CV (class 3-end) Flashcards
________ _____ ______ is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.
Valvular heart disease
________ _______: the inability of one of the heart’s valves to open properly, resulting in a reduced volume of blood exiting the chamber and considerable pressure in the exit chamber.
Valvular stenosis
_________ _______: An autoimmune reaction secondary to infection by streptococcus bacteria. After a period of some weeks, antibodies which have developed to fight the infection appear to sense a chemical similarity between the bacteria and heart tissue.
Rheumatic Fever
Mention of heart murmur or any of the causes of valvular disorder on the case history should lead to the RMT establishing _____ _________ with patient.
CCHF Status
T/F: All heart murmurs are clinically significant.
False
______ _____ heart murmurs typically indicate some degree of heart failure
Adult onset
T/F: When treating a patient with a heart murmur, you can probably expect to see a decrease in BP post-treatment.
False: There will probably be an increase.
The most common cause of mitral valve prolapse (MVP) is abnormally stretchy or “floppy” valve leaflets (called _____________ valve disease) and their supporting chordae tendonae, causing parts of the valve flop or bulge back into the atrium.
Myxomatous valve disease
T/F: Mitral Valve Prolapse doesn’t always cause backflow/ regurgitation. In fact, most people who have MVP don’t have backflow and never have any related symptoms or problems.
True
With MVP, a ‘click’ sound can be heard during _______, which is the protrusion due to the valve damage and the leaking of blood back into the upper chambers.
Systole
T/F: Mitral valve prolapse occurs in about 15% of the population.
False: 5%
A genetic connective tissue disorder, specifically it affects the elastic fibers in the extracellular matrix. Patients present with long and thin body with long fingers - “spider hands”, joint hypermobility, spinal deformities - pectus excavatum or pigeon chest. Eyes may also feature bilateral dislocation of the lens, due to weakness of the suspensory ligaments, myopia (near sightedness), retinal detachment.
Marfan’s Syndrome
What effect does Marfan’s Syndrome have on a patient’s CV system?
They are prone to mitral valve prolapse, progressive dilation of the aortic valve ring, weakness of the aorta or other arteries.
Expected life expectancy is 30-40 years old, surgery and medications prolong life, echocardiogram every 6 months to monitor the status of the aorta, canes and wheelchairs are a possibility.
Defined as an increase in the amount of fluid in the interstitial space either beneath the skin or in an organ cavity, typically palpable. It can be a local or generalized condition.
Edema
________: excess fluid in the peritoneal cavity
Ascites
_______: Edema, usually of the skin of the extremity, that, when firmly pressed with a finger, will maintain the depression produced by the finger.
Pitted Edema
_________ ____s are a symptom of chronic venous insufficiency in the superficial veins.
Varicose veins
Blood Pressure = _____ _____ x _____ _______ x _____ __________ __________
Blood Pressure = Heart Rate x Stroke Volume x Total Peripheral Resistance
or
Blood Pressure = Cardiac Output x Total Peripheral Resistance
Abnormal drop in blood pressure with a change in position, usually moving from a recumbent to a standing position.
Orthostatic/Postural Hypotension
_________ _________: the inability of the patient to stand upright for 1-2 minutes. Other symptoms include: dizziness, visual changes, head and neck discomfort, poor concentration, palpitations, tremor, anxiety, syncope.
Orthostatic Intolerance
The result of a decrease in blood pressure right after eating a meal.
Postprandial Hypotension
For a person with diabetes, a threshold of ≥ ___/__ is used to determine hypertension, regardless of measurement method.
130/80
____% of hypertensive population have Primary/Benign/Essential/Idiopathic Hypertension
90-95%
Situations where the blood pressure elevates, sometimes quite dramatically, when readings are being taken by medical professionals. The person may otherwise have normal pressure or significantly lower readings.
White Coat Hypertension
___-_______ _________: aka “bad cholesterol” transports cholesterol particles throughout the body. LDL cholesterol builds up in the walls of arteries, making them hard and narrow.
Low-density Lipoproteins
High-density lipoproteins (HDL), or “good” cholesterol, picks up excess cholesterol and takes it back to the ____.
Liver
Addition of more squamous epithelial
cells/layers to reinforce the tissue, a clear, thick, goopy, inflexible material that looks like hyaline, can described as “heavy marshmallow”
Hyalinization
Inner endothelial wall of blood vessel (tunica
intima/Interna) becomes damaged and repairs with scar tissue due to the force of the blood pressure.
