Hypertension (Circulatory Pathologies) Flashcards
What is Hypertension?
The elevation of blood pressure above the normal range for a prolonged period of time and it can increase the risk of stroke or heart attack
With hypertension, the heart works harder to pump blood against increased arterial pressure
As the heart performs more, it develops more mass and requires more oxygen
Initially, this adaptation works, but over time, the heart’s ability to function as a pump can be affected, leading to heart failure
It is often called the “silent killer” because the transition from health to illness is often asymptomatic with few signs clinically detected in the heart or kidneys
Individuals may experience headache, shortness of breath or dizziness
Untreated hypertension can lead to pathological changes to the blood vessels such a atherosclerosis, stroke, heart attacks and peripheral vascular disease as well as heart and kidney problems
Risk Factors
- Anyone over 45 years old
- Those with a family history of premature cardiovascular disease, hypertension, stroke or hyperlipidemia
- African Americans are affected ⅓ more than caucasians
- Men more than women until women reach menopause, then they even out
- Pregnant women have an increased risk of elevated blood pressure, especially:
+ Teenagers or women over 35 the body is hormmonly balance in different age
+ African american women
+ Women in their first pregnancy
+ Women with a history of hypertension, diabetes, kidney disease or heart problems
+ Women whose mother had a high blood pressure disorder in pregnancy
- Hypertension is often associated with:
+ Heart disease
+ Myocardial infarction and post infarction heart attack
+ Angina pectoris
+ Left ventricular hypertrophy
+ Transient ischemic attacks and stroke
+ Arteriosclerosis
+ Kidney disorders
+ Diabetes
+ Metabolic disorders such as hyperthyrodism
- Lifestyle risk factors for hypertension include:
+ Smoking
+ Stress
+ High sodium intake in those genetically predisposed
+ Oral contraceptive use
+ Obesity
+ Excessive alcohol intake
+ Physical inactivity
Types of Hypertension
- Primary Hypertension:
- Aka idiopathic or essential hypertension
- A silent, long-term condition that is not associated with any underlying disease
- Secondary Hypertension:
- The result of an underlying pathology such as kidney disease, vascular disease or alterations in adrenal functions (often from a tumor)
- Malignant hypertension is an accelerated and potentially fatal form of secondary hypertension that can develop in a small number of people
Effects of Massage on Circulation
Massage mechanically assists in emptying blood and lymph vessels and facilitating forward movement of the blood and lymph
Blood vessels collapse and refill as massage techniques are applied
Vasomotor nerves supplying the blood vessels are also stimulated, resulting in visible hyperemia after prolonged massage in an area
Consideration must be taken when dramatically increasing venous and lymphatic fluid return to the heart. Full body lymphatic drainage and other full body applications of techniques can cause a sudden increase in the volume of lymphatic fluid or venous return through the body to the heart
Health History Questions
- When was the hypertension diagnosed?
- What treatment was given? Were lifestyle changes encouraged and were they adhered to?
- Are you on any medication?
- Is your blood pressure stable now?
- Has your physician or other health care providers imposed any lifestyle restrictions such as no hot bath?
- Is this your first massage? If so, does your physician know you are receiving a massage?
- Do you consent for me (the therapist) to contact your physician to get more information about your condition?
Is there a history of heart disease?
Assessment
With any new client, blood pressure should be taken before the treatment, even it’s normal
If blood pressure has changed from previous readings, the therapist should ask about recent activities that may have temporarily increased the blood pressure
As a guide, client’s should be referred to their physician if there are changes in BP from the person’s normal range or if the BP is measured twice on two different occasions with a value of 140-180 mmHg or 90-105 mmHg
With a client who is diagnosed with hypertension, blood pressure is measured before each treatment
Contraindications
- A client with severe hypertension, complicated pathology or those who have moderate hypertension but appear non compliant with medical treatment, their physician should be contacted to determine the appropriateness and safety of massage therapy and the extent of treatment modifications
- Increasing SNS firing will elevate blood pressure
- Prolonged painful techniques are avoided
- Potentially painful techniques are applied to a limited area
- Caution regarding the neck and associated vasculature, especially the carotid artery. Caution taken to not rotate the neck for prolonged periods of time
- Avoid techniques and modalities that would contribute to the return of large volumes of venous and lymphatic fluid to the heart
- Prolonged elevation of the legs above the level of the heart is not recommended
- Full body lymphatic drainage is CI’d
- Full body hydrotherapy applications or prolonged heat applications over the back or over the pectoral region are avoided
Massage Modifications
The number of modifications within the treatment will relate to the severity of the hypertension and the client’s compliance with medical advice
A client with mild, stable hypertension who is compliant with medical treatment, will generally not require modifications
If a client has moderate, stable hypertension, modifications such as reduced treatment time in the prone position and some elevation of the upper body while the client is in the supine position would be appropriate
If there is any doubts about treatment, contact their physician and in the meantime, exercise caution with treatment
Massage Positioning
When determining a safe treatment position, inquire what the client’s sleeping position is or if there are any restrictions from their physician
If a person is able to lie on their stomach while they sleep, the prone position may be used during treatment
Reduction of the time spent in the prone position may be recommended due to pressure on the abdominal aorta
Side Lying is appropriate though it is thought that left-side lying can place additional stress on the heart, therefore, time in this position may be reduced or avoided in the case of moderate to severe hypertension
Supine is the preferred position, with pillows supporting the trunk in a semi-seated posture
The seated position is excellent for clients with moderate to severe hypertension as it puts the least stress on the cardiovascular system
Massage
A key goal of treatment is to reduce SNS firing which will reduce blood pressure
Soothing, less vigorous techniques are used
Slow, relaxed breathing is encouraged
Visualization is effective if the client is comfortable with this technique
With moderate hypertension or where there are complicating cardiovascular conditions rather than starting with techniques to the trunk, begin by massaging the limbs, using short, segmental strokes
Throughout treatment, the therapist should be aware of changes in the client and signs of cardiovascular distress (increased heart rate, dizziness, increased respiratory rate, shallow breathing, sweating, facial flushing) if any of these are observed, modifications should be made. If the symptoms continue, stop the treatment and place the client in a seated position
Start w legs and arm, see how they do with it, after that is back, no long deep stroke, work in small segment
Self Care
Relaxation training and meditation have been shown to reduce blood pressure not in RMT scope of practice
Moderate aerobic exercise has been found to improve cardiovascular health and reduce lifestyle changes
Encourage maintaining physician prescribed lifestyle changes
