Blood vessel conditions Flashcards
Laminar flow
normal condition for blood flow throughout the circulatory system, blood moving in parallel down the length of a blood vessel
Turbulent
flow is not linear, can be classified as chaotic.
Under conditions of high flow, such as from high blood pressure
Where does turbulent flow occur in
large arteries at branch points, in diseased and narrowed (stenotic or partially obstructed) arteries and across stenotic (a constriction or narrowing of a passage)
What increases the energy required to drive blood flow?
Turbulence, it increases the loss of energy in the form of friction, which generates heat
Thrombus
formation or presence of a blood clot in a blood vessel ie vein or artery
greek prefix of Thrombo meaning
lump or clump, or a curd or clot of milk
Causes of injury to the blood vessel walls can be
direct trauma ex. lacerations, smoking, turbulence from high blood pressure, infection, atherosclerosis
Plaques
fatty deposits that build up between the tunica intima and tunica media walls of the arteries and cause them to harden and narrow
Platelets
recruited to the injured area to form an initial plug
Fibrin
a protein that crosslinks with itself to form a mesh that makes up the final blood clot
Blood clots in an artery are called
arterial thrombi, caused when an artheroclerotic plaque ruptures and a clot forms at the rupture site
Occlude
completely or partially block the blood flow at that point (arterial thrombi), can cause a myocardial infarction/heart attack
Blood clotrs in a vein are called
venous thrombosis, can occur when a person becomes immobilized and muscles are not contracting to push blood back to the heart
Embolus
piece of material travelling in a BV that when it blocks the vessel is referred to as an emoblism
If a thrombus breaks loose and travels through the blood stream it is called
thromboembolus
When it blocks a vessel it is called
a thromboembolism
What other materials can emboli be made up of
fat gobules (eg cholesterol from an atherosclerotic plaque, bone marrow from a bone fracture) air bubble (from a syringe or caused by the bends /decompression sickness), infected materials (eg. from IV drug use, heart valve infections, septic thrombophelbitis), cancer, foreign substances
An embolism in the brain can cause a
transient ischemic attack (TIA) or ischemic stroke/cardiovascular accident (CVA), cerebrovascular infarction
Embolism in the lung
pulmonary embolism (PE), primarily caused by disloged thrombi from leg veins (eg. deep vein thrombosis) which end up passing through the right side of the heart into pulmonary artery
Infarction
tissue death due to loss of blood supply to the affecred area
Myocardial infarction
due to a blockage of a coronary artery, but can also be caused by other factors including arterial spasms that completely constrict blood flow
Stroke/Cerebrovascular infarction
can be caused by a blockage/occlusion (eg. thrombosis, embolism) or a rupture and hemorrhage of a cerebral artery
Limb infarction
may include skeletal muscle infarction, avascular necrosis/osteonecrosis of bones or necrosis of a part or an entire limb, caused by either thrombosis or emboluiusm
Mechanical compression and vasocontriction can also cause ____ and ____
ischemia and infarction
Blood vessel inflammatory conditions
Angiitis/vasculitis
inflammation of a blood or lymph vessel (general term)
Arteritis
inflammation of an artery
Phlebitis
inflammation of a vein
Phlebitis and phlebothrombosis
presence of a clot in addition to phlebitis but unassociated with the veins inflammation
Signs and symptoms of arteritis and phlebitis
significal local inflammation- with more superficial blood vessls there is usually a distinct hot red streak apparent on the skin surface above the inflamed vesse, redness are likely
Edema- in phlebitis distal swelling is also typical as the inflamed section of the vein acts as an impediment to venous return
Pain- emanates from the site in a more disseminated intense achiness; may be ischemic pain in the tissues surfaced by the BV
What are some concerns for the RMT
Platelet activation is inevitable when the wall of a BV is inflamed, so there is a high risk of thrombosis and its complications
On site massage could:
-intensify the injury or irritation
-intensify the thrombosis at the site
-Promote embolism
-Disseminate (scatter widely) infection if present
-Weaken or rupture the vessel wall
