Cardiovascular Diseases


The therapist should ask about both current and previous conditions to develop an appropriate treatment plan for the client. *— Why should therapists ask clients whether they are taking medications? The medications might have side effects that could affect the massage considerations, and the client might need to have certain medications readily available in case of an emergency. *— The presence of a pacemaker, implantable cardioverter defibrillator (ICD), or catheter requires modifying massage positions and taking other precautions. Shortness of breath can also indicate a need to modify massage positions. *— Fatigue, anxiety, headaches, and insomnia can be indicators of cardiovascular disease or medication side effects. Therapists need to discuss these symptoms with the client and might need to refer the client to a health care provider for evaluation or clearance before performing massage. *— If the client has hives or rashes, then those areas should be avoided during the massage what signs should the therapist look for when assessing the client’s skin? The therapist should look for bruising, pallor, flushing, jaundice, cyanosis, and superficial varicosities. The temperature of the skin should also be evaluated. *— Nail beds should be checked for clubbing and spooning. *— If edema is suspected, the cause of the edema must be ascertained before proceeding. Swollen lymph nodes can suggest the presence of a local or systemic infection. Hematological agents are anticoagulants and platelet inhibitors. What are some side effects associated with hematological agents? Abdominal pain, gastric irritation, hemorrhaging, nausea, and skin rashes are all potential side effects of hematological agents. *— Which massage techniques should be carefully monitored or avoided if clients are taking these medications? Ironing, deep petrissage; ischemic compression; and deep, specific frictions should be avoided because they could result in internal bleeding. Which class of medications listed here has hallucinations as a possible side effect? Hallucinations are a possible side effect of cardiac glycosides, which are used to improve the strength and efficiency of the heart or to control the rate and rhythm of the heartbeat. *— Which class of medications listed here has edema as a possible side effect? Edema is a possible side effect of lipid-lowering drugs, which are used to lower the lipid content of the blood. Local massage around the surgical incision is contraindicated until the client is fully healed. *— The therapist should exercise caution when performing shoulder joint mobilizations on clients with pacemakers since moving the client’s arm over the client’s head could disturb the lead connections for the pacemaker. An implantable cardioverter defibrillator (ICD) is a device that briefly passes an electric current through the heart to help it beat steadily. It is surgically implanted and is used in patients at risk of sudden death from ventricular fibrillation. The shock is painful to the client. It can be felt by the massage therapist as a tingling sensation but it is not harmful. A central venous catheter (central line) is a form of intravenous access that can be used for a prolonged period of time. The catheter is usually sutured to fascia and muscle and it can protrude from the client’s skin. Central venous catheters are most often placed in the jugular vein, subclavian vein, or femoral vein. The catheter makes it difficult if not impossible for the client to lie prone comfortably. Use pillows or a side-lying position for the client’s comfort. *— Local massage is contraindicated near the area or joints where the catheter is located to avoid damaging the device or surrounding the tissues. If the client has any of these conditions, the massage therapist needs to refer the client to the client’s health care provider for diagnosis and treatment. The massage therapist should also consult the health care provider about what type of massage, if any, should be performed. Hives (urticaria) is a relatively common allergic reaction that causes itchy raised skin welts. These should be avoided during massage. *— What is the significance of unexplained chest or calf pain? These can be signs of a serious underlying pathology, such as coronary artery disease, deep vein thrombosis, myocardial infarction, or phlebitis, that requires medical attention and can affect massage therapy or contraindicate it altogether. Limbs unequal in temperature can indicate inflammation, ischemia, or Raynaud’s syndrome. *— What is the significance of chronic fatigue? It can be a sign of chronic fatigue syndrome, congestive heart failure, depression, or other pathologies that require the massage therapist to consult with the client’s health care provider. Anemia occurs when the oxygen-carrying capacity of the blood decreases, the number of erythrocytes decreases, or the amount of functional hemoglobin in the blood decreases. *— What are the different types of anemia? Some different types of anemia include iron-deficiency anemia, B12-deficiency (pernicious) anemia, hemolytic