2 cardiopulmonary physical therapy

8/2/2019 2 Cardiopulmonary Physical Therapy

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Cardiopulmonary physical therapy

lecture 2

Dr. Shaukat Ali Pt, Dpt.

Lecturer ISRS


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Why anatomy of cardiopulmonary

system is important to pt?

The heart lies in series with the lungs, constituting thecardiopulmonary unit, the central component of theoxygen transport pathway .Virtually all the blood returned to the right side of the heart passes through the

lungs and is delivered to the left side of the heart forejection to the systemic, coronary, andbronchopulmonary circulations.

Because of this interrelationship, changes in either lungor heart function can exert changes in the function of

the other organ. A detailed understanding of theanatomy of the heart and lungs, and how these organswork synergistically is essential to the practice ofcardiopulmonary physical therapy.


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Layout of todays lecture.

anatomy of the cardiopulmonary system,

including

Bony thorax

Thoracic cavitypleural cavities and

mediastinum

heart


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Thoracic cage


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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 cagerib fracture and cervical rib


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Approaches to cavity of thoracic cage

Two ends, superior and inferior

Superior apertureinlet 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.


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Inferior aperturebroader

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 volumeand vital capacity of the lungs in different

postures.


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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


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Mechanism of action.

Increase in vertical and transverse diameter of

thoracic cavity

How?


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Bones of the thoracic cage

Sternum.

Vertebral column.vertebrae

Ribs 12 in number, number can be morethan 12 or less than 12typical ribsatypical

ribsobliquity of ribs increases.. Length of

ribs increasestrue ribs, false

ribsfeatures of typical ribs

Joints of thorax.


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Respiratory movements.

Lungs expand passively during inspiration and

retracts during expiration..due to..two

factors1)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 handlemovement and Bucket handle movement)


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Pump handle movement.sternum acts like a pump andvertebrosternal ribs (2-6) act like the handle of the pump handlemachine.rib acts like a lever with fulcrum some what near itstubercle.. Effort arm. Load arm, disproportionality b/w the twoarms lengththe effort arm is longer than the load arm, slight

movement at the effort arm results in. Magnified movement atthe load arm end.

The anterior end of a rib is lower than the posterior end, so whenthe posterior end is pushed downward the anterior end is pulledupward and forward in this way AP diameter of the thorax isincreased along the up and downward movements of the 2 to 6

true ribs the sternum moves up and forward in what are calledpump handle movement. The movements takes place at thecostovertebral and manubriosternal joints.


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Bucket handle movement. Occurs at the 8, 9 and 10thfalse ribs the shafts of these ribs lie below the planepassing the two end of these ribs, so when ever theseribs are elevated the shaft moves outward like bucket

handle movement which results in increase in thetransverse diameter of the thorax.

The thorax resembles a cone tapering upward, thatwhy each rib is longer than the rib above so when a

lower rib is elevated it takes the place of the higherone and in this the transverse diameter is increased.


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Respiratory muscles

Diaphragmalready 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, pectoralismajor, pectoralis minor, trapezius, erector spinae,abdominal muscles.


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Thoracic cavity


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Thoracic cavity containsright and left pleuralcavities occupied by thelungs on either sides, thetwo pleural cavities areseparated by a thickpartition calledmediastinum.

Mediastinum is the

median septum of thethoracic cavity

How mediastinum isformed?


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Divided into superior

and inferior

mediastinum

The inferior is dividerinto anterior, middle

and posterior

mediastinum

Contents of each part of

mediastinum.


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trachea

Wide tube lying

Starts at the lower border of. And lower end deviatesslightly to the right side anddivides in to ..

Length4-6 inch Diameter, 2cm in male and 1.5

cm in female

The upper end lies at the leverof ..

The lower end lies at the levelof in supine

And in sitting.

Clinical importance.


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Pleura

Parietal pleurae:lines the thoracic wall, covers the thoracicsurface of the diaphragm and the lateralaspect of the mediastinum, and extends intothe root of the neck to line the undersurfaceof the suprapleural membrane at thethoracic inlet.

Visceral Pleurae:completely covers the outer surfaces of thelungs and extends into the depths of theinterlobar fissures.

The parietal and visceral layers of pleura areseparated from one another by a slitlikespace, the pleural cavity, which contains

pleural fluid to minimize friction duringmovement.


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Divisions of Parietal pleurae

Cervical pleuraeextends up into the neck, lining

the undersurface of the suprapleuralmembrane.

Costal pleuralines the inner surfaces of the ribs,

the costal cartilages, the intercostal spaces,the sides of the vertebral bodies, and theback of the sternum

Diaphragmatic Pleuraecovers the thoracic surface of the

diaphragm

Mediastinal Pleuraecovers and forms the lateral

boundary of the mediastinum


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The parietal pleura is sensitive to pain,temperature, touch, and pressure and issupplied as follows:

The costal pleura is segmentally supplied bythe intercostal nerves.

The mediastinal pleura is supplied by the

phrenic nerve.

The diaphragmatic pleura is supplied overthe domes by the phrenic nerve and aroundthe periphery by the lower six intercostalnerves.

Visceral Pleurae covering the lungs issensitive to stretch but is insensitive tocommon sensations such as pain and touch.It receives an autonomic nerve supply fromthe pulmonary plexus


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bronchi

The trachea bifurcates behind thearch of the aorta into the rightand left principal (primary, ormain) bronchi.

The bronchi divide , giving rise toseveral million terminalbronchioles that terminate in oneor more respiratory bronchioles.

Each respiratory bronchioledivides into 2 to 11 alveolar ducts

that enter the alveolar sacs. Thealveoli arise from the walls of thesacs


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The right principal (main) bronchusis wider, shorter, and more verticalthan the left and is about 1 in. (2.5cm) long. Before entering the hilumof the right lung, the principalbronchus gives off the superior lobarbronchus. On entering the hilum, itdivides into a middle and an inferiorlobar bronchus.

The left principal (main) bronchusis narrower, longer, and morehorizontal than the right and is about2 in. (5 cm) long. It passes to the leftbelow the arch of the aorta and in

front of the esophagus. On enteringthe hilum of the left lung, theprincipal bronchus divides into asuperior and an inferior lobarbronchus.


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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.


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2 cardiopulmonary physical therapy

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