mosby ’s pathology lesson 8.1 objectives massage therapists · 43 copyright ©2010, 2006 by...

Chapter 8Chapter 8

Cardiovascular Cardiovascular

PathologiesPathologies

MosbyMosby’’s PATHOLOGYs PATHOLOGY

forfor Massage TherapistsMassage Therapists

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson 8.1 ObjectivesLesson 8.1 Objectives

�� Discuss anatomic structures and physiologic Discuss anatomic structures and physiologic

processes related to the cardiovascular processes related to the cardiovascular

system.system.

3Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

�� Three fluids interact with stationary cells to Three fluids interact with stationary cells to

help maintain homeostasis by delivering help maintain homeostasis by delivering

oxygen and nutrients and by removing oxygen and nutrients and by removing

wastes:wastes:

�� BloodBlood

�� Interstitial fluid Interstitial fluid

�� LymphLymph


�� Three fluids bring nutrients to and remove Three fluids bring nutrients to and remove

waste from stationary cells:waste from stationary cells:

�� BloodBlood

�� Interstitial fluidInterstitial fluid

�� LymphLymph


Cardiovascular SystemCardiovascular System

�� Main components:Main components:

�� BloodBlood

�� HeartHeart

�� Blood vesselsBlood vessels


Cardiovascular System Cardiovascular System (cont(cont’’d.)d.)

�� Blood: consist of a liquid portion called Blood: consist of a liquid portion called

plasma and blood cellsplasma and blood cells

�� Functions of blood: Functions of blood:

�� Transports oxygen from the lungsTransports oxygen from the lungs

�� Transports nutrients from the digestive tractTransports nutrients from the digestive tract

�� Removes wasteRemoves waste

�� Regulates pH using buffersRegulates pH using buffers


�� Blood cellsBlood cells

�� Erythrocytes: redErythrocytes: red blood cells; blood cells; contains hemoglobincontains hemoglobin

�� Leukocytes: white blood cellsLeukocytes: white blood cells

�� Thrombocytes: plateletsThrombocytes: platelets

Cardiovascular SystemCardiovascular System (cont(cont’’d.)d.)

From Solomon EP: From Solomon EP: Introduction to human anatomy and Introduction to human anatomy and

physiology,physiology, ed 2, St. Louis, 2003, Saunders.ed 2, St. Louis, 2003, Saunders.


�� Blood (contBlood (cont’’d.)d.)

�� Helps adjust body temperatureHelps adjust body temperature

�� Clots to protect against excessive loss due to Clots to protect against excessive loss due to

injuryinjury

�� Protects the body from diseaseProtects the body from disease

Cardiovascular System Cardiovascular System (cont(cont’’d.)d.)


�� Plasma proteinsPlasma proteins

�� TransportersTransporters

�� Help with blood coagulationHelp with blood coagulation

�� Part of lymphatic/immune systemPart of lymphatic/immune system

�� EnzymesEnzymes

�� HormonesHormones


�� HeartHeart

�� PericardiumPericardium

�� MyocardiumMyocardium

�� EndocardiumEndocardium

�� EpicardiumEpicardium


From From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and The human body in health and

illness,illness, ed 3, Philadelphia, 2007, Saunders.ed 3, Philadelphia, 2007, Saunders.


�� Heart chambersHeart chambers

�� Atria: superior Atria: superior

chambers; left and chambers; left and

rightright

�� Ventricles: inferior Ventricles: inferior

chambers; left and chambers; left and

rightright


From Solomon EP: From Solomon EP: Introduction to human anatomy and Introduction to human anatomy and

physiology,physiology, ed 2, St. Louis, 2003, Saunders.ed 2, St. Louis, 2003, Saunders.


�� Heart valvesHeart valves

�� TricuspidTricuspid

�� Mitral (bicuspid)Mitral (bicuspid)


From Thibodeau, GA, Patton KT: From Thibodeau, GA, Patton KT: Anatomy & Physiology,Anatomy & Physiology, ed 6, St. Louis, 2007, Mosby.ed 6, St. Louis, 2007, Mosby.


