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Flashcards in Cadiovascular cases DSA Deck (34):
1

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.

2

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

3

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

4

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

5

Segmental facilitation

- 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

6

Sleep apnea

- 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

7

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

8

Consequences of lymphatic congestions

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

9

Serume nitric oxide levels

A reason for the beneficial effects of exercise

10

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

T1-T6

Synpases occur in the upper thoracic/cervical chain ganglia

11

Right sided distribution of sympathetic fibers

Pass to the right deep cardiac plexus

Innervate the right heart and SA nodes

12

Left sided distribution of sympathetics to the heart

Pass to left deep cardiac plexus

Innervate the heart and the AV node

13

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

Sinus tachycardia

Paroxysmal supraventricular tachycardia

14

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

Ectopic foci

Ventricular tachycardia

Ventricular fibrillaiton

15

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

16

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

Vagus nerve

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

17

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

Sinus bradycardia

18

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

AV blocks

19

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

20

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

21

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

22

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

Thoracic inlet

Respiratory diaphragm: lower thoracics, lower ribs, upper lumbars

Sympathetics

23

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

poor nutrition, stress, environmental toxins, somatic dysfunction

24

What determines arterial pressure?

Cardiac output and peripheral resistance

Cardiac output: SV and HR

Peripheral resistance: vascular structure and function

25

What is the most common cause of HTN?

Essential- we don't know what causes it

Increased sympathetic activity

26

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

27

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

 

28

Anterior wall MI somatic dysfunction

T2-3 on left

29

Inferior wall MI somatic dysfunction

Dysfunction with C2 and cranial base (vagus)

30

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)

31

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

32

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

33

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

34

Exercise

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