Notes Cardio system Powerpoint
Roberta L. Wolff
3. There is no question that you will encounter clients with all manners of pathologies of
the blood, heart, and blood vessels. Through understanding of this system, you will
then be able to understand cardiovascular pathologies and develop appropriate
treatment plans for clients with these diseases.
What are some other functions of blood?
Blood transports glucose, amino acids, lipids, and hormones to cells. Carbon dioxide
diffuses from the tissues into the blood, which carries it away.
● Buffers are chemicals that help neutralize acids and bases; these are produced as
cellular by-products of the cell’s metabolic activities.
4. The Blood
Red blood cells (RBCs, erythrocytes)
Produced in bone marrow
Production stimulated by erythropoietin (EPO) from kidneys
98% of blood cells
Lifespan = 4 months
Dead RBCs removed by spleen
Turnover: 2 million/second
No nuclei, lots of hemoglobin (iron-based)
3
5 million per mm
Biconcave discs: all identical, smooth and flexible
White blood cells (WBCs, leukocytes)
Translucent
Different types for different functions
Neutrophils, basophils, eosinophils, monocytes, lymphocytes (Fig. 5.1)
5. Erythrocytes help carry oxygen to cells. Leukocytes are part of the immune system
and they help destroy pathogens. As shown in the image, there are many types of
leukocytes. Thrombocytes are responsible for clotting to prevent excess blood loss.
● What does hemoglobin do?
Hemoglobin is the respiratory pigment found in erythrocytes.
6. Platelets (thrombocytes)
Fragments of larger cells (megakaryocytes)
Smooth until stimulated, then spiky, sticky
Release chemicals that weave fibrin
Make thrombi, crusts
Anticoagulants, thrombolytics prevent or melt clots
7. Plasma proteins are proteins that are found in the blood plasma. Some examples
include the following: albumins, globulins, fibrinogens, and antibodies.
● Enzymes are proteins that accelerate chemical reactions.
● What is the function of hormones?
Hormone actions vary widely, but they basically serve as signals to their target cells.
For example, they can signal stimulation or inhibition of growth or metabolism.
1|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
8. Blood Vessels
Aorta → arteries → arterioles → capillaries → venules → veins → vena cava →
heart
Closed system: platelets and RBCs should not be able to leave
60,000 miles of vessels
3-ply construction of veins and arteries
Tunica intima (endothelium)
Tunica media (smooth muscle)
Tunica externa/adventitia (connective tissue)
Capillaries are simple squamous epithelium: excellent for permeability
9. The pericardium is the sac enclosing the heart. The pericardium possesses two layers
of membrane with serous fluid between to help decrease friction within the
pericardium while the heart is beating.
● What is the myocardium?
The myocardium is composed of cardiac muscle, which is responsible for the heart’s
pumping action. It is enclosed by the epicardium on the outside and is lined with
endocardium on the inside, both of which are composed of flattened epithelial
cells.
10. The right atrium receives deoxygenated blood. When the RA contracts, blood is
pushed through the tricuspid valve and enters the right ventricle. The RV contracts,
pushing blood through the pulmonary semilunar valve and the blood enters the
pulmonary trunk, leading to the lungs.
● Blood, now oxygenated, returns to the heart’s left atrium through the pulmonary
veins. When the LA contracts, blood pushes open the bicuspid valve and enters the
left ventricle. The LV contracts, and blood pushes open the aortic semilunar valve;
the blood then enters the aorta, which carries the oxygenated blood out to the
entire body.
● The tricuspid valve is also known as the right atrioventricular valve (shown in the slide
image). The mitral valve is also known as the left atrioventricular valve.
11. Valves between the atria and ventricles maintain coordinated unidirectional flow
of blood from the atria to the ventricles. To review, the valve between the right
atrium and the right ventricle is the tricuspid valve. Between the left atrium and the
left ventricle is the mitral, or bicuspid, valve.
12. ● The superior vena cava drains the upper part of the body, and the inferior vena
cava drains the lower part of the body of deoxygenated blood. The inferior vena
cava and the superior vena cava drain directly into the right atrium.
● The pulmonary trunk begins at the base of the right ventricle and branches into two
pulmonary arteries that connect to each lung. The right ventricle pumps blood into
the pulmonary trunk.
● The left ventricle pumps oxygenated blood through the aorta to the entire body.