�� Major blood vessels connected to heartMajor blood vessels connected to heart

�� Superior vena cavaSuperior vena cava

�� Inferior vena cavaInferior vena cava

�� Pulmonary trunkPulmonary trunk

�� AortaAorta

�� Coronary sinusCoronary sinus

�� Coronary arteriesCoronary arteries


�� Pulmonary and systemic circulationPulmonary and systemic circulation

�� Deoxygenated blood enters right atriumDeoxygenated blood enters right atrium

�� Moves to right ventricleMoves to right ventricle

�� Moves to lungsMoves to lungs

�� Oxygenated blood enters left atriumOxygenated blood enters left atrium

�� Moves to left ventricleMoves to left ventricle

�� Moves throughout the bodyMoves throughout the body


�� Coronary circulationCoronary circulation

�� HeartHeart’’s own blood supplys own blood supply

�� Coronary arteries branch off aortaCoronary arteries branch off aorta

�� Coronary veins drain deoxygenated bloodCoronary veins drain deoxygenated blood

�� Coronary sinus drains into right atriumCoronary sinus drains into right atrium


�� HeartHeart’’s conduction s conduction

systemsystem

�� AutorhythmicityAutorhythmicity

�� Ensures a regular, Ensures a regular,

coordinated coordinated

heartbeatheartbeat


From From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and The human body in health and

illness,illness, ed 3, Philadelphia, 2007, Saunders.ed 3, Philadelphia, 2007, Saunders.


�� HeartHeart’’s conduction systems conduction system

�� Sinoatrial node nerve impulse sets paceSinoatrial node nerve impulse sets pace

�� Atria contract at same time, ventricles relaxAtria contract at same time, ventricles relax

�� Atrioventricular node contactedAtrioventricular node contacted

�� Ventricles contract at same time, atria relaxVentricles contract at same time, atria relax


�� Heart rate increasesHeart rate increases

�� Hormone epinephrine (adrenaline)Hormone epinephrine (adrenaline)

�� Sympathetic nervous systemSympathetic nervous system

�� Heart rate decreasesHeart rate decreases

�� Parasympathetic nervous systemParasympathetic nervous system


�� Blood vesselsBlood vessels

�� ArteriesArteries

•• ArteriolesArterioles

�� CapillariesCapillaries

�� VeinsVeins

•• VenulesVenules



�� Major arteries and veinsMajor arteries and veins


From From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and illness,The human body in health and illness, ed 3, Philadelphia, 2007, Saunders.ed 3, Philadelphia, 2007, Saunders.


�� ArteriesArteries

�� Distribute oxygenated bloodDistribute oxygenated blood

�� Branch off aortaBranch off aorta

�� Have thick walls with smooth muscle and elastic Have thick walls with smooth muscle and elastic

tissuestissues


�� ArteriolesArterioles

�� Distribute oxygenated bloodDistribute oxygenated blood

�� Smallest branches of arteriesSmallest branches of arteries

�� Single layer of tissue covered by some smooth Single layer of tissue covered by some smooth

musclemuscle


�� CapillariesCapillaries

�� Distribute nutrients and remove waste through Distribute nutrients and remove waste through

interstitial fluidinterstitial fluid

�� Smallest branches of arterioles and venulesSmallest branches of arterioles and venules

�� Single layer of epithelial tissueSingle layer of epithelial tissue


�� VenulesVenules

�� Remove deoxygenated bloodRemove deoxygenated blood

�� Smallest branches of veinsSmallest branches of veins

�� Single layer of tissue covered by some smooth Single layer of tissue covered by some smooth

musclemuscle


�� VeinsVeins

�� Remove deoxygenated Remove deoxygenated

bloodblood

�� Thin walls with smooth Thin walls with smooth

muscle and elastic muscle and elastic

tissuestissues

�� Skeletal muscles help Skeletal muscles help

move bloodmove blood

�� Valves prevent backflowValves prevent backflow

From Modified from Thompson JM et al: From Modified from Thompson JM et al: MosbyMosby’’s clinical s clinical

nursing,nursing, ed 5, St. Louis, 2002, Mosby.ed 5, St. Louis, 2002, Mosby.


