A Massage Therapist’s Guide to Pathology 5e

1. A Massage Therapist’s Guide to Pathology 5e Chapter Five Circulatory System Conditions

2. Chapter 5 Introduction • General Function: the Circulatory System • Delivers nutrients, fuel, • Delivers oxygen • Removes wastes • Maintains temperature • Clotting • Protection from pathogens • Chemical balance • Massage can support or impair this function

3. Chapter 5 Introduction, cont. • Structure and Function: the Heart • Septum divide L/R • Right side pumps to pulmonary circuit • Left side pumps to systemic circuit • AV valves divide into top and bottom halves • Atria, ventricles • “lub-dup” is closing of AV and semilunar valves • Ventricles work harder than atria • Implications for seriousness of heart attacks

5. Chapter 5 Introduction, cont. • Structure and Function: Blood Vessels • Aorta → arteries → arterioles → capillaries → venules → veins → vena cava → heart • Closed system: platelets and RBCs should not be able to leave • 60,000 miles of vessels • 3-ply construction of veins and arteries: • Tunica intima (endothelium) • Tunica media (smooth muscle) • Tunica externa/ adventitia (connective tissue) • Capillaries are simple squamous epithelium: excellent for permeability

6. Chapter 5 Introduction, cont. Structure and Function: the Blood • Red blood cells (erythrocytes) • Born in bone marrow • Production stimulated by EPO from kidneys • 98% of all blood cells • Lifespan = 4 months • Dead RBCs removed by spleen • Turnover: 2 million/second • No nuclei, lots of hemoglobin (iron-based) • 5 million per mm3 • Biconcave discs: all identical, smooth and flexible

7. Chapter 5 Introduction, cont. • White blood cells (leukocytes) • Translucent • Different types for different functions • Neutrophils, basophils, eosinophils, monocytes, lymphocytes

9. Chapter 5 Introduction, cont. • Platelets (thrombocytes) • Fragments of larger cells (megakaryocytes) • Smooth until stimulated, then spiky, sticky • Release chemicals that weave fibrin • Make thrombi, crusts

10. Chapter 5 Introduction, cont. • Blood Disorders • Anemia • Embolism, thrombus • Hemophilia • Leukemia • Myeloma • Sickle cell disease • Thrombophlebitis, deep vein thrombosis

11. Chapter 5 Introduction, cont. • Vascular Disorders • Aneurysm • Atherosclerosis • Hypertension • Raynaud syndrome • Varicose veins • Heart Conditions • Heart attack • Heart failure

12. Anemia • Definition: • Insufficient 02 carrying capacity • Often a symptom or complication rather than freestanding problem

13. Anemia, cont. • Etiology: what happens? • Either a shortage of RBCs or a shortage of hemoglobin • Leads to low O2 carrying capacity • Process depends on type of anemia

14. Anemia, cont. Types of anemia • Idiopathic a.: • May be due to poor nutritional uptake due to stress or other factors

15. Anemia, cont. Types of anemia • Nutritional a.: • Something vital is missing from the diet: • iron • folic acid • vitamin B12 • Can lead to pernicious anemia, brain damage • Copper, protein, some others…

17. Anemia, cont. Types of anemia • Hemorrhagic a.: • From blood loss • Trauma (acute) • Slow leak (chronic) • Ulcers, kidney disease, heavy menstruation

18. Anemia, cont. Types of anemia • Hemolytic a.: • Premature destruction of RBCs • Splenomegaly, jaundice may also be present • Reticulocytes (immature RBCs) increase

19. Anemia, cont. Types of anemia • Aplastic a.: • Bone marrow is not functioning • All blood cells are affected • Can be autoimmune, renal failure, folic acid deficiency, viral, exposure to radiation… • Myelodysplastic anemia: bone marrow makes non-functioning cells: risk of leukemia, myeloma

20. Anemia, cont. Types of anemia • Secondary a.: • Due to underlying cause: • Ulcers • Kidney disease • Hepatitis • Acute infection • Blood cancer

21. Anemia, cont. • Signs and Symptoms: • Fatigue • Pallor • Dyspnea, rapid breathing • Rapid heartbeat • Intolerance to cold • Heart problems

22. Anemia, cont. • Treatment: • Depends on underlying cause • Medication • Transfusion, stem cell implants, other strategies • Medications: • Oral, injected nutritional supplements • Steroidal anti-inflammatories for autoimmune disease • Synthetic EPO to boost RBC production

23. Anemia, cont. • Massage • Risks: Anemia can be part of other diseases that contraindicate massage. Anything that compromises sensation (pernicious anemia) or that is related to infection or cancer requires special adaptation for bodywork. • Benefits: Massage may help with fatigue, but probably makes no changes in blood cell production or nutrition. A client who manages anemia and can adapt to the changes that massage brings about is a good candidate for bodywork.