2|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
●
The coronary sinus and the coronary arteries make up the heart’s own blood supply
system.
What is pulmonary circulation?
Pulmonary circulation consists of the flow of deoxygenated blood from the right side
of the heart to the lungs and the flow of oxygenated blood from the lungs back to
the left side of the heart.
● What is systemic circulation?
Systemic circulation consists of the flow of deoxygenated blood from the rest of the
body into the right side of the heart and the flow of oxygenated blood from the left
side of the heart back out to the rest of the body.
13. none
14. What is coronary circulation?
Coronary circulation consists of the flow of the heart’s own blood supply. The blood
vessels that supply oxygenated blood to the heart are known as coronary arteries.
The blood vessels that remove deoxygenated blood from the heart are known as
coronary veins. The coronary veins drain the deoxygenated blood into the coronary
sinus, which drains into the right atrium of the heart.
15. ● Impulses the heart generates travel through a specific pathway in the heart
called the conduction system.
● The heart’s autorhythmicity is its ability to repeatedly generate its own electrical
impulses.
● The electrical impulse is generated in the SA node, which then travels through the
atria, causing them to simultaneously contract. While the atria are contracting, the
ventricles are relaxing. When the impulse reaches the inferior part of the right atrium,
it contacts the AV node, which then sends the impulse to the AV bundle located in
the interventricular septum. The AV bundle splits into right and left bundle branches,
which then sends the impulse to the right and left ventricles via the Purkinje fibers.
The right and left ventricles simultaneously contract, and at this point the atria
relaxes.
16. The heart contains nerve tissues that produce and transmit electrical impulses that
trigger the heart to contract in a synchronized manner.
● The sinoatrial node generates electrical impulses that are carried to both atria. After
the atria contract, the right atrium passes the electrical impulses on to the
atrioventricular node, which then passes the impulses on to both ventricles.
● What is the heart’s pacemaker?
The sinoatrial node sets the pace for the rest of the heart to beat, so it is known as
the heart’s pacemaker.
When epinephrine is released into the bloodstream, it increases the heart rate and
stroke volume, dilates the pupils, and constricts arterioles in the skin and intestines
while dilating the arterioles in the leg muscles.
● What is the difference between the sympathetic and parasympathetic nervous
systems?
3|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
The sympathetic nervous system prepares the body to cope with stress, fear, or
physical exertion. The parasympathetic system does fundamentally the opposite by
conserving energy and slowing and relaxing the body.
17. The blood vessels are the part of the cardiovascular system that transports blood
throughout the body. The blood vessels are a closed system of tubes.
● The flow of blood through the body goes from the heart, to the arteries, to the
arterioles, to the capillaries, to the venules, to the veins, and back to the heart.
● Arteries have thick walls and lots of smooth muscle with elastic tissue (shown on left
of image). The elastic tissue allows arteries to stretch and accommodate the surge
of blood coming out of the heart. An elastic recoil helps move blood along.
● Capillaries have a single layer of epithelium, which makes it easier for the exchange
of substances.
● Venous walls are thinner than arterial walls. Veins possess valves to prevent backflow
of blood.
18. What is the function of the systemic arteries?
The systemic arteries carry blood away from the heart.
● The superior vena cava is the large but short vein that carries deoxygenated blood
to the right atrium of the heart. The inferior vena cava is the large and long vein that
carries deoxygenated blood from the lower body to the right atrium of the heart.
● The branches of the aorta are shown in Appendix B on page 466 and is a massage
endangerment site.
19.
●
●
●
Arteries carry oxygenated blood away from the heart to the rest of the body. The
pulmonary arteries are exceptions since they carry deoxygenated blood from the
heart to the lungs.
The elastic tissue in the arteries allows them to stretch to accommodate the surge of
blood being pumped into them from the heart. What role does the smooth muscle
tissue play in the arteries?
The smooth muscle tissue contracts and relaxes, regulating the body’s blood
pressure.
Arteries branch out into arterioles, which branch out into narrower vessels called
capillaries.
Arterioles need to withstand less pressure than the arteries do, so their walls are not
as thick.
20. ● Capillaries are the smallest of the body’s blood vessels. They provide a bridge
between arterioles and venules.
● Why are capillary walls so thin?
