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Circulatory SystemThe circulatory system, through the medium of the blood, works tomaintain homeostasis, which is the tendency to maintain a stable internalenvironment
Delivery of nutrients andoxygen
If cells do not receiveblood they die as instroke, heart attack,pulmonary embolism,renal infaction anddecubitus ulcers
Removal of waste products
Waste includes carbondioxide and noxiouscompounds. If bloodand lymph supply islimited, affected cellscan drown in their ownwaste products
Temperature
Blood vessles dilatewhen it's hot andconstrict when cold. Also, prevents hotplaces (heart, liver,working muscles) fromgetting too hot. Helpsto maintain a stableenvironment
Clotting
Occurs when a roughplace develops in theendothelium of a bloodvessel, causing a chainof chemical reactionsthat results in thespinning of tiny fiversthat catch cells to plug
Massage can help or impairthis system.
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any gaps. Sometimesa curse rather thanbenefit.
Protection from Pathogens
Defends against hordsof microorganisms thattry to gain access to thebody's internalenvironment.
Chemical Balance
Supplied with enzymesand other buffers thatkeep pH balance withinthe safety zone.
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The BloodIncludes Red Blood cells (Erythrocytes), White Blood cells (Leukocytes)and Platelets (Thrombocytes)
Red Blood Cells
Produced and dying at 2million per second
Comprise 98% of blood cells.
Life span is about 4 months
Deliver oxygen to cells andcarbon dioxide to lungs
White Blood Cells
Not really white, they're clear
Different type fight differenttype infections
in different stages ofdevelopment
Types include: neutrophils,basophils, eosinophils,monocytes and lymphocytes
Platelets
Fragments of huge cells bornin red bone marrow.
Usually smooth, but becomespiky and sticky whenstimulated
Travel system looking forleaks or rough places inblood vessels. When found,
All are produced in the red bonemarrow.
Varieties of White Blood CellsA. Neutrophil; B. Eosinophil; C. Basophil; D.
Lymphocyte; E. Monocyte
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they create a clot.
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The HeartDivided into left and right halves by the septum; right halfpumps to the lungs and left half pumps to the rest of thebody.
Each half divided into top and bottom; small topchambers are called atria and is where blood from lungsand body returns; lower chambers are called ventricles.
Muscles of the atria are thinner and weaker;ventricle muscles are thicker and stronger
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Blood VesselsArteries/Arterioles = Vessels leaving the heart
Veins/Venules = Vessels going toward the heart
Capillaries = Vessels that connect Arteries and Veins
Arteries and Veins consist of 3 layers:
Internal layer (tunica intima) of epithelium
Middle layer (tunica media) of smooth muscle
External layer (tunica externa) of tough connective tissue.
Capillaries are delicate variations thereof and as such are muchmore delicate and easy to damage
Circulatory System consistsof 60,000 miles of tubing
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Blood Disorders
Anemia
Embolism, Thrombus
Hematoma
Hemophilia
Leukemia
Malaria
Myeloma
Sickle Cell Disease
Thrombophlebitis, Deep Vein Thrombosis
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Anemia
Insufficient oxygen-carrying capacity ; Often a symptom orcomplication rather than freestanding problem
Demographics3.4 million people in the United
States
Mostly women
People with chronic diseases:cancer, infection, bone marrow
suppression
Etiology
Idiopathic anemia
No identified cause, massage may offer temporaryimprovement
Nutritional anemia
Some deficiency; massage won’t have much affect
Cautions for pernicious anemia
Iron deficiency anemia
Needed to form hemoglobin
