Cardiac pain: anatomic pathways and physiologic mechanisms.

摘要: It may be concluded that the pathways of cardiac pain have been thoroughly established, with exception conduction anginal attacks occasionally referred to neck and jaws. Afferent impulses traverse axons travel in cervical thoracic sympathetic nerves. In case pathway, all on entering paravertebral ganglionated chain must descend upper level before they can gain access spinal cord. Other reach 3 superior ganglia via more direct Both fibers join nerves over communicant rami. After passing through intervertebral foramina, enter posterior roots terminate lateral horn Here establish synapses secondary afferent neurons spinothalamic tract, decussate opposite anterior column, are carried rostrally nucleus ventralis posterolateralis thalamus. This is principal locus brain for perception visceral pain. contrast well-defined cutaneous sensibility, there no cortical area exact localization postcentral region cerebral cortex. Another factor poor paucity sensory endings heart. A third appears limited number tracts. These central shared other from surface body. As a result, heart large part distribution 4 segments. Accounting superficial reference by Mackenzie9s theory viscerocutaneous reflex longer justifiable. Even after interrupted procaine or amputation arm, still felt its previous distribution. Neither stimulation vagi nor interruption transmission these has found any beneficial effect patients suffering angina pectoris. Sensory denervation therefore out destruction trunks severing corresponding roots.