Capillaries have walls composed of a single layer of cells so that diffusion can take
place. The walls are so thin that molecules such as oxygen, water, and lipids can
pass through them to enter the tissues. Waste products such as carbon dioxide and
urea can also diffuse back into the blood in the capillaries to be carried away for
removal from the body.
4|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
21. Venules channel blood from the capillary beds to veins. They have thinner walls
than arterioles. Why?
The walls of venules do not need to be as thick as the walls of arterioles because
they do not have to withstand the pressure of the heart forcing blood through them.
They’re simply part of the recovery system.
22. ● Veins return deoxygenated blood to the heart, except the pulmonary veins,
which carry oxygenated blood from the lungs back to the heart.
● Why do veins have valves?
Blood flows more slowly in veins than in it does in arteries, so veins have one-way
valves to prevent backflow caused by gravity.
● What drives blood flow in the veins?
Skeletal muscle contraction drives blood flow in the veins.
23. ● The walls of both arteries and veins possess three layers (tunics).
● The innermost layer is called the tunica intima (or tunica interna), which is
endothelial tissue fused with a small quantity of elastic connective tissue. The middle
layer is the tunica media, which contains quantities of both connective tissue and
smooth muscle. The outer layer possesses mostly dense connective tissue and is
called the tunica adventitia (or tunica externa).
24. ● If a client exhibits any of the listed symptoms, the therapist should refer the client
to the client’s health care provider.
● What is the difference between bradycardia and tachycardia?
Bradycardia is a lower than normal heart rate, and tachycardia is a higher than
normal heart rate.
● Hives (urticaria) is a relatively common allergic reaction that causes itchy raised skin
welts. These should be avoided during massage.
●
●
●
What is the significance of unexplained chest or calf pain?
These can be signs of a serious underlying pathology, such as coronary artery
disease, deep vein thrombosis, myocardial infarction, or phlebitis, that requires
medical attention and can affect massage therapy or contraindicate it altogether.
Limbs unequal in temperature can indicate inflammation, ischemia, or Raynaud’s
syndrome.
What is the significance of chronic fatigue?
It can be a sign of chronic fatigue syndrome, congestive heart failure, depression, or
other pathologies that require the massage therapist to consult with the client’s
health care provider.
26. See Box 8-1 on page 221 for general manifestations of cardiovascular disease.
Discussions of leukemias, which are types of blood cancer, are located in Chapter 14.
5|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
27. ● Ultimately, anemia leads to inadequate oxygen at the cellular level. This
condition is called hypoxia.
● The therapist should first ascertain the type of anemia the client has. Clearance from
the client’s health care provider is needed for more severe types. Reduce treatment
time and pressure if the client is overly fatigued and be ready to assist the client off
table if needed.
28. Massage
Depends on cause
May offer temporary improvement; probably not long term
Won’t reverse etiology of most types of anemia
Cautions: heart rate; pernicious anemia may change sensation
Sickle cell and malaria are discussed elsewhere
29. Table 8-1 on page 225 contains information on the different types of anemia.
● In sickle-cell anemia, what does the abnormal hemoglobin do?
The abnormal hemoglobin causes the red blood cells to “sickle.” Clinical
manifestations of sickle cell anemia are shown in figure 8-12 on page 226.
● A unique symptom of aplastic anemia is petechiae, or minute hemorrhaging in the
skin. This is shown in figure 8-13 on page 227. Petechiae is also regarded as a skin
lesion (see page 62).
30. none
31. Slide: blood smear from patient with Sickle Cell Anemia. The Abnormal cells show
blue.
32. none
33. ● There are three types of hemophilia, but all of them impair blood clotting or
prevent it entirely.
● Massage is contraindicated for clients with moderate to severe hemophilia because
of the danger of causing excessive bruising from blood leaking of broken capillaries.
34. ● Intact endothelial cells possess an antithrombotic property which inhibits the
formation of a thrombus. If endothelial cells are injured, they initiate a chain of
events leading to thrombus formation. Injury can occur from inflammation and
infections or trauma and injury. This is why surgery, atherosclerosis, and hypertension
promote thrombus formation.
● If a piece of thrombus breaks off and flows through the bloodstream, it is referred to
as an embolus.
35. ● Thrombi form as part of a coagulation sequence to prevent blood loss from
disrupted vessels.
● These two diagrams reveal the first and last stages of thrombus formation. The
platelets, red blood cells, white blood cells, and fibrin meshwork congregate to form
a thrombus at the location of the defect.
