Download Werner`s A Massage Therapist`s Guide to Pathology (Fourth Edition)

Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Lesson Plans
Chapter 5 — Circulatory System Conditions.
Goals of the Lesson:
Cognitive: Students will be able to understand the general functionality of the circulatory system, as well as the
circulatory system conditions and blood disorders.
Motor: N/A
Affective: Students will be able to aid in the early detection of circulatory conditions as well as identify the proper modality
treatments required.
Learning Objectives:
The lesson plan for each objective starts on the page shown below.
5-1
Name two deficiencies that may cause nutritional anemia.... ...................................................................................... 341
5-2
Define hemophilia. ...................................................................................................................................................... 350
5-3
Name the most likely destination for loose blood clots on the venous side of the systemic circuit. ........................... 345
5-4
Name three possible destinations for loose blood clots or other debris on the arterial side of the systemic
circuit. .......................................................................................................................................................................... 347
5-5
Name two signs or symptoms of deep vein thrombosis............................................................................................... 364
5-6
Name the tissue that is damaged first in chronic hypertension. ................................................................................... 378
5-7
Name three controllable risk factors for the development of atherosclerosis. ............................................................. 371
5-8
Name the difference between primary and secondary Raynaud syndrome. ................................................................ 382
5-9
Name two factors that determine the severity of a heart attack. .................................................................................. 388
5-10
Describe how right-sided heart failure can develop as a result of left-sided heart failure. .......................................... 395
You Will Need:
Gather the following materials and teaching aids for the following lessons:
5-2
Print-outs of table 1.1.
5-5
Freshly cut stalks of celery, glasses half full of water, and dark food coloring..
5-6
Depending on the size of the class, you will need table salt, soda, water, milk, and bowls for each group of
students.
Page 1
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Selected Key Terms
Acute compartment syndrome
Allogenic transplants
Angiogram
Ankle-brachial index
Angioplasty
Atrial fibrillation
Auscultation
Autogenic transplants
Bence Jones proteins
Bruit
Buerger disease
C-reactive protein
Chronic venous insufficiency
Cor pulmonale
Diastole
Dysphagia
Dyspnea
Ecchymosis
Embolism
Endarterectomy
Epistaxis
Erythropoietin
Extramedullary plastocytoma
Fibrinogen
Hematoma
Hematuria
Hemoglobin
Hemolytic
Hemophilia
Hemophilic arthritis
Homocysteine
Induction
Infarction
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Selected Key Terms (cont.)
Intermittent claudication
Intrinsic Factor
Malignant hypertension
Monoclonal immunoglobulins
Myelodysplastic anemia
Nail fold capillaroscopy
Percutaneous transluminal
coronary angioplasty (PTCA)
Peripheral vascular disease
Plastocytomas
Priapism
Prophylaxis
Raynaud syndrome
Rennin
Restenosis
Reticulocytes
Splenomegaly
Sympathectomy
Tachycardia
Telangiectasias
Thalassemia
Thrombocytopenia
Thrombus
Tunica intima
Tunica media
Stenosis
Systole
Venography
Virchow triad
Page 2
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-1
Name two deficiencies that may cause nutritional anemia.
Date:
Lecture Outline
Content
 Circulatory System Conditions
 Blood Disorders
o Anemia
o Embolism, thrombus
o Hematoma
o Hemophilia
o Leukemia
o Malaria
o Myeloma
o Sickle cell disease
o Thrombophlebitis, deep
vein thrombosis
 Vascular Disorders
o Aneurysm
o Atherosclerosis
o Hypertension
o Raynaud syndrome
o Varicose veins
 Heart Conditions
o Heart attack
o Heart failure
Text
page
341–
342
PPt
slide
10–13
Figures, Tables, and
Features
Resources and
In-Class Activities
Features
Resources
Anemia
p. 341
Answer to Chapter
Objectives (SRCD)
 Anemia = Insufficient oxygencarrying capacity
 Often a symptom or
complication rather than
freestanding problem
 Affects about 3.4 million
people in US
o Most are women or
peoples with chronic
Page 3
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Answers to Chapter Review
Questions (SRCD)
In-Class Activities
Outside Assignments
Evaluation
Outside Assignments
Certain kinds of nutritional
anemia can be prevented
or treated through diet.
