Congestive Heart Failure Notes - Ben Benjamin

1 11A Webinar with Tracy Walton, MS, LMTC ongestive Heart Failureand Massage TherapyPart 5 of the Common Cardiovascular Conditions Webinar SeriesBackground Author Educator Researcher Massage Therapist Specialist in massage therapy and cancer care2 Tracy WaltonWebinar 1: Blood clot symptoms & signs, Webinar 2: Blood clot riskWebinar 3: Hypertension and hypotensionWebinar 4: Angina, Heart attackToday s Webinar: Congestive Heart Failure32 Learning Objectives Specific interview questions about CHF complications Significant massage adaptations for clients with CHF How the Filter and Pump Principle guides the massage session4 Pretest1. Which of the following is true of Congestive Heart Failure (CHF)?a. The Heart may not be able to fill efficientlyb. The Heart is weak, but has not abruptly stopped pumpingc.

2 The Heart may not be able to pump efficientlyd. All of the above are true of Congestive Heart Failure (CHF)5 Pretest2. Which of the following statements describes CHF symptoms or signs?a. Swelling in feet and ankles when the right Heart is affectedb. Swelling in lungs when the right Heart is affectedc. Swelling in legs and abdomen when the left Heart is affectedd. Swelling in feet and ankles when the left Heart is affected63 Pretest3. Which massage position is likely to be the most comfortable for a client who has CHF with left Heart Failure ?a. Supine with legs elevatedb. Prone with extra support at waistc. Upright sitting with support at headd. Sidelying with legs elevated7 Pretest4. Which one of the following principles specifies a non-circulatory massage session if a Heart , liver, kidney, or spleen is compromised?

3 A. The Vital Organ Principleb. The Filter and Pump Principlec. dvt risk Principle 1d. The Plaque Problem Principle 8 Pretest5. Which one of the following CHF signs/symptoms, occurring in a patient with longstanding CHF, suggests the need for an immediate medical referral?a. Shortness of breath on exertionb. Fatiguec. Swelling in the anklesd. Sudden weight gain 94 Pretest6. Which of the following principles should be used with clients with CHF?a. dvt risk Principle 1b. The Vital Organ Principlec. The Plaque Problem Principled. All of the above should be used with clients with CHF10 Background11 Congestive Heart Failure (CHF) Heart is too weak or stiff to fillorpump efficiently, cannot pump enough to meet the body s not mean Heart has stopped pumpingCan be acute or chronicStatistics In US, nearly 5 million people have Heart Failure Next to childbirth, the most common reason for hospital admission 550,000 cases diagnosed each year 1% of people age 50 yrs 5% of people age 75 yrs or older 25% of people 85 yrs or older 10% of people w/CHF die after 1 year 50% die within 5 years after diagnosis125If Heart cannot pumpCan t send blood outto tissues Ejection fraction is the amt of blood ejected compared to max volume available to ejectNormal ejection fraction >50%If Heart cannot fillHeart stiff (less compliant)

4 When filling with bloodFlood backs up upstream 1314 Conditions Leading to CHF Coronary artery disease Hypertension Heart valve disorders Arrhythmias ( Heart rhythm disorders) Longstanding alcohol abuse Thyroid disorders Viral infection of muscle Certain medications + underlying CADS tages of Heart FailureA. At high risk of developing CHFB. Asymptomatic(but has structural Heart disease)C. Symptoms with mild to moderate activityD. Symptoms at rest (has advanced structural Heart disease)15616 Symptoms17 Chronic Heart Failure Signs/SymptomsShortness of breath (SOB) (dyspnea) on exertion or lying downFatigue, weaknessSwollen feet, ankles, legs, Swelling in genitals, abdomen (ascites)Sudden weight gainRapid or irregular heartbeatCough, wheezing (white/pink phlegm)Loss of appetite, nauseaDecreased alertness, confusion18 AcuteHeart Failure Signs/SymptomsSame symptoms as chronic Heart failurebutWorseningSudden worseningSudden onsetA new symptom developsSudden fluid buildupSudden, severe SOB,coughing up pink, foamy mucusChest pain (if Heart attack is causing Failure )

5 7 When Left Heart Fails Fluid collects in lungs Pulmonary edema Lung congestion impedes airway expansion SOB with activity SOB with lying down19 When Right Heart Fails Fluid backs up in feet, lower legs As CHF worsens, backup in thighs As CHF worsens, backup in hips, genitals Worst: fluid backup in abdomen (ascites) Weight gain with fluid retention Edema is pitting20 Complications of Heart Failure Kidney damage or Failure Liver damage Heart valve problems Heart attack Stroke218 End Stage 88% report breathlessness 75% of patients report pain 69% report fatigue22 Treatment for Heart FailureLowerblood pressureWiden arteries to heartAvoidstraining the heartHelp Heart pump more efficiently23 Treatment Diuretics ACE inhibitors Angiotensin II receptor blockers Nitrates Beta blockers Natriuretic peptides Digoxin IV Inotropes (Stimulants)249 Non-drug Treatments/Monitoring25 Salt restrictionFluid restrictionLower extremity elevationExerciseSupplemental oxygenDaily weight checksMassage for Congestive Heart Failure ?