25. Embolism, thrombus • Definition: • Embolism: traveling clot • Thrombus: lodged clot

27. Embolism, thrombus, cont. • Etiology: what happens? • 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 • Clots are constantly forming and melting • Sometime pro-clotting mechanism is stronger than anti-clotting • Clots may stay in place (thrombi) or fragment and travel (emboli) • Emboli travel until vessel is too small to pass through

28. Embolism, thrombus, cont. Types of embolism, thrombus • Venous thrombosis: see thrombophlebitis, deep vein thrombosis

29. Embolism, thrombus, cont. Types of embolism, thrombus • Pulmonary embolism: • From a clot that forms on venous side of systemic circuit: fragments and travels to lungs • Often related to deep vein thrombosis, complications of trauma, orthopedic surgery • Risk factors: • Other cardiovascular disease • Pregnancy • Overweight • Smoking • Hormone supplements

31. Embolism, thrombus, cont. Types of Types of embolism, thrombus • Arterial thrombus: • Complication of atherosclerosis • Made worse with chronic inflammation, stress • Clots can grow on site to occlude the artery or they can fragment and travel (= embolism)

32. Embolism, thrombus, cont. Types of embolism, thrombus • Arterial embolism: • Complication of atherosclerosis, atrial fibrillation, rheumatic heart disease • Often made of clotted blood, can be other debris • Brain, coronary arteries, kidneys, legs are most common sites; damaged tissue is infarction

34. Embolism, thrombus, cont. • Signs and Symptoms: • May be silent • PE: • Dyspnea, hemoptysis, lightheadedness, chest pain, sweating • Arterial embolism: • Sharp, tingling pain, tissue damage and death

35. Embolism, thrombus, cont. • Treatment: • Medications • Surgery • Supplement O2 if necessary • Compression stockings • Medications: • Antiplatelet drugs • Anticoagulants • Thrombolytics

36. Embolism, thrombus, cont. • Massage • Risks: A client with a tendency to form clots may not be able to adapt to mechanical types of bodywork; whether the risk is local or systemic depends on the type of bodywork. • Benefits: Non-mechanical forms of bodywork may be soothing and supportive for clients at risk for embolism or thrombus. Clients with a history of problems but no lingering problems can enjoy massage with no cautions.

38. Hemophilia • Definition: • Genetic disorder: • Usually x-linked • Absence of various clotting factors

39. Hemophilia, cont. • Etiology: what happens? • 12 distinct clotting factors help form clots • Person with hemophilia has difficulty forming solid, long-lasting clots because of clotting factor insufficiency • Don’t bleed faster, do bleed longer than others • Rated as mild, moderate, severe • Severe hemophilia = 60% of diagnoses; <1% normal clotting factors • Usually an x-linked genetic mutation • Carried by mothers, passed on to sons

40. Hemophilia, cont. • Complications: • Leading COD in children with hemophilia is intracranial bleeding • Bleeding into joint capsules with inflammation and extensive damage: • Hemophiliac arthritis • Muscle and nerve damage • Compartment syndrome, contracture • Infected blood products

41. Hemophilia, cont. Types of hemophilia • Type A: • Most common form, about 80% of all cases • Deficiency of clotting factor VIII

42. Hemophilia, cont. Types of hemophilia • Type B: • AKA Christmas disease • Insufficient Factor IX • About 15% of cases

43. Hemophilia, cont. Types of hemophilia • Von Willebrand disease: • Dysfunction of von Willebrand factor • Helps Factor VIII • Genetic mutation, ranges in severity • Not x-linked; men and women affected equally

44. Hemophilia, cont. • 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 • Can be from trauma or spontaneous

45. Hemophilia, cont. • Treatment: • Supplement clotting factors • Can be done at home now, prophylactically or after injury • Careful exercise, weight control • Medications: • Concentrated clotting factors • Recombinant clotting factors • Desmopressing to promote clotting factor production • Antifibrinolytics to slow clot breakdown

46. Hemophilia, cont. • Massage • Risks: Severe hemophilia contraindicates rigorous bodywork or anything that might cause bruising. Consult with client and health care team for other cautions. • Benefits: Gentle or energetic massage can help with pain and stress. For milder cases massage that fits within the limitations of the tissues to avoid bruising is appropriate

48. Leukemia • Definition: • “White blood”: • Cancer of bone marrow • Overlap between leukemia and lymphoma • 38,000 diagnoses in US/year • 200,000 survivors alive today

49. Leukemia, cont. • Etiology: what happens? • Myeloid or lymphoid cells make most WBCs in bone marrow • Leukemia happens when mutation leads to production of non-functioning WBCs • Can be acute (aggressive) or chronic (slow-growing) • Usually acquired (not inherited) genetic mutations • Exposure to toxins, radiation • Untreated disease leads to death from excessive bleeding, infection

50. Leukemia, cont. Types of leukemia • Acute myelogenous leukemia (AML): • Aggressive cancer of meyloid cells • Mostly in people 65+ • Linked to exposure to… • Radiation • Chemo for other cancers • Benzene • Can form tumors outside marrow