Have students research
iron deficiency anemia,
listing foods that
counteract, as well as those
foods that can continue the
deficiency.
Through discussion,
provide a list of symptoms
Evaluation
describing a blood
disorder, asking students to Chapter review questions:
Circulatory System
identify the appropriate
Conditions.
disorder.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.

disease
Several kinds of anemia
o Idiopathic anemias
o Nutritional anemias
o Hemorrhagic anemias
o Hemolytic anemias
o Aplastic anemia
o Secondary anemias
 Anemia, page 341.
 Nutritional anemias
 Some deficiency in diet;
massage won’t have much
affect
 Cautions for pernicious
anemia
 Iron deficiency anemia
o Needed to form
hemoglobin
o Most common in women:
need twice as much iron
as men; get fewer calories
o Pregnant women
especially
 Folic acid deficiency anemia
o Needed to form RBCs
o Water soluble: any excess
can’t be stored
 Pernicious anemia
o Inadequate Vitamin B12:
not enough in diet
(vegans) or poor access in
stomach (lack of intrinsic
factor)
o Can lead to central
nervous system (CNS)
damage, anemia
 Other nutritional deficiencies
o Copper, protein, others
Page 4
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 5
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-2
Define hemophilia.
Date:
Lecture Outline
Content
 Hemophilia = Genetic disorder
characterized by absence of
various clotting factors
 Affects about 18,000 men in
US
 About 400 new cases/year
o Carried on Xchromosome: women are
carriers who pass it to
their sons
 About one-third of cases are
spontaneous mutations
 It is possible but rare for
women to have hemophilia
Text
page
350–
64
PPt
slide
29–33
Figures, Tables, and
Features
Features
Resources and
In-Class Activities
Resources
Hemophilia
p. 350
Answer to Chapter
Objectives (SRCD)
Modality
Recommendations for
Hemophilia
Answers to Chapter Review
Questions (SRCD)
p. 352
In-Class Activities
Sidebars
5.1: Von Willebrand
Disease: An Equal
Opportunity Mutation
p. 351
 Hemophilia, page 350
 Etiology
 Hemophilia A (80% of
cases)
o Deficiency in clotting
factor VIII
 Hemophilia B (also called
Christmas disease) (15% of
cases)
o Deficiency in clotting
factor IX
 Other: much rarer than A or
B
 Person with hemophilia has
difficulty forming solid,
Page 6
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
The word hemophilia is
formed from the word
roots “hemo” and “philia.”
Pair students into groups
of two providing each
group with a print-out of
Table 1.1. Ask the groups
to come up with as many
different medical terms as
possible using either
“hemo” or “philia.”
Materials
Print-outs of table 1.1.
Outside Assignments
Evaluation
Outside Assignments
Hemophilia is sometimes
called “the royal disease.”
Ask students to write a
report researching the
derivation of this
nickname.
Evaluation
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
long-lasting clots
o Don’t bleed faster, do
bleed longer than others
 Rated as mild, moderate,
severe
o Severe hemophilia = 60%
of diagnoses; <1% normal
clotting factors
 Signs and Symptoms
 Signs at birth: umbilical cord
bleeds excessively
 Early childhood:
infant/toddler accidents
 Bruising, hematomas,
nosebleeds, hematuria, joint
pain from bleeds into
capsule
 Complications
 Leading cause of death in
children with hemophilia is
intracranial bleeding
 Bleeding into joint capsules
with inflammation and
extensive damage
o Hemophiliac arthritis
o Ankles, knees, elbows
 Muscle and nerve damage
 Infected blood products
o Vaccinate for hepatitis A,
B
 Resistance, hypersensitivity
to synthetic clotting factors
 Treatment
 Supplement clotting factors
o Can be done at home now,
prophylactically or after
injury
Page 7
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.