Onion Skinning
T/F: Massage Therapy decreases blood viscosity.
True: Increased fluid return from tissue can increase blood plasma volume, lowering red blood cell concentration, causing hemodilution
As a massage progresses, ____________ the sympathetic tone and total peripheral resistance tends to outweigh the _______ venous return (cardiac output) and the net end effect is usually a slight ________ in blood pressure from the original (pre-massage) reading.
As the massage progresses, decreasing the sympathetic tone and total peripheral resistance tends to outweigh the increased venous return (cardiac output) and the net end effect is usually a slight decrease in blood pressure from the original (pre-massage) reading.
The increased cardiac output of massage can result in an overall increase of blood pressure, which peaks in the first ___ minutes and is somewhat mitigated by activation by the parasympathetic nervous system by the end of treatment.
15 minutes
Type of medications that acts on kidneys (nephrons) to increase production of urine / decrease blood volume and therefore hydrostatic pressure.
Diuretics/Water Pills
____ ________s modify sympathetic nervous system reactivity by competing with sympathetic neurotransmitters (adrenaline, norepinephrine) for the beta receptor sites of the heart.
Beta Blockers
__________s slow down the heart rate and increase the efficiency of contraction (which increases the force of contraction) and refilling phases of the cardiac cycle, causing similar results to beta blockers.
Glycosides
______ _______s either block sympathetic neurotransmitters (catecholamines, such as norepinephrine-NE) from synapsing on the smooth muscle of the arterial system or decrease the number of sympathetic neurotransmitter impulses emitted from the vasomotor center in the brain.
Alpha Blockers
_______ __________ modify/limit the uptake and use of
calcium in smooth muscle cells in blood vessel walls (in the tunica media layer), and some also work in the cardiac muscle (in the AV node), thereby decreasing the tone of the smooth muscle in the blood vessel walls and improving the contractile properties of cardiac muscle.
Calcium Antagonists / Calcium Channel Blockers
If you ______ ACE (Angiotensin Converting Enzyme), you ____ the amount of Angiotensin II and _____ vasoconstriction.
If you inhibit ACE (Angiotensin Converting Enzyme), you limit the amount of Angiotensin II and reduce vasoconstriction.
_____ (an enzyme) is produced in the kidneys and released into circulation when blood pressure decreases to initiate the renin-angiotensin system.
Renin
___________s slow down clotting, thereby reducing fibrin formation and preventing clots from forming and growing.
Anticoagulants
Drugs called __________ actively break down thrombi and clots, typically used in hospital settings, in urgent or emergency situations.
Thrombolytics
\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ is the normal condition for blood flow throughout most of the circulatory system. It is characterized by concentric layers of blood moving in parallel down the length of a blood vessel. The highest velocity is found in the center of the vessel. The lowest velocity is found along the vessel wall.
Laminer Flow
The highest velocity of blood flow is found in the center of the _____. The lowest velocity is found along the vessel ____.
The highest velocity is found in the center of the vessel. The lowest velocity is found along the vessel wall.
The highest velocity of blood flow is found in the center of the _____. The lowest velocity is found along the vessel ____.
The highest velocity is found in the center of the vessel. The lowest velocity is found along the vessel wall.
Under conditions of high blood flow - such as from high blood pressure - particularly in the ascending aorta, laminar flow can be disrupted and become ________.
Turbulent
Turbulence increases the energy required to drive blood flow because it increases the loss of energy in the form of friction, which generates ____.
Heat
The formation or presence of a blood clot in a blood vessel, i.e.vein or artery is called _________. The clot itself is called a _______.
Thrombosis
Thrombus
With atherosclerosis, fatty deposits called ______s build up between the tunica intima and tunica media walls of the arteries and cause them to harden and narrow
Plaques
________ are recruited to the injured blood vessel to form an initial plug.
Platelets
_______ is a protein that crosslinks with itself to form a mesh that makes up the final blood clot.
Fibrin
If occlusion occurs in coronary artery, it can cause a _______ ________/heart attack.
Myocardial infarction
Blood clots in a vein (______ ________) can occur when a person becomes immobilized and muscles are not contracting to push blood back to the heart
Venous thrombosis
An ________ is a piece of material traveling in a blood vessel that when it blocks the vessel is referred to as an ________.
Embolus
Embolism
If a thrombus breaks loose and travels through the bloodstream, it is a ____________ and when it blocks a vessel, it is a _______________.
Thromboembolus
Thromboembolism
T/F: an air bubble can become an embolus.
