Medstudent X

Today we had an awesome lecture on the neurological science behind viscerosomatics. A viscerosomatic reflex is useful because by feeling someone’s paraspinal muscles, you can tell if they have something going on with their internal organs. You can even tell which organ because each organ corresponds to specific spinal segments, and if there’s damage to that organ, only those segments get tough and ropy.

The simplified version is this: your organs have sensory nerves that connect to your spinal cord. Those nerves don’t only connect in one place, they can spread out up and down the spinal cord, often crossing several different vertebrae. Your muscles also have sensory nerves that do this. Both your muscle nerves and your organ nerves talk to other nerves in about the same place that go up to your brain. What can happen is that when an organ undergoes severe stress (like a heart attack), it can release so much pain transmitter that it actually sends a signal backwards down to the muscle, causing it to spasm.

They did a study, and osteopathic physicians could tell if there was a cardiac infarction (aka heart attack) by only feeling the persons back and looking at their history with more than 95% confidence! That’s crazy!

Coronary artery atherosclerosis is the single largest killer in Europe and the US, as it can lead to ischaemic heart failure.

Signs and symptoms

Chest pain, shortness of breath, weakness, tiredness, dizziness, palpitations, irregular heartbeat, angina

Leg oedema (swelling), weight gain, diaphoresis (sweating)

High or low blood pressure

Pathology

Atherosclerosis describes a focal accumulation of lipid and thickening of arterial intima (ie, sclerosis [hardening]). Characterised by:

Endothelial dysfunction

Vascular inflammation

Buildup of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall

And resulting in:

Plaque formation

Vascular remodelling

Acute and chronic luminal obstruction

Abnormalities of blood flow

Diminished oxygen supply to target organs

Click here for my more detailed post on the process of atherosclerosis 

Atherosclerosis has periods of activity and quiescence. Plaques (or atheromas) may take <15 develop and occur in regions of branching and curvature and where blood undergoes sudden changes in velocity and direction of flow. 

Limitation of blood flow from obstructed coronary artery to causes ischaemia (lack of oxygen) of the heart’s muscle cells, which may die leading to myocardial infarction (heart attack).

Coronary artery atherosclerosis takes time to develop, and causes symptoms gradually worsening to heart failure if the plaques continue to build. Not everyone with CAD will have a heart attack, but their life may still be severely impaired.

Eight Ways to Remember Anything by Alex Lickerman M.D.