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CHAPTER 7: CARDIOVASCULAR AND LYMPHATIC/IMMUNE PATHOLOGIES

Questions to Ask Client DuringPremassage Interview

Commentary

Does the client have any cardiovascular

conditions? Does the client have anylymphatic/immune system conditions?

These should include current as well as

previous conditions. For example, massageconsiderations for a client who experienced

a heart attack 6 months before the massage

differ from massage considerations for aheart attack 5 years before the massage.

If the client has any cardiovasculardisorders, is it being managed by

medication? If nitroglycerine is being used,

is it nearby if needed?

Table 7-1 has more information includingpossible side effects.

Does the client have a pacemaker, an

implantable cardioverter defibrillator

(ICD), or central venous catheter?

The massage therapist needs to be prepared

to use the modified supine position, side-

lying position, or seated position if needed.Pillows and bolsters may provide extra

comfort and support. Boxes 7-1, 7-2, and

7-3have additional information.

Does the client experience shortness of

breath? Are there any positions that help ormake it worse?

The massage therapist needs to be prepared

to use the modified supine position, side-lying position, or seated position if needed.

Does the client complain of fatigue,anxiety, insomnia, or headaches?

These may be indicators of cardiovasculardisease or medication side effects. The

massage therapist needs to discuss thesesymptoms with the client, and may need torefer the client to the clients health care

provider for evaluation or clearance before

proceeding with massage.

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proceeding with massage.

need to be obtained from the clients healthcare provider before massage therapy can

be performed. If the edema is not due to aserious condition such as congestive heartfailure or renal failure, massage can be

performed. The massage therapist should

elevate the affected area during treatmentto promote drainage.

Can any swollen lymph nodes be palpated? This often indicates local or systemicinfection. 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 AFFECTMEDICATION CLASSIFICATION MEDICATION NAME TREATMENT

Alpha receptor drugs Doxazosin (Cardura), prazosin Abdominal discomfort, anxiety,(Minipress), tamsulosin constipation and diarrhea, edema,

(Flomax), terazosin (Hytrin) hypertension, irregular heartbeat, jointpain, nausea and vomiting, skin rashes,vertigo

Angiotensin-converting Benazepril (Lotensin), Anxiety, chest pain, diarrhea, dry mouth,enzyme inhibitors captopril (Capoten), edema, fever, gastrointestinal irritation,(ACE inhibitors) enalapril (Vasotec), headaches, hypotension, insomnia, joint

fosinopril (Monopril), pain, lethargy, nausea and vomiting,lisinopril (Prinivil, Zestril), vertigo

moexipril (Univasc),perindopril (Aceon),quinapril (Accupril),ramipril (Altace),trandolapril (Mavik)

Hematological agents* Acetylsalicylic acid (aspirin), Abdominal pain, gastric irritation,dipyridamole (Persantine), hemorrhage, nausea, skin rashes

heparin, streptokinase,warfarin (Coumadin),clopidogrel (Plavix)

Beta blockers Acebutolol (Sectral), atenolol Abdominal pain, anxiety, bruising, chest(Tenormin), bisoprolol pain, chills, constipation and diarrhea,(Zebeta), carteolol (Cartrol), disorientation, drowsiness, dry mouth,carvedilol (Coreg), labetolol edema, fever, headaches, hypotension,(Trandate), metoprolol insomnia, irregular heartbeat, joint pain,

(Lopressor, Toprol-XL), lethargy, nausea and vomiting, shortnessnadolol (Corgard), pindolol, of breath, skin rashes, vertigopropranolol (Inderal),sotalol (Betapace), timolol(Blocadren)

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POSSIBLE SIDE EFFECTS THAT MAY AFFECTMEDICATION CLASSIFICATION MEDICATION NAME TREATMENT

Diuretics Amiloride (Midamor), Diarrhea, disorientation, dry mouth,bumetanide (Bumex), gastrointestinal irritation, headaches,

chlorothiazide (Diuril), hyperglycemia, lethargy, musclehydrochlorothiazide cramps/spasms, nausea and vomiting,(Esidrix, Oretic) shortness of breath, vertigospironolactone (Aldactone),triamterene (Dyrenium,Dyazide, Maxzide)furosemide (Lasix),

torsemide (Demadex)Lipid-lowering drugs Bile acid sequestrants Abdominal cramps, allergic reactions,[cholestyramine (Questran), bruising, chest pain, constipation,colesevelam (Welchol), disorientation, drowsiness, dry mouth,colestipol (Colestid)] Fibric fever, flushing, gastrointestinal irritation,acid derivatives [clofibrate, gout, hypoglycemia, hypertension andfenofibrate (Tricor), hypotension, insomnia, irregulargemfibrozil (Lopid)] HMG heartbeat, joint pain, lethargy, nausea

