EHR519 Lecture Notes - Lecture 10: Coronary Artery Disease, Afferent Nerve Fiber, Angina Pectoris
1. Week 10 – Initial Pre-Screening in Cardiopulmonary
Clients
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Silent Myocardial Ischemia
Definition: objective documentation of myocardial ischemia in the absence of angina or anginal
equivalents.
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The afferent fibers that run in the cardiac sympathetic nerves are
usually thought of as the essential pathway for the transmission of
cardiac pain. The atria and ventricles are abundantly supplied with
sympathetic sensory innervation; from the heart, the sensory nerve
endings connect to afferent fibers in cardiac nerve bundles, which in
turn connect to the upper 5 thoracic sympathetic ganglia and the
upper 5 thoracic dorsal roots of the spinal cord. Within the spinal
cord, impulses mediated by this sympathetic afferent route probably
converge with impulses from somatic thoracic structures onto the
same ascending spinal neurons. This would be the basis for cardiac
pain referred to the chest, wall, arm, back etc. In addition to this
“convergence-projection theory,” the contribution of vagal afferent
fibers must be acknowledged for an explanation of cardiac pain
referred to the jaw and neck. How these vagal fibers are activated
remains unclear. Furthermore, somatic localization of ischemic pain
cannot predict the site of myocardial ischemia (anterior, inferior, or
lateral) from one patient to the next.
Causes and Diagnosis of Exercise-induced VasoVagal Syncope
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Document Summary
Week 10 initial pre-screening in cardiopulmonary. Definition: objective documentation of myocardial ischemia in the absence of angina or anginal equivalents. The afferent fibers that run in the cardiac sympathetic nerves are usually thought of as the essential pathway for the transmission of cardiac pain. Within the spinal cord, impulses mediated by this sympathetic afferent route probably converge with impulses from somatic thoracic structures onto the same ascending spinal neurons. This would be the basis for cardiac pain referred to the chest, wall, arm, back etc. Convergence-projection theory, the contribution of vagal afferent fibers must be acknowledged for an explanation of cardiac pain referred to the jaw and neck. How these vagal fibers are activated remains unclear. Furthermore, somatic localization of ischemic pain cannot predict the site of myocardial ischemia (anterior, inferior, or lateral) from one patient to the next. In addition to asking the client to answer question 4, you can complete the following:
