Cadiovascular cases DSA

Question 1

Fascia of the kidney

Answer 1

The fascia unites with its pair at T12-L1 in front of the vertebrae. Therefore “tethering” of one kidney affects the other.

Question 2

How does a “tethered” kidney increase neural input?

Answer 2

A “tethered” kidney places traction on the renal artery, changing the cross section from a circle to an ellipse –> changes laminar flow to turbulent flow in the artery This decreases the blood pressure in the afferent arteriole across the juxtaglomerular apparatus causing a release of renin This increase neural input because of the stretch on the arterial supply

Question 3

Summary of sympathetic effects on the heart

Answer 3

1. Increases workload on the heart 2. Increases oxygen demand on the heart 3. Decreases oxygen supply to cardiac tissue 4. Increases cardiac tissue irritability

Question 4

Summary of parasympathetic effects on the heart

Answer 4

1. Decreases workload 2. Decreases tissue irritability/arrhythmias 3. Decreases morbidity/mortality rates Happier environment for the heart

Question 5

Segmental facilitation

Answer 5

• Spinal segment receives exaggerated input from soma or viscera - Efferent motor and autonomic components of the spinal segment are maintained in a state of excitement - Further stimulation of the segment results in additional activation - Segment is hyperirritable and focuses the ascending or descending input to increase activity at the facilitated segment

Question 6

Sleep apnea

Answer 6

• Significant predictor for coronary artery disease. High correlation in heart failure pts. - Hypoxia and hypercapnia increase sympathetic activation - Muscle sympathetic nerve activity is elevated in pts and persists despite the administration of oxygen - Platelet activation is increased

Question 7

Consequences of diaphragmatic restriction and a rigid thoracic cage

Answer 7

Diaphragmatic restriction reduces the area in which the heart can move/relax A rigid thoracic cage decreases the area in which the heart can move/relax

Question 8

Consequences of lymphatic congestions

Answer 8

Impairs gaseous exchange in the lungs Encourages collage formation (scar tissue) Exercise can improve lymphatic flow by 30x

Question 9

Serume nitric oxide levels

Answer 9

A reason for the beneficial effects of exercise

Question 10

Where does the sympathetic innervation of the heart have its origins?

Answer 10

T1-T6

Synpases occur in the upper thoracic/cervical chain ganglia

Question 11

Right sided distribution of sympathetic fibers

Answer 11

Pass to the right deep cardiac plexus

Innervate the right heart and SA nodes

Question 12

Left sided distribution of sympathetics to the heart

Answer 12

Pass to left deep cardiac plexus

Innervate the heart and the AV node

Question 13

What is the result of hypersympathetic activity to the right side of the heart?

Answer 13

Sinus tachycardia

Paroxysmal supraventricular tachycardia

Question 14

What is the result of hypersympathetic activity to the left side of the heart?

Answer 14

Ectopic foci

Ventricular tachycardia

Ventricular fibrillaiton

Question 15

What types of somatic dysfunction can increase sympathetic tone to the heart?

Answer 15

Upper thoracic dysfunction- especially extended segments

Upper rib dysfunction, many times associated with upper thoracic dysfunction

Cervical dysfunciton- affecting the superior, middle, and inferior cervical ganglion

Question 16

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

Answer 16

Vagus nerve

Have ipsilateral distribution: right vagus-SA node, left vagus, AV node

Question 17

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

Answer 17

Sinus bradycardia

Question 18

What is the result of hyperparasympathetic activity to the left side of the heart?

Answer 18

AV blocks

Question 19

What is the course of the vagus nerve?

Answer 19

Originates in the medulla

Exits via the jugular foramen b/w the occipital and temporal bones

Has connections with the first 2 cervical ganglion

Enters the chest via the thoracic inlet

Question 20

What types of somatic dysfunctions can affect the vagus nerves

Answer 20

Occipitomastoid compression affecting the jugular foramen

Occiput, atlas, axis (upper cervical spine)

Thoracic inlet: upper thoracics, upper ribs, clavicles, lower cervicals, cervical fascia

Question 21

Lympathic drainage of the heart

Answer 21

Lympathics carried back to the heart via the right lymphatic duct

Courses through the thoracic inlet on the way back to the heart

Driven by synchronized diaphragmatic function and muscle activity- overall body movement

Question 22

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

Answer 22

Thoracic inlet

Respiratory diaphragm: lower thoracics, lower ribs, upper lumbars

Sympathetics

Question 23

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

Answer 23

poor nutrition, stress, environmental toxins, somatic dysfunction

Question 24

What determines arterial pressure?

Answer 24

Cardiac output and peripheral resistance

Cardiac output: SV and HR

Peripheral resistance: vascular structure and function

Question 25

What is the most common cause of HTN?

Answer 25

Essential- we don’t know what causes it

Increased sympathetic activity

Question 26

Consequences of somatic dysfunction on the adrenal gland

Answer 26

Will facilitate catecholamine release from the adrenal gland resulting in increased cardiac output and peripheral resistance

Will activate renin-ANG-aldoesterone system resulting in vasoconstriction and Na and fluid retention via aldosterone

Question 27

How can somantic dysfunctions affecting the cranium, occiput, and atlas affect the heart?

Answer 27

May alter carotid receptor function and contribute to alterations in blood pressure

Question 28

Anterior wall MI somatic dysfunction

Answer 28

T2-3 on left

Question 29

Inferior wall MI somatic dysfunction

Answer 29

Dysfunction with C2 and cranial base (vagus)

Question 30

OMM goals for the cardio pt

Answer 30

1. Bring autonomic balance back to the cardiovascular system- prevent ventricular fibrillation. Reducing symp tone will cause dilation of the coronary arteries –> improved myocardial perfusion
2. Improve arterial supply and venous and lymphatic drainage to the heart

Pay special attention to CV4- can balance autonomics

Pay special attention to cervical spine (vagus)

Question 31

HVLA in the cardiac pt

Answer 31

should be avoided during initial management

• Can cause short term sympathetic activity which may result in vasoconstriction of coronary arteries and extend infarct

Gentler techniques are initially a better option

Question 32

Chronic heart failure associated with

Answer 32

Intravascular and interstitial volume overload and inadequate tissue perfusion

Symptoms: Fatigue and SOB most common. Also anorexia, nausea, early satiety associated with abdomnial pain/fullness, confusion, disorientation, sleep/mood disturbances and nocturia

Question 33

Pathogenesis of CHF

Answer 33

• Something damages the heart muscle and reduces its ability to contact.
• Vicious downward spiral develops due to activation of neurohormonal systems –> decreased CO leads to unloading of high-pressure baroreceptors in left ventricle, carotid sinus, and aortic arch. Afferent signals to CNS to relase ADH –> reabsorption of free water, activation of sympathetics

Causes include: coronary artery disease, MI, hypertension, toxic damage, viral infection

Question 34

Exercise

Answer 34

Improves autonomic nervous system function, regional blood flow, endothelial function, skeletal muscle function, quality of life

Can improve exercise duration as much as pharmaceutical agents