True
An embolism in the brain can cause a _______ ______ _______ (TIA) or __________ ________ (CVA).
Transient ischemic attack (TIA) Cardiovascular accident (CVA)
An embolism in the lung is referred to as a pulmonary embolism (PE). This is primarily caused by dislodged thrombi from ___ veins which end up passing through the right side of the heart into a pulmonary artery.
Leg veins (i.e. Deep Vein Thrombosis)
________ is tissue death (necrosis) due to loss of blood supply to the affected area (blood vessel blocked or ruptured).
Infarction
The resulting lesion from infarction is referred to as an _____.
Infarct
Stroke/Cerebrovascular infarction can be caused by a blockage/occlusion (e.g. thrombosis, embolism) or a rupture and hemorrhage of a _______ ______.
Cerebral artery.
________: inflammation of a vein
Phlebitis
With arteritis/phlebitis, massage therapy is CI’d locally until medical clearance. When the inflammation is in a ____/____ vessel, massage therapy may be completely CI’d.
Large/core vessel
The massage therapist should always be alert to the possibility of inflammatory conditions in blood vessels following a _____ or _______, and as a risk factor in conditions where vasculitis is part of the condition’s profile.
Following an injury or surgery.
Since ______ ________ is a common condition that is often clinically silent, it is a good practice to palpate the superficial temporal arteries of patients over 50 before massaging locally.
Temporal Arteritis
The rates of _______ _______ are highest in areas of the Mediterranean, Middle East and Asia where heavy smoking is most common. Typical Sufferer is male, aged 19-40 at diagnosis and is a heavy smoker.
Beurger’s disease
Flare-ups of this disease include acute angiitis in hands and feet that may eventually affect larger areas of arms and legs. It is often intensely painful – pain from the blood vessels, nearby tissues and supply tissues.
Buerger’s disease
The following describes _______ ______:
The lower extremities are elevated to a 45 to 90 degree angle and supported in this position until the skin blanches (appears dead white). The feet and legs are then lowered below the level of the rest of the body until redness appears. Finally, the legs are placed flat on the bed for a few minutes.
Buerger’s excercise
__________ conditions are characterized by:
‘Attacks’ of arteriolar spasm
Typically affect the hands; may involve the feet, nose, ears
During an attack the affected part blanches and may become cyanotic.
Ischemic pain
Episodes may last from a few minutes to a few days, varies greatly
Appears to be an irritation or over-reaction of the sympathetic innervation
Raynaud’s
Raynaud’s ________ is idiopathic, affecting otherwise healthy individuals. Typical sufferer is somewhat more likely to be female. Attacks are not associated with development of thrombosis or ongoing blood vessel or tissue damage.
Raynaud’s disease
Raynaud’s _______ is associated with occupational use of vibrating equipment like hydraulic drills/jackhammers and is secondary to autoimmune conditions like SLE, cancer. Attacks are typically more severe.
Raynaud’s phenomenon
During a Raynaud’s attack: if tissue is intact and not too fragile and thrombosis risk is low, use _____ hydrotherapy and gently massage the hands and feet. Try not to elevate hands or feet.
Warm (not hot).
An RMT can safely treat _______ ______ by avoiding overloading or traumatizing the vessel and maintaining awareness of local tissue fragility, since the layered type of thrombosis that develops is exceptionally stable and almost never gives off emboi.
Varicose veins
T/F: following surgery for a varicose vein, an RMT should avoid massage treatment of area as well for a week or two.
True
The __________ lining of the heart is a continuation of the intimal layer of the blood
vessels and also lines the heart valves (tricuspid, aortic and mitral).
Endocardial
T/F: The valve cusps are extensions of the endocardium
True
Lesions or clusters of the infecting organism or localizations of autoimmune activity that often develop on/inside the cusp (i.e. pockets) of the valves.
Vegetations
Vegetations of bacterial or fungal origin are susceptible to breaking away from the wall/valve under the hemodynamic pressure of the heart. They can create dangerous emboli. This type of unstable vegetation is referred to as _______.
Friable
While treating a patient with endocarditis, an RMT should avoid treatment while the condition is active and the risk of ________ is high, and may want to modify pressure if patient is taking _________, which could increase bleeding/bruising.
Embolism
Anticoagulants
________ ___________ is a disease associated with myocarditis that usually starts in your heart’s main pumping chamber (left ventricle). The ventricle stretches and thins (dilates) and can’t pump blood as well as a healthy heart can. Over time, both ventricles may be affected.