�� TunicsTunics

�� Tunic intima: innermost layerTunic intima: innermost layer

�� Tunic media: middle layerTunic media: middle layer

�� Tunic adventitia: outer layerTunic adventitia: outer layer

•• VasaVasa--vasorum: blood supply for large vessels (vessels of vasorum: blood supply for large vessels (vessels of

the vessels)the vessels)


�� Refer client to health care provider:Refer client to health care provider:

�� Bradycardia or tachycardiaBradycardia or tachycardia

�� PalpitationsPalpitations

�� Difficulty with or rapid breathingDifficulty with or rapid breathing

�� Skin discolorations (pallor, redness, jaundice, Skin discolorations (pallor, redness, jaundice,

cyanosis)cyanosis)

�� Unexplained bruising or skin irritationUnexplained bruising or skin irritation

�� Presence of rashes, hives, or scalinessPresence of rashes, hives, or scaliness


�� Refer client to health care provider:Refer client to health care provider:

�� Unexplained chest or calf painUnexplained chest or calf pain

�� Edema (pitting edema, molted skin, or limbs of Edema (pitting edema, molted skin, or limbs of

unequal circumference)unequal circumference)

�� Limbs unequal in temperatureLimbs unequal in temperature

�� Chronic fatigue or dizzinessChronic fatigue or dizziness

�� Exercise intoleranceExercise intolerance



�� Define disorders of blood and circulation and Define disorders of blood and circulation and

list appropriate massage considerations for list appropriate massage considerations for

each.each.

�� Contrast and compare types of anemia.Contrast and compare types of anemia.

�� Identify disorders of the heart and list Identify disorders of the heart and list

appropriate massage considerations for each.appropriate massage considerations for each.

�� Explain different types of arrhythmias.Explain different types of arrhythmias.


Disorders of Blood and Disorders of Blood and

CirculationCirculation

�� AnemiaAnemia

�� HemophiliaHemophilia

�� ThrombosisThrombosis

�� EmbolismEmbolism

�� ShockShock


AnemiaAnemia

�� Reduction in RBC quantity or Reduction in RBC quantity or their hemoglobin, which their hemoglobin, which impairs the bloodimpairs the blood’’s ability to s ability to carry O2carry O2

�� Obtain medical clearance for Obtain medical clearance for severe forms; reduce severe forms; reduce treatment time and pressure treatment time and pressure if client is overly fatigued if client is overly fatigued

From Damjanov I, Linder J: From Damjanov I, Linder J: Pathology: a color atlas,Pathology: a color atlas, St. Louis, St. Louis,

2000, Mosby; Copyright Dennis Kunkel Microscopy, Inc.; and 2000, Mosby; Copyright Dennis Kunkel Microscopy, Inc.; and

MialeMiale JB: JB: Laboratory medicine: hematology,Laboratory medicine: hematology, ed 6, St. Louis, ed 6, St. Louis,

1982, Mosby.1982, Mosby.



�� IronIron--deficiency deficiency –– Associated with Associated with iron depletion; most common iron depletion; most common type type

�� Pernicious Pernicious –– Larger than normal Larger than normal RBCRBC

�� Folic Acid Folic Acid –– Associated with folic Associated with folic acid deficiencyacid deficiency

�� Sickle Cell Sickle Cell –– Associated with Associated with RBC destruction, changing to RBC destruction, changing to sickle shapesickle shape

�� Aplastic Aplastic –– Associated with bone Associated with bone marrow failure; a rare, lifemarrow failure; a rare, life--threatening formthreatening form


HemophiliaHemophilia

�� Genetic disorder that impairs the bloodGenetic disorder that impairs the blood’’s clotting s clotting

mechanismsmechanisms

�� Massage is contraindicated in moderate or Massage is contraindicated in moderate or

severe forms; otherwise, obtain clearance and severe forms; otherwise, obtain clearance and

use lighter pressure; use lighter pressure; joint mobilizations joint mobilizations are are

omitted or cautiously appliedomitted or cautiously applied


ThrombosisThrombosis

�� Transformation of fluid blood into a Transformation of fluid blood into a gelatinous mass; also called blood clot gelatinous mass; also called blood clot formationformation

�� Avoid deep or vigorous techniques on lower Avoid deep or vigorous techniques on lower extremities for up to 10 days after the client is extremities for up to 10 days after the client is ambulatory if client is at risk for thrombosis ambulatory if client is at risk for thrombosis (e.g., recent surgery) (e.g., recent surgery)


Thrombosis Thrombosis (cont(cont’’d.)d.)