Careful exercise, weight
control
 Massage
 Rigorous mechanical
massage is contraindicated
 Energetic work appropriate
and helpful for stress, pain
relief
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 8
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-3
Name the most likely destination for loose blood clots on the venous side of the
systemic circuit.
Date:
Lecture Outline
Content
 Embolism: traveling clot
 Embolism, Thrombus, page 345



Platelets flow through
circulatory system; activated
by any rough spot or
inflammatory chemicals
Clots form at sites of
damage, areas of slow,
irregular blood flow
Emboli travel until vessel is
too small
 Pulmonary embolism
 The lungs are the one and
only destination for clots or
debris anywhere on the
venous side of the systemic
circuit.
o unless the heart has patent
foramen ovale
 From a clot that forms on
venous side of systemic
circuit (Fig. 5.4)
 650,000 pulmonary
emboli/year
 200,000 deaths
 Often related to deep vein
Text
page
345–
368
PPt
slide
19–23
Figures, Tables, and
Features
Figures
Resources and
In-Class Activities
Resources
Outside Assignments
Evaluation
Outside Assignments
5.3: A thrombus is a
Answer to Chapter
The term “embolism” was
lodged clot; an embolus is a Objectives (SRCD)
coined in 1848 by Rudolph
moving clot.
Carl Virchow. Ask
p. 345
students to research
Answers to Chapter Review Virchow and his
Questions (SRCD)
5.4: Sources of pulmonary
significance in the study of
embolism.
pathologies.
p. 346
In-Class Activities
The signs and symptoms
Evaluation
of pulmonary embolism
Chapter review questions:
can look like a heart
Circulatory System
attack. Through
Conditions.
discussion, ask students to
p. 399
identify key differentiating
factors between the two.
Page 9
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
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, hormone
replacement therapy
o Number 3 cause of death
in hospital setting
 Signs and symptoms of
pulmonary embolism
 Usually none till after
damage has occurred
 Dyspnea, chest pain,
coughing with bloody
sputum
 Can look like heart attack
 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
Page 10
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.




Low-dose presurgical
anticoagulants
Elevation of legs
External compression of legs
Early ambulation
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 11
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-4
Name three possible destinations for loose blood clots or other debris on the arterial side
of the systemic circuit.
Date:
Lecture Outline
Content
 Arterial embolism
 Complication of
atherosclerosis
o Could also be from
bacterial infection, atrial
fibrillation, rheumatic
heart disease
 Emboli are usually clots
o Can also be plaque, bone
chip, bubble, knot of
cancer cells
 When septum is intact
o All venous emboli travel
to lungs
 Arterial emboli can go
anywhere except the
lungs
 Coronary artery (heart
attack)
 Carotid/ cervical artery
(stroke)
 Renal artery (renal
infarction)
 Femoral artery (muscle
infarction)
 Other
Text
page
347348
PPt
slide
24–26
Figures, Tables, and
Features
Features
Resources and
In-Class Activities
Resources
Modality
Recommendations for
Embolism, Thrombus
Answer to Chapter
Objectives (SRCD)
p. 348
Answers to Chapter Review
Questions (SRCD)
 Signs and Symptoms
 May be silent
 May involve sharp tingling
Page 12
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Related Chapters
Cerebral aneurysms are
discussed in the section on
stroke in Chapter 4.
In-Class Activities
Most modality
recommendations for
embolism are
contraindicated except
PNF/MET/Stretching.
Through discussion, ask
students to identify why
this modality is considered
supportive.
Outside Assignments
Evaluation
Outside Assignments
The most commonly used
method to predict clinical
probability of pulmonary
embolism is the Wells
score. Ask students to
research how this
prediction rule has evolved
since 1995.
Evaluation
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
pain, tissue damage and
death
 Treatment
 Prophylactic anticoagulants
 Massage
 Rigorous circulatory
massage is contraindicated
for clients who tend to form
clots
 Cautions with anticoagulant
medications
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 13
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-5
Name two signs or symptoms of deep vein thrombosis.