Massage therapy is CI’d locally until medical clearance, when the inflammation is in a large/core vessel massage therapy may be completely CI’d
Temperal arteritis/ Giant cell arteritis
idiopathic, progressive, low grade arteritis (inflammation of an artery) of the superficial temporal artery, common in individuals over 50
Symptoms of giant cell arteritis (GCA)
very often no symptoms, when symptoms present: UL headache often confused with migrane, ipsilateral facial pain/ numbness/ parathesia, ipsilateral vision problem
RMT concerns for GCA
local petrissage/friction, types of manipulations are contraindicated, palpate the superficial temporal arteries of patients over 50 before locally massaging
Beurgers disease/ thromboangiitis obliterans (TAO)
a genetically conditioned hypersensitivity condition ie. the person has an inherited susceptibility to develop this condition in reaction to exposure to the allergen, in this case smoking
Typical sufferer of beurgers disease
male, aged 19-40, heavy smoker
Clinical presentation and signs and symptoms of Beurgers
flare up of acute angiitis in hands and feet that may eventually affect larger areas of arms and legs, often intensly painful- pain from the BV nearby tissues and supply tissues, very high thromboembolism, flare up and remission pattern varying frequency
RMT considerations for beurgers
precluding massage therapy (make impossible), massaging unaffected body parts may be reasonable as long as the risk of promoting problems by increasing systemic circulation is evaluated, cold/cool applications may be beneficial during a flare up, there is often a reduced sensation in the affected body parts due to reduced perfusion of the local peripheral nerves,
If medically cleared to massage during remission- conscious of tissue fragility and other aspects of reduced perfusion and drainage, massage and hydrotherapy approaches should avoid mobilizing large volumes of blood, evaluate the efficacy of pumping modalities, use persons ADLS regarding exercise tolerance to help set your guideline for acceptable levels of stimulus during treatment, strenous exercise should be avoided
Raynauds disease and raynauds phenomenon conditions characterized by
- Attacks of arteriolar spasm- constriction of arteries
- Typically affect the hands, may involve the feet, nose, ears
- during an attack the affected part blances and may becom cyanotic
- ischemic pain from not getting enough blood supply
- episodes may last from a few minutes to days, varies greatly
- appears to be an irritation or over reaction of the sympathetic innervation
Raynauds disease
idiopathic, affecting healthy individuals, typical suffere is somewhat more likely to be female, attacks are associated with development of thrombosis or ongoing BV or tissue damage, generally not treated medically
Raynauds phenomenon
assocaited with a known cause: occupational use of vibrating equipment like hydraulic drills/jackhammers- called white hand, secondary to autoimmune conditions like SLE, cancer or beurgers, attacks are typically more severe
RMT considerations for patients with raynauds conditions
check with patient for attack triggers; cold exposure most common attack trigger, dont treat with cold hydro, stress is the next common trigger, carefully assess tissue status and thrombosis status, try not to elevate hands or feet use warm hydrotherapy,
Varicose veins
result from valvular incompetence in veins, usually seen in lower limbs
Anal varicosities are called
hemorrhoids
3 main causes of varicose veins
- Chronically elevated hydrostatic pressure in the vein: most common cause
- Inheritence
- direct damage- trauma, surgery, post phlebitis, disease states that affect veins
Clinical presentation and signs and symptoms of varicose veins
- vein becomes progressively elevated, tortuous, lumpy
- bluish segments indicate static blood, thrombosis
- local tissue develops dystrophic changes, fragility
- ulcerations in severe cases
- may be significal distal edema
- achy pain, heavy feeling in limb
RMT considerations for varicose veins
- Avoid direct penetrating manipulations on site (just aggressive on- site work)
- Avoid overloading or traumatizing the vessel
- Maintain awareness of local tissue fragility
- avoid overloading the venous circulation
What are some treatments to remove varicose veins
laser, sclerotherapy, venasea
Clinically relevant- avoid massage treatment of area as well for a week or two
