2 Cardiopulmonary Physical Therapy

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Cardiopulmonary physical therapy lecture 2
Dr. Shaukat Ali Pt, Dpt. Lecturer ISRS

Why anatomy of cardiopulmonary system is important to pt?
• The heart lies in series with the lungs, constituting the cardiopulmonary unit, the central component of the oxygen transport pathway .Virtually all the blood re turned to the right side of the heart passes through the lungs and is delivered to the left side of the heart for ejection to the systemic, coronary, and bronchopulmonary circulations. • Because of this interrelationship, changes in either lung or heart function can exert changes in the function of the other organ. A detailed understanding of the anatomy of the heart and lungs, and how these organs work synergistically is essential to the practice of cardiopulmonary physical therapy.

Layout of today’s lecture.
• anatomy of the cardiopulmonary system, including • Bony thorax • Thoracic cavity……pleural cavities and mediastinum • heart

Thoracic cage

Thorax
• • • • • Trunk….. Divided into thorax and abdomen Thoracic cage….an osseocartilaginous elastic cage……. How thoracic cage is formed? Shape of the thoracic cage…….cone like The transverse section of thorax ….. Kidney shaped.. Oval shaped ,the transverse diameter is…… • Childern up to the age of 2 years.. The thoracic cavity is circular… the AP diameter……. • In infants the ribs are placed horizontal while in adult the ribs are placed obliquely ….. • Applied anatomy of thoracic cage…………rib fracture and cervical rib

Approaches to cavity of thoracic cage
• • • • • • • • Two ends, superior and inferior Superior aperture……inlet of thorax Shape…… kidney shaped… Formation of inlet…. Plane of inlet Diaphragm of the inlet. Function of the diaphragm of the inlet. Structures passing through the inlet….viscera, vessels and nerves, muscles • Applied anatomy of the inlet of the thorax.

• • • • • •

Inferior aperture…broader…… How outlet is formed?.... Diaphragm of the out let…. Openings in the out let diaphragm……. Principal muscle of inspiration…. Contribution of diaphragm to the tidal volume and vital capacity of the lungs in different postures.

• • • • • •

Origin of diaphragm Diaphragm is divided into 2 halves.. Right and left Each half has got three parts…. Central tendon… insertion of the diaphragm. Position of the diaphragm in different postures…. On x-ray the position of the diaphragm indicates about the phase of respiration. • Nerve supply • Clinical anatomy

• Mechanism of action. • Increase in vertical and transverse diameter of thoracic cavity How……?

Bones of the thoracic cage
• Sternum…. • Vertebral column….vertebrae • Ribs… 12 in number, number can be more than 12 or less than 12……typical ribs…atypical ribs……obliquity of ribs increases….. Length of ribs increases……true ribs, false ribs……features of typical ribs • Joints of thorax…….

Respiratory movements….
• Lungs expand passively during inspiration and retracts during expiration…..due to…..two factors……1)…alteration in the capacity of thoracic cavity is brought about by……..2)elastic recoil of the pulmonary alveoli and of the thoracic wall……. • Principles of movements. (Pump handle movement and Bucket handle movement)

• Pump handle movement….sternum acts like a pump and vertebrosternal ribs (2-6) act like the handle of the pump handle machine….rib acts like a lever with fulcrum some what near its tubercle….. Effort arm…. Load arm, disproportionality b/w the two arms length……the effort arm is longer than the load arm, slight movement at the effort arm results in……. Magnified movement at the load arm end. • The anterior end of a rib is lower than the posterior end, so when the posterior end is pushed downward the anterior end is pulled upward and forward… in this way AP diameter of the thorax is increased… along the up and downward movements of the 2 to 6 true ribs the sternum moves up and forward in what are called pump handle movement. The movements takes place at the costovertebral and manubriosternal joints.