Dilated Cardiomyopathy
T/F: Myocarditis is not considered to be an absolute C/I for massage in the ‘active’ phases.
True
The __________ helps anchor the heart in place,
preventing excessive movement of the heart in
the chest cavity with changes in body position;
helps to protect the heart from infections and invading tumours; and may help keep the heart from enlarging.
Pericardium
An increase in pericardial fluid is called an _________.
Effusion
In the presence of a large pericardial effusion, the heart sounds may be diminished or absent. The reduction of cardiac filling from a large effusion may lead to __________ ___________ (increased fluid and resultant pressure fully restrict heart filling and pumping, leading to cardiac arrest and death).
Cardiac Tampanade considered to be the most painful heart condition
Disorders of the heart rate and rhythm caused by disturbances in the _________ system.
Conduction
_________ ________ is a potentially lethal arrhythmia that can occur with one MI or to a heart that has been damaged by coronary artery disease (CAD). This causes the ventricles to quiver uselessly, instead of pumping blood and requires resuscitation and emergency electrical counter shock (defibrillation).
Ventricular Fibrillation
_________ __________ is the most common cardiac dysrhythmia. It is usually not lethal immediately but may increase the risk of heart failure and stroke. It is a total disorganization of atrial activity without effective atrial contraction, which means that the upper chambers will quiver instead of contract and allows blood to pool and clots to form, leading to possible embolism and stroke.
Atrial Fibrillation (AF)
______ __________ : Abnormally rapid heart rate
more than 100 bpm
Sinus Tachycardia
Abnormally low heart rate (the sinus node discharges at a rate less than 60 bpm).
Sinus Bradycardia
_____________ is the dominant form of arteriosclerosis. It affects the primarily the elastic (aorta, carotid, iliac) and large to medium-sized muscular arteries (coronary, popliteal). Its prevalence is so great in North America that its complications combine to constitute the most common cause of death in our population.
Atherosclerosis
The characteristic lesion of atherosclerosis is the atheroma, also referred to as a ________.
Plaque
_______ _______: Intermittent Ischemic Attacks of cardiac muscle causing pain in the heart distribution pattern.
Angina Pectoris
_________ _________: Intermittent Ischemic Attacks of skeletal muscle causing pain in the legs (often limiting exercise tolerance)
Intermittent Claudication
_________ ________ _______: Intermittent Ischemic Attacks of Brain Tissue
Transient Ischemic Attack (TIA)
T/F: Angina pectoris is an absolute CI for massage.
False: While very unstable angina (erratic frequent attacks, attacks are precipitated very easily) may not be a good match with massage therapy, in most cases of angina pectoris the patient can be massaged with appropriate attention to possible precipitators.
________ is a bulge (dilation) of a weak spot on the artery wall.
Aneurysm
The most common type of aneurysm, bulging or ballooning out on all sides of the blood vessel.
Fusiform
A round outpouching on one side of the vessel, these are the most common form of cerebral aneurysm, and typically form at the junction between arteries.
Sacular/berry
Aneurysm that almost always occurs in the aorta (due to the speed and force of the blood ejected from the heart) Blood penetrates the tunica intima, infiltrates the tunica media, causes collapsing of lumen. The blood, under very high pressure, in the presence of a tunica intima layer lesion, slices into the aortic wall severely damaging the media layer (separating it from the externa layer) and filling the vessel wall with blood.
Dissecting
Cerebral Aneurysms occur most commonly within the ______ __ ______.
Circle of Willis:
Anterior cerebral artery (left and right)
Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)
Interruption in blood flow to the brain. Two types: ischemic/occlusive and hemorrhagic.
Cardiovascular Accident (CVA)/Stroke
A test that can indicate deep vein thrombosis in the calf.
Homan’s Sign
Over 90% of Mi’s are a result of ________ and _________.
Thrombosis and Atheroma
After about __-__ minutes of ischemia to the myocardium the cells sustain irreversible damage/death.
20-40 minutes
T/F: Surviving the first year after an MI is one of the most important factor for long term survival/recovery.
True
T/F: If a medical doctor approves massage treatment for an MI survivor, the treatment is safe. If they say no, it is important to do our own assessment to determine for ourselves whether it’s safe to continue.
False: Even if a Medical Doctor approves treatment, DO YOUR OWN ASSESSMENT AND MAKE YOUR OWN DECISIONS. A Medical Doctor’s ‘no’ is always no.
A procedure in which a balloon- tipped catheter is inserted into a damaged artery, and the balloon is inflated. The balloon compresses the plaque, pushing it against the artery wall, to allow for freer blood flow.