6|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
36. ● An embolus can potentially lodge in a blood vessel and cause ischemia in the
area that is fed by that vessel. This may result in serious injury or death.
● The most common type of embolus is a thrombus; a portion of a clot breaks free
(now called a thromboembolus) and travels along until it lodges in a vessel too
narrow to allow passage. Other types of emboli are bubbles of air, pieces of fat or
bone marrow, and even pieces of tumor or atherosclerotic plaque.
● Why is deep, vigorous massage contraindicated?
It is contraindicated because of the danger of dislodging the clot.
37. ● The most frequent cause of thromboemboli is a reduction on the normal blood
flow, usually from prolonged sitting or lying down. Causes for other emboli types
include bone fracture from injury or accident. Surgery is another cause.
● The diagram on the left shows the locations of common venous emboli and lists the
symptoms of a pulmonary embolism. The diagram on the right shows the locations of
common arterial emboli.
● A photograph of a saddle embolus, which is featured on the left, is shown on page
230, figure 8-18.
38. ● Ask clients about any allergies they might have so that you can avoid any
reactions to product ingredients that might lead to shock.
● Why is massage contraindicated?
Massage is contraindicated because a person in shock requires immediate medical
attention.
● Table 8-2 on page 231 discusses different types of shock.
39. ● Shock can be classified by its cause. What are the three mechanisms that cause
shock?
Shock is caused by one of three mechanisms: (1) hypovolemia (reduced blood
volume); (2) heart failure; or (3) generalized dilation of the peripheral vascular
system. All three result in inadequate blood flow to organs, causing multiple organ
failure.
40. ● Shock can be classified by its cause. What are the three mechanisms that cause
shock?
Shock is caused by one of three mechanisms: (1) hypovolemia (reduced blood
volume); (2) heart failure; or (3) generalized dilation of the peripheral vascular
system. All three result in inadequate blood flow to organs, causing multiple organ
failure.
● The symptoms of shock are listed in the diagram on this slide, along with possible
causes of shock and which organs are affected by shock.
● What is dyspnea? Shortness of breath. It can also mean difficult or painful breathing.
41. none
7|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
42. ● The pain generally originates in the chest and radiates down the inner side of the
left arm or to the neck and throat, as seen in the diagram. Angina pectoris is often a
symptom of coronary artery disease.
● If a client has an attack during massage and is known to have angina, help them
into an upright position and assist in medications administration. If nitroglycerin is
taken, ask client to sit or lie down for 20-30 minutes or until they know they will not
get dizzy or faint. If the client has three medication doses within a 10 minute period,
and no pain relief, treat as a heart attack and call 911.
● If a client has an attack during the massage and does NOT have a history of angina,
call 911 if pain persists after 2 minutes.
●
●
If a client has an attack during massage and is known to have angina, help them
into an upright position and assist in medications administration. If nitroglycerin is
taken, ask client to sit or lie down for 20-30 minutes or until they know they will not
get dizzy or faint. If the client has three medication doses within a 10 minute period,
and no pain relief, treat as a heart attack and call 911.
If a client has an attack during the massage and does NOT have a history of angina,
call 911 if pain persists after 2 minutes.
43. ● Normal heart rate is traditionally stated as 60-100 BPM, but many now consider
the range to be 50-100 because of people with well-conditioned hearts have lower
heart rates.
● Also called irregular heart beat, arrhythmias are common, usually harmless, and do
not always indicate disease.
● Clients with chest pain should be referred to their physicians for evaluation and
treatment.
● Table 8-3 on p. 233 of the textbook provides a discussion of each of these and other
arrhythmia types.
● Serious arrhythmias require emergency treatment and may include intravenous
medications, electrical shock therapy, or surgery to implant an artifical pacemaker
or ICD.
44. ● The most common form of CHF is left-sided CHF (60% of cases). However, when
the right side of the heart fails, the other follows.
● Table 8-4 on page 234 contains information of the different classifications of chronic
CHF
45. ● The term congestive is used to describe what happens as one or both sides of
the heart fail; blood backs up into, or congests, the lungs, liver, other organs, and
the lower extremities.
● Some of the signs of congestive heart failure are listed on the diagram. What are
some other signs?
● Shortness of breath and fatigue are also symptoms of CHF.
