Fascia of the kidney
The fascia unites with its pair at T12-L1 in front of the vertebrae. Therefore "tethering" of one kidney affects the other.
How does a "tethered" kidney increase neural input?
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
Summary of sympathetic effects on the heart
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
Summary of parasympathetic effects on the heart
1. Decreases workload 2. Decreases tissue irritability/arrhythmias 3. Decreases morbidity/mortality rates Happier environment for the heart
- 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
- 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
Consequences of diaphragmatic restriction and a rigid thoracic cage
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
Consequences of lymphatic congestions
Impairs gaseous exchange in the lungs Encourages collage formation (scar tissue) Exercise can improve lymphatic flow by 30x
Serume nitric oxide levels
A reason for the beneficial effects of exercise
Where does the sympathetic innervation of the heart have its origins?
Synpases occur in the upper thoracic/cervical chain ganglia
Right sided distribution of sympathetic fibers
Pass to the right deep cardiac plexus
Innervate the right heart and SA nodes
Left sided distribution of sympathetics to the heart
Pass to left deep cardiac plexus
Innervate the heart and the AV node
What is the result of hypersympathetic activity to the right side of the heart?
Paroxysmal supraventricular tachycardia
What is the result of hypersympathetic activity to the left side of the heart?
What types of somatic dysfunction can increase sympathetic tone to the heart?
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
Where does the parasympathetic innervation of the heart have its origins?
Have ipsilateral distribution: right vagus-SA node, left vagus, AV node
What is the result of hyperparasympathetic tone to the right side of the heart (SA node)
What is the result of hyperparasympathetic activity to the left side of the heart?
What is the course of the vagus nerve?
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
What types of somatic dysfunctions can affect the vagus nerves
Occipitomastoid compression affecting the jugular foramen
Occiput, atlas, axis (upper cervical spine)
Thoracic inlet: upper thoracics, upper ribs, clavicles, lower cervicals, cervical fascia
Lympathic drainage of the heart
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
What are some areas of somatic dysfunction that can negatively affect lymphatic flow?
Respiratory diaphragm: lower thoracics, lower ribs, upper lumbars
What are some negative environmental signals that may have a negative impact on gene expression?
poor nutrition, stress, environmental toxins, somatic dysfunction
What determines arterial pressure?
Cardiac output and peripheral resistance
Cardiac output: SV and HR
Peripheral resistance: vascular structure and function
What is the most common cause of HTN?
Essential- we don't know what causes it
Increased sympathetic activity
Consequences of somatic dysfunction on the adrenal gland
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
How can somantic dysfunctions affecting the cranium, occiput, and atlas affect the heart?
May alter carotid receptor function and contribute to alterations in blood pressure
Anterior wall MI somatic dysfunction
T2-3 on left
Inferior wall MI somatic dysfunction
Dysfunction with C2 and cranial base (vagus)
OMM goals for the cardio pt
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)
HVLA in the cardiac pt
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
Chronic heart failure associated with
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
Pathogenesis of CHF
- 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
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