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To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illnesss To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Part 1. To the Heart of the Matter The framework of the dissertation To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Human Context of Disease Throughout history, mankind has been continually striving to develop and refine an understanding of the mechanisms of the life processes ultimately defined by disease and death. Disease symbolises the portal between these two apparently irreconcilable aspects of human existence and its enigma has been the challenge of physicians since the dawn of time. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Veil of Context - Conceptual models for defining disease Conceptual models of disease have their foundations in the context of the contemporary understanding, and are derived from observation of the life processes. Disparities that arise between differing theories can be understood as being products of incompatibilities in the context within which they are described, and are not necessarily reflective of theoretical misinterpretation or misunderstanding. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Context of Medicine in an Historical Perspective Ancient Medical context (monistic) Disease processes understood in relation to environmental, social and spiritual relationships Classical Biomedical approach (reductionist) Rooted in the Cartesian dualistic concept of division between psyche and soma To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Context of Medicine in a Contemporary Perspective Psychonueroendocrinology (PNE) PNI/PNE combination of specialist research developing a model for understanding the relationships between all aspects of the human condition. Western Herbal Medicine Combination of an empiricism and biomedicine Optimally, biomedical principles are used as an adjunct to understanding health and disease processes To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Hypothesis The context of the empirical therapeutic philosophy of Western Herbal Medicine demonstrates a conceptual understanding that is concurrent with modern biomedical research. Cardiovascular illness as a Debate Forum The choice of cardiovascular illness has been made in the light of recent advancements in the biomedical theories relating to these conditions within psychoneuroendocrinology (PNE). The comprehensive nature of PNE research into CV illness facilitates a comparison of understanding based upon broad therapeutic principles. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Part 2. To the Heart of the Matter The contemporary biomedical understanding To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Cardiovascular System ~ the modern biomedical context (Psychoneuroendocrinology) Hypothalamic-Pituitary-Adrenocortical (HPA) Axis Corticotropin Releasing Factor (CRF) Intrinsic Neurological Activity of CRF Locus Coeruleus ANS Amygdaloid Nucleus Interaction Glucocorticoids Autonomic Nervous System (ANS) To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Cardiovascular System ~ the modern biomedical context (Psychoneuroendocrinology) Hypothalamic-Pituitary-Adrenocortical (HPA) Axis Corticotropin Releasing Factor (CRF) Intrinsic Neurological Activity of CRF Locus Coeruleus ANS Amygdaloid Nucleus Interaction Glucocorticoids Autonomic Nervous System (ANS) To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Cardiovascular Pathogenesis ~ a psychoneuroendocrinological understanding CV pathogenesis is intimately associated with the passive stress response and the related influence of HPA hormonal activity. HPA activity ? CRF activity CV Pathogenesis To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Cardiovascular Pathogenesis ~ The Role of CRF Amagdaloid nucleus: produces CRF in response to anxiety & stress (mediated by norepinephrine) CRF Hypothalamic/Pituitary Axis and Corticotropin Releasing Factor influence Glucocorticoid activity Influences myocardial performance Influences the vasoconstrictive activities of the catecholamines and angiotensin II Influences the production of the vasodilator prostaglandins and reduces vascular endothelium permeability. Influences circulatory cholesterol Proposed ’ feedforward’ mechanism Influences circulatory triglyceride Influences of the cardio-renal axis Influences angiotenisn Influences aldosterone Locus Coeruleus Production of norepinephrine Influences the Autonomic Nervous System Influences sympathetic vasomotor activity Influences vagal activity Influences SA node firing Influences AV conduction Influences the Tractus Solitarius Influences circulatory baro- and chemorecepotor feedback To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Cardiovascular Pathogenesis ~ The Role of Heart Rate Variability Heart rate variability describes low frequency modulation of the heart rate Dynamic physiological accommodation for cardiovascular peripheral challenge Control by Cardiac autonomic innervation BP = TPR(HR x SV) BP = TPR(HR x SV) Reduction in heart rate variability results in an increase in blood pressure variability To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Psychoneuroendocrinology ~ A Model for Cardiovascular Pathogenesis Implicated pathological processes: HPA influence: Glucocorticoid induced pathology: Platelet reactivity Circulatory triglycerides & circulatory cholesterol Disturbances in ANS activity ANS influence: Cardiac regulation: Heart Rate Variability Blood Pressure Variability Ventricular instability To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Psychoneuroendocrinology ~ A Model for Cardiovascular Pathogenesis A Relationship between psychological disturbance and CV disease. Stress, anxiety & depression are linked to CV disease aetiology. HPA and ANS activity are intimately related to CV system regulation. Negative emotional and cognitive responses dysregulate the finely tuned control mechanisms, which influence HPA/ANS interaction, resulting in disturbance of the CV system dynamics. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Part 3. To the Heart of the Matter ~ the western herbal medicine context To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness The Heart ~ holistic perspectives in Western Herbal Medicine An examination the vitalistic therapeutic understanding of CV illness evident in traditional WHM Humoral Medicine Physiomedicalist & Eclectic based Herbal Medicine Areas of examination: Treatment philosophy Herbal materia medica To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Cardiovascular illness ~ The humoral context In Humoral Medicine aetiological understanding is directly related to the application of herbal remedies. The concept of temperament, used to describe health, illness, the activity of herbal remedies and subsequently treatment, was central in defining the basis of the therapeutic strategy. The heart is susceptible to affliction by negative emotion, due to the antithesis of the temperament of negative emotion in relation to the eucrasia of the heart. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Cardiovascular illness ~ The Physiomedicalist context Physiomedicalism described disturbances of the heart and vascular system in an eclectic vitalistic context: Physiological understanding Autonomic nervous system balance Expression of the vital energy within the constitutional limitations of the individual To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Cardiovascular remedies in empirical Western Herbal Medicine Anemone pulsatilla L. Avena sativa L. Borago officinalis L. Convallaria majalis L. Crataegus oxyacanthoides Thuill. Leonurus cardiaca L. Melissa officinalis L. Selenicerus grandiflorus (L.) Britt. & Tilia spp. Veratrum viride Viscum album L. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness To the Heart of the matter ~ Aspects of conceptual commonality In both Physiomedicalism and Humoral Medicine, CV remedies are often described in terms that relate them to nervous system activity, e.g. Nervousness, exhaustion, depression & gloom These conditions correspond with the states implied in the development of CV illness proposed within the context of PNE MSc Dissertation presentation Ken Lunn February 2003 Thank you To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Psychoneuroimmunology ~ Glucocorticoid activity upon the Cardiovascular system Sustains myocardial performance Facilitates the vasoconstrictive activities of the catecholamines and angiotensin II Decreases the production of the vasodilator prostaglandins and reduces vascular endothelium permeability Increases circulatory cholesterol Increases circulatory triglyceride Hypothalamus Corticotropin Releasing Factor (CRF) Pituitary Adrenocorticotropic Hormone (ACTH) Catacholamines Adrenal Cortex Glucocorticoid production Facilitate Facilitate Vasoconstrictive activity Sustain myocardial performance vasodilator prostaglandins Back To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness Thalamus, Hypothalamus & Cortex Stress/Anxiety Activity Neurological Activation Psychoneuroimmunology ~ CRF/ANS interaction Neurological Activation Amygdalioid Nucleus Endogenous CRF production CRF Activity Afferent CV Feedback Sympathetic vasomotor innervation Parasympathetic vasomotor innervation Afferent CV feedback activity Norepinephrine Activity Locus Coeruleus (LC) Potentiation of Norepinephrine Activity Vasomotor Regions in the Brain (Sympathetic) Activity Iintermediolateral columns of the spinal cord Inhibitory effect Tractus Solitarius (TS) Inhibitory effect Baro- and Chemoreceptors Afferent Cardiovascular Feedback Activity Dorsal Motor Vagus Nucleus (Parasympathetic) Activity Vasomotor Innervation Efferent Activity Iintermediolateral columns of the spinal cord Inhibitory effect Vagus Motor Innervation Efferent Activity Back