Cardiovascular Flashcards
Arteriosclerosis:
is a generic term used for hardening of arteries and arterioles. May
involve any artery in the body and also may affect arterioles. A degenerative arterial
disease where muscle and elastic tissue of the tunica media are replaced by fibrous
tissue. The arterial walls become thickened, hard, and lose elasticity.
Atherosclerosis:
s a multifactorial disease of arteries
affected by atheromas. Affects only the aorta and its
major branches. Abnormal masses of lipids, complex
carbohydrates, blood and blood products, fibrous
tissue and calcium deposits in the tunica intima of
arteries not arterioles. Note: arteriosclerosis and
atherosclerosis often co-exist.
Coronary atherosclerosis:
degeneration of coronary
arteries with gradual decrease of the lumen (e.g. increased
fibrotic tissue, decreased elastic tissue; thrombus may
develop).
Atherosclerosis/Arteriosclerosis: Sign/Symptom
likely no symptoms present until the vessel is
blocked or narrowed enough to alter blood flow or thrombus/embolism formation.
Arteries in the heart may cause angina or heart attack. Symptoms: chest pain, difficulty
breathing, restlessness, dizziness, anxiety.
Ischemic heart disease:
insufficient coronary blood flow (a.k.a. heart attack,
myocardial infarct = necrosis of part of the heart due to occlusion of the coronary
arteries)
Coronary thrombosis:
occlusion of the coronary artery. Very little anastomosis
and/or collateral circulation exists in cardiac muscle.
Arteries that supply head/brain, may experience_______ if embolism occurs
TIA or stroke
weakness, numbness, slurred speech
Arteries in the arms/legs patient may experience pain in arms or legs and ___________ (peripheral vascular disease)
intermittent
claudication
Aneurysm
abnormal dilation of blood vessels. If vessel walls become weakened,
aneurysms may occur – potential to rupture vessel, excessive bleeding and potential
organ damage or fatal. Sudden severe pain in head or abdomen (brain, aorta)
Hypertension:
elevation of systolic and/or diastolic BP, either primary (85% due to
unknown cause) or secondary (15% is secondary to renal disease, adrenal cortical
tumour).
High BP threshold is______ ; “dangerous” is
_______
140/90
160/95
Signs and symptoms
HBP
Asymptomatic until complications develop
Variable depending on organs affected
Dizziness, light-headedness, HA, fatigue, facial flushing and
personality changes can all occur
Possible edema in lower extremities
The cardiovascular system consists of the
heart and blood vessels: arteries, capillaries,
and veins.
It’s estimated there are approximately_______of blood vessels in the
human body.
100,000 km
The cardiovascular “loop” transports
oxygen, nutrients and hormones to each cell
carbon dioxide and metabolic end products out from each cell
Factors that affect the normal function of the heart or blood vessels potentially
predispose the cells to poor nutritional status. Heart disease including:
Angina
Hypertension
Valvular dysfunction
diseases of the vasculature that compromise tissue health such as:
Arteriosclerosis
Atherosclerosis
The massage therapist treating a patient/client/guest with a cardiovascular
dysfunction has many challenges. Techniques and modalities used should not:
Increase the work of the heart: e.g. by dramatically increasing venous return
Increase the risk of local tissue damage: e.g. XFF can cause prolonged bleeding in
malnourished tissue
Interact with the use of medications: e.g. vasodilators and hydrotherapy
Increase the risk of a secondary systemic complication: e.g. dislodging a thrombus
Cardiovascular Conditions: History:
Diet, health habits, medications, recent MD visits, fitness level,
general health, pain at rest, intermittent claudication, ask about
respiratory status
Cardiovascular Conditions: Observation:
Edema, varicosities, facial colorations, extremity
coloration (skin color: flushing, cyanosis/grey/white caused by poor
arterial supply or hypoxia). Dyspnea caused by pulmonary edema
resulting in labored or difficult breathing – may be related to cardiac
insufficency
Cardiovascular Conditions: Palpation:
Pulses – assess if they are normal, absent, dimished,
bounding (compare bilaterally). Bradycardia (decreased) or tachycardia
(increased), temperature of extremities and core, clamminess and
sweating due to sympathetic/reflexive changes, edema (pitting vs non
pitting)
Cardiovascular Conditions: Movements:
may assess intermittent claudication if client can not tell
you
Cardiovascular Conditions: Neurological:
TOS
Cardiovascular Conditions:
Referred Pain:
MI refers to shoulder, down arm and can along back and
sternum. Trigger points can also refer to these areas (pec mj/mn,
serratus anterior, scalene, levator scapula etc)
Special tests:
Central cardiovascular: blood pressure, respiratory status,
Peripheral vascular: capillary refill test, allen’s test, manual
compression test, pulses, leg raise for varicose veins, pitted edema test,
homan’s test
How to find pulses:
Use the ___ of your finger, not the____ . Don’t push _____ or you can _____
the vessel.