Most common in women: need twice as much iron asmen; get fewer calories
Pregnant women especially
Folic acid deficiency anemia
Needed to form RBCs
Water soluble: any excess can’t be stored
Pernicious anemia
Inadequate Vitamin B : not enough in diet (vegans) orpoor access in stomach (lack of intrinsic factor)
Can lead to central nervous system (CNS) damage,anemia
Other nutritional deficiencies
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Copper, protein, others
Aplastic anemia
Suppressed bone marrow activity
Shortage of all blood cells
Autoimmune problem, renal failure, folate deficiency,viral infection, radiation, some toxins
Myelodysplastic anemia: similar problem, related toleukemia, myeloma
Secondary anemias
Complication of other disorders
Ulcers
Kidney disease
Hepatitis
Acute infectious disease
Leukemia, myeloma, lymphoma
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more Anemia
Signs and Symptoms Massage
Pallor
Dyspnea
Fatigue
Rapid heart rate
Intolerance to cold
Depends on cause
May offer temporary improvement; probably not long term
Won’t reverse etiology of most types of anemia
Cautions: heart rate; pernicious anemia may change sensation
Sickle cell and malaria are discussed elsewhere
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Embolism, ThrombosisEmbolism: traveling clot ; Thrombus: lodged clot
EtiologyPlatelets flow through circulatory system; activated byany rough spot or inflammatory chemicalsClots form at sites of damage, areas of slow, irregularblood flowEmboli travel until vessel is too small
Pulmonary embolism
From a clot that forms on venous side of systemiccircuit
650,000 pulmonary emboli/year
200,000 deaths
Often related to deep vein thrombosis (DVT),complications of trauma, orthopedic surgery
Risk factors for pulmonary embolism
Other types of cardiovascular disease, recent trauma,bed rest, surgery, pregnancy, recent childbirth,overweight, smoking, birth control hormones, hormonereplacement therapy
Number 3 cause of death in hospital setting
Signs and symptoms of pulmonaryembolism
Usually none till after damage has occurred
Dyspnea, chest pain, coughing with bloody sputum
Can look like heart attack
Demographics3.4 million people in the United
States
Mostly women
People with chronic diseases:cancer, infection, bone marrow
suppression
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Complications of pulmonary embolism
Increased risk of another event
Loss of lung function → right-sided heart failure
Treatment
Thrombolytics, anticoagulants
Surgery if necessary
Prevention
Identify risk
Low-dose presurgical anticoagulants
Elevation of legs
External compression of legs
Early ambulation
Arterial embolism
Complication of atherosclerosis
Could also be from bacterial infection, atrialfibrillation, rheumatic heart disease
Emboli are usually clots
Can also be plaque, bone chip, bubble,knot of cancer cells
When septum is intact
All venous emboli travel to lungs
Arterial emboli can go anywhere except the lungs
Coronary artery (heart attack)
Carotid/ cervical artery (stroke)
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Renal artery (renal infarction)
Femoral artery (muscle infarction)
Other
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Signs and Symptoms Treatment Massage
May be silentMay involve sharp tingling pain,tissue damage and death
Prophylactic anticoagulants
Rigorous circulatory massageis contraindicated for clientswho tend to form clotsCautions with anticoagulantmedications
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Hematoma
Bleeding, pooling of blood Bruise = superficial capillaries(ecchymosis)
Between muscle sheaths, inbrain = more serious
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more Hematoma
Signs and Symptoms Treatment Massage
Bruises
reddish/purple,black/blue whenacute
Yellow/green whensubacute
Larger intermuscular bleeds
Inflammation withdiscoloration
Heat, pain, usually infleshy areas
Bruises
nothing, or hot andcold
