Introduction To Respiratory And Cardiovascular
System
BY:
DR. OLA MOHAMED EL-GOHARY
BSC, MSC, PHD, CAIRO UNIVERSITY
LECTURER OF PHYSICAL THERAPY FOR
INTERNAL MEDICINE AND GERIATRICS,
PHAROS UNIVERSITY
Objective :
Identify the Respiratory system structure and its function.
Known Respiratory System Conducting passages and its part.
Demonstrate the main respiratory control system in the human body.
Explain the main respiratory mechanism and muscle of respiration.
Identify the main component of the cardiovascular system .
Explain the main cause of coronary artery disease.
Demonstrate the different main symptoms of heart disease and how to
improve the quality of life in coronary artery patients.
Respiratory system structure and function:
Life depends on the delivery of oxygen to body tissues.
In order to release energy as part of tissue metabolism, cells require oxygen in
addition to nutrients.
When cells use oxygen, carbon dioxide is produced, which is a metabolic waste
product that can be deadly if it accumulates.
The respiratory system's principal duty is to supply the body with oxygen derived from
ambient air and to expel carbon dioxide.
Respiration is a complex process that includes four stages: ventilation, external
respiration, gas transport, and internal respiration.
The respiratory system:
The process of physiological respiration includes two major
parts: external respiration and internal respiration.
External respiration, also known as breathing, involves
bringing air into the lungs (inhalation) and releasing air into the
atmosphere (exhalation).
During internal respiration, oxygen, and carbon dioxide are
exchanged between the cells and blood vessels.
Follow:
Respiration begins at the nose or mouth, where
oxygenated air is brought in before moving down the
pharynx, larynx, and the trachea. The trachea
branches into two bronchi, each leading into a lung.
Each bronchus divides into smaller bronchi, and
again into even smaller tubes called bronchioles. At
the end of the bronchioles are air sacs called alveoli,
and this is where gas exchange occurs.
The respiratory system:
Follow:
We do not breathe in only oxygen or carbon dioxide. Often the terms
"oxygen" and "air" are used interchangeably. The air we breathe in indeed
has more oxygen than the air we breathe out, and the air we breathe out has
more carbon dioxide than the air that we breathe in. However, oxygen is just
one of the gases found in our air. (In fact, the air has more nitrogen than
oxygen.
The respiratory system does not work alone in transporting oxygen through the
body. The respiratory system works directly with the circulatory system to
provide oxygen to the body. Oxygen from the respiratory system moves into
blood vessels that then circulate oxygen-rich blood to tissues and cells.
Follow:
In health, the human cardiorespiratory system has a substantial reserve capacity to cope
with the demands of exercise or illness. Breathlessness or fatigue is not normally a feature
of resting activity. In patients with heart or lung disease, the erosion of physiological
reserve eventually imposes limitations upon the activities of daily life.
Parts of the Respiratory System:
1. UPPER RESPIRATORY TRACT: The ‘upper respiratory tract is the term for the extra-
thoracic components of the respiratory system. It broadly consists of the nose, nasal
cavity, pharynx, and the larynx.
2. LOWER RESPIRATORY TRACT: The lower respiratory system, or lower respiratory
tract consists of: trachea, bronchi ,bronchioles, and the alveoli which make up the lungs.
These structures pull in air from the upper respiratory system, absorb the oxygen, and
release carbon dioxide in exchange. Other structures, namely the thoracic cage (or rib
cage) and the diaphragm, protect and support these functions.
Respiratory System Conducting passages:
THE BRONCHIAL TREE:
The branching pattern of airways is often referred to as the ‘bronchial tree’. The airways divide and
subdivide again. In all, there are approximately 23 generations (divisions) of airway in the human
lung.
The trachea bifurcates into the right and left main bronchi, which then supply their respective lungs.
This point of bifurcation is termed the ‘carina’. The right main bronchus branches off from the
trachea at an angle of 20–30 degrees, while the left main bronchus branches off at an angle of 45–55
degrees. As the right main bronchus is more vertical than the left, aspirated food and drink are more
likely to end up in the right lung if the person is in an upright position.
Follow:
Each main bronchus then divides into lobar bronchi: three on the right and two on the left. Each lobar bronchus
supplies the lobe of a lung and subdivides into segmental bronchi and then bronchi and bronchioles of ever
decreasing size. Finally, terminal bronchioles divide into respiratory bronchioles. Respiratory bronchioles are
hybrid structures and are part bronchiole, part alveoli. The respiratory bronchioles then give rise to the 300
million alveoli that are present in a healthy adult.
