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/AAffective: 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...........................................................................................3415-2 Define hemophilia.........................................................................................................................................................3505-3 Name the most likely destination for loose blood clots on the venous side of the systemic circuit.............................3455-4 Name three possible destinations for loose blood clots or other debris on the arterial side of the systemic
circuit.............................................................................................................................................................................3475-5 Name two signs or symptoms of deep vein thrombosis................................................................................................3645-6 Name the tissue that is damaged first in chronic hypertension.....................................................................................3785-7 Name three controllable risk factors for the development of atherosclerosis...............................................................3715-8 Name the difference between primary and secondary Raynaud syndrome..................................................................3825-9 Name two factors that determine the severity of a heart attack....................................................................................3885-10 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..
Page 1Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Selected Key Terms
Acute compartment syndromeAllogenic transplantsAngiogramAnkle-brachial indexAngioplastyAtrial fibrillationAuscultationAutogenic transplantsBence Jones proteinsBruitBuerger diseaseC-reactive proteinChronic venous insufficiencyCor pulmonaleDiastoleDysphagiaDyspneaEcchymosisEmbolismEndarterectomyEpistaxisErythropoietinExtramedullary plastocytomaFibrinogenHematomaHematuriaHemoglobinHemolyticHemophiliaHemophilic arthritisHomocysteineInductionInfarction
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
5-6 Depending on the size of the class, you will need table salt, soda, water, milk, and bowls for each group of students.
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 2Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Selected Key Terms (cont.)
Intermittent claudicationIntrinsic FactorMalignant hypertensionMonoclonal immunoglobulinsMyelodysplastic anemiaNail fold capillaroscopyPercutaneous transluminal
coronary angioplasty (PTCA)Peripheral vascular diseasePlastocytomasPriapismProphylaxisRaynaud syndromeRenninRestenosisReticulocytesSplenomegalySympathectomyTachycardiaTelangiectasiasThalassemiaThrombocytopeniaThrombusTunica intimaTunica mediaStenosisSystoleVenographyVirchow triad
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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Circulatory System Conditions Blood Disorders
o Anemiao Embolism,
thrombuso Hematomao Hemophili
ao Leukemiao Malariao Myelomao Sickle cell
diseaseo Thrombop
hlebitis, deep vein thrombosis
Vascular Disorderso Aneurysmo Atheroscle
rosiso Hypertensi
ono Raynaud
syndromeo Varicose
veins Heart Conditions
o Heart attack
o Heart failure
341–342
10–13 FeaturesAnemia p. 341
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThrough discussion, provide a list of symptoms describing a blood disorder, asking students to identify the appropriate disorder.
Outside AssignmentsCertain 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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 3Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Anemia = Insufficient oxygen-carrying capacity Often a symptom or
complication rather than freestanding problem
Affects about 3.4 million people in USo Most are
women or peoples with chronic disease
Several kinds of anemiao Idiopathic
anemiaso Nutritional
anemiaso Hemorrha
gic anemiaso Hemolytic
anemiaso Aplastic
anemiao Secondary
anemias
Anemia, page 341.
Nutritional anemias Some deficiency in diet;
massage won’t have much affect
Cautions for pernicious anemia
Iron deficiency anemiao Needed to
form hemoglobino Most
common in women: need twice as much iron as men; get fewer calories
Page 4Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
o Pregnant women especially
Folic acid deficiency anemiao Needed to
form RBCso Water
soluble: any excess can’t be stored
Pernicious anemiao 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 deficiencieso Copper,
protein, others
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 5Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
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 X-chromosome: 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
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,
350–64
29–33 FeaturesHemophiliap. 350
Modality Recommendations for Hemophiliap. 352
Sidebars5.1: Von Willebrand Disease: An Equal Opportunity Mutationp. 351
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThe 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.”
MaterialsPrint-outs of table 1.1.
Outside AssignmentsHemophilia is sometimes called “the royal disease.” Ask students to write a report researching the derivation of this nickname.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 6Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
long-lasting clotso Don’t
bleed faster, do bleed longer than others
Rated as mild, moderate, severeo 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 damageo Hemophili
ac arthritiso Ankles,
knees, elbows Muscle and nerve damage Infected blood products
o Vaccinate for hepatitis A, B
Resistance, hypersensitivity to synthetic clotting factors
Treatment
Page 7Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Supplement clotting factors o Can be
done at home now, prophylactically or after injury
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 8Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
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
345–368
19–23 Figures5.3: A thrombus is alodged clot; an embolus is amoving clot.p. 345
5.4: Sources of pulmonary embolism.p. 346
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThe signs and symptoms of pulmonary embolism can look like a heart attack. Through discussion, ask students to identify key differentiating factors between the two.
