Download Cardiovascular class

Cardiovascular class
Oxygen filled blood
(red)
CO2 blood, from veins
(blue)
Definitions etc
 Comes from the lungs
 Into the left atrium
 Pass the bicuspid/mitral valve
 Into the left ventricle
 Out through the aortic valve
 To the aorta
 Out to the body
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From the body and lungs
Into the Inferior and Superior vena cava; coronary
sinus
To the right atrium
Through the tricuspid valve
To the right ventricle
Through the pulmonary valve
To the pulmonary artery
To the lungs
Valve control
Papillary muscles assist the chordea tendineae in closing the
valves
Perfusion
Delivery of fresh arterial blood to a tissue in correct relationship to
its current metabolic need.
Ischemia
Inadequate perfusion, not enough blood to tissues
Infarction
Cell necrosis (tissue death)
Occlusive infarction
Blockage of blood vessel, no blood passes by
Hemorrhagic infarction
Blood vessel ruptures/opens
White infarction
Proximal occlusion, tissue appears pale due to lack of blood
Red infarction
Distal occlusion, tissue filled with static blood, tends to pool, due
to problems with distal drainage vessels
Hyperemia
Accumulation or attraction of a higher than normal volume of
blood into a tissue, area turns red
Active hyperemia
Cause by a stimulus, heat, inflammation etc, increases delivery of
blood
Passive hyperemia
Blood is impaired from leaving the tissue, problem with drainage,
red infarction
Thrombosis
The process of thrombus development
Thrombus
Occlusion formed by platelet formation, trapped blood cells and
Atherosclerosis
fibrin formation
Cholesterol buildup
Embolus
Any material, that shouldn’t be there, moving in the blood stream.
Air/nitrogen bubbles, bone chips, injured or diseased tissue, fat,
foreign bodies
Embolism
An infarction that results when an embolus occludes a blood
vessel
Aneurysm
A weak spot in a blood vessel wall that bulges under pressure,
and eventually bursts
Hypertension
Elevated blood pressure
Hemodynamic pressure
Pressure exerted as a result of the propulsion of blood under
pressure
Hydrostatic pressure
Pressure of the weight of blood on blood vessel walls
Bifurcation
Area where blood vessel splits
Berry or saccular
aneurysm
Result of a discrete specific weak spot in a blood vessel
Fusiform aneurysm
Weakness involving the entire blood vessel circumference, entire
vessel gets larger
Dissecting aneurysm
Always occurs in the aorta, infiltrating the tunica media causing a
collapse in the lumen
Tunica intima
Aka. Tunica interna, internal layer of blood vessels
Tunica adventitia
Aka tunica externa, external layer of blood vessel
Tunica media
Middle layer of blood vessel
Edema
Excess accumulation of fluid in the interstitium
Anti-edemous factors
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Edemous factors
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Action of lymphatic capillaries
Colloid osmotic pressure in blood (albumin)
Healthy normal capillary walls and heart, kidney and liver
functions
Tissue density
Normal musculoskeletal mobility
Colloid osmotic pressure of the interstitium
Increased capillary wall permeability
Increased hydrostatic pressure of blood, more fluid exits
vessels
Anasarca
 Nutrition factors
 Imbalances of sodium
Fluid accumulation throughout the body, full body edema
Ascites
The accumulation of fluid in the peritoneal cavity, abdominal
region
Hydrothorax/pleural
effusion
Pericardial effusion
Accumulation of fluid in the pleural cavity
Colloids
Large molecular weight particles present in a solution
Colloid osmotic
pressure
Osmotic effect of particles in the colloidal solution as opposed to
dissolved crystalloids such as sodium
Osmosis
Passage of water from a dilute solution through a semipermeable membrane to a more concentrated solution
Kwashiorkor
Severe protein deficiency
Frank-Starling law
The more stretch placed on a cardiac muscle the stronger the
contraction
Congestive heart failure
(CHF)
The failure of the heart in its function as a pump left sided
ventricular weakness.
Acute CHF
Inability of the heart to pump against an overwhelming obstacle.