Conducting Zone:
The major functions of the conducting zone are to provide a route for incoming and outgoing air, remove debris
and pathogens from the incoming air, and warm and humidify the incoming air. Several structures within the
conducting zone perform other functions as well. The epithelium of the nasal passages, for example, is essential to
sensing odors, and the bronchial epithelium that lines the lungs can metabolize some airborne carcinogens.
Respiratory Zone:
The respiratory zone includes :the respiratory bronchioles,
alveolar ducts, and alveoli, and is the site of oxygen and
carbon dioxide exchange with the blood. The respiratory
bronchioles and the alveolar ducts are responsible for 10%
of the gas exchange. The alveoli are responsible for the
other 90%.
Alveoli:
An alveolar duct is a tube composed of smooth muscle and
connective tissue, which opens into a cluster of alveoli. An alveolus is
one of the many small, grape-like sacs that are attached to the
alveolar ducts.
An alveolar sac is a cluster of many individual alveoli that are
responsible for gas exchange. An alveolus is approximately 200 mm
in diameter with elastic walls that allow the alveolus to stretch during
air intake, which greatly increases the surface area available for gas
exchange. Alveoli are connected to their neighbors by alveolar
pores, which help maintain equal air pressure throughout the alveoli
and lung.
Follow:
❑ The alveolar wall consists of three major cell types: type I alveolar cells, type II
alveolar cells, and alveolar macrophages.
A type I alveolar cell :is a squamous epithelial cell of the alveoli, which constitute
up to 97 percent of the alveolar surface area. These cells are about 25 nm thick
and are highly permeable to gases.
A type II alveolar cell :is interspersed among the type I cells and secretes
pulmonary surfactant, a substance composed of phospholipids and proteins that
reduces the surface tension of the alveoli.
Roaming around the alveolar wall is the alveolar macrophage: a phagocytic cell
of the immune system that removes debris and pathogens that have reached the
alveoli.
Pulmonary Surfactant:
Pulmonary surfactant is a surface-active lipoprotein complex,
secreted by type II alveolar cells. The main lipid component of
surfactant (dipalmitoylphosphatidylcholine) reduces surface tension
and increases pulmonary compliance. This prevents the lung from
collapsing at the end of expiration.
In humans, surfactant production begins in type II alveolar cells
during the terminal sac stage of lung development. Lamellar bodies
appear in the cytoplasm at about 20 weeks’ gestation.
Follow:
Babies born prematurely before 28–32 weeks’ gestation may develop infant respiratory
distress syndrome (IRDS), characterized by:
1-poor lung compliance
2-increased work of breathing.
3-Reduced surfactant production.
4-Increased surface tension.
5-Decreased lung compliance.
6-Atelectasis.
BRONCHIAL TREE:
The lung:
The spongy, pinkish organ looks like two upside-down cones in the chest. The right lung
.is made up of three lobes. The left lung has only two lobes to make room for your heart.
Follow:
❑ LUNGS AND PLEURAE: The cone-shaped lungs are located in the thoracic
cage and are positioned vertically around the heart.
❑ The two lungs contain millions of alveoli within a broelastic matrix. They do not
have a very rigid structure and are held in contact with the rib cage by negative
pressure between the pleural surfaces. The resting volume of the lung is
determined by the outward spring of the rib cage and the inward elastic recoil of
the lung matrix.
❑ Expansion and contraction of the lung involves the controlled stretching or
relaxation of the lung by the respiratory muscles. The position of lung resting
volume can be influenced if the lung is stiffer than usual (as in interstitial
disease) or if it is more compliant (as when damaged by emphysema).
Follow:
The lungs are divided into lobes. The right lung is larger and has three lobes: upper, middle,
and lower.
The left lung has just two lobes: upper and lower.
The left lung is smaller because the heart is situated to the left of the midline and therefore some
of the space of the left lung is taken up by the heart (cardiac notch).
The lobes of the lungs are separated by fissures:
➢ The right lung is divided by the horizontal fissure(Which separates the upper and middle lobe)
and the oblique fissure (which separates the lower lobe from the upper and middle lobe).
The left lung only has two lobes and therefore just has an oblique fissure (between the upper
and lower lobe). Each lobe of the lung is divided into bronchopulmonary segments. There are 10
bronchopulmonary segments in the right lung and eight in the left lung.
Cardiopulmonary segment:
Follow:
A bronchopulmonary segment is a functionally and anatomically independent unit of the lung
that has its segmental bronchus, artery, and vein.
Segments are separated from one another by connective tissue septa.
This means that if an isolated tumor or disease is present in one bronchopulmonary segment,
it can be surgically removed (segmentectomy), causing minimal disruption to adjacent
segments of the lung.
Respiratory physiotherapists should be familiar with the names of the bronchopulmonary
segments and the anatomical position of each segmental bronchus.