Outside AssignmentsThe term “embolism” was coined in 1848 by Rudolph Carl Virchow. Ask students to research Virchow and his significance in the study of pathologies.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 9Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
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 therapyo 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
Page 10Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Identify risk 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 11Copyright © 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 sideof the systemic circuit. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Arterial embolism Complication of
atherosclerosiso Could also
be from bacterial infection, atrial fibrillation, rheumatic heart disease
Emboli are usually clotso Can also
be plaque, bone chip, bubble, knot of cancer cells
When septum is intacto 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
Signs and Symptoms
347-348
24–26 FeaturesModality Recommendations for Embolism, Thrombusp. 348
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
Related ChaptersCerebral aneurysms are discussed in the section onstroke in Chapter 4.
In-Class ActivitiesMost modality recommendations for embolism are contraindicated except PNF/MET/Stretching. Through discussion, ask students to identify why this modality is considered supportive.
Outside AssignmentsThe 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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 12Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
May be silent May involve sharp tingling
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 13Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Thrombophlebitis, Deep Vein 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
Etiology Thrombi = stationary clots;
can fragment and travelo Usually to
lung → pulmonary embolism
o (exception with patent foramen ovale; cross over to arterial side)
Virchow triado Injury to
364–368
58–68 FeaturesCase History 5.1: Deep Vein Thrombosisp. 367
Modality Recommendations for Thrombophlebitis, Deep Vein Thrombosis, p. 368
Figures5-6: A. blood clotlodged in a vein can causedistal edema.p. 366
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesSimilar 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.”
MaterialsFreshly cut stalks of celery, glasses half full of water,
Outside AssignmentsDeep vein thrombosis has been nicknamed “economy class syndrome.” Ask students to research and write a report on this nickname.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 14Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
endotheliumo Hypercoag
ulabilityo Venous
stasis 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
and dark food coloring.
Page 15Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Sometimes distal edema (Fig. 5.6)
Chronic problem → skin rashes, ulcers
With infection: fever, malaise
DVT more dangerous, higher risk of serious damageo May show
pitting edema
Diagnosis Ultrasound: fast,
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
Page 16Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
candidate for circulatory massage
Signs may be indistinct, misleading
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 17Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
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 factorso Obesity,
smoking, high cholesterol, atherosclerosis, water retention
o Genetic predisposition
Etiology Blood pressure variables
o Pressure inside vessels
o Pressure
378–382
80–88 Figures2.45: First-degree Burn.p. 75
2.46: Second-degree Burn.p. 75
2.47: Third-degree Burn.p. 76
Tables5.1: Blood Pressure Ratingsp. 379
FeaturesModality Recommendations for Hypertensionp. 382
ResourcesAnimation 5 (SRCD)
Answer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesSalt 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
Outside AssignmentsSodium 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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 18Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
outside vesselso Blood
volumeo Vessel
diameter (animation 5)
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
theories explaining why they achieved those results.
MaterialsDepending on the size of the class, you will need table salt, soda, water, milk, and bowls for each group of students.
Page 19Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
o 63.4% know
o 45.3% treat it at all
o 29.3% treat it successfully
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 stresso 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 20Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Atherosclerosis = hardening of the arteries from any cause. Subtype of arteriosclerosis Hardening of arteries due to
plaqueo Damage
causes spasm, blood clotso 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 progressiono 1.
Endothelial damage Carbon monoxide;
high levels of low-density lipoproteins (LDLs) and triglycerides; high iron
Occurs most readily at branches or sharp curves
371–378
72–79 Figures5-9: Atherosclerosis.p. 372
5-10: Coronary artery disease.p. 373
5-11: Arterial infarction sites.p. 377
Sidebar5.4: Heart Disease in the United States: Sobering Statisticsp. 374
5.5: A brief Digression on Cholesterolp. 375
FeaturesModality Recommendations for Atherosclerosisp. 378
ResourcesAnimation 4 (SRCD)
Answer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesPair 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.