Angioplasty
A procedure in which a small wire mesh tube is placed into a damaged artery via a catheter to support and stretch the artery walls and provide for unrestricted blood flow. Normally done in conjunction with the angioplasty procedure.
Stenting
A procedure in which a bladed catheter is used to cut away plaque in the arteries. The plaque is then removed when the catheter is withdrawn from the artery.
Directional Atherectomy
_________ _____ ______ is the term used for weakness or failure of the heart in its function as the pump for the cardiovascular system. When the heart is not strong enough to meet the challenges of its role, functions such as tissue nutrition, waste clearance, blood filtration and re-oxygenation, etc. are impaired.
Congestive heart failure
The _________ ________ ______ is a number that is analyzed to see if the heart is pumping enough blood out. It is the percentage of the blood pumped out versus the total blood within the chamber.
Ventricular ejection fraction (VEF) =
Amount of blood pumped out of the ventricle (SV)
____________________________________________
Amount of blood pumped into the ventricle (end diastolic volume)
The average VEF for the left ventricle is somewhere between ___% and ___%.
55% and 75%
_______/______ _______ ______ occurs when the heart chamber is unable to produce adequate force to push the blood out through the aorta and thus the body. This will then lead to a reduced ejection fraction (rEF) of the heart.
Systolic / Pumping Heart Failure
Systolic heart failure will be indicated once the ventricular ejection fraction is below ___%.
40%
Causes of systolic heart failure are usually due to some form of damage to the _________, causing a decrease in contractility and thus force of the heart.
Myocardium
_________ ________ ________, aka coronary artery disease (CAD) leads to damage of the myocardium if atherosclerosis has developed in even just one of the coronary arteries. The ischemia weakens the muscle walls and will have a negative effect on the contractility.
Ischemic heart disease
Chronic hypertension creates an increase in arteriole pressure, making it more difficult for the ____ _______ to pump that blood out to the systemic circulation. This then causes hypertrophy (note: this may also cause diastolic heart failure).
Left ventricle
With _______ __________, the heart chamber grows in size in an attempt to fill the ventricle with higher volumes of blood as per the Frank- Starling mechanism to generate an increase force. Although this may work for a while it will lead to muscles becoming thinner and weaker and then lead to systolic HF.
Dilated Cardiomyopathy
_________ ______ _______ occurs when the chamber of the heart is unable to fill up the proper amount prior to each heartbeat. It will present with a preserved Ejection Fraction (pEF); however the stroke volume is still insufficient.
Diastolic Heart Failure
__________ ___________ is a condition that results in the hypertrophy of the cardiac muscle with no known reason.
Hypertrophic Cardiomyopathy
T/F: CCHF is the inability of the heart to pump against an overwhelming obstacle (e.g. massive pulmonary embolism or massive myocardial infarction).
False: This is Acute CHF
With _____ sided heart failure, there is an accumulation of blood in the systemic circulation (venous system).
Right
Heart failure originating on right side due to respiratory dysfunction, usually caused by primary pulmonary hypertension or other respiratory conditions.
Cor Pulmonale
With ____ sided failure, there is a decrease in cardiac output, an increase in left ventricular diastolic pressure, pulmonary edema, fatigue and dyspnea after mild physical exertion, a persistent cough (especially when lying down (orthopnea)), paroxysmal nocturnal dyspnea, orthopnea, and tachycardia
Left
Increased heart rate means less time spent in _______. This causes decreased perfusion and therefore nutrition of the heart wall because the myocardium is perfused during ______.
Diastole
Stress on the heart results in increased chamber dilation (increases chamber volume, increasing force of contraction by pre-stretching fibers) as per the _____-______ ____ of the heart
Frank-Starling Law
______ _________ results in decreased chamber size, which decreases the amount of blood that can enter the chamber.
Myocardial Hypertrophy
An overbulked heart wall will see decreased _______ and ____ clearance in systemic tissues results in reduced healing/tissue health. This increases susceptibility to disease and increases stress on and reduces function/performance of the kidneys, liver and glandular tissues and the heart itself.
Decreased perfusion and waste clearance.
________ heart compresses and restricts ventilation/lung capacity which increases stress on the heart and likewise congested lungs crowd the heart.
Enlarged heart
________ at rest is consistent with advanced/severe CCHF
Dyspnea
In Semi-Fowler position, the patient’s torso is raised ___-___ degrees.
30-45 degrees