• Bucket handle movement…. Occurs at the 8, 9 and 10th false ribs… the shafts of these ribs lie below the plane passing the two end of these ribs, so when ever these ribs are elevated the shaft moves outward like bucket handle movement which results in increase in the transverse diameter of the thorax. • The thorax resembles a cone tapering upward, that why each rib is longer than the rib above so when a lower rib is elevated it takes the place of the higher one and in this the transverse diameter is increased.

• Respiratory muscles • Diaphragm…already discussed • External intercostal, 11 in number. Origin, insertion, fibers direction, role….. • Internal intercostal, 11 in number. Origin, insertion, fibers direction, role….. • Accessory muscles….SCM, scalenes…. Serratus anterior, rhomboids major and minor, pectoralis major, pectoralis minor, trapezius, erector spinae, abdominal muscles.

Thoracic cavity

• Thoracic cavity contains right and left pleural cavities occupied by the lungs on either sides, the two pleural cavities are separated by a thick partition called mediastinum. • Mediastinum is the median septum of the thoracic cavity • How mediastinum is formed?

• Divided into superior and inferior mediastinum • The inferior is divider into anterior, middle and posterior mediastinum • Contents of each part of mediastinum.

trachea
• Wide tube lying…… • Starts at the lower border of ……. And lower end deviates slightly to the right side and divides in to …….. • Length…4-6 inch • Diameter, 2cm in male and 1.5 cm in female • The upper end lies at the lever of …….. • The lower end lies at the level of ……… in supine • And in sitting. • Clinical importance.

• •

Pleura Parietal pleurae: lines the thoracic wall, covers the thoracic surface of the diaphragm and the lateral aspect of the mediastinum, and extends into the root of the neck to line the undersurface of the suprapleural membrane at the thoracic inlet. Visceral Pleurae: completely covers the outer surfaces of the lungs and extends into the depths of the interlobar fissures. The parietal and visceral layers of pleura are separated from one another by a slitlike space, the pleural cavity, which contains pleural fluid to minimize friction during movement.





• •

Divisions of Parietal pleurae Cervical pleurae extends up into the neck, lining the undersurface of the suprapleural membrane. Costal pleura
lines the inner surfaces of the ribs, the costal cartilages, the intercostal spaces, the sides of the vertebral bodies, and the back of the sternum





Diaphragmatic Pleurae
covers the thoracic surface of the diaphragm



Mediastinal Pleurae covers and forms the lateral boundary of the mediastinum


 

The parietal pleura is sensitive to pain,

temperature, touch, and pressure and is supplied as follows: The costal pleura is segmentally supplied by the intercostal nerves. The mediastinal pleura is supplied by the phrenic nerve.



The diaphragmatic pleura is supplied over the domes by the phrenic nerve and around the periphery by the lower six intercostal nerves.



Visceral Pleurae covering the lungs is

sensitive to stretch but is insensitive to common sensations such as pain and touch. It receives an autonomic nerve supply from the pulmonary plexus

bronchi
• The trachea bifurcates behind the arch of the aorta into the right and left principal (primary, or main) bronchi. • The bronchi divide , giving rise to several million terminal bronchioles that terminate in one or more respiratory bronchioles. • Each respiratory bronchiole divides into 2 to 11 alveolar ducts that enter the alveolar sacs. The alveoli arise from the walls of the sacs



The right principal (main) bronchus is wider, shorter, and more vertical than the left and is about 1 in. (2.5 cm) long. Before entering the hilum of the right lung, the principal bronchus gives off the superior lobar bronchus. On entering the hilum, it divides into a middle and an inferior lobar bronchus. The left principal (main) bronchus is narrower, longer, and more horizontal than the right and is about 2 in. (5 cm) long. It passes to the left below the arch of the aorta and in front of the esophagus. On entering the hilum of the left lung, the principal bronchus divides into a superior and an inferior lobar bronchus.



assignment
• • • • • • • • • • Q.1 Discuss the lung under the following headings. Borders Fissures and lobes Bronchopulmonary segments Q.2 Discuss the heart under following headings Surface anatomy External features of heart Chambers of heart Conduction system of heart Coronary circulation of heart.

Thanks…..
BEST WISHES…….

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