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Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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...........................................................................................035-2 Name the most likely final destination for loose blood clots on the venous side of the systemic circuit.....................055-3 Name three possible destinations for loose blood clots or other debris on the arterial side of the systemic
circuit.............................................................................................................................................................................085-4 Identify the most likely consequence of untreated hemophilia.....................................................................................105-5 Name two signs or symptoms of deep vein thrombosis................................................................................................135-6 Name the tissue that is damaged first in chronic hypertension.....................................................................................165-7 Name three controllable risk factors for the development of atherosclerosis...............................................................195-8 Name the difference between primary and secondary Raynaud syndrome..................................................................235-9 Name two factors that determine the severity of a heart attack....................................................................................265-10 Describe how right-sided heart failure can develop as a result of left-sided heart failure............................................29
You Will Need:
Gather the following materials and teaching aids for the following lessons:5-5 Freshly cut stalks of celery, glasses half full of water, and dark food coloring.
Page 1Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Selected Key Terms
Allogenic transplantsAngioplastyAtrial fibrillationAutogenic transplantsBence Jones proteinsBuerger diseaseC-reactive proteinChronic venous insufficiencyDiastoleDysphagiaDyspneaEmbolismEndarterectomyEpistaxisErythropoietinExtramedullary plastocytomaFibrinogenHematomaHematuriaHemoglobinHemolyticHemophiliaHemophilic arthritisHomocysteineInfarctionIntermittent claudicationMalignant hypertensionMonoclonal gammopathyMyelodysplastic anemiaPercutaneous transluminal
coronary angioplasty (PTCA)Peripheral vascular diseasePlastocytomas
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 2Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Selected Key Terms (cont.)
Raynaud syndromeRestenosisReticulocytesSplenomegalyTelangiectasiasThrombocytopeniaThrombusTunica intimaTunica mediaStenosisSystoleVirchow triad
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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
228-232
12-23 FeaturesAnemia p. 229
Figures5.2: Different types of white blood cellsp. 229
5.3: Iron deficiency anemiap. 230
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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. 270
Page 3Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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
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
o Pregnant women especially
Page 4Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint. Objective 5-2
Name the most likely final 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 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
232-235
25-30 FeaturesEmbolism, Thrombusp. 232
Sidebar 5.1 DVT+PE = VTEp. 235
Figures5.4: A thrombus is alodged clot; an embolus is a
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
In-Class Activities
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.
Page 5Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
too small Pulmonary embolism
The lungs are the one and only destination for clots or debris anywhere on the venous side of the systemic circuito Unless the
heart has patent foramen ovale
From a clot that forms on venous side of systemic circuit (Fig. 5.5)
650,000 pulmonary emboli/year
200,000 deaths Often related to deep vein
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 until after
damage has occurred Dyspnea, chest pain,
coughing with bloody
moving piece of debrisp. 233
5.5: Sites of origin for pulmonary embolip. 233
The signs and symptoms of pulmonary embolism can look like a heart attack. Through discussion, ask students to identify key differentiating factors between the two.
EvaluationChapter review questions: Circulatory System Conditions. p. 270
Page 6Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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 Low-dose presurgical
anticoagulants Elevation of legs External compression of legs Early ambulation
Legend: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 7Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
Objective 5-3
Name three possible destinations for loose blood clots or other debris on the arterial 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
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 May be silent May involve sharp tingling
234-235
31-36 Figure5.6: Arterial infarction sites
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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. 270
Page 8Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 9Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
Objective 5-4
Identify the most likely consequence of untreated 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
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, long-lasting clotso Don’t
235-237
38-46 FeaturesHemophiliap. 235
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
In-Class ActivitiesThe word hemophilia is formed from the word roots “hemo” and “philia.” Pair students into groups of two. Ask the groups to come up with as many different medical terms as possible using either “hemo” or “philia.”