Outside AssignmentsThe 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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 21Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
o 2. Monocytes arrive, move in, become macrophages
o 3. Macrophages take up LDL. Become foam cells:
beginning of plaqueo 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
Page 22Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Homocysteine Others: BMI, fibrinogen,
lipoproteins, stress management, etc.
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 pectoriso 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
Page 23Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
o Bypass, angioplasty, endarterectomy
Massage Determined by client’s
resilience: is it safe to exercise rigorously?
Adjust for medications as needed
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 24Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Raynaud Syndrome Primary Raynaud disease:
vasoconstriction in extremities (also nose, ears, lips)
Secondary Raynaud phenomenon: complication of underlying disorder
Raymaud Syndrome, page 382
Demographics Primary: mostly women 15–
40 years old Some kind of Raynaud
syndrome may affect 5–10% of general population
Etiologyo Arterioles
spasmo Temporary
episodes, can become permanent
o Chemical components: tunica intima secretes chemicals that affect vasospasm, viscosity of blood
o May be
382–384
89–95 Figures5-12: Raynaud syndrome.p. 383
FeaturesModality Recommendations for Raynaud Syndromep. 384
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesAll cells involved in inflammation are coordinated by chemical messages. Discuss the chemical interactions throughout each stage of healing.
Outside AssignmentsOne 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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 25Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
related to hyperreactivity to cold, stress
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 Whiteo Blueo Red
Episodes last less than 1minute to several hours
Secondary can be extreme and long lasting: atrophy, ulcerations, skin and nail damage
Page 26Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Treatment Depends on cause
o Quit smoking, avoid 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 27Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Heart Attack = damage to cardiac 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
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
388–395
104–111
Figures5-15: Heart attacks affecting the left ventricle.p. 390
Sidebar5.6 Other Heart Conditionsp. 392
FeaturesHeart Attackp. 389
Compare and Contrast 5.2: Chest Pain, Chest Pain, Chest Painp. 393
Case History 5.2: Heart Attackp. 394
Modality Recommendations for Hearth Attackp. 395
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
Related Chapters
In-Class ActivitiesNot 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 AssignmentsWHO criteria have classically been used to diagnose myocardial infarction. Ask students to identify the criteria, providing a specific plan for a possible treatment.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 28Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Etiology Usually blockage in
coronary artery impedes blood flowo 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 ischemiao Can’t
contract with coordinationo May
trigger fibrillationso Ventricula
r fibrillation → high risk of sudden death
Seriousness determined by size, location of infarcto May
impair muscle functiono 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
Page 29Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
have ito 400,000
diagnoses/yearo Triggered
by extra effort Unstable angina
o Sudden onset of severe chest pain, no trigger
o Reliable predictor
Dynamic processo Blockage
may accrue over hourso 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
Page 30Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Treatment Identify location of
blockage, break it up as soon as possibleo Thromboly
tics o Percutaneo
us transluminal coronary angioplasty
o Oxygen, pain management
Later care: anticoagulants, nitroglycerin, observation, evaluation
Lifestyle changes
Massage Depends on resilience,
ability to adapt to changes
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 31Copyright © 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 OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
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
compensateso Heart
grows (cardiomegaly)o Ventricles
become stiff, inelastic Stress hormones boost short-
term function, damage in long-term
Heart may fibrillate →
395–399
112–117
Figures5-16: Left-sided heart failure leads to pulmonary edema.p. 397
5-17: Right-sided heart failure leads to systemic edema.p. 398
FeaturesHeart Failurep. 395
Modality Recommendations for Heart Failurep. 399
ResourcesAnimation 6 (SRCD)
Answer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThrough discussion, provide a list of possible symptoms of heart failure asking the students to identify each as a symptom of left, right or biventricular heart failure.
Outside AssignmentsThere 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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Page 32Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
circulatory system collapse 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
Page 33Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
fluid into legs (Fig. 5.17) or lowest structure
o Can also cause liver, kidney damage
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
Page 34Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
may be helpful
Legend: IRCD = instructor’s resource CD-ROM; SRCD = student resource CD-ROM: PPt = PowerPoint.
Page 35Copyright © 2009 Wolters Kluwer | Lippincott Williams & Wilkins