Co A reductase inhibitors and vomiting, shortness of breath,[atorvastatin (Lipitor), vertigofluvastatin (Lescol),lovastatin (Mevacor),pravastatin (Pravachol),simvastatin (Zocor)]Nicotinic acid [niacin(Nicolar)]

Vasodilators Nitroglycerin Anxiety, disorientation, edema, headaches,hypotension, irregular heartbeat, jointpain, nausea, skin rashes, vertigo

*Wh li t t ki ti l t d pl t l t i hibit t h i h d p ffl ( i i ) d p p t i

Table 7-1 MEDICATIONS USED TO MANAGE CARDIOVASCULAR DISEASECONTD

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An artificial pacemaker is a surgically implanteddevice that sends out small electrical currents tostimulate the heart to contract. Newer

pacemakers are activity-adjusted pacemakers thatautomatically speed up the heartbeat duringexercise. The artificial pacemaker is implantedunder the skin with wires going directly to thesinoatrial node or the atrioventricular node.

Box 7-1

Artificial Pacemaker

Because the site is usually very sensitive, localmassage is contraindicated. The primary concernis to make sure the incision from the surgery has

completely healed. While the client is prone, asoft pillow to be placed under the chest shouldbe offered. This will provide added comfort forthe client during the massage.

Superiorvena cava

Apex ofthe heart

Site of incision

Pacemaker withlithium batteryand timer

Wire

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

near the device over the head when mobilizingthe shoulder joint, as it may disturb the leadconnections.

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The implantable cardioverter defibrillator is adevice used to treat dangerously fast heart ratesin the ventricles (see Box 7-6). It can detectheart rhythms and, when necessary, deliversan electrical shock to restore normal heart rateand rhythm. Much like a pacemaker, thedefibrillator is implanted under the skin near

the clavicle. It is attached to one or more leadspositioned in the right ventricle, and rightatrium when necessary. The electrical shock ispainful to the client. The shock may be felt by

the massage therapist if the client is touchingthe patient when the device discharges. It mayf l lik ti li ti if f lt t ll d i

Box 7-2

Implantable Cardioverter Defibrillator

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A central venous catheter, or central line, is aflexible tube that is inserted and sewn into alarge vein (usually the right subclavian vein in

the upper chest) and left in place for anextended period. This type of catheter is used tokeep a vein open for dialysis, blood withdrawal,chemotherapy, and frequent administration ofmedications, which must be taken regularly andcannot be taken orally. The three common typesof central venous catheters are Hickmancatheters, Quinton catheters, and Groshong

catheters. Another style of central venouscatheter inserted under the skin of the chestwall, a port-a-cath, does not have an externalopening.

The use of these catheters makes it difficult orimpossible for the client to lie pronecomfortably. The massage therapist should usebolsters, pillows, or other positionalmodifications such as a side-lying position forthe clients comfort. Sometimes a small towel orwashcloth over the area is all that is needed. Thecatheter is usually sutured to fascia and muscle.During the massage, the massage therapistshould take precautions not to dislodge thecatheter by exerting tension or excessive

movement on nearby skin tissues. Avoid tractionnear the area or on joints near the area where

Box 7-3

Central Venous Catheter

the device is located so as not to damage thedevice or the surrounding tissues. Avoid tractionnear the area or on joints near the area where

the device is located so as not to damage thedevice or the surrounding tissues. Massagelubricant should not come into contact with thecatheter dressing or sutures. If a catheter isplaced in the arm, the area below the cathetershould not be massaged because these tissuesmay be sensitive. Pressure from massage can alsopossibly damage the tissues. Massage work above

the catheter in these extremities should begentle. Avoid shoulder joint mobilizations nearthe device.

From IV feederSubclavianvein

Incision

Catheterinsidesuperiorvena cava

Copyright 2004, Mosby, Inc. All rights reserved.