Subungual hematomas mayhave to be aspirated
Intermuscular bleeds should bewatched
Compartmentsyndrome
Myositis ossificans
Locally contraindicated whileacute and painful
Work gently, usehydrotherapy, stay withintolerance
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Hemophelia
Genetic disorder ; Absence of various clotting factors
EtiologyHemophilia A (80% of cases)
Deficiency in clotting factor VIII
Hemophilia B (also called Christmas disease) (15% ofcases)
Deficiency in clotting factor IX
Other: much rarer than A or B
Person with hemophilia has difficulty forming solid,long-lasting clots
Don’t bleed faster, do bleed longer thanothers
Rated as mild, moderate, severe
Severe hemophilia = 60% of diagnoses;
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Signs andSymptoms Complications Treatment Massage
Signs at birth:umbilical cordbleeds excessively
Early childhood:infant/toddleraccidents
Bruising,hematomas,nosebleeds,hematuria, joint painfrom bleeds intocapsule
Leading cause of deathin children withhemophilia isintracranial bleeding
Bleeding into jointcapsules withinflammation andextensive damage
Hemophiliacarthritis
Ankles,knees,elbows
Muscle and nervedamage
Infected blood products
Vaccinatefor hepatitisA, B
Resistance,hypersensitivity tosynthetic clottingfactors
Supplement clottingfactors
Can be done athome now,prophylacticallyor after injury
Careful exercise, weightcontrol
Rigorous mechanicalmassage iscontraindicated
Energetic workappropriate andhelpful for stress,pain relief
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Leukemia
White blood ; Cancer of bone marrow
Etiology
Myeloid or lymphoid cells from bone marrow
Bone marrow produces multitudes of non-functioningWBCs
Can be acute (aggressive) or chronic (slow-growing)
Usually acquired genetic mutations
Exposure to toxins, radiation
Untreated leads to death from excessive bleeding,infection
Four main types
AML: acute myelogenous leukemia
CML: chronic myelogenous leukemia
ALL: acute lymphocytic leukemia
CLL: chronic lymphocytic leukemia
Demographics35,000 diagnoses/year
22,000 deaths
Leading cause of death by cancerin children; more common in adults
208,000 patients in the UnitedStates
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Signs and Symptoms Diagnosis Treatment Massage
Bone marrowdysfunction
Suppressedproductionof normalblood cells
Fatigue,anemia
Easybruising,bleeding
Chronicinfections
Blood tests, bonemarrow biopsies,spinal tap
Crossover withlymphoma
Depends on what cellshave been affectedChemotherapy
Four stages
Induction
Consolidation
CNSprophylaxis
Maintenancetherapy
Radiation therapy ifunresponsive to chemo
Bone marrow transplant
Biologic therapies
Treatments canexacerbate symptoms
Rigorous circulatorymassage may be toodemanding
Other types of workmay be helpful
Work as part of healthcare team
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Malaria
Vector-borne infection of blood cells ; Four species of protozoa
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium falciparum
Spread by Anopheles mosquitoes
Etiology
Life cycle of Plasmodium
Human is bitten by female mosquito
Immature parasite introduced to bloodstream
Travels to liver, grows 6–9 days
Reenters bloodstream
Invades healthy RBCs
Feeds on hemoglobin
Replicates
Infected cells rupture, releasing parasitesand toxins
P. falciparum can be fatal
Transmitted through blood, mother to child
DemographicsWorldwide: 500 million/year
1.5 million to 3 million deaths/year,average age = 4 years old
90% of cases in sub-SaharanAfrica
No longer common in the UnitedStates : 1,000–2,000 diagnoses ayear (mostly travelers)
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more Malaria
Signs and Symptoms Diagnosis Prevention Massage
Physical symptoms
Oftenmissed inthe UnitedStates
Blood smears
Other testsindevelopment
Some parasitesbecoming resistant tochloroquine
Important to treat fully
Prophylacticmedication
Mosquito nets,insecticide, etc.
