Class 15 Flashcards
What are Treatment Planning Considerations – CCHF/Hypertension?
- Evaluate each case to match treatment intensity to individual’s CV resilience. Mild cases often require small or no adaptations, more severe cases require multiple treatment plan adjustments. When in doubt, proceed conservatively initially. This may include MD consultation.
- Consider treatment duration.
- Consider partial body or lighter full body treatments.
- Positioning adaptations may be needed:
prone position, esp. with abdominal pillow, can decrease aorta expansion & place additional stress on heart in supine, consider elevating upper body; &, not elevating feet above heart level comfortably positioned & supported in seated can be an option for all or part of treatment
- Pay attention to patient comfort, both physically & in therapeutic relationship. Ensure patient knows what to expect, is at ease with consent & giving feedback.
- Major emphasis is needed on achieving relaxation response at beginning of treatment. Include diaphragmatic breathing.
- Modify techniques, elevation & passive movements to reduce venous return (e.g., de- emphasize long effleurage & petrissage techniques); focus on smaller, more segmental approaches (e.g., muscle squeezing, wringing, etc.). Also, consider how much lymph drainage is appropriate for case relative to heart’s resilience.
- It may be necessary to focus more on extremities initially (after relaxation, or part of it) in order to reduce TPR earlier in treatment.
- Adapt hydro (temperature intensity/contrast, size of application, duration, perhaps weight of application). Avoidance of hydro altogether may make sense in some cases.
- Awareness of sympathetic nervous system activators – pain, temperature, feeling uncomfortable.
- Avoid applying pressure bilaterally on neck.
- Awareness of potential for orthostatic intolerance/hypotension when the person is sitting or standing after massage & advise accordingly.
- Tissue health/fragility adaptations.
- Adapt to medications as needed.
What is VALVULAR HEART DISEASE?
damage to, or defect in, one or more of four heart
valves: mitral, aortic, tricuspid or pulmonary.
Valve conditions usually lead to increased workload on heart.
What is Valvular Regurgitation / Valvular Insufficiency?
Inability of valve to close properly, resulting in backflow; stresses heart because chambers about to receive new blood are partially prefilled with regurgitated blood, since blood does not progress forward & needs to be re-pumped
- Heart Murmur: sound of regurgitation from “leaky” valve, can be heard on auscultation
What is Valvular Stenosis?
Inability of valve to open properly, resulting in insufficient flow of blood out of chamber & considerable pressure inside chamber as result; compromises chamber’s fill cycle as well as cardiac output volumes
What is Valvular Incompetence?
non-specific term just means valve is not functioning properly
What is Valvular Prolapse?
Valve flaps that are looser bulge under pressure; is most common in mitral valve where bulge is into LA; may or may not include regurgitation
Stenosis of a valve can occur because?
Flaps have become adhered to each other, or because flaps have become diseased/scarred in way that makes them too stiff/inflexible to fully open. Of course, both can be present.
valves can be both stenotic & regurgitating if damaged valve doesn’t open or close properly.
What are Most Common Causes of Heart Valve Damage?
- Hypertension/CHF
- Complication of Myocardial Infarction
* Typically d/t papillary muscle damage that makes valve regurgitative - Rheumatic Fever
Autoimmune reaction secondary to streptococcal infection such as strept throat (beta-hemolytic streptococcus type, specifically). After period of some weeks, antibodies that have developed to fight strept infection appear to sense chemical
similarity between strept bacteria & endothelial heart tissue. Valves often particularly aggressively attacked. - Endocarditis
- Congenital Anomaly (fairly common)
- Radiation Damage
What is Rheumatic Fever?
Autoimmune reaction secondary to streptococcal infection such as strept throat (beta-hemolytic streptococcus type, specifically). After period of some weeks, antibodies that have developed to fight strept infection appear to sense chemical
similarity between strept bacteria & endothelial heart tissue. Valves often particularly aggressively attacked.
What is a Complication of Myocardial Infarction typically due to?
papillary muscle damage that makes valve regurgitative
What are Signs/Symptoms of Heart Valve Damage?
- Varies tremendously
- In minor cases there are often no symptoms at all, although detectable murmur is usually present as a sign
- General fatigue, poor adaptation to exercise, stress
- Shortness of breath, incl. when lying flat
- Feelings of discomfort in the chest, perhaps pain
- Heart palpitations, irregular beat
- Dizziness, orthostatic hypotension
- Edema; dependent edema & ascites most common
- Unintentional weight gain (fluid accumulation related to CHF)
What are Concerns for the RMT for Heart Valve Damage?
- Mention of heart murmur, or any causes of valvular disorder on case hx, should lead to RMT establishing CHF status.
- Some heart murmurs are not clinically significant. Some present since childhood with no problems, although may become more of an issue with age or other heart stressors.
- Adult-onset heart murmurs tend to be associated with hypertension or heart attack, & therefore some degree of heart failure.
- Hearts with clinically significant valve problems typically do not adapt easily to increased CO. Watch for signs of dyspnea & increased sympathetic ns. activity. Watch for increase in BP during/post tx. From clinical reasoning perspective, there is strong overlap with CHF, so decisions & treatment adaptations involve same guidelines & red flags.
What is Mitral Valve Prolapse (MVP)?
Prolapse is most common in mitral valve. Valve leaflets, & often their attached chordae tendinae, are “stretchy”, valve structures bulge into atrium. Although, regurgitation is not inevitable, prolapsed valve tends to not close perfectly so some degree of regurgitation is common. Can be “click” sound during systole when valve protrudes. In many cases, condition is minor & isn’t problem for person. This may change, however, with age &/or onset of other heart stressors.
Frequently present with no other form of heart disease. Mitral valve prolapse occurs in about
2% of the population. Males may have more clinical problems with MVP than females.
What are Common Causes Mitral Valve Prolapse (MVP)?
- Genetics – runs in families
- Connective tissue conditions such as Marfan’s Syndrome, Ehlers-Danlos Syndrome, SLE, RA
- More likely to occur with CAD d/t papillary muscle ischemia, or post-MI
- More likely to occur with hypertrophic LV
- Scoliosis
- Thyroid conditions, esp. Graves Disease
- Idiopathic
What are Concerns of Mitral Valve Prolapse (MVP)?
- Can promote arrythmia
- Bulgy flaps can harbour bacteria, promoting endocarditis
- Bit more risk of thrombus formation around valve (embolism risks)
