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Osteopathic Recognition Resource Library: Cardiology

Purpose: to provide links to journal articles that can be used for journal clubs in any specialty to support the milestones for OR.

OMM for Cardiology

Case Study

A pediatric patient is in the ICU on telemetry and intubated because of airway instability secondary to a retropharyngeal abscess and S. agalactiae pneumonia, is chronically constipated, has an NG tube, and is getting IV fluids.  The patient is highly agitated despite being sedated, and is tachycardic.  The patient is has somatic dysfunctions C3-5, all along the T spine on the Left and Right.  He’s treated once or twice daily with V spread, suboccipital release, myofascial to the cervicals, thoracic inlet release, thoracic pump, rib raising, lumbar paraspinal inhibition, diaphragm doming, and release of the abdominal ganglia.  While all of this assists in breathing and stooling issues, over a period of several days his mother notices that his heart rate and blood pressure change in a normalizing direction immediately after each treatment, with a generalized improvement continuing until the next treatment, when it normalizes further. 

Readings

  • Foundations Volume 2, Chapter 24 “An Osteopathic Perspective on Cardiology”
  • Foundations Volume 3, Chapter 55 "Adult with Chronic Cardiovascular Disease"
  • Ceritelli F, et. al. Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-Months follow-up of intima media and blood pressure on a cohort affected by hypertension. J Bodyw Mov Ther. 2011 Jan;15(1):68-74. Epub 2010 May 8. 
      • Techniques:  Lumbar and Thoracic Spring tests, six planes of cervical motion, FABER test
  • Hanten WP, Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T. Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates. J Orthop Sports Phys Ther. 1998 Mar;27(3):213-8. 
      • Techniques:  CV4, Craniosacral respiratory rates
  • Henley, CE et al. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. Osteopath Med Prim Care. 2008; 2: 7. Published online 2008 June 5.
      • Techniques:  Cervical myofascial release, carotid massage
  • Spiegel AJ et al. Osteopathic Manipulative Medicine in the Treatment of  Hypertension:  An Alternative, Conventional Approach.  Heart Disease 2003 July/August; 5(4): 272-78.
      • Techniques: Thoracolumbar and mid-thoracic myofascial release and rib raising.
  • Wax CM, Abend DS, Pearson PH. Chest pain and the role of somatic dysfunction. JAOA. 1997 Jun;97(6):347-52, 355.
      • Techniques: Counterstrain, FPR, HVLA to first rib

 

 

Study Questions from Readings

1. Which of the following is an explanation as to why OMT might help to reduce blood pressure?

  1. Sympathetic stimulation of the kidneys results in a functional retention of water and salt, which decreases blood pressure.
  2. Sympathetic stimulation represses catecholamine secretion, which stimulates vasoconstriction in the subcutaneous, mucosal, splanchnic and renal vascular beds, which lowers blood pressure.
  3. Sympathetic modulation increases renin secretion by a direct a-adrenergic receptor-mediated effect, decreasing blood pressure.
  4. Vascular and cardiac hyperreactivity to sympathetic stimuli raises blood pressure, so modulating that stimulus can reduce blood pressure. 

Rationale

 

 

2. A patient reports chest pain that is on the Left sternal border and radiates up the neck.  Upon examination of the spine, in which of the following segments is this patient likely to have a somatic dysfunction?

  1. T5-T6 on the left
  2. T2-T5 on the left
  3. T2-T5 on the right
  4. T5-T6 on the right
  5. C5-C7 on the left
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