Date:
Lecture Outline
Content
Text
page
364–
 Thrombophlebitis, Deep Vein
368
Thrombosis = Veins have
become obstructed with clots
 Usually calves, thighs, pelvis
 Thrombophlebitis = lesser,
greater saphenous veins
 DVT = popliteal, femoral,
iliac veins
 Demographics
 Often unrecognized,
untreated
 DVT may happen 2 million
times
 Diagnosed in 600,000
o 200,000 deaths
 Up to 5% population may
have a DVT at some point
PPt
slide
58–68
Figures, Tables, and
Features
Resources and
In-Class Activities
Features
Resources
Case History 5.1: Deep
Vein Thrombosis
Answer to Chapter
Objectives (SRCD)
p. 367
Modality
Recommendations for
Thrombophlebitis, Deep
Vein Thrombosis, p. 368
Figures
5-6: A. blood clot
lodged in a vein can cause
distal edema.
p. 366
 Etiology
 Thrombi = stationary clots;
can fragment and travel
o Usually to lung →
pulmonary embolism
o (exception with patent
foramen ovale; cross over
to arterial side)
 Virchow triad
o Injury to endothelium
o Hypercoagulability
o Venous stasis
Page 14
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Answers to Chapter Review
Questions (SRCD)
In-Class Activities
Similar to the way our
blood flows through our
veins and arteries, a piece
of celery uses a process
called transpiration. Divide
the class into small groups.
Provide each group with a
clear glass, water, dark
food coloring, and a stalk
of celery. Have the groups
add the food coloring to
the water, then place the
stalk of celery in the water
with the leafy side facing
up. Throughout the class,
have the students check the
progress of the colored
water throughout the
celery’s “vascular bundle.”
Materials
Freshly cut stalks of celery,
glasses half full of water,
Outside Assignments
Evaluation
Outside Assignments
Deep vein thrombosis has
been nicknamed “economy
class syndrome.” Ask
students to research and
write a report on this
nickname.
Evaluation
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.

Possible triggers
o Physical trauma
o Varicose veins
o Local infection
o Reduced circulation
o Immobility
o Pregnancy and childbirth
o Certain types of cancer
o Surgery
o High-estrogen birth
control pills or hormone
replacement therapy
o Other factors: cigarette
smoking, hypertension,
paralysis, and some
genetic conditions
 Clot forms; sudden
movement or change in
position causes debris to
break off and travel
 Thrombophlebitis, Deep Vein
Thrombosis, page 364
 Signs and Symptoms
 May be obvious with signs
of inflammation
 Sometimes distal edema
(Fig. 5.6)
 Chronic problem → skin
rashes, ulcers
 With infection: fever,
malaise
 DVT more dangerous,
higher risk of serious
damage
o May show pitting edema
 Diagnosis
 Ultrasound: fast,
Page 15
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
and dark food coloring.
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.


noninvasive, high chance of
false positive
Venography: more accurate,
slower, more risk of damage
MRI: fast, noninvasive,
accurate, expensive, not
available everywhere
 Treatment
 Thrombolytics to break
clots; anticoagulants to
prevent future ones
 Risk of bleeding
 Pneumatic compression,
support hose for DVT
 Superficial
thrombophlebitis: hot packs,
analgesics, gentle exercise
 Vena cava filter
 Case History 5-1: Deep Vein
Thrombosis, page 367
 Massage
 A client with diagnosed
blood clots is not a good
candidate for circulatory
massage
 Signs may be indistinct,
misleading
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 16
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-6
Name the tissue that is damaged first in chronic hypertension.