Vaccine indevelopment
BacilleCalmette-Guérin(BCG) hasmanyproblems
Contraindicated whileacute
Get information onkidney, liver damageto make other choices
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Myeloma
Cancer of bone marrow, specifically maturing B cells
Etiology
Normally, only a few B cells in bone marrow before theymigrate to lymph tissue
Usually spine, pelvis, ribs, skull
While B cells mature in bone marrow, they undergo aDNA mutation
Proliferate into tumors
Secrete cytokines that block osteoblastactivity, stimulate osteoclasts ; Bonethinning, holes
Produce faulty antibodies
Monoclonal immunoglobulins (M-proteins)
Fragments can show in urine: Bence Jonesproteins
Progress can be tracked through urinalysis
Kidneys can sustain damage
(Tumors outside bone = plastocytomas)
Three types of myeloma
Multiple myeloma
Solitary myeloma
Extramedullary plastocytoma
Demographics
16,700 diagnoses/year
58,300 current patients
11,000 deaths/year
Usually diagnosed around age 70
Older black men morethan other groups
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Signs and SymptomsDiagnosis and
Staging Treatment Massage
Silent early
Bone pain, fractures
Anemia, infections,bleeding
Kidney problems
Amyloidosis
Urinalysis
Bone marrow biopsy,aspiration
Blood test
Radiography, magneticresonance imaging(MRI)
Stages I–III
Watchful waiting
Chemotherapy, bonemarrow stem celltransplantation
As with other bloodcancers, support ratherthan challenge stability
Work forimmunesupport,pain relief
High risk offractures
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Sickle Cell Disease
Autosomal recessive genetic condition ; Production ofabnormal hemoglobin
Etiology
Recessive gene: one copy = SC trait, not disease
Two people with SC trait have 25% chance of passingit on to each child
SC trait has no health consequences
SC disease: hemoglobin is abnormal, RBCs havesickle shape ; Lifespan of RBC = 10 days
Three variations
SS form (most common)
SC form
S-beta thalassemia
Demographics
SC gene most common in blacks,Hispanics, Mediterraneans, fromMiddle East
2 million people with SC trait in theUnited States
72,000 have SC disease
8,000 births/year
500 deaths/year
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Signs andSymptoms Complications Treatment Massage
Inadequate oxygen-carrying capacity
Fatigue
Shortnessof breath
Pallor
Jaundice,splenomegaly
Other complications
Sickle cell crises:infarctions
Hand-footsyndrome
Organdamage
Infections (lostspleen function)
Gallstones
Vision loss
Acute chestsyndrome (looks likepneumonia)
Others
Delayedgrowth,chronicskinulcers atlowerlegs,priapism
Work to limit severity,frequency of SC crises
Over-the-counter(OTC) painmedication,hot pack
Heavierpainkillers
Prophylaxisforpneumonia
Rigorous exercise notrecommended
Circulatory,mechanicalmassagecontraindicated
Reflexive,energetic maybe helpful
Warm packs,gentle strokingfor pain
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Aortic Aneurysm
Veins have become obstructed with clots ; Usually calves,thighs, pelvis
Thrombophlebitis = lesser, greater saphenousveins
DVT = popliteal, femoral, iliac veins
Etiology
Thrombi = stationary clots; can fragment and travel
Usually to lung → pulmonary embolism
(exception with patent foramen ovale; crossover to arterial side)
Virchow triad
Injury to endothelium
Hypercoagulability
Venous stasis
Possible triggers
Physical trauma
Varicose veins
Local infection
Reduced circulation
Immobility
Pregnancy and childbirth
Certain types of cancer
Surgery
High-estrogen birth control pills or hormonereplacement therapy
Demographics
Often unrecognized, untreated
DVT may happen 2 million times
Diagnosed in 600,000
200,000 deaths
Up to 5% population may have aDVT at some point
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Other factors: cigarette smoking,hypertension, paralysis, and some geneticconditions
Clot forms; sudden movement or change in positioncauses debris to break off and travel
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more Thrombophlebitis, Deep Vein Thrombosis
Signs andSymptoms Diagnosis Treatment Massage
May be obvious withsigns ofinflammation