anemia, and hemorrhagic anemia. *— If the client is not debilitated, the following massage techniques can be helpful: gliding strokes, kneading, and friction. These help oxygenate anemic clients. What are some common causes of aneurysms? Common causes of aneurysms include the following: atherosclerosis, hypertension, trauma, and congenital vascular weakness. *— If the client has been diagnosed with an abdominal aortic aneurysm, then abdominal massage is contraindicated. The pain generally originates in the chest and radiates down the inner side of the left arm or to the neck and throat, as seen in the diagram. The pain travels in this pattern because the area that is painful and the region generating the pain are served by the same section of the spinal cord. *— What beneficial effects can massage have on clients with angina? Massage can help these clients reduce stress and decrease the effects of the sympathetic nervous system, which is involved in coronary artery vasoconstriction. Clients with arteriosclerosis are generally instructed to get adequate rest, moderate exercise, and avoid stress. What sort of massage is useful for client with arteriosclerosis? A gentle, relaxing massage can help clients reduce stress. Deep pressure massage can cause pain, which causes the client’s blood pressure to increase, so it should be avoided. *— Atherosclerosis is generally associated with obesity, hypertension, hypercholesterolemia, and diabetes. *— Why should therapists avoid the use of deep pressure massage and electric massagers when working with clients who have atherosclerosis? Narrowed arteries lead to impeded blood flow, especially to crucial organs such as the heart and the brain. This also means that the client is likely to be prone to blood clot formation. Deep pressure massage and electric massagers are likely to dislodge blood clots that can get lodged in small blood vessels and lead to difficulty breathing, a heart attack, or a stroke. If the client is cleared for massage, after recovering from the cardiac arrest, then a lighter massage of shorter duration is indicated. If the client is further along on the route to recovery, moderate pressure can be used, but deep pressure is dangerous for a healing heart since it can cause an elevated heart rate. *— If a client has an attack during a massage treatment, what should be done? The therapist should assist the client in taking the necessary medications, and then 911 or the local emergency services should be contacted. What are some of the possible outcomes of a stroke? Muscle weakness or paralysis, an increase or decrease in sensation, speech abnormalities, or death could occur. *— If massage therapy is approved, then the goals of the massage treatment should be the following: prevent joint stiffness, decrease muscle spasticity, and address any postural changes. Therefore massage strokes should be slow, superficial, soothing, and rhythmic. What are some possible causes of CHF? Causes of CHF include the following: coronary artery disease, long-term hypertension, and myocardial infarcts. *— If clearance is obtained, what sort of massage should be performed? A light massage of shorter duration is recommended since vigorous massage stimulates blood flow, which can unduly strain a weak heart. Some of the signs of congestive heart failure are listed on the diagram. What are some other signs? Shortness of breath and fatigue are also symptoms of CHF. *— Why is lymphatic massage contraindicated if the client has edema in the extremities? It is contraindicated because lymphatic massage stimulates lymph flow and lymph drainage back into the bloodstream, and the increase in blood volume can put undue strain on a weak heart. Coronary artery disease is the leading cause of death in the United States. *— Clients with coronary artery disease are often prone to blood clots, which is why deep pressure and electric massagers should be avoided. *— The risk factors listed here are those for which intervention has been shown to reduce the incidence of coronary artery disease. What are some risk factors for which intervention is likely (but not shown) to reduce the incidence of coronary artery disease? The following are risk factors for which intervention is likely to reduce the incidence of coronary artery disease: obesity, physical inactivity, diabetes, low HDL, oral contraceptives, hysterectomy or oophorectomy, and menopause without hormone replacement. Why is local massage contraindicated for clients with hemangiomas? Local massage is contraindicated because pressure over the hemangioma could cause subcutaneous bleeding. What are some common causes of hematomas? Hematomas often result from trauma or surgery. *— Why is local massage contraindicated for clients with hematomas? Local massage is contraindicated because it might dislodge blood clots and it could also worsen the pain of the hematoma. There are three types of hemophilia, but all of them impair blood clotting or prevent it entirely. *— Massage is contraindicated for clients with moderate to sever hemophilia because of the danger of causing bleeding. For