CBL Cardiovascular Disease Techniques

Question 1

Intercostal respiratory muscles

Answer 1

External intercoastals
- elevate the ribs during inhalation

Internal intercoastals
- depress ribs w/ exhalation

Innermost intercoastals
- aid in exhalation

Question 2

What joints in the spine are closest to the sympathetic chain ganglia?

Answer 2

Costovertebral joints

Question 3

Upper thoracic paraspinal inhibition/traction steps

Answer 3

1) seated next to supine patient w/ hands under upper thoracic spine
2) find the posterior rib angles w/ finger pads
3) contact the soft tissues just superficial to these rib angles w/ fingers perpendicular to the persons body (parallel to the long axis of the ribs)
4) lean backwards w/ torso slightly transferring a minimal traction force through hands to soft tissues

Question 4

Thoracic spine BLT steps

Answer 4

• note: this is an INDIRECT technique*
  1) Stand/sit directly to the side of the supine patient where the affected vertebra is
  2) contact the spinous process of the affected segments w/ finger pads and make firm contact
  3) move vertebra into rotation (right and left)

4) move vertebra into flexion or extension (push the spinous process together or apart)
- if there is tightness in both, keep neutral

5) translate right -> left and left -> right to induce sidebending
- remember If it is type 1, to induce sidebending opposite, push veterbal body medially

6) DONT TAKE TO BARRIER, only to where disengagement is found
7) add desperation as well

Question 5

Craniocervical MFR release

Answer 5

Note: this is an INDIRECT technique

1) patient supine w. Doctor at head of table seated
2) place hands so that the palms are on the occiput and the fingers surround the posterior and lateral cervical regions , with fingers interlaced.
3) perform layer palpation
4) assess motion in rotation, translation and flexion/extension
5) stack those 3 w/ compression or traction (which ever is relaxed)
6) add respiration

Question 6

5 models of OMT

Answer 6

BIomechanical

Respiratory-circulatory

Neurological

Metabolic energy

Behavioral

Question 7

Why is metoprolol a special BB?

Answer 7

It is specific to B1 receptors and does NOT affect B2 receptors
- very good with patients w/ COPD and asthma

Question 8

What is the most common sympathetic innervation point for an acute MI

Answer 8

T2 spinal segment on the left

Question 9

Techniques used for balancing sympathetic vs parasympathetic tones

Answer 9

Sympathetic

• Rib raising
• work on the thoracic vertebrae w/ ribs (T1-T5)

Parasympathetic

• suboccipital inhibition
• work on the upper cervical vertebrae (specifically OA/AA)

Question 10

Travell Trigger points

Answer 10

Found on the right pectorals muscle and is almost always seen in patients w/ SVTs

Question 11

What is the starting point for most treatments w/ increased sympathetic

Answer 11

Ribs

usually start proximal and work to ribs specifically to reduce input through facilitated segments

Question 12

Hyperactivity of the right vagus predisposes someone to what?

Answer 12

Brady arrhythmias

• this is because it effects the SA node and controls the Atria
• also includes sick sinus syndrome

Question 13

Hyperactivity of the left side of the vagus nerve predisposes someone to what?

Answer 13

AV heart blocks

• because it innervates the AV node and controls ventricles
• examples are any heart blocks

Question 14

Sympathetic affects on the heart

Answer 14

Increases heart contraction

Shorten diastole

Increases ventricular output

Increases rate of contraction

Increases BP

Question 15

What rib joint is closest to the sympathetic chain ganglion

Answer 15

Costoverterbal joints

Question 16

Do you use indirect or direct treatment for acute MIs?

Answer 16

Indirect treatments
- due to causing initial sympathetic stimulation which would make the condition worse

Initial treatment is usually aimed at the upper thoracic spine and rib cage to decrease chance of additional segmental imputes

Question 17

NYHA class indications for CHF

Answer 17

1: no symptoms or limitations w/ ordinary activity
2: mild symptoms (mild dyspnea/ angina) w/ ordinary activity
3: symptoms are present except at rest
4: symptoms are always present
* note abnormal gait increases cardiac workload up to 300%*

Question 18

Ergoreceptors

Answer 18

Afferent mechanoreceptors and metabolic receptors that give input to control ventilation

Question 19

Prolonged sympathetic stimulation to the kidney results in what?

Answer 19

Retention of sodium and water through B-1 receptors

Question 20

Sympathetic and parasympathetic activity effects on lymphatic drainage

Answer 20

Sympathetics control the diameter of the thoracic duct and large lymph vessels
- increased sympathetics = reduce the diameter and overall flow