Sometimes distaledema
Chronic problem →skin rashes, ulcers
With infection: fever,malaise
DVT moredangerous, higherrisk of seriousdamage ; May showpitting edema
Ultrasound: fast,noninvasive, highchance of falsepositive
Venography: moreaccurate, slower,more risk of damage
MRI: fast,noninvasive,accurate, expensive,not availableeverywhere
Thrombolytics tobreak clots;anticoagulants toprevent future ones
Risk ofbleeding
Pneumaticcompression,support hose forDVT
Superficialthrombophlebitis:hot packs,analgesics, gentleexercise
Vena cava filter
A client withdiagnosed bloodclots is not a goodcandidate forcirculatory massage
Signs may beindistinct,misleading
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Vascular Disorders
Aneurysm
Atherosclerosis
Hypertension
Raynaud Syndrome
Varicose Veins
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Aortic Aneurysm
Bulge in blood vessel wall or heart ; Usually at aorta or inbrain. If an aneurysm ruptures, extensive bleeding canhappen
Etiology
If walls of high-pressure arteries lose elasticity, theycan bulge
As aneurysm grows, walls get thinner
Usually happens at thoracic or abdominal aorta orbase of brain
Sometimes the whole ventricle of heart canbulge
Factors
Compromised smooth muscle
Smoking
Congenitally weak arterial wall muscle
Inflammation
Untreated syphilis
Trauma
Types of aneurysms
Saccular
Fusiform
Berry
Dissecting
Demographics
Most patients are men 60 years orolder
About 15,000 deaths/year
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more Aortic Aneurysm
Signs and Symptoms Diagnosis Treatment Massage
Sometimes silent
May press on otherstructures
Dysphagia,chest pain,hoarseness,coughing(thoracicaorta)
Throbbinglump nearumbilicusback pain(abdominalaorta)
Blood makes specificsound (bruit)
Palpable in thin people
Ultrasound, computedtomography (CT), MRI
Complications
Pressure on nearbystructures
Blood clots
Rupture, hemorrhage
Rupturedcerebralhemorrhageis fatal 50%of time
Rupturedaortichemorrhageis nearlyalways fatal
Endovascular or opensurgery
Replacementgraft, Dacronsubstitute,stent
Small bulges may notneed immediate repair
Circulatory massagerequires too muchadaptation
A client with adiagnosed aneurysmmay get benefit fromreflexive, energeticwork to lower blood
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Atherosclerosis
Subtype of arteriosclerosis
Hardening of arteries due to plaque
Damage causes spasm, blood clots
Diameter is occluded
Coronary artery disease (CAD) = atherosclerosis at coronaryarteries
Etiology
Multifactorial process ; Influenced by gender, age, race,diet, others
Basic progression
1. Endothelial damage
Carbon monoxide; high levels of low-densitylipoproteins (LDLs) and triglycerides; high iron
Occurs most readily at branches or sharp curves
2. Monocytes arrive, move in, become macrophages
3. Macrophages take up LDL.
Become foam cells: beginning of plaque
4. Foam cells infiltrate and damage smooth muscletissue.
Secrete growth factors that cause smooth musclecells to proliferate
Release enzymes that damage arterial walls,promote clotting
5. Platelets arrive
Secrete growth factors
Form clots
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Cause vascular spasm
Unchangeable risk factors
Heredity, genetics
Gender
Age
Kidney disorders
Modifiable risk factors
Smoking
High cholesterol levels
High blood pressure
Sedentary lifestyle
Diabetes
Other Risk Factors
C-reactive protein
Homocysteine
Others: BMI, fibrinogen, lipoproteins, stressmanagement…
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Signs andSymptoms Diagnosis Treatment Massage
None early: 50%occlusion beforedysfunction
(angiogenesis,adaptability)
Later: poor stamina,shortness of breath,complications
Complications
High blood pressure
Aneurysm
Arrhythmia
Thrombus orembolism, peripheralvascular disease
Angina pectoris
Stableanginapectoris
Unstableanginapectoris
Heart attack
Angiogram, CT, bloodtests,echocardiogram,ultrasound, ankle-brachial index
Diet and exercise
Drugs
Lower bloodpressure,cholesterol,platelet activity
Surgery
Bypass,angioplasty,endarterectomy
Determined byclient’s resilience: isit safe to exerciserigorously?
Adjust formedications asneeded
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Hypertension
High Blood Pressure: Consistently above 140/90
Etiology
Blood pressure variables
Pressure inside vesselsPressure outside vesselsBlood volumeVessel diameter
Types of high blood pressure
Essential: 95%Secondary (temporary complication)Malignant hypertension: diastolic rises very quickly—medical emergency
Blood pressure readings
Risk of damage to vessels begins when systolic >115, diastolic > 75A measurement is based on two or more readingsat different office visits
Category Systolic Diastolic
Optimal
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Signs and Symptoms Treatment Massage
Silent killer
Shortness of breath;headache/dizziness; swellingof ankles; sweating, anxiety
Complications
Edema
Atherosclerosis
Stroke
Enlarged heart, heart failure
Aneurysm
Kidney disease
Vision problems
Of 65 million with hypertensionin the United States
63.4% know
45.3% treat it at all
29.3% treat itsuccessfully
70% of people withhypertension don’t control it wellenough to preventcomplications
DASH diet
Exercise
Medication
Diuretics,vasodilators, beta-blockers
Medication causesside effects; highblood pressure hasno symptoms
Depends on health, resilienceof client
Massage can lower bloodpressure and stress
Get info on kidney,heart problems
No deep abdominalwork
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Raynaud Syndrome
Primary Raynaud disease: vasoconstriction in extremities (alsonose, ears, lips) ; Secondary Raynaud phenomenon:complication of underlying disorder
Etiology
Arterioles spasm
Temporary episodes, can become permanent
Chemical components: tunica intima secreteschemicals that affect vasospasm, viscosity of blood
May be related to hyperreactivity to cold, stress
Causes (primary)
Stress (sympathetic response), cold, mechanicalirritation
Slow onset, less severe than secondary
Both hands and feet often affected
Causes (secondary)
Arterial diseases: diabetes, atherosclerosis, Buergerdisease
Autoimmune connective tissue diseases: scleroderma,lupus, rheumatoid arthritis
Sensitivity to some drugs: beta-blockers and ergotcompounds
Neurovascular compression: carpal tunnel syndrome,thoracic outlet syndrome, crutch use
Demographics
Primary: mostly women 15–40years old
Some kind of Raynaud syndromemay affect 5–10% of generalpopulation
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more Raynaud Syndrome
Signs and Symptoms Treatment Massage
Usually bilateral
Cycle of colors
White
Blue
Red
Episodes last < 1minute toseveral hours
Secondary can be extreme andlong lasting: atrophy,ulcerations, skin and naildamage
Depends on cause
Quit smoking, avoidvasoconstrictors, soak in warmwater, dress for weather,protect hands when working incold, etc.
Deal with stress: biofeedback,massage
Medication to dilate bloodvessels, counteractnorepinephrine
Surgery: sympathectomy
Depends on cause
Primary indicatesmassage
Secondary: beguided byunderlying disorder,general health
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Varicose Veins
Varix= twisted
Valves in superficial veins collapse, vein is stretched,distorted ; Can happen at anus (hemorrhoids), esophagus,scrotum, legs
Etiology
In the leg
Small veins pick up blood from internalmuscle capillaries
Run on superficial aspect, feed into largerveins that perforate leg muscles
Muscle contraction/relaxation movesblood from superficial to deep and uplegs
Damage to valves in superficial veins
Wear and tear
Standing all day
Mechanical obstruction ; Knee socks,brace, pregnancy
Systemic problems: kidney, livercongestions
Structural anomalies
When a valve is damaged
Blood adds pressure on the next valvedown
Veins become twisted, ropy
Demographics
Women > men
Progesterone weakensvein walls
History of pregnancy
Half of people 50 years or older
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more Varicose Veins
Signs and Symptoms Treatment Massage
Lumpy, bluish wanderinglines
Protrude from skin
Back, medial aspect of calfand thigh
Itching, throbbing pain
Complications
Varicose ulcers
Leg cramps
Blood clots (melt easily)
Risk of DVT, especially withsudden onset or change insize
Support hose, elastic bandages
Avoid long periods on feet, restwith feet up
Avoid constricting clothes
Surgery
Vein stripping
Ambulatoryphlebectomy
Other
Sclerosing injections
Laser
Radiofrequency
Local contraindication
Heavy massagedistal alsocontraindicated