From Damjanov I: From Damjanov I: Pathology for the healthPathology for the health--related professions,related professions, ed 2, Philadelphia, 2000, WB Saunders.ed 2, Philadelphia, 2000, WB Saunders.


EmbolismEmbolism

�� Occlusion of a blood Occlusion of a blood vessel by an embolusvessel by an embolus�� Embolus: floating matter Embolus: floating matter in the intravascular space in the intravascular space carried by bloodcarried by blood

�� Massage is Massage is contraindicatedcontraindicated

From Gould B: From Gould B: Pathophysiology for the health professions,Pathophysiology for the health professions,

ed 2, Philadelphia, 2002, WB Saunders.ed 2, Philadelphia, 2002, WB Saunders.


Embolism Embolism (cont(cont’’d.)d.)

From Damjanov I: From Damjanov I: Pathology for the healthPathology for the health--related professions,related professions, ed 2, Philadelphia, 2000, WB Saunders.ed 2, Philadelphia, 2000, WB Saunders.


ShockShock

�� Failure of the cardiovascular system to Failure of the cardiovascular system to

deliver enough oxygen and nutrients to meet deliver enough oxygen and nutrients to meet

the bodythe body’’s needss needs

�� Massage is contraindicatedMassage is contraindicated



Shock Shock (cont(cont’’d.)d.)

Modified from Damjanov I: Modified from Damjanov I: Pathology for the healthPathology for the health--related professions,related professions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.


Disorders of the HeartDisorders of the Heart

�� Angina pectorisAngina pectoris

�� ArrhythmiasArrhythmias

�� Congestive heart Congestive heart

failurefailure

�� Rheumatic feverRheumatic fever

�� Rheumatic heart Rheumatic heart

diseasedisease

�� Cardiomyopathy Cardiomyopathy

�� EndocarditisEndocarditis

�� MyocarditisMyocarditis

�� PericarditisPericarditis

�� Myocardial infarctionMyocardial infarction

�� Cardiac arrestCardiac arrest


Angina Pectoris (Angina)Angina Pectoris (Angina)

�� Chest pain caused by Chest pain caused by

reduced blood supply reduced blood supply

to heartto heart

�� Be sure to keep client Be sure to keep client

warm (cold may trigger warm (cold may trigger

an attack); ensure an attack); ensure

client has necessary client has necessary

medicationsmedications

From Goodman C, From Goodman C, BoissonnaultBoissonnault W, Fuller K: W, Fuller K: Pathology: Pathology:

implications for the physical therapist, implications for the physical therapist, ed 2, Philadelphia, ed 2, Philadelphia,

2003, WB Saunders.2003, WB Saunders.


ArrhythmiasArrhythmias

�� Any deviation from a normal heartbeat or Any deviation from a normal heartbeat or

rhythm; term encompasses abnormally fast or rhythm; term encompasses abnormally fast or

slow rhythms as well as irregular rhythms slow rhythms as well as irregular rhythms

�� Reduce treatment time and pressure if client is Reduce treatment time and pressure if client is

overly fatigued overly fatigued


Arrhythmias, Types Arrhythmias, Types (cont(cont’’d.)d.)