Chronic CHF
Progressive loss of the heart, strength or effectiveness as a
pump due to chronic stresses
Accumulation of fluid in the pericardial space
Intrinsic factors of CHF
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Wall septum or chamber defect
Valve dysfunction, backflow
Heart beat regulation problems, neural firing
Heart wall infarction, strength and elasticity decreases
Decreased heart wall fitness
Ischemic states/decreased perfusion of heart walls
Extrinsic factors of CHF
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Hypertension
Chronic respiratory conditions
Malnutrition
Obesity
Anemia
Smoking
Sedentary lifestyle
Liver/kidney disorders
Endocrine dysfunction
Conditions/disease that damage blood vessels
Emotional stress
CHF progression
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Excessive physical stress
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Increased heart rate
Chamber dilation
Myocardial hypertrophy, enlarged heart
Corpulmonale
Heart failure originating on the right side due to respiratory
dysfunction
Tricuspid valve
Valve between right atrium and right ventricle
Bicuspid/mitral valve
Valve between left atrium and left ventricle
Aortic valve
Valve between left ventricle and aorta
Pulmonary valve
Valve between right ventricle and pulmonary artery
Inferior vena cava
Drains area below diaphragm
Superior vena cava
Drains area above diaphragm
Coronary sinus
Drains the heart itself
RMT concerns in
treating CHF
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Hypertension
Normal BP
Positioning
o Prone – applies pressure on chest, more restriction
on breathing
o Supine – best tolerated, trunk elevation
o Side lying – often good, limitation on time
o Seated – well tolerated, caution with trunk forward
Hydrotherapy – modify:
o Emersion of percentage of body
o Temperature extremes
o Duration
o Hydrostatic pressure on body, level of water
o Type of application
o Amount of body surface covered
Monitor SNS activation, avoid elements that increase it
Time of day, when meds taken
Modify self care – hydro, exercise
Tissue fragility – modify pressure
Awareness of treatment plans elements that increase
venous return. Modify broad continuous strokes of EFF
A condition of chronically elevated blood pressure
140/90 and above
o There can be too much blood going through a normal
sized vessel, or
o The vessel is too small to accommodate normal blood flow
Women 110/70
Men 120/80
Blood pressure
Measures the relationship between cardiac output and the total
peripheral resistance
CO x TPR = BP
The sum of all elements that resist the flow of blood
Total peripheral
resistance
The total resistance of all blood vessels downstream of the aorta
Systolic pressure
Indicates the greatest pressure in the arterial wall during
ventricular contraction.
o Largely determined by stroke volume
o It will increase if the volume of blood increases
o Or blood vessel walls have increased rigidity
The resting pressure in the arterial wall
o Largely determined by the health of arteries and arterioles
o It will increase if there is an increase in vascular resistance
o Influenced by the elasticity of arterial walls, the total
peripheral resistance and aortic Valvular competence
Diastolic pressure
Pulse pressure
The difference between systole and diastole.
Normal is 35-45, resting.
Mean arterial pressure
Avg. pressure in the systemic circulation
Diastole + 1/3rd of pulse pressure. Normal range 83-93.
Korotkoff sounds
Sounds made by blood rushing through compressed but slightly
opened vessels.
Venous return
Influenced by the ANS – stroke volume decreases as heart rate
increases
Stroke volume
The amount of blood ejected from each ventricle during each
heartbeat.
Systolic pressure.
Meds to manage
Hypertension
Diuretics
Beta blockers
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Increase production of Urine
Decrease blood volume and hydrostatic pressure
Usually first drug of choice
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blocks sympathetic neurotransmitters (adrenaline,
norepinephrine) from synapsing on the heart, decreasing the
hearts rate of contraction and increasing its force of
contraction
Side effects - BB: breathing difficulties, parasthesia and
decrease in sensation, dysrhythmia,
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Glycosides
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Alters sodium/potassium pump with in cardiac muscle cell and
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decreases neural firing rate.