For mild cases: avoid deep,sharp pressure
Telangiectasias okay formassage
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Heart Conditions
Heart Attack
Heart Failure
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Heart Attack
Damage to cardiac muscle from ischemia ; Muscle tissuedoesn’t repair; replaced by scar tissue
Damaged area = infarct
Heart attack = myocardial infarction
Etiology
Usually blockage in coronary artery impedes bloodflow
Could be clot, debris that travels fromelsewhere
Prolonged coronary spasm (drugoverdose)
New plaques more likely to break off than old ones
Cardiac cells die of ischemia
Can’t contract with coordination
May trigger fibrillations
Ventricular fibrillation → high risk of sudden death
Seriousness determined by size, location of infarct
May impair muscle function
May damage conduction system
DemographicsNumber 1 cause of death in the UnitedState
1 million heart attacks/year(1:5 deaths)500,000+ deaths/year
13 million survivors alivetoday
Risk profile
Sedentary, hypertension,high cholesterol, smoking,overweightMale 45+, Female 55+Family historyFemale 35+ who takes birthcontrol pills
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more Heart Attack
Signs and Symptoms Diagnosis Treatment Massage
Pressure, pain in thechest
Spreading pain
Light-headedness,nausea, sweating
Others: shortness ofbreath, nausea, anxiety,weakness, fainting,palpitations, cold sweat,stomach/abdominal pain
Angina pectoris (chestpain)
Stable angina
6.5 millionhave it
400,000diagnoses/year
Triggered byextra effort
Unstableangina
Sudden onsetof severe chestpain, no trigger
Reliablepredictor
Dynamic process
Blockage mayaccrue overhours
Earlyintervention
Hard to identify ahead oftime
Angiogram for high-riskpatients
Other tests
High speed CT
Contrastechocardiogram
Blood test forC-reactiveprotein
MRI for plaque
Identify location ofblockage, break it up assoon as possible
Thrombolytics
Percutaneoustransluminalcoronaryangioplasty
Oxygen, painmanagement
Later care:anticoagulants,nitroglycerin,observation, evaluation
Lifestyle changes
Depends onresilience,ability toadapt tochanges
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can limitdamage
Complications
Embolism
Atrial and ventricularfibrillations
Aneurysm
Heart failure
Shock
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Heart Failure
Progressive loss of heart function ; Not cardiac arrest
Etiology
Heart pumps 2,000 gal/day
If resistance develops, heart compensates
Heart grows (cardiomegaly)
Ventricles become stiff, inelastic
Stress hormones boost short-term function, damage inlong-term
Heart may fibrillate → circulatory system collapse
Heart failure usually related to other cardiovasculardisease
Can be related to congenital weakness with heartmuscle or valves
Types of heart failure: systolic v. diastolic
Systolic heart failure: left ventricle is enlarged; can’tpush hard enough
Diastolic heart failure: both ventricles are enlarged andinelastic
Types of heart failure: left side v. right side
Left-sided heart failure
Resistance in arteries (atherosclerosis, etc.)
Back up of fluid in lungs: pulmonary edema,shortness of breath, cough
Right-sided heart (cor pulmonale)
Resistance in lungs (emphysema,pulmonary embolism, pulmonary edema)
Demographics
3 million in the United States haveheart failure
400,000 new diagnoses/year
Mostly among survivors of heartattacks, CAD, aneurysm, etc.
Men> women till age 75; then men= women
African Americans two times morethan others
1 million hospitalizations/year
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Back up of fluid into legs or lowest structure
Can also cause liver, kidney damage
Biventricular heart failure
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more Heart Failure
Signs and Symptoms Diagnosis Treatment Massage
Depends on whichside of heart isdysfunctional
Shortness of breath,low stamina, edema,chest pain, indigestion,arrhythmia, distendedvessels in neck, coldsweaty skin…
Observation,auscultation
Radiography forcardiomegaly
Electrocardiogram
May be rated I–IV orA–D
Depends on location,severity
Rest, change in diet,modify physical activity
Medication
Beta-blockers,digitalis,diuretics,vasodilators
Surgery: repairdamaged valves, meshbag, transplant
Heart can’t keep upwith needs; massageshouldn’t challengeany further
Energetic/reflexivework may be helpful
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