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. 270
Page 10Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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 Supplement clotting factors
o Can be
Page 11Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 12Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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
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
endotheliumo Hypercoag
ulabilityo Venous
stasis Possible triggers
o Physical trauma
o Varicose veins
o Local
244-248
77-84 FeaturesThrombophlebitis, Deep Vein Thrombosisp. 245
Case History 5.1 Deep Vein Thrombosisp. 246
Figures5.9 Deep vein thrombosisp. 247
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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. 270
Page 13Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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
Signs and Symptoms May be obvious with signs
of inflammation Sometimes distal edema 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
and dark food coloring.
Page 14Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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
Massage A client with diagnosed
blood clots is not a good candidate for circulatory massage
Signs may be indistinct, misleading
Legend: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 15Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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
Etiology Blood pressure variables
o Pressure inside vessels
o Pressure outside vessels
o Blood volume
o Vessel diameter
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
255-258
114-124
FeaturesHypertensionp. 256
Tables5.1: Blood Pressure Ratingsp. 256
Sidebar 5.4 Heart Disease in the United States: Sobering Statisticsp. 256
ResourcesAnimation (SR)
Answer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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. 270
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Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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 USo 63.4%
knowo 45.3%
treat it at allo 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
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.
Video: For more information on blood pressure see the animation at thePoint.lww.com/Werner5e
Page 17Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
Depends on health, resilience of client
Massage can lower blood pressure and stresso Get
information on kidney, heart problems
o No deep abdominal work
Legend: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 18Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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. 5-14)
Etiology Multifactorial process
o Influenced by gender, age, race, diet, and other factors
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
o 2. Monocytes arrive, move
250-254
98-112 FeaturesArtherosclerosisp. 251
Sidebar 5.2 : A Brief Digression on Cholesterolp. 252
Figures5.12: Atherosclerosis.p. 251
5.13: Carotid artery disease. Note the point of stenosis just past the bifurcationp. 254
5.14: Coronary artery diseasep. 254
ResourcesAnimation (SR)
Answer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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.
Video: For more
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. 270
Page 19Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
in, become macrophageso 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 Homocysteine Others: BMI, fibrinogen,
information on monocytes see the animation at thePoint.lww.com/Werner5e
Page 20Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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 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
Surgeryo Bypass,
angioplasty, endarterectomy
Page 21Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
Massage Determined by client’s
resilience Adjust for medications as
needed
Legend: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 22Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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
Etiologyo Arterioles
spasmo 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
Causes (Primary) Stress (sympathetic
response), cold, mechanical irritation
Slow onset, less severe than secondary
Both hands and feet often
258-260
126-134
FeaturesRaynaud Syndromep. 258
Figures5.16: Raynaud syndrome.p. 259
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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. 270
Page 23Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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
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
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,
Page 24Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
massageo Medicatio
n 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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 25Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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 Muscle tissue doesn’t repair;
replaced by scar tissue Damaged area = infarct Heart attack = myocardial
infarction
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 infarct
262-267
149-156
FeaturesHeart Attackp. 263
Figures5.19 Myocardial infarctionsp. 264
Compare and Contrast 5-2: Chest Pain, Chest Pain, Chest Painp. 265
Case History 5.2: Heart Attackp. 266
ResourcesAnswer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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.
Video: For more information on coronary artery disease see the animation at thePoint.lww.com/Werner5e
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. 270
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Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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 anginao 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
Page 27Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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 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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
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Werner’s A Massage Therapist’s Guide to Pathology (Fifth 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
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 → 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
267-268
158-168
FeaturesHeart Failurep. 267
Figures5.20: Left-sided heart failure p. 268
5-21: Right-sided heart failure p. 269
ResourcesAnimation (SR)
Answer to Chapter Objectives (SR)
Answers to Chapter Review Questions (SR)
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.
Video: For more information on heart failure see the animation at thePoint.lww.com/Werner5e
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. 270
Create an exam for Chapter 5 using the Brownstone Test Generator on the IR.
Have students practice for the exam using the interactive quiz bank on the SR.
Chapter 5 crossword puzzle, robotman, and
Page 29Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
inelastic
Types of heart failure: left side v. right side Left-sided heart failure (Fig.
5.20)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. 5.21) 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
game show (SR and IR).
Page 30Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Werner’s A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 5— Circulatory System Conditions
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: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.
Page 31Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins