Haemodynamic

Disorders
 Edema and its types
 Hyperemia /congestion, Hemorrhage, Thrombosis,
Embolism, Infarction, Shock.
Terminologies:
 Etiology: study about the cause of disease
 Pathogenesis: study about the mechanism of disease
• Structural. E.g: flu
• Functional. E.g: tumor
• Both
 Manifestation: signs and symptoms
 Prognosis: the fate of the disease
 Risk factor
Courses objectives

• Discuss the concept of general pathology

• Discuss recognizing signs and symptoms that are considered serious
red flags
• Discuss and disseminate pertinent information and findings, and
ascertain the appropriate steps to follow during physical therapy
management
 Edema:
• Edema is caused by too much fluid trapped in
the body’s tissues
• Palpable swelling produced by the expansion
of the interstitial fluid volume.
• Fluid in the small spaces surrounding the
organs and tissues

• Mostly in feet, legs, and ankles. Other parts of

your body like the face, hands, and abdomen.
Sign and Symptoms:
• Swelling and puffiness
• Stretched or shiny skin
• Pitting or dimples appear
• Increased in sized
• Feeling of heaviness
• Shortness of breath
• Irregular heartbeat
• Chest pain
Etiology:
• Standing for a long time
• Venous insufficiency
• Underlying medical conditions like heart, lungs, liver, renal, and
thyroid
• Side effects of medicines. Blood pressure of pain management
• Poor nutrition. High sodium diet
• Pregnancy
• Compromised immune system
Types of edema/ oedema
•Peripheral edema: This affects the feet, ankles, legs, hands, and arms. Symptoms include
swelling, puffiness, and difficulty moving certain parts of the body.
•Pulmonary edema: This occurs when excess fluid collects in the lungs, making breathing
difficult. This can result from congestive heart failure or acute lung injury. It is a serious
condition, it can be a medical emergency, and it can lead to respiratory failure and death.
•Cerebral edema: This occurs in the brain. It can happen for a range of reasons, many of which
are potentially life-threatening. Symptoms include:
•headache
•neck pain or stiffness
•whole or partial vision loss
•changes in consciousness or mental state
•nausea
•vomiting
•dizziness
• Macular edema: This is a serious complication of diabetic retinopathy.
Swelling occurs in the macula, which is part of the eye that enables
detailed, central vision. The person may notice changes to their central
vision and how they see colors.
• Pitting edema: With this type, which can occur in peripheral edema,
pressure applied to the skin leaves an indent or pit in the skin.
• Periorbital edema: This refers to inflammation and puffiness around the
eye or eyes. The puffiness is due to fluid buildup and is usually
temporary.
Pathology of Edema
2. Reduced plasma oncotic pressure

Reduced albumin synthesis in liver or protein

malnutrition

Fall in plasma oncotic pressure

The net movement of fluid into interstitial tissue

causing edema
3. Lymphatic obstruction

Localized
lymphedema

Impaired lymphatic
drainage
Physical therapy for Edema:
• ‘RICE’: Rest, ice, compression, and elevation
• Massage: first strokes on the affected area can push back the fluid to
the heart.
• Edema compression stockings
 Hyperemia and Congestion
• Increased amount of blood in the vessels of an organ or
tissue
• It may affect the liver, heart, skin, eyes, and brain
• Types of hyperemia
There are two types of hyperemia:
• Active hyperemia happens when there’s an increase in
the blood supply to an organ. This is usually in response
to a greater demand for blood — for example if you’re
exercising.
• Passive hyperemia is when blood can’t properly exit an
organ, so it builds up in the blood vessels. This type of
hyperemia is also known as congestion.
 Sign and Symptoms:

• Redness
• Swelling
• Other symptoms depend upon the cause of the problem:
Heart failure: shortness of breath, coughing and wheezing, fatigue,
nausea, rapid heartbeat
Deep vein thrombosis: swelling, redness, pain
Hepatic vein thrombosis: pain in the right upper abdomen, swelling,
cramps in legs and ankle, itching
Hemorrhage
• Bleeding from the ruptured blood vessels
• Internal bleeding and external bleeding

Causes:
• Alcohol and drug abuse
• Blood clotting disorders
• Trauma and injury
• High blood pressure

Sign and Symptoms:

• Dizziness
• Shortness of breath
• Chest pain
Thrombosis
• When blood clots block veins and arteries.
• It can be life threatening such as stroke and heart attack.
• There are two components to a thrombus: platelets and red blood
cells that form plug and mesh work of cross linked fibrin protein.
• Factors that can cause thrombus:
1. Damage to endothelial lining of blood vessels
2. Hypercoagulable state
3. Arterial or venous blood stasis
Sign and symptoms
• Pain in the affected area
• Swelling
• Chest pain
• Numbness or weakness on one side of body

Types:
• Venous thrombosis: blood clot in vein
• Arterial thrombosis: blood clot in artery
Causes:
• Injury or disease in leg veins
• Immobility
• Fracture
• Medications
• Obesity
• Inherited disorder
• Autoimmune disease
• atheriosclerosis
Embolism
• Blockage of blood vessels due to foreign body such as blood clot or an
air bubbles, usually detached plaque.
• rare emboli are composed of fat droplets, nitrogen bubbles,
atherosclerotic debris (cholesterol emboli), tumor fragments, bone
marrow, or even foreign bodies.
• Emboli travel through the blood until they encounter vessels too small
to permit further passage, causing partial or complete vascular
occlusion.
Pulmonary Embolism
• Pulmonary emboli originate from deep venous thromboses and are the most common
form of thromboembolic disease.
• In more than 95% of cases, PEs originate from leg DVTs .

Systemic Thromboembolism
• Embolism in the blood vessels of heart. Most common in people with CVD and
smoking habits.

Air Embolism:
Gas bubbles within the circulation can coalesce to form frothy masses that obstruct
vascular flow and cause distal ischemic injury. For example, a very small volume of air
trapped in a coronary artery during bypass surgery, or introduced into the cerebral
circulation by neurosurgery in the “sitting position,” can occlude flow with dire
consequences
Causative Factors
• Blood clots
• Adiposity
• Dyslipidemia
• Amniotic fluid leak from fetus into mother’s blood vessels
• Trapped air bubble
Infarction
• Tissue death or necrosis due to inadequate supply of blood to the
affected area.
• Caused by blockage, rupture, compression or constriction of blood
vessels.
• Infarcts are classified according to color and the presence or absence
of infection; they are either red (hemorrhagic) or white (anemic)
• And also on the basis of locations: heart, brain, lungs, etc.
Factors That Influence Development of an
Infarct:
• Anatomy of the vascular supply. The availability of an alternative
blood supply is the most important determinant of whether vessel
occlusion will cause tissue damage
• Rate of occlusion. Slowly developing occlusions are less likely to cause
infarction, because they provide time for development of collateral
pathways of perfusion
• Tissue vulnerability to hypoxia
Shock
• Life-threatening condition of circulatory failure causing inadequate
oxygen delivery.
• Types of shocks:
Cardiac shock: due to heart problems. E.g. myocardial infarction
Hypovolemic shock: caused by reduced blood volume. E.g.
hemorrhage
Associated with systemic inflammation: infections, burns, trauma.
Stages of Shock
• An initial nonprogressive phase during which reflex compensatory
mechanisms are activated and perfusion of vital organs is maintained
• A progressive stage characterized by tissue hypoperfusion and onset
of worsening circulatory and metabolic imbalances, including lactic
acidosis
• An irreversible stage that sets in after the body has incurred cellular
and tissue injury so severe that even if the hemodynamic defects are
corrected, survival is not possible