8|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
46. ● Acute CHF, with the resultant pulmonary edema, represents a medical
emergency.
● For chronic CHF, a thorough intake will help determine massage appropriateness.
Ascertain, by questioning and observation, current symptoms before proceeding
with massage.
● If the therapist has any question about the stability of the client’s condition or if the
client states that his or her symptoms have worsened, medical clearance should be
obtained.
● Table 8-5 on page 237 contains important information on how to adapt massage for
clients with CHF during different stages of their disease.
47. ● The New York Heart Association developed a classification system used to assess
the severity of disease based on physical limitations. This system can be used to
determine the appropriateness of massage.
48. ● An artifical pacemaker is a medical device that restores the heartbeat to a
normal rate. It is surgically implanted and most often used in people who have heart
conditions such as arrhythmias and heart failure.
● Leads (wires from the device) are not attached to the inside of the heart but are
placed near the heart. Over time, the wire tips remain in position by fibrosis. The
process of fibrosis is complete in about six weeks -- hence the 6 wk restriction of
overhead arm movements.
● While client is prone, place a soft pillow under the chest for added comfort.
49. ● An implantable cardioverter defibrillator (ICD) is a device that briefly passes an
electric current through the heart to help it beat steadily. It is surgically implanted
and used to reduce the risk of sudden death from ventricular fibrillation.
● Once the incision from either surgery is fully healed and the implanted device is
stable, scar mobilization is permissible. Be sure to mobilize tissue toward the scar
rather than away from it to avoid overstretching healed tissue.
● If an ICD delivers a shock, it means that the heart is currently in crisis and is making
adjustments. In these cases, it is best to discontinue massage for that day.
50. ● Local massage around the surgical incision is contraindicated until the client is
fully healed.
● The therapist should exercise caution when performing shoulder joint mobilizations
on clients with pacemakers since moving the client’s arm over the client’s head
could disturb the lead connections for the pacemaker.
51. The shock is painful to the client. It can be felt by the massage therapist as a tingling
sensation but it is not harmful.
9|Page
Notes Cardio system Powerpoint
Roberta L. Wolff
52. ● What are symptoms of rheumatic fever?
Symptoms include fever, joint pain with limited range of motion, chest pain,
abnormal heart sounds, and enlargement of the heart. Other disease manifestations
are a rash on the trunk, jerky body movements, and small nodules on tendon
sheaths of joints. The person may also have shortness of breath, fatigue, and loss of
appetite.
● Rheumatic fever is a disorder requiring immediate medical attention. Massage is
postponed until the condition has resolved and medical clearance is given.
53. ● What are symptoms of rheumatic fever?
Symptoms include fever, joint pain with limited range of motion, chest pain,
abnormal heart sounds, and enlargement of the heart. Other disease manifestations
are a rash on the trunk, jerky body movements, and small nodules on tendon
sheaths of joints. The person may also have shortness of breath, fatigue, and loss of
appetite.
● Rheumatic fever is a disorder requiring immediate medical attention. Massage is
postponed until the condition has resolved and medical clearance is given.
54. ● There are three types of cardiomyopathy, shown as B, C, and D in the slide
image.
● Most symptoms of cardiomyopathy are similar to CHF.
● If medical clearance is obtained, what type of massage should be given?
Reduce the treatment time and pressure if the client is overly fatigued and be ready
to assist the client off table if needed. Clients with chest pain should be referred to
their physicians for evaluation and treatment.
55. ● The heart’s valves are folds of the endocardium, so they are often affected by
endocarditis.
● Endocarditis can be a primary disorder or complication of another disease. It may
occur when pathogens, usually bacteria, enter the bloodstream and attach to
defects in the endocardium or the heart valves.
56. none
57. ● The person may experience chest pain, shortness of breath, tachycardia, edema
in the lower extremities, or a dry cough. Some people also report the sensation of a
pounding heart.
● Why is massage contraindicated?
Massage is contraindicated because pericarditis is a debilitating disorder that
requires medical attention.
58. none
59. none
10 | P a g e
Notes Cardio system Powerpoint
Roberta L. Wolff
60. ● How can massage help clients with a history of myocardial infarction?
Massage can help clients relax, reduce stress, and decrease the effects of the
sympathetic nervous system.
● It is important that clients have with them their necessary medications, such as
nitroglycerin, in the event of a medical emergency. Be sure to consider any related
conditions, such as CHF, when formulating the client's treatment plan.
