It is always important to follow the hierarchy. The pericardium is dependent on many other systems and is usually the last component to be treated. As one progresses through the hierarchy, it is important to monitor the patient’s responses. Depending on their general state of health, they may react to certain treatments, as the body attempts to restore balance. If these responses are significant, such as respiratory distress or severe pain, etc., it may be necessary to slow the pace of treatment, i.e. space the treatments out. Coordination with their MD or ND may be necessary, in order to ensure that the patient is being properly monitored, with regard to laboratory and clinical evaluation, as well as medications. Recall that other influences, such as the cranial base (vagal tone) and the upper thoracic spine (sympathetic nerve supply), may also be involved. If the patient is tolerating treatment, then progressing to the pericardial fascia may proceed.