6 26 Massage Guidelines for Heart Failure27 EssentialsMassage Therapy GuidelinesHeart FailureFollow PlaqueProblem Principle 10 EssentialsMassage Therapy GuidelinesHeart FailureFollow dvt risk PrinciplesMassage Guidelines for Heart Failure28 EssentialsMassage Therapy GuidelinesHeart FailureFollow dvt risk Principle 1 Massage Guidelines for Heart Failure29 Massage Guidelines for Heart Failure30 EssentialsMassage Therapy GuidelinesHeart FailureAvoid general circulatory massage 11 Effleurage,Petrissage, orRepeated compressions31 Pressure level 3 or above Circulatory massage The Massage Pressure Scale32 Classifies massage pressures: Simple terms Tissues displaced Common uses Therapist body use(From Walton, T. Medical Conditions and Massage Therapy: A Decision Tree Approach.)

7 Philadelphia: Lippincott Williams & Wilkins, 2011.)The Filter and Pump PrincipleIf a filtering organ or a pumping organ (liver, kidney, spleen, (the Heart )or lymph node)is functioning poorly or overworking,do not work it harder with circulatory Disease Continuum34 MildSevereCHFH eart Disease Continuum35 MildSevereStrongerGentlerMassage Therapy ContinuumCHFThe Vital Organ PrincipleIf a vital organ is compromised in function, use gentle massage elements; do not place too much demand on the client s body3613 Massage Therapy Guidelines Contact Lubricant Pressure Joint Movement Friction Position Siteof massage Draping Speed Rhythm Session length Session timing Session intent Medical consultation Medical referralThe Vital Organ PrincipleWhich of these massage elements needs to change?

8 How should it change?37 The Interview and the Massage38 Kidney failureLiver functionPeripheral artery diseaseStrokeSkin healthCHFThe Interview and the Massage3914 The Interview and MassageWhen were you diagnosed with CHF?Longer ago = more familiarity, more complicationsMild, moderate, or severe? Advanced?More severe/advanced gentler massage overallLeft or right Heart affected? If left, ask about breathing problems;If right, look for swelling in lower body40 The Interview and MassageSymptoms? At rest? With activity?If symptoms occur at rest, adjust to advanced diseaseShortness of breath Adapt positioningFatigue, weakness Gentle overallSwelling No circulatory massage at siteSudden weight gain, changes in heartbeat, cough Medical referralConfusion, alertness Simple communication,get health info from caregiver, doctor41 The Interview and MassageComplications?

9 Effects on other organs [list]? If kidney Failure , ask kidney Failure ?sIf liver disease, ask liver ?sIf extremities affected, ask peripheral artery disease ?sIf stroke history, ask stroke ?s4215 Kidney failureLiver functionPeripheral artery diseaseStrokeSkin healthCHFThe Interview and the Massage43 The Kidney Failure Questions44 The Kidney Failure QuestionsMild/moderate/severe? Need for dialysis?No general circulatory massageIf dialysis, use caution at access sitesVery gentle session overall if severeSkin effects? Bruising or bleeding? Itching? Limit overall pressure (level 1-2 max) if bruising/bleedingSteady pressure for itching4516 The Kidney Failure QuestionsOsteoporosis? Gentle pressure and joint mvt. overall, especially at spineMuscle pain, twitching, cramping?

10 Full, firm contact; avoid strong joint mvt., care w/positionNeuropathy?Care w/pressure, joint mvt. at sensation impairmentAnemia?Gentle pressure, reposition gradually, slow rise from table 46 The Liver Questions47 The Liver QuestionsLevel of liver function? Doctor concerned? If low, avoid general circulatory massage Swelling? Other swollen, congested organs?Elevate upper body if necessarySkin effects? Bruising or bleeding? Jaundice? Itching? Limit overall pressure (level 1-2 max) if bruising/bleedingNo general circulatory massage if jaundiceSteady pressure for itching4817 The Liver QuestionsAny effects on nervous system, cognitive functions?If cognition affected, direct questions to caregiver, massage to changes in perception, use simple communication; look for nonverbal cuesOsteoporosis?