61. ● A on this slide depicts a myocardial infarction from thrombus. Areas supplied by
the occluded artery are destroyed by lack of blood flow.
● Since myocardial tissue does not regenerate, damaged tissue is replaced by
fibrotic, noncontractle tissue, which becomes a permanent scar of the heart wall. B
on this slide shows a cross section of a heart with the area of infarct darkened.
62. ● Be able to recognize and respond to warning signs of a heart attack.
● If a client complains of chest pain that lasts more than a few minutes, especially with
the other signs listed in the slide, call 911. If the client becomes unresponsive before
EMS arrives, begin CPR if you are qualified to do so. When EMS arrives, give them
information regarding the incident, including medications, such as nitroglycerin, that
the client took prior to their arrival.
●
The early warning signs listed on this slide and the next slide are considered less
common warning signs, and they are often associated with warning signs for heart
attacks in women.
63. none
64. ● If measures are not taken to stimulate the heart’s pumping action, damage to
the brain, kidneys, liver, heart, and lungs occurs, quickly leading to death.
● The acute care principle is “time is muscle.” This process involves the administration
of CPR (best administered within 3 to 6 minutes of the cardiac arrest). Medications
are given to support heart functions once the person is transported to an
emergency medical facility.
65. Cerebrovascular accidents are discussed with neurological conditions and
disease.
66. ● Clients with arteriosclerosis are generally instructed to get adequate rest,
moderate exercise, and avoid stress. Medications such as beta-blockers,
vasodilators, and anticoagulants are often used.
● Atherosclerosis, a type of arteriosclerosis, is the most common form of the disease;
the two terms are often used interchangeably.
Healthy arteries are flexible, strong and elastic. Over time, however, too much pressure
in your arteries can make the walls thick and stiff — sometimes restricting blood flow
to your organs and tissues. This process is called arteriosclerosis, or hardening of the
arteries.
11 | P a g e
Notes Cardio system Powerpoint
Roberta L. Wolff
67. ● Arteries are blood vessels that carry oxygen and nutrients from your heart to the
rest of your body. Healthy arteries are flexible, strong and elastic. Over time, however,
too much pressure in your arteries can make the walls thick and stiff — sometimes
restricting blood flow to your organs and tissues. This process is called arteriosclerosis, or
hardening of the arteries.
● Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used
interchangeably. Atherosclerosis refers to the buildup of fats in and on your artery walls
(plaques), which can restrict blood flow. These plaques can also burst, causing a blood
clot. Although atherosclerosis is often considered a heart problem, it can affect arteries
anywhere in your body. Atherosclerosis is a preventable and treatable condition.
● It is helpful not to think of atherosclerosis as a single disease, but as a pathologic
process that leads to many other diseases. It takes years for complications to
manifest; diabetes, hypertension, and smoking accelerate this process.
● Because atherosclerosis is most often related to other disease, the massage
considerations for those specific diseases should be followed.
68. ● This image shows the correlation of atherosclerosis to many other diseases.
● Atherosclerosis is responsible for most MI’s and strokes. Atherosclerosis of the aorta is
the leading cause of aortic aneurysms.
● Table 8-6 on page 246 contains information of factors leading to atherosclerosis,
both modifiable and nonmodifiable.
69. none
70. none
71. ● Atherosclerosis begins with an injury to the endothelium. The injury creates
immunological and inflammatory changes, causing a fatty streak to form. Over
time, a crust forms over the streak, called a fibrous plaque, which not only thickens
the vessel wall, but creates a projecting mass with an irregular surface. Platelets
easily adhere to the surface, forming blood clots, which further obstructs the lumen.
This stage is called complicated lesion.
● Initially, the person is asymptomatic. As arteries become obstructed, symptoms are
related to lack of blood flow and depend on location of the affected vessel. For
example, obstructed coronary arteries will present symptoms such as chest pain and
may lead to myocardial infarction.
72. ● Coronary artery disease is a leading cause of disability and death in the United
States.
● Since CAD may occur with related diseases, massage considerations for those
specific diseases should be considered. Other medical conditions present, such as
angina, should be addressed in the treatment plan as well.
73. ● The main cause of CAD is atherosclerotic plaque that narrows the lumen of
coronary arteries. Symptoms typically advance as the blockage increases,
proceeding from asymptomatic to angina pectoris, CHF, and eventually MI.
