?

A

thoracolumbar junction

chapman’s reflexes

34
Q

What can decrease ADH’s effect of increasing aldosterone in treating HTN?

A

Free SB symphysis

35
Q

What techniques are helpful in treating retained fluids and electrolytes?

A

Fascial techniques

36
Q

What types of SD can also alter carotid receptor fxn and contribute to alterations in BP?

A

—Somatic dysfunction affecting the:

cranium (SBS compression, occipitomastoid compression affecting jugular foramen),

occiput,

atlas and

remainder of cervical spine

  • may alter carotid receptor function and contribute to alterations in blood pressure
37
Q

What treatments can affect CN IX, X effect on baroreceptors, decreasing peripheral resistance?

A

OA

Cervical tissues

38
Q

What can reduce ANS contributions to increased peripheral resistance (what treatments)?

A

Decrease Sympathetics

ribs

chain ganglion

39
Q

How can you reduce allostatic load in the patient?

A

—Treat the entire patient Osteopathically to overall reduce the allostatic load

40
Q

What areas should you pay special attention to in HTN and CV cases?

A

—Pay special attention to the cranial mechanism, cervicals, upper thoracics and thoracolumbar junction

—Don’t forget Chapman’s reflexes

41
Q

—A 30 year old male presents for an initial routine physical. He has not seen a physician for 12 years and has no complaints.
—Review of systems negative
—Medical histories noncontributory
—Vitals Temp 99.0F, BP 145/95, Pulse 70, Respirations 14
—Physical exam – normal
—What is the diagnosis?

A

MI

42
Q

—A 30 year old male presents for an initial routine physical. He has not seen a physician for 12 years and has no complaints.
—Review of systems negative
—Medical histories noncontributory
—Vitals Temp 99.0F, BP 145/95, Pulse 70, Respirations 14
—Physical exam – normal

—How will you manage it?

What is the common COD?

A

—Most common cause of death within the 1st 24 hours is ventricular fibrillation (50% occur within 1st hour)
—Treat them sooner versus later

43
Q

MI is associated with what SD?

A

—Many demonstrate autonomic imbalance
—Dysfunction at T2-3 on left in patients with anterior wall MI
—Dysfunction at C2 and cranial base (vagus) with inferior wall MI

44
Q

What is the OMM treatment goal with an MI?

A

—Goals:
— Bring autonomic balance back to the cardiovascular system
—Prevent ventricular fibrillation
—Reducing sympathetic tone will cause dilation of the coronary arteries – improved myocardial perfusion

—Improve arterial supply and venous and lymphatic drainage to heart

45
Q

What techniques should you not use with a suspected MI?

A

—Avoid HVLA technique (especially to the upper thoracics) during the initial management.

46
Q

Why should you not use HVLA with a suspected MI?

A

—HVLA can cause a short-term increase in sympathetic activity
—May result in vasoconstriction of coronary arteries and extend infarct

47
Q

When treating a patient for MI:

Again, treat the whole patient Osteopathically to improve function and motion but pay special attention to the

A

—Cranial mechanism (CV 4 helps balance autonomics)
—Cervical spine (Vagus)

48
Q

What are some more good techniques for using OMM to treat an MI?

A

—Upper thoracic spine and upper ribs
—Thoracolumbar junction
—Chapman’s reflexes affecting heart, adrenals and kidneys

—Gentler techniques are initially a better option!

49
Q

—A 48-year-old male is brought to your emergency department via ambulance with chest pain of 45 minutes duration. A 12-lead EKG is suggestive of an inferior wall MI
—What do you do?

A

MONA, no HVLA

50
Q

What is CHF associated with?

A

—Clinical syndrome associated with:
—Intravascular and interstitial volume overload
—Inadequate tissue perfusion

51
Q

What are the symptons of CHF?

A

—Fatigue and SOB most common
—Also see anorexia, nausea, early satiety associated with abdominal pain/fullness, confusion, disorientation, sleep/mood disturbances and nocturia

52
Q

What is the pathogenesis of CHF?

A

Pathogenesis – progressive disorder
—Something damages the heart muscle or reduces its ability to generate force (contract)
—Many causes including coronary artery disease, MI, hypertension, toxic damage (excessive alcohol), viral infection, etc.
—Regardless of cause, result is overall decline in pumping capacity of heart

—Vicious downward spiral develops due to activation of neurohormonal systems

53
Q

What is the spiral of CHF?

A

Decreased CO
—– unloading of high-pressure baroreceptors in left ventricle, carotid sinus and aortic arch

—Afferent signals to CNS – releases ADH (antidiuretic hormone)
—Reabsorption of free water
—Activation of sympathetic efferents to heart, kidney, peripheral vasculature and skeletal muscles

54
Q

In the ‘spiral’ of CHF, sympathetic stimulation of the kidney is associated with?

A

—Release of renin and activation of renin-angiotensin-aldosterone pathway
—Salt and water retention
—Vasoconstriction and increased vascular resistance
—Myocyte hypertrophy
—Myocyte death
—Myocardial fibrosis

55
Q

What is the goal of OMM in treating CHF?

A

—Goal is to break into the downward spiral
—Reduce intravascular and interstitial volume overload (improve renal function)
—Improve tissue perfusion
—Optimize cardiac function

56
Q

When treating CHF osteopathically what should you pay special attention to?

A

Treat entire patient Osteopathically but especially pay attention to:
—Cranial mechanism
—Cervical spine
—Upper thoracics
—Thoracolumbar junction (kidneys and adrenals)
—Lymphatics (thoracic inlet, respiratory and other diaphragms)

—Proceed slowly - these patients can be very fragile!

57
Q

Exercise is a key treatment for CHF. What does it improve?

A

—Autonomic nervous system function
—Regional blood flow
—Endothelial function
—Skeletal muscle function
—Quality of life

58
Q

Exercise training can improve exercise duration by how much?

A

—Exercise training can improve exercise duration as much as pharmaceutical agents (digoxin and ACE inhibitors)

59
Q

What can an osteopath combine to help provide the best outcome for CHF?

A

—We combine exercise, pharmacologic management and OMM for best possible outcomes

—Manage other comorbid conditions including hypertension, diabetes, thyroid disease, etc.

60
Q
A

OPP III Exam 1 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions