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OS 3, Exam 2 > Osteopathic Approach to the Cardiac Patient - Ogden > Flashcards

Osteopathic Approach to the Cardiac Patient - Ogden Flashcards

1
Q

RIGHT thoracic sympathetic fibers originate from ___ and pass ____ and innervates what?

A
  • Originate from right cervical ganglia
  • Passes to the right of the right deep cardiac plexus.
    • Innervates the SA node
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2
Q

LEFT thoracic sympathetic fibers originate from ___ and pass ____ and innervates what?

A
  • Originate from let cervical ganglia
  • Passes to the left deep plexus.
    • Innervates AVN)
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3
Q

What does hyperactivity of RIGHT v. LEFT T1-6 sympathetics result in?

A

Right - SVT

Left - Predisposes to ectopic foci and vfib.

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4
Q

What are asymmetries in tone linked with?

A

Genesis of serious arrhythmias

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5
Q

What 3 things is increased tone linked with?

A

1) Linked with coronary vasospasm
2) Increased morbidity post-MI - inhibits collateral circulation
3) VASOCONSTRICTION, inc PVR and shunting dt rich sympathetic supply in vessels.

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6
Q

What does increased tone do to vessels?

Decreased tone?

A

Increased tone&raquo_space; vasoconstriction

Decreased tone&raquo_space; vasodilation

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7
Q

Name the main PSNS source and what the R/L sides innervate.

A

VAGUS
Right vagus&raquo_space; SAN
Left vagus&raquo_space; AVN

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8
Q

Hyperactivity of RIGHT v. LEFT vagus result in what, respectively?

A 
Right = sinus brady arrhythmias
Left = AVblock
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9
Q

What 3 things stimulate PSNS viscero-visceral reflexes, resulting in SLOWING of the heart?

A

1) Irritation of larynx (results in bradyarrhyth and block)
2) Pressure on carotid body (both carotids)
3) Pressure on globe of eye (oculocardiac reflex, creating bradyarrhyth)

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10
Q

What anatomic locations have abundant vagal connections?

A

OA, AA, C2

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11
Q

Where is the main drainage of the heart and lungs?

A

Right lymphatic duct.

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12
Q

What four things do lymphatics play a significant role in in CVsystem?

A
  • Pulm edema
  • Ascites
  • HM
  • Peripheral edema in CHF
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13
Q
  • Thoracic duct: PSNS or SNS control?

- What does hyperactivity lead to?

A
  • SNS control

- Hypersympathetic activity can reduce flow capacity

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14
Q

What type of dysfunctions illustrate somatic system involvement with CV system (3)?

A
  • Severe scoliosis (>75degrees)
  • Gait
  • Anterior chest wall syndrome
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15
Q

How does gait affect CV system?

A

Abnormal gait patterns increase cardiac workload up to 300%.

*Optimizing gait pattern can mean independence for some.

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16
Q

How does Anterior Chest Wall Syndrome (any substernal chest pain) affect CV system?

A
  • Often mis-dx as cardiac dysfunction, but… somatic factors do co-exist with cardiac disease.
  • **Reduction in cardiac sx after OMM cannot rule out the need for further w/u or therapeutics in a given pt.
17
Q

What are somatic causes of chest pain (5)?

A
  • Cervical/thoracic/sternal/rib dysfunction
  • COSTOCHONDRITIS (Tietze’s Syndrome)
  • Intercostal neuritis
  • Myofascial trigger points - Pec Major/Minor
  • Rib fx
18
Q

What level are palpatory changes felt at in classic cardiac and coronary patterns?

A

T2-4

19
Q

What level do anterior wall infarctions have more pain referral pattern changes?

A

T1-4 of left

*73-79% accuracy to angiography for CAD

20
Q

What level can palpatory changes be felt at in posterior and inferior wall MIs? Why?

A
  • C2, because they’re rich in vagal patterns.

- Increased bradyarrhythmias

21
Q

How do MIs possibly present in diabetics?

A
  • May manifest as heartburn

- May be mild back pain

22
Q

OMM tx process for MI

A

Decrease SNS activity in upper thoracics with INDIRECT thoracic paraspinal inhibition:

 - Treat vagal hyperactivity (C2 and cranial base)
 - Tx SNS hyperactivity T1-6
23
Q

What condition must the post-MI patient be in in order to tx MI with OMM?

A

STABLE

24
Q

What type of MI would you treat vagal hyperactivity (C2 and cranial base)

A

Inferior MI

- Goal: to dec brady, hypoT, prevent dec. coronary flow to ischemic tissue

25
Q

What type of MI would you treat SNS hyperactivity T2-3 on left?

A

Anterior wall MI

- Goal: dec. risk of SVT and ventricular arrhythmias

26
Q

What OMM tx would you do if patient was post-resuscitation?

A

Indirect tx to ribs and sternum

27
Q

What two lymphatic tx’s would you do for MI?

A
  • Pectoral traction

- Diaphragm addressed through thoracolumbar fascia

28
Q

What three post-MI things have reduced incidence if OMM is used?

A

Arrhythmia, shock, mortality

29
Q

What OMM tx is emphasized most for CHF?

A

Lymphatics and autonomics

30
Q

Impaired cardiac lymph drainage can result in (4):

A
  • Peripheral edema
  • Ascites (thoracic duct dilation)
  • MV endocarditis
  • Inc. areas of infarction and morbidity/mortality
31
Q

What 2 OMM tx are used to improve thoracic cage compliance in CHF?

A
  • Thoracic MFR

- Rib raising

32
Q

Rib raising techniques to improve thoracic cage compliance in: 1) acute CHF and 2) after acute phase.

A

1) gentle paraspinal inhibition

2) gentle DIRECT method and mild springing

33
Q

CHF tx: What 5 steps do you take to enhance lymphatic return to the heart?

A
  1. Free thoracic inlet - MFR
  2. Acute phase = pectoralis lift
  3. CV4 (cranial technique)
  4. Soft tissue of thoracolumbar junction
  5. Effleurage/Petrissage
34
Q

CHF tx: What 3 steps do you take to maximize diaphragmatic efficiency?

A
  1. Suboccipital inhibiton to C-spine
  2. Thoracolumbar soft tissue release (dec viscerosomatic reaction)
  3. Redome diaphragm
35
Q

CHF tx: What 2 steps do you take to normalize autonomic tone?

A
  1. Rib raising

2. Tx OA somatic dysfunction

36
Q

CHF tx cautions

A
  • Do not place pt fully supine
  • Do not do forceful direct tx
  • Do not tire pt out
  • Do not do unnecessary abdominal pressure (liver pump/classic thoracic pump)
37
Q

What 4 things modify vagal tone to decrease chance of bradyarrhythmia?

A
  • Oculocardiac reflec
  • Carotid sinus
  • Valsalva
  • OA/AA/C2
38
Q

What decreases chances of tachyarrhythmias?

A
  • Reduce segmental facilitation in the UPPER THORACICS

- Address SNS - inhibition of paraspinal release

OS 3, Exam 2 (10 decks)

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