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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 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 Edemous factors 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 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 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 Excessive physical stress 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 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 Increase production of Urine Decrease blood volume and hydrostatic pressure Usually first drug of choice 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, Glycosides Alters sodium/potassium pump with in cardiac muscle cell and 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 A.C.E. inhibitors 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 Antithrombotics 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 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) Fatty wax like material Used to construct cell membranes Essential to nerves and brain function Makes hormones Part of bile High Density Lipoproteins Fatty proteins that keep undesirable cholesterol from the arteries Lipoprotein = cholesterol + transport protein LDL Low Density Lipoproteins High amounts of cholesterol, low amts of protein Deposits cholesterol in arteries to form plaque Atheroma Plaque formation made up of fat/cholesterol HDL Arteriosclerosis Silent Myocardial ischemia Angina pectoris 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 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 Complication and symptom of CAD Episodic symptoms because of a partially occluded artery Arrhythmias Alterations in normal HB pattern Dysrhythmia and Arrhythmia are aka’s. for Abnormal heart rate Intermittent Claudication Ischemic attacks of skeletal muscle causing pain the legs Transient Ischemic attack Ischemic attacks of brain tissue Stenosis Thinning, narrowing, thickening, fusing or blockage of a passage way of one or more arteries Stable angina Attacks that happen only when the heart needs extra oxygen, ie: climbing stairs, jogging Unstable angina Attacks that occur even when at rest Mx: Nitroglycerin Vasodialator Syncope Fainting Cardiomyopathy Weakening of the heart muscle MxTx modifications for treating CAD 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