CHAPTER 7: CARDIOVASCULAR AND LYMPHATIC/IMMUNE PATHOLOGIES Questions to Ask Client During Premassage Interview Does the client have

any cardiovascular conditions? Does the client have any lymphatic/immune system conditions? Commentary These should include current as well as previous conditions. For example, massage considerations for a client who experienced a heart attack 6 months before the massage differ from massage considerations for a heart attack 5 years before the massage. Table 7-1 has more information including possible side effects. The massage therapist needs to be prepared to use the modified supine position, sidelying position, or seated position if needed. Pillows and bolsters may provide extra comfort and support. Boxes 7-1, 7-2, and 7-3 have additional information. The massage therapist needs to be prepared to use the modified supine position, sidelying position, or seated position if needed. These may be indicators of cardiovascular disease or medication side effects. The massage therapist needs to discuss these symptoms with the client, and may need to refer the client to the clients health care provider for evaluation or clearance before proceeding with massage. These areas need to be avoided during the massage. Commentary It should be assessed for color (bruising, pallor, flushed, jaundiced, cyanotic, superficial varicosities) and temperature (client may be cold or hot or may feel cold/hot to the touch). Chapter 2 has a discussion of nail clubbing and spooning. If so, caution is advised. The massage therapist needs to ascertain the cause of the edema from the client, and clearance may

If the client has any cardiovascular disorders, is it being managed by medication? If nitroglycerine is being used, is it nearby if needed? Does the client have a pacemaker, an implantable cardioverter defibrillator (ICD), or central venous catheter?

Does the client experience shortness of breath? Are there any positions that help or make it worse? Does the client complain of fatigue, anxiety, insomnia, or headaches?

Does the client have any hives or rashes on the skin? Observations and Palpations Made During Premassage Interview and Massage Treatment What is the condition of the clients skin?

Is the clients nail bed color and shape in good condition? Are there any signs of edema (i.e., pitting edema or molted skin)?

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Can any swollen lymph nodes be palpated?

need to be obtained from the clients health care provider before massage therapy can be performed. If the edema is not due to a serious condition such as congestive heart failure or renal failure, massage can be performed. The massage therapist should elevate the affected area during treatment to promote drainage. This often indicates local or systemic infection. Massage may be contraindicated if the client has an infection.

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Table 7-1

MEDICATIONS USED

TO

MANAGE CARDIOVASCULAR DISEASE POSSIBLE SIDE EFFECTS THAT MAY AFFECT TREATMENT Abdominal discomfort, anxiety, constipation and diarrhea, edema, hypertension, irregular heartbeat, joint pain, nausea and vomiting, skin rashes, vertigo Anxiety, chest pain, diarrhea, dry mouth, edema, fever, gastrointestinal irritation, headaches, hypotension, insomnia, joint pain, lethargy, nausea and vomiting, vertigo

MEDICATION CLASSIFICATION Alpha receptor drugs

MEDICATION NAME Doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax), terazosin (Hytrin)

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

Hematological agents*

Beta blockers

Calcium channel blockers

Cardiac glycosides

Benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik) Acetylsalicylic acid (aspirin), dipyridamole (Persantine), heparin, streptokinase, warfarin (Coumadin), clopidogrel (Plavix) Acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), labetolol (Trandate), metoprolol (Lopressor, Toprol-XL), nadolol (Corgard), pindolol, propranolol (Inderal), sotalol (Betapace), timolol (Blocadren) Amlodipine (Norvasc), bepridil (Vascor), Diltiazem (Cardizem, Cartia-XT, Dilacor-XR, Diltia-XT, Tiazac), Felodipine (Plendil), Isradipine (Dynacirc), Nicardipine (Cardene), Nimodipine (Nimotop), Nifedipine (Adalat, Procardia), Nisoldipine (Sular), Verapamil (Calan, Covera-HS, Isoptin, Verelan) Digitalis compounds (digoxin, Lanoxin)

Abdominal pain, gastric irritation, hemorrhage, nausea, skin rashes

Abdominal pain, anxiety, bruising, chest pain, chills, constipation and diarrhea, disorientation, drowsiness, dry mouth, edema, fever, headaches, hypotension, insomnia, irregular heartbeat, joint pain, lethargy, nausea and vomiting, shortness of breath, skin rashes, vertigo

Allergic reaction, anxiety, chest pain, drowsiness, dry mouth, fever, headaches, hypotension, insomnia, irregular heartbeat, joint pain, lethargy, nausea, shortness of breath, skin rashes, vertigo

Allergic reactions, diarrhea, disorientation, hallucinations, irregular heartbeat, nausea and vomiting

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Table 7-1 MEDICATIONS USED MEDICATION CLASSIFICATION Diuretics

