Sunday, 30 August 2009

The cardiac plexus


Cardiologists are busy "ablating aberrant pathways" in patients with arrhythmias. Some of these abnormal pathways are clearly aberrant nerves (UCLA group).
http://www.ncbi.nlm.nih.gov/pubmed/19631911?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Superior, middle and inferior cardiac nerves converge bilaterally on the cardiac plexus on the posterior surface of the left atrium among the pulmonary veins - in "tiger country". No cardiac surgeons go there; neither do many cardiologists. http://www.bartleby.com/107/220.html
One of the original descriptions was by Robert Lee of St Georges Hospital, London in 1851. He had already found the inferior hypogastric plexus in postpartum women (where it is enlarged) then he proceeded to non-pregnant women and animals to confirm the observations. His preparations were preserved in alcohol - not formalin. The above is a plasticised specimen that shows an outline of the plexus rather than all of it.
One common source of midline autonomic injury is persistent physical efforts during defaecation which has different effects from infancy to the elderly. Another is childbirth for the same reasons. There will be many other sources of injury. If cardiologists ablate neural pathways, will they not result in more "sprouting" of pathways ? Some more natural history must be helpful.

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