Date:
Lecture Outline
Content
 Hypertension = High blood
pressure
 Persistently above 140/90
 Hypertension, page 379
 Demographics
 65 million people in US
o 1 in 3 adults
 Men > women until
menopause, then men =
women
 African Americans more
than other races
 Age: half of people 60 years
or older have hypertension
 Other factors
o Obesity, smoking, high
cholesterol,
atherosclerosis, water
retention
o Genetic predisposition
Text
page
378–
382
PPt
slide
80–88
Figures, Tables, and
Features
Resources and
In-Class Activities
Figures
Resources
2.45: First-degree Burn.
p. 75
Animation 5 (SRCD)
2.46: Second-degree Burn.
p. 75
Answer to Chapter
Objectives (SRCD)
2.47: Third-degree Burn.
p. 76
Answers to Chapter Review
Questions (SRCD)
Features
Modality
Recommendations for
Hypertension
p. 382
 Etiology
 Blood pressure variables
o Pressure inside vessels
o Pressure outside vessels
o Blood volume
o Vessel diameter
(animation 5)
Page 17
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Outside Assignments
Sodium is an
environmental factor of
hypertension that relieves a
lot of attention. Ask
students to research how
salt consumption can affect
a person’s bloodstream.
Evaluation
Tables
5.1: Blood Pressure
Ratings
p. 379
Outside Assignments
Evaluation
In-Class Activities
Salt is a highly absorptive
substance. Divide the class
into small groups
providing each with the
materials to conduct an
experiment illustrating the
absorptive properties of
table salt. Each group will
need a container of salt,
and three different liquids
varying in chemical
makeup (milk, soda,
water). Instruct each group
to pour a small amount of
each liquid into separate
bowls, pouring a mound of
salt on top. The groups
should document the time
differences in the
absorption, applying
theories explaining why
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
 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 > 75
 A measurement is based on
two or more readings at
different office visits
 Signs and Symptoms
 Silent killer
 Shortness of breath;
headache/dizziness; swelling
of ankles; sweating, anxiety
 Complications
 Edema
 Atherosclerosis
 Stroke
 Enlarged heart, heart failure
 Aneurysm
 Kidney disease
 Vision problems
 Treatment
 Of 65 million with
hypertension in US
o 63.4% know
o 45.3% treat it at all
o 29.3% treat it successfully
Page 18
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
they achieved those
results.
Materials
Depending on the size of
the class, you will need
table salt, soda, water,
milk, and bowls for each
group of students.
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.

70% of people with
hypertension don’t control it
well enough to prevent
complications
 DASH diet
 Exercise
 medication
o Diuretics, vasodilators,
beta-blockers
o Medication causes side
effects; high blood
pressure has no symptoms
 Massage
 Depends on health,
resilience of client
 Massage can lower blood
pressure and stress
o Get info on kidney, heart
problems
o No deep abdominal work
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 19
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-7
Name three controllable risk factors for the development of atherosclerosis.
Date:
Lecture Outline
Content
Text
page
371–
 Atherosclerosis = hardening of
378
the arteries from any cause.
 Subtype of arteriosclerosis
 Hardening of arteries due to
plaque
o Damage causes spasm,
blood clots
o Diameter is occluded (Fig.
5.9)
 Coronary artery disease
(CAD) = atherosclerosis at
coronary arteries (Fig. 5.11)
 Atherosclerosis, page 372
 Etiology
 Multifactorial process
o Influenced by gender, age,
race, diet, others
 Basic progression
o 1. Endothelial damage
 Carbon monoxide; high
levels of low-density
lipoproteins (LDLs)
and triglycerides; high
iron
 Occurs most readily at
branches or sharp
curves
o 2. Monocytes arrive, move
in, become macrophages
PPt
slide
72–79
Figures, Tables, and
Features
Resources and
In-Class Activities
Figures
Resources
5-9: Atherosclerosis.
p. 372
Animation 4 (SRCD)
5-10: Coronary artery
disease.
p. 373
Answer to Chapter
Objectives (SRCD)
5-11: Arterial infarction
sites.
p. 377
Sidebar
5.4: Heart Disease in the
United States: Sobering
Statistics
p. 374
5.5: A brief Digression on
Cholesterol
p. 375
Features
Modality
Recommendations for
Atherosclerosis
p. 378
Page 20
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Answers to Chapter Review
Questions (SRCD)
Outside Assignments
Evaluation
Outside Assignments
The terms
“arteriosclerosis,”
“arteriolosclerosis,” and
“atherosclerosis” are very
similar, yet distinct, in
both spelling and meaning.
Ask students to research
the differences comparing
and contrasting the three.
Resources
Answer to Chapter
Objectives (SRCD)
Answers to Chapter Review
Questions (SRCD)
In-Class Activities
Pair students in groups of
two, asking each group to
come up with as many risk
factors for
arteriolosclerosis as
possible. Through
discussion, ask the class as
a whole to classify each
factor as unchangeable or
modifiable.
Evaluation
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
o 3. Macrophages take up
LDL.
 Become foam cells:
beginning of plaque
o 4. Foam cells infiltrate and
damage smooth muscle
tissue.
 Secrete growth factors
that cause smooth
muscle cells to
proliferate
 Release enzymes that
damage arterial walls,
promote clotting
o 5. Platelets arrive
 Secrete growth factors
 Form clots
 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, stress
management, etc.
Page 21
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
 Signs and Symptoms
 None early: 50% occlusion
before dysfunction
 (angiogenesis, adaptability)
 Later: poor stamina,
shortness of breath,
complications
 Complications
 High blood pressure
 Aneurysm
 Arrhythmia
 Thrombus or embolism,
peripheral vascular disease
(Fig. 5.11)
 Angina pectoris
o Stable angina pectoris
o Unstable angina pectoris
 Heart attack
 Diagnosis
 Angiogram, CT, blood tests,
echocardiogram, ultrasound,
ankle-brachial index
 Treatment
 Diet and exercise
 Drugs
o Lower blood pressure,
cholesterol, platelet
activity
 Surgery
o Bypass, angioplasty,
endarterectomy
 Massage
 Determined by client’s
resilience: is it safe to
exercise rigorously?
Page 22
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.

Adjust for medications as
needed
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 23
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-8
Name the difference between primary and secondary Raynaud syndrome.
Date:
Lecture Outline
Content
 Raynaud Syndrome
 Primary Raynaud disease:
vasoconstriction in
extremities (also nose, ears,
lips)
 Secondary Raynaud
phenomenon: complication
of underlying disorder
Text
page
382–
384
PPt
slide
89–95
Figures, Tables, and
Features
Resources and
In-Class Activities
Figures
Resources
5-12: Raynaud syndrome.
p. 383
Answer to Chapter
Objectives (SRCD)
Features
Modality
Recommendations for
Raynaud Syndrome
p. 384
 Raymaud Syndrome, page 382
 Demographics
 Primary: mostly women 15–
40 years old
 Some kind of Raynaud
syndrome may affect 5–10%
of general population
 Etiology
o Arterioles spasm
o Temporary episodes, can
become permanent
o Chemical components:
tunica intima secretes
chemicals that affect
vasospasm, viscosity of
blood
o May be related to
hyperreactivity to cold,
stress
Page 24
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Answers to Chapter Review
Questions (SRCD)
In-Class Activities
All cells involved in
inflammation are
coordinated by chemical
messages. Discuss the
chemical interactions
throughout each stage of
healing.
Outside Assignments
Evaluation
Outside Assignments
One inflammatory
indicator, C-reactive
protein, has been drawing
attention lately. Have
students research the
substance and discuss its
history as well as its
current and possible future
diagnostic uses.
Evaluation
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
 Causes (Primary)
 Stress (sympathetic
response), cold, mechanical
irritation
 Slow onset, less severe than
secondary
 Both hands and feet often
affected
 Causes (Secondary)
 Arterial diseases: diabetes,
atherosclerosis, Buerger
disease
 Autoimmune connective
tissue diseases: scleroderma,
lupus, rheumatoid arthritis
 Sensitivity to some drugs:
beta-blockers and ergot
compounds
 Neurovascular compression:
carpal tunnel syndrome,
thoracic outlet syndrome,
crutch use
 Signs and Symptoms
 Usually bilateral
 Cycle of colors (Fig. 5.12)
o White
o Blue
o Red
 Episodes last less than
1minute to several hours
 Secondary can be extreme
and long lasting: atrophy,
ulcerations, skin and nail
damage
 Treatment
 Depends on cause
o Quit smoking, avoid
Page 25
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
vasoconstrictors, soak in
warm water, dress for
weather, protect hands
when working in cold, etc.
o Deal with stress:
biofeedback, massage
o Medication to dilate blood
vessels, counteract
norepinephrine
o Surgery: sympathectomy
 Massage
 Depends on cause
o Primary indicates massage
o Secondary: be guided by
underlying disorder,
general health
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 26
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-9
Name two factors that determine the severity of a heart attack.
Date:
Lecture Outline
Content
Text
page
 Heart Attack = damage to cardiac 388–
395
muscle as a result of ischemia
 CAD (Fig. 5.15)
 Muscle tissue doesn’t repair;
replaced by scar tissue
 Damaged area = infarct
 Heart attack = myocardial
infarction
PPt
slide
104–
111
Figures, Tables, and
Features
Figures
5-15: Heart attacks
affecting the left ventricle.
p. 390
Sidebar
5.6 Other Heart Conditions
p. 392
Features
 Demographics
 Number 1 cause of death in
the United State
 1 million heart attacks/year
(1:5 deaths)
 500,000+ deaths/year
 13 million survivors alive
today
 Risk profile
o Sedentary, hypertension,
high cholesterol, smoking,
overweight
o Male 45+, Female 55+
o Family history
o Female 35+ who takes
birth control pills
Heart Attack
p. 389
Compare and Contrast 5.2:
Chest Pain, Chest Pain,
Chest Pain
p. 393
Case History 5.2: Heart
Attack
p. 394
Modality
Recommendations for
Hearth Attack
p. 395
 Etiology
 Usually blockage in
coronary artery impedes
blood flow
Page 27
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Resources and
In-Class Activities
Resources
Answer to Chapter Objectives
(SRCD)
Answers to Chapter Review
Questions (SRCD)
Related Chapters
In-Class Activities
Not all chest pain means
heart attack. Read a list of
the duration, trigger,
activity and causes from
Compare and Contrast 5.2,
asking students to identify
the feature.
Outside Assignments
Evaluation
Outside Assignments
WHO criteria have
classically been used to
diagnose myocardial
infarction. Ask students to
identify the criteria,
providing a specific plan
for a possible treatment.
Evaluation
Chapter review questions:
Circulatory System
Conditions.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
o Could be clot, debris that
travels from elsewhere
o Prolonged coronary spasm
(drug overdose)
 New plaques more likely to
break off than old ones
 Cardiac cells die of ischemia
o Can’t contract with
coordination
o May trigger fibrillations
o Ventricular fibrillation →
high risk of sudden death
 Seriousness determined by
size, location of infarct
o May impair muscle
function
o May damage conduction
system
 Signs and Symptoms
 Pressure, pain in the chest
 Spreading pain
 Light-headedness, nausea,
sweating
 Others: shortness of breath,
nausea, anxiety, weakness,
fainting, palpitations, cold
sweat, stomach/abdominal
pain
 Angina pectoris (chest pain)
 Stable angina
o 6.5 million have it
o 400,000 diagnoses/year
o Triggered by extra effort
 Unstable angina
o Sudden onset of severe
chest pain, no trigger
o Reliable predictor
 Dynamic process
o Blockage may accrue over
hours
Page 28
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
o Early intervention can
limit damage
 Complications
 Embolism
 Atrial and ventricular
fibrillations
 Aneurysm
 Heart failure
 Shock
 Diagnosis
 Hard to identify ahead of
time
 Angiogram for high-risk
patients
 Other tests
o High speed CT
o Contrast echocardiogram
o Blood test for C-reactive
protein
o MRI for plaque
 Treatment
 Identify location of
blockage, break it up as soon
as possible
o Thrombolytics
o Percutaneous transluminal
coronary angioplasty
o Oxygen, pain management
 Later care: anticoagulants,
nitroglycerin, observation,
evaluation
 Lifestyle changes
 Massage
 Depends on resilience,
ability to adapt to changes
Page 29
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 30
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.
