Review IV Flashcards by Matt Stanton

SOAP PMH for OMT

birth Hx
sports Hx
trauma Hx
braces

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SOAP OMT procedure

need consent

pt and dr perception of improvement

CPT code

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SOAP assessment for OMT

DDx - not specific diagnosis but area of SD

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estrogen

after menopause - HTN increases in women

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african american

more likely to have HTN

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causes of essential HTN

white coat
metabolic syndrome
genetics
salt intake
obstructive sleep apnea

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causes of secondary HTN

kidney
adrenal gland
congenital vessel defect
meds
illegal drugs - coke/amphetamines
thyroid disorders

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age 60 and older

initiate pharmacy for BP > 150/90

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age 30-59

initiate pharmacy for BP > 140/90

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age less than 30

initiate pharmacy for BP > 140/90

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cardiovascular sympathetics

T1-5,6

-sympathetic

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renal sympathetics

T6-L2

-sympathetic to adrenal gland and kidney

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tight psoas major

altered motion and function in lower thoracic/upper lumbar region

catecholamines from adrenal - increased CO and TPR

activated RAAS - vasoconstriction and sodium/fluid retention via aldosterone

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sympathetics on kidney

vasoconstriction of afferent arterioles

decreased GFR
increased renin
decreased urine

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T1-6,5

sympathetics to heart

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T6-L2

sympathetics to adrenals and kidney

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clavicles

affecting anterior cervical fascia - and carotid artery baroreceptors

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cranium SD

SBS compression
occipitomastoid compression
affecting jugular formane

occiput, atlas and c spine

alter carotid receptor function
-contribute to alterations in blood pressure

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kidney chapmans

1 “ lateral and 1 “ superior from umbilicus

intertransverse region T12-L1

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myocardium chapmans

anterior between ribs 2 and 3 near sternal border

posterior between T2-3 near spinous processes

adrenal chapmans

1” lateral and 2 “ superior from umbilicus

intertransverse region T11-12

JNC8 meds

for HTN

thiazide diuretics, ACE inhibitors, ARBs, CCBs

titrate at monthly intervals

chapmans for adrenal reseaerch

serum aldosterone dropped as well as systolic and diastolic BP

kidney

retroperitoneal T12-L2
-surrounded perirenal fat

fascia - funnel - apex on top

fascia unites with its pair at level of T12-L1 in front of vertebrae

tethering one kidney affects the other

tethered kidney

traction on renal a -changing laminar to turbulent flow decrease in BP in afferent arteriole across JG apparatus -renin release also increased neural input because of stretch on arterial supply

sympathetics to heart

T1-5,6 -upper thoracic and cervical chain ganglia synapses right sided - right deep cardiac plexus - right heart and SA node left sided - left deep cadiac plexus - left heart and AV node

SA node

right sided sympathetic fibers

AV node

left sided sympathetic fibers

increased sympathetics to heart

increased workload increased O2 demand decreased O2 supply increased cardiac tissue irritability

parasympathetics to heart

decreasead workload decreased irritability and arrhythmias decreased morbidity and mortality

sympathetic ganglia

attached to rib heads

hemorrhagic stroke

linked to HTN happened to FDR

louisa burns

did experiment to increase SD at atlas, T3 and rib 3 increased HR, weak pulse, irregular rhythm, atlas lesions - variable rhythm resulted in: - cross striations in myocardium - hemorrhages in myocardium - increased edema between muscle fibers - overfilling of blood vessels - loss of visible plasma layer within the vessels

OMT after CABG

increased O2 sat 1-2 hours post surgery

cardiac index

CO normalized to body surface area with OMT after CABG -increased - more CO

sleep apnea

predictor for CAD - also in heart failure patients - associated with HTN - hypoxia and hypercapnia - increase sympathetics CV4 - can improve sleep in normal subjects

cardiorenal model for HF

excessive salt or water retention or renal dysfunction | -systolic heart failure

hemodynamic model for HF

reduced CO and excessive TPR increased EF doesn't always correlate with improved outcome decreased peripheral vasoconstriction did not improve EF

muscle hypothesis model for HF

abnormal skeletal m results in activation of muscle ergoreceptors which leads to enhanced signals to resp ventilation and sympathetic activation fix with exercise, OMT, biofeedback, yoga, cardio-selective beta blockers

constraint on diastole

internal contour of lower thoracic cage | -kyphosis, scoliosis, pectus excavatum

ANG II

activates collagen synthesis

aldosterone

stimulates collagen deposition stimulates sodium retention

rigid thoracic cage and diaphragm restriction

decreased area for heart during diastole

exercise

release of endothelial nitric oxide beneficial effect

course of vagus nerve

originates on medulla exits skull at jugular foramen -between occipital and temporal bones connections with first 2 cervical somatic nerves enters chest via thoracic inlet

occipitomastoid compression on jugular foramen

parasympathetics

lymph from heart and lungs

right lymphatic duct | -through thoracic inlet

OMT for HF

reduction of SNS to upper left thoracic cranial - CV4 rib raising - decrease sympathetics