TO

MANAGE CARDIOVASCULAR DISEASECONTD POSSIBLE SIDE EFFECTS THAT MAY AFFECT TREATMENT Diarrhea, disorientation, dry mouth, gastrointestinal irritation, headaches, hyperglycemia, lethargy, muscle cramps/spasms, nausea and vomiting, shortness of breath, vertigo

MEDICATION NAME Amiloride (Midamor), bumetanide (Bumex), chlorothiazide (Diuril), hydrochlorothiazide (Esidrix, Oretic) spironolactone (Aldactone), triamterene (Dyrenium, Dyazide, Maxzide) furosemide (Lasix), torsemide (Demadex) Bile acid sequestrants [cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)] Fibric acid derivatives [clobrate, fenobrate (Tricor), gembrozil (Lopid)] HMG Co A reductase inhibitors [atorvastatin (Lipitor), uvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor)] Nicotinic acid [niacin (Nicolar)] Nitroglycerin

Lipid-lowering drugs

Abdominal cramps, allergic reactions, bruising, chest pain, constipation, disorientation, drowsiness, dry mouth, fever, ushing, gastrointestinal irritation, gout, hypoglycemia, hypertension and hypotension, insomnia, irregular heartbeat, joint pain, lethargy, nausea and vomiting, shortness of breath, vertigo

Vasodilators

Anxiety, disorientation, edema, headaches, hypotension, irregular heartbeat, joint pain, nausea, skin rashes, vertigo

*When clients are taking anticoagulants and platelet inhibitors, massage techniques such as deep efeurage (e.g., ironing); deep petrissage; ischemic compression; and deep, specic frictions (e.g., crossber, chucking, circular) should be carefully monitored or avoided. These specic techniques often produce a mild inammatory response that is usually resolved within 48 hours. Performing these techniques when a client is taking these medications may result in internal bleeding (bruising) and excessive inammatory response.
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Box 7-1 Articial Pacemaker An articial pacemaker is a surgically implanted device that sends out small electrical currents to stimulate the heart to contract. Newer pacemakers are activity-adjusted pacemakers that automatically speed up the heartbeat during exercise. The articial pacemaker is implanted under the skin with wires going directly to the sinoatrial node or the atrioventricular node. Because the site is usually very sensitive, local massage is contraindicated. The primary concern is to make sure the incision from the surgery has completely healed. While the client is prone, a soft pillow to be placed under the chest should be offered. This will provide added comfort for the client during the massage.

Site of incision Pacemaker with lithium battery and timer Wire

Superior vena cava

Apex of the heart

The leads (wires) going from the pacemaker to the heart often travel up over the clavicle and down into the chest cavity. For this reason, the massage therapist should avoid moving the arm

near the device over the head when mobilizing the shoulder joint, as it may disturb the lead connections.

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Box 7-2 Implantable Cardioverter Debrillator The implantable cardioverter debrillator is a device used to treat dangerously fast heart rates in the ventricles (see Box 7-6). It can detect heart rhythms and, when necessary, delivers an electrical shock to restore normal heart rate and rhythm. Much like a pacemaker, the debrillator is implanted under the skin near the clavicle. It is attached to one or more leads positioned in the right ventricle, and right atrium when necessary. The electrical shock is painful to the client. The shock may be felt by the massage therapist if the client is touching the patient when the device discharges. It may feel like a tingling sensation, if felt at all, and is generally not harmful to the massage therapist. Massage should be discontinued if the device delivers a shock during treatment. The client then needs to seek immediate medical attention.

ICD

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Box 7-3 Central Venous Catheter A central venous catheter, or central line, is a exible tube that is inserted and sewn into a large vein (usually the right subclavian vein in the upper chest) and left in place for an extended period. This type of catheter is used to keep a vein open for dialysis, blood withdrawal, chemotherapy, and frequent administration of medications, which must be taken regularly and cannot be taken orally. The three common types of central venous catheters are Hickman catheters, Quinton catheters, and Groshong catheters. Another style of central venous catheter inserted under the skin of the chest wall, a port-a-cath, does not have an external opening. The use of these catheters makes it difcult or impossible for the client to lie prone comfortably. The massage therapist should use bolsters, pillows, or other positional modications such as a side-lying position for the clients comfort. Sometimes a small towel or washcloth over the area is all that is needed. The catheter is usually sutured to fascia and muscle. During the massage, the massage therapist should take precautions not to dislodge the catheter by exerting tension or excessive movement on nearby skin tissues. Avoid traction near the area or on joints near the area where the device is located so as not to damage the device or the surrounding tissues. Avoid traction near the area or on joints near the area where the device is located so as not to damage the device or the surrounding tissues. Massage lubricant should not come into contact with the catheter dressing or sutures. If a catheter is placed in the arm, the area below the catheter should not be massaged because these tissues may be sensitive. Pressure from massage can also possibly damage the tissues. Massage work above the catheter in these extremities should be gentle. Avoid shoulder joint mobilizations near the device.
From IV feeder Subclavian vein

Incision Catheter inside superior vena cava

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