Objective 5-10
Describe how right-sided heart failure can develop as a result of left-sided heart failure.
Date:
Lecture Outline
Content
 Heart Failure = Progressive loss
of heart function
 Not cardiac arrest
 Demographics
 3 million in the United
States have heart failure
 400,000 new diagnoses/year
o Mostly among survivors
of heart attacks, CAD,
aneurysm, etc.
 Men> women till age 75;
then men = women
 African Americans two
times more than others
 1 million
hospitalizations/year
 Etiology
 Heart pumps 2,000 gal/day
 If resistance develops, heart
compensates
o Heart grows
(cardiomegaly)
o Ventricles become stiff,
inelastic
 Stress hormones boost shortterm function, damage in
long-term
 Heart may fibrillate →
circulatory system collapse
Text
page
395–
399
PPt
slide
112–
117
Figures, Tables, and
Features
Resources and
In-Class Activities
Figures
Resources
5-16: Left-sided heart
failure leads to pulmonary
edema.
p. 397
Animation 6 (SRCD)
5-17: Right-sided heart
failure leads to systemic
edema.
p. 398
Answer to Chapter
Objectives (SRCD)
Answers to Chapter Review
Questions (SRCD)
In-Class Activities
Features
Heart Failure
p. 395
Modality
Recommendations for
Heart Failure
p. 399
Page 31
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Outside Assignments
Evaluation
Outside Assignments
There is no gold standard
for diagnostic criteria of
heart failure, but a few
commonly used systems
are the "Framingham
criteria,” the "Boston
criteria," the "Duke
criteria," and the "Killip
class.” Ask students to
compare and contrast 2 of
those systems.
Through discussion,
provide a list of possible
symptoms of heart failure
Evaluation
asking the students to
Chapter review questions:
identify each as a symptom Circulatory System
of left, right or
Conditions.
biventricular heart failure.
p. 399
Instructor’s Notes
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.


Heart failure usually related
to other cardiovascular
disease
Can be related to congenital
weakness with heart muscle
or valves
 Types of heart failure: systolic v.
diastolic
 Systolic heart failure: left
ventricle is enlarged; can’t
push hard enough
 Diastolic heart failure: both
ventricles are enlarged and
inelastic
 See animation 4
 Types of heart failure: left side v.
right side
 Left-sided heart failure (Fig.
5.16)
o Resistance in arteries
(atherosclerosis, etc.)
o Back up of fluid in lungs:
pulmonary edema,
shortness of breath, cough
 Right-sided heart
(corpulmonale)
o Resistance in lungs
(emphysema, pulmonary
embolism, pulmonary
edema)
 Often a complication of
pulmonary disease
accumulated through
left-sided heart failure
o Back up of fluid into legs
(Fig. 5.17) or lowest
structure
o Can also cause liver,
kidney damage
Page 32
Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Chapter 5— Circulatory System Conditions.

Biventricular heart failure
 Signs and symptoms
 Depends on which side of
heart is dysfunctional
 Shortness of breath, low
stamina, edema, chest pain,
indigestion, arrhythmia,
distended vessels in neck,
cold sweaty skin
 Diagnosis
 Observation, auscultation
 Radiography for
cardiomegaly
 Electrocardiogram
 May be rated I–IV or A–D
 Treatment
 Depends on location,
severity
 Rest, change in diet, modify
physical activity
 Medication
o Beta-blockers, digitalis,
diuretics, vasodilators
 Surgery: repair damaged
valves, mesh bag, transplant
 Massage
 Heart can’t keep up with
needs; massage shouldn’t
challenge any further
 Energetic/reflexive work
may be helpful
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 33
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