�� Bradycardia Bradycardia –– <50 or 60 BPM<50 or 60 BPM

�� Tachycardia Tachycardia –– >100 BPM >100 BPM

�� Atrial fibrillation Atrial fibrillation –– atria quiver rather than atria quiver rather than

contract contract

�� Ventricular fibrillation Ventricular fibrillation –– ventricles quiver rather ventricles quiver rather

than contractthan contract


Congestive Heart FailureCongestive Heart Failure

�� HeartHeart’’s inability to meet body demands; s inability to meet body demands;

associated with disease (longstanding HBP, associated with disease (longstanding HBP,

CAD) or from heart problems (past MI, valvular)CAD) or from heart problems (past MI, valvular)

�� Types are: Types are:

�� LeftLeft--sided CHF sided CHF –– Most common Most common

�� RightRight--sided CHF sided CHF –– usually from leftusually from left--sided CHFsided CHF


Congestive Heart Failure Congestive Heart Failure (cont(cont’’d.)d.)

From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of Essentials of

human diseases and conditions,human diseases and conditions, ed 2, Philadelphia, ed 2, Philadelphia,

2000, WB Saunders.2000, WB Saunders.


Congestive Heart Failure Congestive Heart Failure (cont(cont’’d.)d.)

�� For acute cases, massage is contraindicatedFor acute cases, massage is contraindicated

�� For chronic cases, determine massage For chronic cases, determine massage

appropriateness or treatment modifications appropriateness or treatment modifications

by presenting symptomsby presenting symptoms

�� Example: in cases of severe pitting edema, avoid Example: in cases of severe pitting edema, avoid

the area the area



Artificial Pacemaker Artificial Pacemaker

�� Delivers small electrical Delivers small electrical

currents to stimulate heart currents to stimulate heart

contractioncontraction

�� Postpone massage until Postpone massage until

physician removes restriction physician removes restriction

of strenuous activity; then of strenuous activity; then

avoid overhead movement of avoid overhead movement of

the pacemakerthe pacemaker--side arm for side arm for

additional 6 wksadditional 6 wks


Implantable Cardioverter Implantable Cardioverter

Defibrillator (ICD)Defibrillator (ICD)

�� Delivers electrical shock to Delivers electrical shock to

restore normal heart rate restore normal heart rate

and rhythmand rhythm

�� If ICD delivers a shock If ICD delivers a shock

during massage, discontinue during massage, discontinue

massage; otherwise massage; otherwise

massage modifications massage modifications

same as artifical pacemakersame as artifical pacemaker


�� Massage considerations:Massage considerations:

�� Massage is postponed until client is completely Massage is postponed until client is completely

recovered from surgery and cleared by his or her recovered from surgery and cleared by his or her

physician.physician.

�� Surgery incision should be fully healed.Surgery incision should be fully healed.

�� Scar mobilization is permissible.Scar mobilization is permissible.

�� Avoid moving the arm near the pacemaker over the Avoid moving the arm near the pacemaker over the

head.head.


�� Massage considerations Massage considerations (cont(cont’’d.)d.)::

�� Offer a soft pillow to place under the chest while Offer a soft pillow to place under the chest while

the client is prone.the client is prone.

�� The therapist might feel the shock if the therapist The therapist might feel the shock if the therapist

is touching the client when the device discharges.is touching the client when the device discharges.

�� Massage should be discontinued if the device Massage should be discontinued if the device

discharges, and the client should seek immediate discharges, and the client should seek immediate

medical attention.medical attention.


Rheumatic FeverRheumatic Fever

�� Condition that develops Condition that develops

as a rare complication as a rare complication

after an untreated strep after an untreated strep

throat infection throat infection

�� Massage is Massage is

contraindicated contraindicated

From Damjanov I: Pathology for the health professions, ed 3, From Damjanov I: Pathology for the health professions, ed 3,

St. Louis, 2006, Saunders.St. Louis, 2006, Saunders.


Rheumatic Heart DiseaseRheumatic Heart Disease

�� Heart disease following Heart disease following

rheumatic fever; affects rheumatic fever; affects

all heart layersall heart layers

�� Massage isMassage is

contraindicatedcontraindicated

From Kumar V, Abbas AK, From Kumar V, Abbas AK, FaustoFausto M: M: Robbins and Robbins and CotranCotran

pathologic basis of disease,pathologic basis of disease, ed 7, Philadelphia, 2005, WB ed 7, Philadelphia, 2005, WB

Saunders.Saunders.


CardiomyopathyCardiomyopathy

�� Any weakening or Any weakening or

change in the heartchange in the heart’’s s

myocardium; associated myocardium; associated

with inadequate heart with inadequate heart

pumpingpumping

�� Obtain medical Obtain medical

clearanceclearance

From Roberts WC, From Roberts WC, FerransFerrans VJ: Pathologic anatomy of the VJ: Pathologic anatomy of the

cardiomyopathies, cardiomyopathies, Human Pathology Human Pathology 6:2876:287--342, 1975 (p. 289).342, 1975 (p. 289).


EndocarditisEndocarditis

�� Inflammation of heartInflammation of heart’’s s

internal lining internal lining

(endocardium)(endocardium)



From Damjanov I: From Damjanov I: Pathology for the health professions,Pathology for the health professions, ed 3, ed 3,

St. Louis, 2006, Saunders.St. Louis, 2006, Saunders.


MyocarditisMyocarditis

�� Inflammation of the heart muscle (myocardium)Inflammation of the heart muscle (myocardium)

�� Massage isMassage is contraindicatedcontraindicated


PericarditisPericarditis

�� Inflammation of the sac Inflammation of the sac

surrounding the heart surrounding the heart

(pericardium)(pericardium)



From Gould BE: From Gould BE: Pathophysiology for the health Pathophysiology for the health

professions,professions, ed 3, St. Louis, 2006, Saunders.ed 3, St. Louis, 2006, Saunders.


Myocardial Infarction Myocardial Infarction

(Heart Attack)(Heart Attack)

�� Death of myocardial tissue from interrupted Death of myocardial tissue from interrupted blood supply and prolonged ischemia blood supply and prolonged ischemia

�� Medical clearance needed for recent Medical clearance needed for recent MIsMIs; ; once obtained, use reduced treatment time once obtained, use reduced treatment time and pressure and maintain this protocol until and pressure and maintain this protocol until client has regained most of his/her strength, client has regained most of his/her strength, then regular massage can resumethen regular massage can resume


Myocardial Infarction Myocardial Infarction (cont(cont’’d.)d.)


Myocardial Infarction Myocardial Infarction (cont(cont’’d.)d.)

�� Warning signs of heart attack:Warning signs of heart attack:

�� Chest pain that may be described as crushing, Chest pain that may be described as crushing,

burning, viselike, heaviness, or fullness burning, viselike, heaviness, or fullness

�� Discomfort in other areas of the upper body such as Discomfort in other areas of the upper body such as

the arm, shoulder, neck, or jawthe arm, shoulder, neck, or jaw

�� Shortness of breath, profuse sweating, fatigue, Shortness of breath, profuse sweating, fatigue,

dizziness dizziness

�� Nausea and indigestionNausea and indigestion

�� Anxiety or fearAnxiety or fear


�� Warning signs of heart attack Warning signs of heart attack (cont(cont’’d.)d.)::

�� Unusual chest pain, stomach or abdominal painUnusual chest pain, stomach or abdominal pain

�� Continuous Continuous midthoracicmidthoracic or interscapular painor interscapular pain

�� Continuous neck or shoulder painContinuous neck or shoulder pain

�� Isolated right biceps painIsolated right biceps pain


�� Warning signs of heart attack Warning signs of heart attack (cont(cont’’d.)d.)::

�� Pain unrelieved by Pain unrelieved by antiacidsantiacids, rest or nitroglycerin, rest or nitroglycerin

�� Nausea and vomiting; fluNausea and vomiting; flu--like manifestation like manifestation

without chest pain/discomfortwithout chest pain/discomfort

�� Unexplained intense anxiety, weakness, or fatigueUnexplained intense anxiety, weakness, or fatigue

�� Breathlessness or dizzinessBreathlessness or dizziness


Cardiac ArrestCardiac Arrest

�� Sudden and unexpected complete cessation Sudden and unexpected complete cessation

of heartbeatof heartbeat

�� Massage is contraindicatedMassage is contraindicated



�� Identify diseases of the arteries and list Identify diseases of the arteries and list

appropriate massage considerations.appropriate massage considerations.

�� Define diseases of veins and list appropriate Define diseases of veins and list appropriate

massage considerations.massage considerations.


Diseases of ArteriesDiseases of Arteries

�� ArteriosclerosisArteriosclerosis

�� AtherosclerosisAtherosclerosis

�� Coronary artery Coronary artery

diseasedisease

�� Peripheral arterial Peripheral arterial

diseasedisease

�� HypertensionHypertension

�� AneurysmAneurysm

�� Orthostatic Orthostatic

hypotensionhypotension

�� Raynaud disease Raynaud disease

and Raynaud and Raynaud

syndromesyndrome

�� Thromboangiitis Thromboangiitis

obliteransobliterans


ArteriosclerosisArteriosclerosis

�� Group of diseases characterized by Group of diseases characterized by

thickening and loss of elasticity in arterial thickening and loss of elasticity in arterial

walls; hardening of the arteries walls; hardening of the arteries

�� See slide on atherosclerosis for massage See slide on atherosclerosis for massage

recommendationsrecommendations


AtherosclerosisAtherosclerosis

�� Presence of lesions called plaque within middlePresence of lesions called plaque within middle--

large size arteries; four main forms:large size arteries; four main forms:

�� CADCAD

�� Cerebrovascular diseaseCerebrovascular disease

�� Atherosclerosis of the aorta Atherosclerosis of the aorta

�� PADPAD

�� Since atherosclerosis leads to other diseases, Since atherosclerosis leads to other diseases,

follow massage recommendations for those follow massage recommendations for those

specific diseases specific diseases


Atherosclerosis Atherosclerosis (cont(cont’’d.)d.)

From Gould B: From Gould B: Pathophysiology for the health professions,Pathophysiology for the health professions,

ed 2, Philadelphia, 2002, WB Saunders.ed 2, Philadelphia, 2002, WB Saunders.


�� NonmodifiableNonmodifiable factorsfactors

�� AgeAge

�� GenderGender

�� GeneticsGenetics

�� Modifiable factorsModifiable factors

��ObesityObesity

��Elevated LDLElevated LDL--cholesterol and cholesterol and triglycerides and low triglycerides and low HDLHDL--cholesterolcholesterol

��Cigarette smokingCigarette smoking

��Sedentary lifestyleSedentary lifestyle

��DiabetesDiabetes

��HypertensionHypertension


Atherosclerosis Atherosclerosis (cont(cont’’d.)d.)


Coronary Artery DiseaseCoronary Artery Disease

�� Narrowed coronary Narrowed coronary arteries from arteries from atherosclerotic atherosclerotic plaqueplaque

� Since CAD leads to other diseases, follow massage recommendations for those specific diseases (angina pectoris, CHF, MI)

From Kumar V, Abbas AK , From Kumar V, Abbas AK , FaustoFausto M: M: Robbins and Robbins and CotranCotran

Pathologic Basis of Disease, Pathologic Basis of Disease, ed 7, Philadelphia, 2005, WB ed 7, Philadelphia, 2005, WB

Saunders. Saunders.


Coronary Artery Disease Coronary Artery Disease (cont(cont’’d.)d.)


Peripheral Arterial DiseasePeripheral Arterial Disease

�� Disease of narrowed Disease of narrowed

arteries outside the arteries outside the

heartheart

�� Local contraindication Local contraindication

(usually lower (usually lower

extremities)extremities)

From Lewis SL et al: From Lewis SL et al: MedicalMedical––surgical nursing,surgical nursing, ed 7, St. ed 7, St.

Louis, 2007, Mosby.Louis, 2007, Mosby.


HypertensionHypertension

�� High blood pressure; High blood pressure;

often asymptomaticoften asymptomatic

�� In cases of untreated In cases of untreated

HBP, treat as an absolute HBP, treat as an absolute

contraindication; contraindication;

otherwise, massage is otherwise, massage is

indicated indicated

From Gould BE: From Gould BE: Pathophysiology for the health professions,Pathophysiology for the health professions,

ed 3, St. Louis, 2006, Saunders.ed 3, St. Louis, 2006, Saunders.


