Lecture 3: OAT Cardiopulmonary Patient

Question 1

At which cobb angles does exercise capacity become effected; at what angles is their respiratory and cardiovascular compromise?

Answer 1

• 5-15° = mild = exercise capacity decreased
• >50° = respiratory compromised
• >75° = CV compromised

Question 2

Length of stride (gait) in pt with severe HF is reduced and how does this affect oxygen consumption/cost?

Answer 2

Oxygen cost associated with short-stepping gait pattern = high

Question 3

Where does lymph from the visceral pleura of the lungs drain into?

Answer 3

DEEP pulmonary plexus

Question 4

Majority of lymphatic drainage from the heart and lungs is carried back through which lymph channel?

Answer 4

Right lymphatic duct

Question 5

The thoracic duct is functionally under the control of which part of the ANS; how does hyperractivity effect lymph flow?*******

Answer 5

Sympathetic control –> hypersympathetic tone–> ↓lymph flow

Question 6

Postganglionic fibers (T1-T5) form the sympathetic cardiac nerves, which converge at the what?

Answer 6

Cardiac plexu

Question 7

The deep cardiac plexus splits into the right and left halfs, what does each innervate?

Answer 7

• Right half –> SA node + right and left coronary plexus
• Left half –> AV node

Question 8

Cholinergic and adrenergic fibers passing through the cardiac plexus are most strongly concentrated where?

Answer 8

SA and AV nodes

Question 9

Sympathetic hyperactivity of the right half of heart affects SA node and increases risk for what?

What about parasympathetic (right vagal) hyperactivity on the right?

Answer 9

• Sympathetic at SA node –> ↑ risk of SVT
• Right vagal at SA node –> sinus BRADYarrhythmias

Question 10

Sympathetic hyperactivity of the left half of heart affects AV node and increases risk for what?

What about parasympathetic (left vagal) hyperactivity at AV node?

Answer 10

• Sympathetic at AV node –> ↑ risk of ectopic foci and Vfib
• Left vagal at AV node –> AV blocks

Question 11

Smooth muscle tone of the airways is predominantly under control by which branch of the ANS?

Answer 11

Parasympathetic

Question 12

Irritation of the pulmonary branches of the vagus nerve produce what strong relex on the heart; example of what type of reflex?

Answer 12

Strong inhibitory reflexes on the heart = viscero-visceral reflex

Question 13

Where is anterior chapman’s point for myocardium and bronchus?

Answer 13

2nd ICS along SB

Question 14

Where is anterior chapman’s point for upper and lower lung?

Answer 14

• Upper = 3rd ICS along SB
• Lower = 4th ICS along SB

Question 15

Where is posterior chapman’s point for the myocardium?

Answer 15

Intertransverse spaces between T2-3

Question 16

Where is posterior chapman’s point for the bronchus?

Answer 16

Lateral to T2 SP

Question 17

Where is posterior chapman’s point for the upper lung?

Answer 17

Intertransverse space between T2-3 AND T3-T4

Question 18

Where is posterior chapman’s point for the lower lung?

Answer 18

Intertransverse space between T4-5

Question 19

Which OMT technique can be used to ↓ SVR associated with HTN?

Answer 19

Paraspinal inhibition

Question 20

What is a caution that should be taken when using OMT in pt with CHF?

Answer 20

To NOT overwhelm the circulatory system and exacerbate sx’s

Question 21

Which OMT technique can be used in CHF under the respiratory-circulatory model to improve breathing?

Answer 21

Rib raising

Question 22

Which 2 OMT techniques under the metabolic-energetic-immune model can help restore electrolyte levels in CHF?

Answer 22

Lymphatic pumps and effleruage

Question 23

Which 2 techniques would fit under the respiratory-circulatory model for tx of arrhythmias?

Answer 23

• Valsalva maneuver
• Carotis sinus massage

Question 24

What are the 3 main goal of OMT for pneumonia?

Answer 24

1. ↓ congestion
2. ↓ sympathetic hyperactivity to pulmonary parenchyma of lung
3. ↓ mechanical impediments to thoracic cage respiratory motion

Question 25

Which 3 OMT techniques can be utilized for the neurological model of tx pneumonia?

Answer 25

• Paraspinal inhibition T1-T7
• CV4
• Tx OA/AA to normalize PNS

Question 26

Which OMT technique is contraindicated in COPD?

Answer 26

Thoracic vacuum

Question 27

If OMT causes ↑ sympathetic tone in a cardiopulmonary pt this could lead to what complication?

Answer 27

Constriction of lymph vessels and systemic blood vessels