clients with milder cases of hemophilia, what sort of massage is indicated? A lighter massage is indicated, and joint mobilizations are contraindicated. Clients who are hemorrhaging require medical attention because excessive blood loss can lead to cardiovascular shock and possibly death. What are some possible causes of hypercholesterolemia? It can be inherited or caused by the consumption of large amounts of saturated fats (found in red meats, eggs, and dairy products). What is considered the threshold blood pressure value for hypertension? The threshold of hypertension is considered to be 140/90 mm Hg. A blood pressure of 160/95 mm Hg is considered serious hypertension. *— What are some possible ways that hypertension can be controlled? Hypertension can be controlled with a low-sodium diet, by losing weight, and with regular exercise. Anti-hypertensive medications can also be used. What are some possible causes of hypotension? Hypotension can be caused by shock, dilated blood vessels, or diminished cardiac output. *— Massage tends to lower blood pressure, so clients with hypotension might need extra assistance getting off the massage table or might need to be massaged in a seated position. How can massage help clients with a history of myocardial infarction? Massage can help clients relax, reduce stress, and decrease the effects of the sympathetic nervous system. *— Why should massage therapists avoid using heat or cold packs? Heat and cold packs should be avoided because extreme cold or heat can bring on a heart attack. Massage therapists should be able to recognize the early warning signs of a heart attack so that they can get the required medical attention for their clients, if necessary. *— The early warning signs listed on this slide are considered the more common ones. *— The early warning signs listed on this slide and the next slide are considered less common warning signs, and they are often associated with warning signs for heart attacks in women. Pain unrelieved by antacids is also considered one of the less common warning signs of a heart attack. Why is massage contraindicated? Massage is contraindicated because pericarditis is a debilitating disorder that requires medical attention. What are some symptoms of peripheral vascular disease? Numbness, pain and discomfort, and skin discoloration are all symptoms of peripheral vascular disease. *— If the symptoms are mild, such a numbness and/or tingling in a small area, then a light pressure massage is indicated. Phlebitis is often accompanied by a thrombus (blood clot). When does phlebitis usually occur? It usually occurs after an acute or chronic infection; pregnancy or childbirth; surgery; prolonged sitting, standing, or immobilization. *— Why is local massage contraindicated? Local massage is contraindicated because it could dislodge the blood clot and/or worsen the accompanying inflammation. What are the general causes of Raynaud’s syndrome? Raynaud’s syndrome is generally caused by exposure to cold, by smoking, or by emotional stress. It usually affects the most distal parts of the body, including fingers, toes, ears, and the nose. *— How can massage be beneficial for clients with Raynaud’s syndrome? Massage helps increase local circulation, reduce stress, and relax the smooth muscle tissue of blood vessels. Massage therapists should ask clients about any allergies they might have so that the therapists can avoid any reactions to product ingredients that might lead to shock. *— Why is massage contraindicated? Massage is contraindicated because a person in shock requires immediate medical attention. What does the abnormal hemoglobin do? The abnormal hemoglobin causes the red blood cells to "sickle." This sickle shape can obstruct blood vessels, and it significantly reduces the amount of oxygen that can be supplied to tissues. *— If clearance from the client’s health care provider is obtained and the client is in remission, what kind of massage is indicated? A short, light massage mostly consisting of gliding strokes is indicated to help the client relax. What are some common causes of telangiectasia? Rosacea, elevated estrogen levels, and collagen vascular diseases are some common causes of telangiectasia. *— Deep pressure massage of the affected areas is contraindicated, but light massage can be helpful. Who is most likely to be affected by thromboangiitis obliterans? Thromboangiitis obliterans occurs most often in young men. *— If the client’s health care provider indicates that blood clots are possible, then local massage is contraindicated. What are some other massage considerations in this case? Deep pressure massage is contraindicated; electric massagers should be avoided; and heat and cold packs are contraindicated. Why is local massage contraindicated? Local massage is contraindicated because of the possibility of dislodging the blood clot. *— What are some other massage considerations associated with clients who have thrombophlebitis? Deep pressure massage in the inner thigh and electric massagers should be avoided. What are some common symptoms of a transient ischemic attack? Some common symptoms of a TIA include the following: abnormal vision in one or both eyes, shortness of breath, vertigo, general loss of sensation, and unconsciousness. *— If clearance from the client’s health care provider is acquired, what are some of the massage considerations? The client might be taking anticoagulants, which mean that a lighter massage is indicated. Also, TIAs could predispose the client to a stroke. Massage depends on how painful to the touch the varicosities are and whether the client has a history of blood clot formation. *— If clearance for massage has been obtained, what are some of the massage considerations? Electric massagers should be avoided. The client’s legs should be elevated above the heart during treatment. Gliding strokes toward the heart can help empty veins, aiding circulation. Secondary conditions are common in clients who have AIDS, since their immune systems are compromised by the HIV virus. Any secondary conditions should be assessed as separate and individual conditions. *— Areas where recent blood work has been performed need to be avoided. Also, joint mobilizations and stretching might need to be limited if the client is bedridden. HIV attacks the immune system of the person infected with the disease. HIV infection generally leads to the onset of AIDS. There have been no known reported cases of massage therapists contracting the HIV virus from clients while performing massage, but therapists should always exercise caution, especially since clients with AIDS are very susceptible to contracting diseases from the therapist. What is Kaposi’s sarcoma? It is an aggressive malignancy of the blood vessels that appears as blue or purple patches. *— Lymphoma is characterized by cancerous lesions of lymphoid tissues. *— What is PCP? PCP is the most common lung disease in persons with AIDS. Tuberculosis is another lung disease. What are herpes simplex and herpes zoster? Herpes simplex is caused by the herpes virus and is characterized by painful, blister like lesions of the mouth, anus, or genitalia. Herpes zoster is caused by the varicella-zoster virus and is characterized by clusters of red, blister like skin lesions that follow the path of an inflamed nerve. *— Thrush is a fungal infection of the mucous membranes. Toxoplasmosis is an infection caused by a protozoan parasite. What type of massage is indicated for clients with chronic fatigue syndrome? A shorter massage is indicated to avoid tiring the client. The therapist should also ask the client for a list of current symptoms before each massage session so that treatment can be adjusted accordingly. What are some of the possible causes of edema? Some possible causes of edema include the following: inflammation, obstruction of lymph flow, removal of lymph channels, physical trauma, high blood pressure, or damaged blood vessels. Edema can be aggravated by pregnancy, obesity, and prolonged standing. *— Massage is contraindicated for clients with a history of heart or kidney disease. For clients without a history of either heart disease or kidney disease, light friction and gliding strokes are recommended. The edematous limb should be supported and elevated during the massage. Why is massage contraindicated for a fever? Massage is contraindicated because it will worsen the symptoms of fever and because a fever often indicates the presence of an infectious disease or other tissue damage. Which type of lupus is the most serious? Systemic lupus erythematosus (SLE), in which the body attacks connective tissue in joints, skin, and organs, is the most serious type of lupus. *— During periods of remission, what sort of massage is indicated? A gentle full body massage is indicated. Special care should be exercised when performing stretches and joint mobilizations. Extra care should also be taken to avoid exposing the client to any form of infection if the client is taking immunosuppressants. What are the symptoms of lymphangitis? Some symptoms of lymphangitis include the following: painful, subcutaneous red streaks extending from the infected area to the axilla or groin; fever; chills; and headaches. *— Why is massage contraindicated? It is contraindicated because massage will only worsen the pain and swelling. What are some of the symptoms of mononucleosis? Some symptoms of mononucleosis include the following: fever, sore throat, red throat, soft palate, stiff neck, enlarged lymph nodes, coughing, rash, and fatigue. *— Why is massage contraindicated? Massage is contraindicated because the disease is highly contagious. However, after the client has recovered, the application of heat packs and a gentle massage in the abdominal region can be helpful. Which types of medication have convulsions as a possible side effect? Nucleoside analogs and protease inhibitors have convulsions listed as a possible side effect. *— Which types of medication have fever as a possible side effect? Non-nucleoside reverse transcriptase inhibitors, nucleoside analogs, and protease inhibitors all have fever listed as a possible side effect.

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