Slows down the heart rate
Caution/side-effects: toxicity (leading to visual disturbance,
confusion, GI irritation, dysrhythmia)
Alpha receptors
Alpha receptors either block sympathetic neurotransmitters from
synapsing on the smooth muscle of the arterial system or
decrease the number of sympathetic neurotransmitters impulses
emitted from the vasomotor center in the brain.
Calcium
antagonists/calcium
channel blockers
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A.C.E. inhibitors
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No calcium = decreased muscle contraction
Modify the uptake and utilization of calcium in the smooth
muscle cells of the blood vessel wall
Caution/Side-effects: swelling in distal extremities, especially
feet and ankles (dependent edema)
Angiotensin converting enzyme
Controls blood pressure
ACE inhibits this chain at the top level and prevents
angiotensin II from being created.
Renin (kidney) + angiotensinogen (liver) => angiotensin I
Angiotensin I + angiotensin Converting enzyme (lungs) => angiotensin II
Angiotensin II -> has a direct effect to vasoconstrict arterioles
Anticoagulants
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Antithrombotics
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help to prevent platelet formation
most common type is aspirin
Caution/side-effects: blood does not clot, deep work will bring
more blood and increase bleeding, bruises etc.
Treatment
approach/adaptations
for hypertension
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Focus on relaxation response before beginning more
standard massage approaches
Modify venous return techniques
Treating the limbs first, trunk last
Avoid compressing the aorta
Avoid bilateral compression of the neck (carotid arteries at
C6).
CAD – Coronary artery
disease
Narrowing of the coronary arteries
Atherosclerosis
Caused by deposition of fibro-fatty lesions on the intimal lining of
lg. and med. Arteries.
Cholesterol
Most common is Warfarin, taken orally, reduces the effect of
vitamin K on blood coagulation.
 Heparin (taken parenterally – injected), after surgery to
prevent coagulation
both prevent thrombin from forming (thrombin is used to convert
fibrinogen to fibrin)
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Fatty wax like material
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Used to construct cell membranes
Essential to nerves and brain function
Makes hormones
Part of bile
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High Density Lipoproteins
Fatty proteins that keep undesirable cholesterol from the
arteries
Lipoprotein = cholesterol + transport protein
LDL
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Low Density Lipoproteins
High amounts of cholesterol, low amts of protein
Deposits cholesterol in arteries to form plaque
Atheroma
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Plaque formation made up of fat/cholesterol
HDL
Arteriosclerosis
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Silent Myocardial
ischemia
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Angina pectoris
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Caused by the deposition of calcium or calcification of an
old atheroma
Causes hardening of the arteries, decreased ability to
vasoconstrict/dialate
Heart muscle is not getting enough oxygen/blood, no
symptoms, very bad
Result is congestive heart failure
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Complication and symptom of CAD
Type of temporary chest pain, pressure or discomfort,
usually in the left arm, chest, and jaw, sometimes on the
right
Caused by intermittent ischemic attacks
90% cause by atherosclerosis
10% by stenosis
Intermittent ischemic
attacks
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Complication and symptom of CAD
Episodic symptoms because of a partially occluded artery
Arrhythmias
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Alterations in normal HB pattern
Dysrhythmia and Arrhythmia are aka’s. for Abnormal heart
rate
Intermittent
Claudication
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Ischemic attacks of skeletal muscle causing pain the legs
Transient Ischemic
attack
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Ischemic attacks of brain tissue
Stenosis
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Thinning, narrowing, thickening, fusing or blockage of a
passage way of one or more arteries
Stable angina
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Attacks that happen only when the heart needs extra
oxygen, ie: climbing stairs, jogging
Unstable angina
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Attacks that occur even when at rest
Mx: Nitroglycerin
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Vasodialator
Syncope
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Fainting
Cardiomyopathy
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Weakening of the heart muscle
MxTx modifications for
treating CAD
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Hydro – temperature, time
Any stimulating technique – fascial, tapotement, frictions,
TrP, deep petrissage
Meds – don’t touch patches, keep a 4 “ diameter away
Pillow – fowler’s position
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