AneurysmAneurysm

�� Localized weakness in a Localized weakness in a

blood vessel wall that bulges blood vessel wall that bulges

outward outward

�� Obtain physician consent; Obtain physician consent;

once obtained, avoid affected once obtained, avoid affected

area (usually the abdomen) area (usually the abdomen)

From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human Essentials of human

diseases and conditions,diseases and conditions, ed 2, Philadelphia, 2000, WB Saunders.ed 2, Philadelphia, 2000, WB Saunders.


Orthostatic HypotensionOrthostatic Hypotension

�� Sudden drop in blood pressure when moving Sudden drop in blood pressure when moving

from recumbent to upright position causing from recumbent to upright position causing

loss of balance; dizzy spellloss of balance; dizzy spell

�� Assist client getting off table if needed; Assist client getting off table if needed;

remind him or her to move slowly rather than remind him or her to move slowly rather than

quicklyquickly


Raynaud Disease and Raynaud Raynaud Disease and Raynaud

SyndromeSyndrome

�� Cycle of periodic Cycle of periodic

temporary, but severe, temporary, but severe,

vasospasms; usually in vasospasms; usually in

fingers and toesfingers and toes

�� Avoid affected area Avoid affected area

during attacks; during attacks;

otherwise, massage otherwise, massage

indicated while indicated while

avoiding cryotherapy avoiding cryotherapy

From From BarkauskasBarkauskas VH et al.: VH et al.: Health and physical Health and physical

assessment,assessment, ed 3, St. Louis, 2002, Mosby.ed 3, St. Louis, 2002, Mosby.


Thromboangiitis ObliteransThromboangiitis Obliterans

�� Inflammatory condition of Inflammatory condition of

smallsmall--medium size medium size

arteries of upper and arteries of upper and

lower extremitieslower extremities

�� Local contraindication; Local contraindication;

avoid all forms of thermoavoid all forms of thermo--

and cryotherapyand cryotherapyFrom From CallenCallen J et al: J et al: Color atlas of dermatology,Color atlas of dermatology, ed 2, ed 2,

Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.


Diseases of VeinsDiseases of Veins

�� PhlebitisPhlebitis

�� ThrombophlebitisThrombophlebitis

�� Varicose veinsVaricose veins


PhlebitisPhlebitis

�� Inflammation of the veinsInflammation of the veins

�� Local contraindication; while massaging other Local contraindication; while massaging other

areas, place the affected limb on cushions to areas, place the affected limb on cushions to

raise it above the level of the heartraise it above the level of the heart


ThrombophlebitisThrombophlebitis

�� Inflammation of a vein Inflammation of a vein

with thrombus formation; with thrombus formation;

HomanHoman’’s sign may be s sign may be

presentpresent

�� Local contraindicationLocal contraindication

From Dockery GL: From Dockery GL: Cutaneous disorders of the lower Cutaneous disorders of the lower

extremity,extremity, Philadelphia, 1997, WB SaundersPhiladelphia, 1997, WB Saunders


Varicose VeinsVaricose Veins

�� Local Local

contraindication if contraindication if

pressure causes pressure causes

pain or if client has pain or if client has

a history of blood a history of blood

clotsclots

�� DilatedDilated veins fromveins from

incompetent valvesincompetent valves

From Lewis SL et al: From Lewis SL et al: MedicalMedical––surgical nursing,surgical nursing, ed 7, St. Louis, 2007, Mosby.ed 7, St. Louis, 2007, Mosby.


Varicose Veins Varicose Veins (cont(cont’’d.)d.)

From Gould B: From Gould B: Pathophysiology for the health professions,Pathophysiology for the health professions, ed 2, Philadelphia, 2002, WB Saunders.ed 2, Philadelphia, 2002, WB Saunders.

mosby ’s pathology lesson 8.1 objectives massage therapists · 43 copyright ©2010, 2006 by...

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