● In some cases, the disease can be asymptomatic until MI occurs.
12 | P a g e
Notes Cardio system Powerpoint
Roberta L. Wolff
74. ● What are some symptoms of PAD?
Symptoms include intermittent calf pain that becomes more severe with time;
weakness, numbness, and fatigue in legs; cyanosis causing skin discoloration; thick,
malformed nails; and a weak or absent peripheral pulse.
● Why is local massage contraindicated?
Because of the possibility of clot formation, the affected area is a local
contraindication.
75. ● Persons with systolic pressures exceeding 140 OR diastolic pressure greater than
90 have hypertension. See table 8-7 on page 251 for a summary of blood pressure
classifications.
● If hypertension is not under control by diet, regular exercise, and/or medication, the
client should not receive massage because of the likelihood of unmonitored severe
complications.
● For clients with hypertension under control, massage helps keep blood pressure
lowered by reducing stress and the activity of the sympathetic nervous system.
● Clients on antihypertensive medications may be prone to postural hypotension; if
the client experiences light-headedness when getting up from the massage table,
be ready to assist.
76. ● What is the difference between true and false aneurysms?
True aneurysm is a weakness in the vessel wall that involves all three arterial layers.
False aneurysm is not a weakness, but a tear in the artery.
● Abdominal aortic aneurysm is the most common form. Aneurysms can also occur in
cerebral arteries, causing stroke. Aneurysms are also found in the extremities.
● What are some common causes of aneurysms?
Common causes of aneurysms include the following: atherosclerosis, hypertension,
smoking, trauma, infections, and congenital vascular weakness.
77. ● What does recumbent mean? Lying down.
● The elderly are particularly susceptible to acute orthostatic hypotension, and it is a
significant risk factor for falls and their associated injuries.
● Massage tends to lower blood pressure temporarily, so clients with hypotension
might need extra assistance getting off the massage table or might need to be
massaged in a seated position.
78. ● If the disease does not have an underlying condition, it is called Raynaud
disease. If the disease is a secondary to an underlying condition, such as
scleroderma or lupus, it is called Raynaud syndrome or Raynaud phenomenon. All
these terms are often used interchangeably.
● Be sure the client is covered at all times with a sheet and a warm blanket.
79. ● Thromboangiitis obliterans, or Buerger disease, is considered rare in the U.S.
● The exact cause of TAO is not known, but it is very strongly associated with long-term
use of smoking tobacco. A genetic component exist as it is more prevalent in
persons of Jewish, Japanese, or Indian decent.
13 | P a g e
Notes Cardio system Powerpoint
Roberta L. Wolff
80. ● When discussing these conditions with your clients and their health care
providers, note that the terms thrombophlebitis, phlebothrombosis, and phlebitis are
often used interchangeably.
81. ● When does phlebitis usually occur?
It usually occurs after an acute or chronic infection; pregnancy or childbirth; surgery;
prolonged sitting (such as on long airplane flights), standing, or immobilization.
82. ● Venous stasis is the most common cause of thrombophlebitis and is due to
prolonged inactivity, such as from long periods of sitting or standing, or from
restrictive clothing. Other causes are injury to the venous wall by trauma or
chemicals, local or systemic inflammatory processes, and increased blood
coagulability.
● Homan’s sign, which is pain in the calf muscle when the foot is dorsiflexed, is a
common but not always a reliable indicator of thrombophlebitis. This test can be
seen in figure 8-51 on page 256.
83. ● Once veins become dilated, they tend to remain so.
● What are some other massage considerations?
The client’s legs should be elevated above the heart during treatment. Massage
proximal to the affected area if it is located on the extremities; for example,
massage the thigh prior to the leg. This technique encourages venous return.
84. ● The diagram on this slide shows the difference between competent and
incompetent valves. Veins with incompetent valves do not seal, which means that
gravity prevents blood from flowing upward. This causes back pressure in the vein,
pushing the walls outward and making them stretched and flabby.
● Blood pools in the veins, leading to the characteristic signs and symptoms of
varicose veins. These include veins that appear bluish purple in color, are bulbous
and tortuous, and feel hard to the touch.
● In severe cases, ulcers form near the ankle. This may be a symptom of chronic
venous insufficiency, which requires immediate attention.
85. end
14 | P a g e