Osteopathic Approach to the Cardiac Patient - Ogden Flashcards
RIGHT thoracic sympathetic fibers originate from ___ and pass ____ and innervates what?
- Originate from right cervical ganglia
- Passes to the right of the right deep cardiac plexus.
- Innervates the SA node
LEFT thoracic sympathetic fibers originate from ___ and pass ____ and innervates what?
- Originate from let cervical ganglia
- Passes to the left deep plexus.
- Innervates AVN)
What does hyperactivity of RIGHT v. LEFT T1-6 sympathetics result in?
Right - SVT
Left - Predisposes to ectopic foci and vfib.
What are asymmetries in tone linked with?
Genesis of serious arrhythmias
What 3 things is increased tone linked with?
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.
What does increased tone do to vessels?
Decreased tone?
Increased tone»_space; vasoconstriction
Decreased tone»_space; vasodilation
Name the main PSNS source and what the R/L sides innervate.
VAGUS
Right vagus»_space; SAN
Left vagus»_space; AVN
Hyperactivity of RIGHT v. LEFT vagus result in what, respectively?
Right = sinus brady arrhythmias Left = AVblock
What 3 things stimulate PSNS viscero-visceral reflexes, resulting in SLOWING of the heart?
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)
What anatomic locations have abundant vagal connections?
OA, AA, C2
Where is the main drainage of the heart and lungs?
Right lymphatic duct.
What four things do lymphatics play a significant role in in CVsystem?
- Pulm edema
- Ascites
- HM
- Peripheral edema in CHF
- Thoracic duct: PSNS or SNS control?
- What does hyperactivity lead to?
- SNS control
- Hypersympathetic activity can reduce flow capacity
What type of dysfunctions illustrate somatic system involvement with CV system (3)?
- Severe scoliosis (>75degrees)
- Gait
- Anterior chest wall syndrome
How does gait affect CV system?
Abnormal gait patterns increase cardiac workload up to 300%.
*Optimizing gait pattern can mean independence for some.
How does Anterior Chest Wall Syndrome (any substernal chest pain) affect CV system?
- 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.
What are somatic causes of chest pain (5)?
- Cervical/thoracic/sternal/rib dysfunction
- COSTOCHONDRITIS (Tietze’s Syndrome)
- Intercostal neuritis
- Myofascial trigger points - Pec Major/Minor
- Rib fx
What level are palpatory changes felt at in classic cardiac and coronary patterns?
T2-4
What level do anterior wall infarctions have more pain referral pattern changes?
T1-4 of left
*73-79% accuracy to angiography for CAD
What level can palpatory changes be felt at in posterior and inferior wall MIs? Why?
- C2, because they’re rich in vagal patterns.
- Increased bradyarrhythmias
How do MIs possibly present in diabetics?
- May manifest as heartburn
- May be mild back pain
OMM tx process for MI
Decrease SNS activity in upper thoracics with INDIRECT thoracic paraspinal inhibition:
- Treat vagal hyperactivity (C2 and cranial base) - Tx SNS hyperactivity T1-6
What condition must the post-MI patient be in in order to tx MI with OMM?
STABLE
What type of MI would you treat vagal hyperactivity (C2 and cranial base)
Inferior MI
- Goal: to dec brady, hypoT, prevent dec. coronary flow to ischemic tissue
What type of MI would you treat SNS hyperactivity T2-3 on left?
Anterior wall MI
- Goal: dec. risk of SVT and ventricular arrhythmias
What OMM tx would you do if patient was post-resuscitation?
Indirect tx to ribs and sternum
What two lymphatic tx’s would you do for MI?
- Pectoral traction
- Diaphragm addressed through thoracolumbar fascia
What three post-MI things have reduced incidence if OMM is used?
Arrhythmia, shock, mortality
What OMM tx is emphasized most for CHF?
Lymphatics and autonomics
Impaired cardiac lymph drainage can result in (4):
- Peripheral edema
- Ascites (thoracic duct dilation)
- MV endocarditis
- Inc. areas of infarction and morbidity/mortality
What 2 OMM tx are used to improve thoracic cage compliance in CHF?
- Thoracic MFR
- Rib raising
Rib raising techniques to improve thoracic cage compliance in: 1) acute CHF and 2) after acute phase.
1) gentle paraspinal inhibition
2) gentle DIRECT method and mild springing
CHF tx: What 5 steps do you take to enhance lymphatic return to the heart?
- Free thoracic inlet - MFR
- Acute phase = pectoralis lift
- CV4 (cranial technique)
- Soft tissue of thoracolumbar junction
- Effleurage/Petrissage
CHF tx: What 3 steps do you take to maximize diaphragmatic efficiency?
- Suboccipital inhibiton to C-spine
- Thoracolumbar soft tissue release (dec viscerosomatic reaction)
- Redome diaphragm
CHF tx: What 2 steps do you take to normalize autonomic tone?
- Rib raising
2. Tx OA somatic dysfunction
CHF tx cautions
- 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)
What 4 things modify vagal tone to decrease chance of bradyarrhythmia?
- Oculocardiac reflec
- Carotid sinus
- Valsalva
- OA/AA/C2
What decreases chances of tachyarrhythmias?
- Reduce segmental facilitation in the UPPER THORACICS
- Address SNS - inhibition of paraspinal release