pad /tip
too hard/occlude
(Sometimes, using a number of fingers along the
course of a vessel, and applying firmer pressure with the distal fingers
will allow you to feel the pulse better in the proximal fingers. It also
may help to use on hand to feel a pulse that’s easy to find while using
the other hand to find the harder one)
Compare pulses _______.
bilaterally
To record pulses:
“____” if strong,
“_____” if weak,
“_____” if absent.
2/2
1/2
0/2
Brachial pulse:
ask pt to flex the elbow to feel the biceps brachii tendon on
the cubital fossa. Apply fingertip pressure on the medial side of the
tendon. The pulse may be more superficial the more proximal you go.
Brachila artery used to be the axillary artery
Radial pulse:
on the lateral side of the wrist, find the bony prominence of the
styloid process . roll your finger medial from this and the artery runs
along the bone. The radial artery is a branch of the brachial artery
Ulnar pulse:
on the medial side of the wrist find the pisiform bone. Roll your
finger laterally from this and the artery runs along here. Harder to find
than the radial artery. This is a branch of the brachial artery.
Femoral pulse:
along the inguinal ligament, about halfway from the ASIS to
the pubic tubercle. Used to be called the iliac artery
Popliteal pulse:
difficult to find – deep. Slightly medial to the center of the
popliteal fossa. Used to be femoral artery
Anterior tibial pulse:
feel along the anterior shin lateral to the tibia. It is
easiest to feel halfway down the shin. Branch of the popliteal artery
Dosalis pedis pulse :
on the top of the foot about 1/3 of the way to the toes,
feel laterally to the extensor hallucis longus tendon. The artery runs
along side the tendon. This is a branch of the popliteal artery.
Posterior tibial pulse :
on the medial side of the ankle find the medial
malleolus. Roll your finger towards the angle of the heel and feel for
the pulse.
Common carotid pulse
only check one at a time. Find the bottom of the
lateral edge of the thyroid cartilage. Then feel 1-2 cm lateral to that
External carotid pulse :
only check one at a time. About 2 cm anterior of the
scm along the fold of the jaw line.
Temporal pulse:
find the top part of the ear that is attached to your face
(about eye level) and about 1 cm anterior is the pulse
What techniques would be safe to perform on a patient with central cardiovascular disease?
MFR depending on tissue health
PROM, Stretches, Joint mobs if indicated
Swedish/petrissage techniques modified to short and segmental strokes
What are red flags to treatment? Consider that pts may be in denial.
Medications
Scarring
Ask about surgical history, family history of cardiovascular disease, risk factors (smoking, lifestyle)
Diseases affecting the blood vessels usually result in some form of
peripheral vascular
disease (PVD).
PVD can affect the
venous or lymphatic circulatory systems.
Occlusive diseases of the blood vessels are a common cause of
disability and usually
occur as a result of ATHEROSCLEROSIS.