Follow:
The lungs are covered with a thin double-layered serous sac called the ‘pleural membrane’. The outer
layer of the membrane is the parietal pleura and the inner layer is the visceral pleura). The parietal
pleura lines the inner surface of the thoracic wall and the superior surface of the diaphragm.
The visceral pleura covers the outer surface of the lungs and also lines the fissures. The potential
space between the parietal and visceral pleurae is the pleural cavity, and this contains a small amount
of pleural fluid.
which acts as a lubricant, allowing the two pleural layers to glide over each other during inspiration
and expiration.
Pleural cavity:
THE THORACIC CAGE:
To maintain their shape, the lungs depend on the support of the rib cage, negative pressure between
the pleural surfaces, and the patency of the airways and alveoli.
The expansion of the rib cage by the respiratory muscles is responsible for the tidal flow of gas into
and out of the lungs. Over the past few years, there has been increasing awareness of the importance
of dysfunction of the respiratory muscles and the bony rib cage in contributing to respiratory
failure. Such conditions include myopathies and polio, as well as skeletal malformations such as
scoliosis, which decrease rib cage compliance and reduce the effectiveness of the musculature.
The thoracic cage is cone-shaped with its wider end inferiorly. It is made up of the thoracic
vertebrae dorsally, the ribs laterally and the sternum and costal cartilages anteriorly.
One function of the thoracic cage is to protect the heart, lungs, and great vessels.
It also provides support for the pectoral girdle and upper limbs and provides a point of attachment
for the neck, trunk, and upper limb muscles. Finally, the rib cage allows the movement necessary for
breathing.
Follow:
There are 12 pairs of ribs and they slope inferiorly as they curve anteriorly. All
the ribs attach posteriorly to the thoracic vertebrae. Ribs are termed ‘true’,
‘false’ or ‘floating’ according to their anterior attachment.
The true ribs (1–7) attach directly to the sternum by individual costal
cartilages. The false ribs (8–10) attach to the sternum indirectly, each joining
the costal cartilage immediately above it. The floating ribs (11–12) have no
anterior attachment.
Movements of the Ribs: The dimensions of the thorax must change in order for
respiration to occur. The vertical, transverse and antero-posterior (AP)
diameters of the thorax increase during inspiration and decrease during
expiration. This rib movement is brought about by the inspiratory muscles
(external intercostals and diaphragm).
Follow:
Rib 1 is capable of very little movement because it is so short and firmly attached
to the manubrium by the first costal cartilage.
The anterior ends of ribs 2–5 are raised during inspiration, along with the body of
the sternum. This increases the AP diameter of the thorax and is known as ‘pump
handle movement’.
Inspiration causes the anterior ends of ribs 8–10 to move in an upward and
outwards direction. This increases the transverse diameter of the thorax. The
resultant upward and outward movement of the shaft of the ribs has been
compared to lifting the handle from the side of a bucket and is termed ‘bucket
handle movement’.
Ribs 6 and 7 are capable of both pump and bucket handle movement.
Ribs 11–12 do not contribute to increasing the diameter of the thorax as they have
no anterior attachment.
AIRWAYS RESISTANCE:
▪ Airways resistance’ refers to the resistance of the respiratory tract to air during
inspiration and expiration. The amount of airways resistance is dependent on the
calibre of the airway, therefore, in general terms the smaller the airway the
greater the resistance.
▪ Airway resistance is an essential parameter of lung function and results from the
frictional forces of the airways, which oppose airflow.
▪ At physiologic levels, airway resistance in the trachea is responsible for turbulent
airflow, while airway resistance in the bronchi and bronchioles allows for more
laminar airflow, in which air smoothly flows to the distal segments of the lungs.
▪ When airway resistance is elevated, as seen with certain pulmonary diseases, air
can become trapped in the lungs, limiting gas exchange and possibly causing
respiratory failure in severe cases.
CONTROL OF BREATHING:
❑ Origin of Breathing:
The respiratory system has no intrinsic driving system like the heart;
therefore it is totally dependent on an external neural drive. The origin of
breathing occurs in respiratory control centres (RCCs) in the brainstem and
occurs automatically without any conscious effort.
The purpose of breathing is to provide adequate VA, i.e. oxygen (O2)
delivery and carbon dioxide (CO2) excretion. VA alters in response to
changing environmental or metabolic demands, e.g. exercise. Adequate VA is
essential to maintain a neutral acid–base balance (7.35–7.45 kPa), which
provides an optimal environment for cellular function.
Respiratory Control Centres (RCCs):
There are four main centres in the brainstem
which regulate respiration:
■ Inspiratory centre ( medulla).
■ Expiratory centre ( medulla).
■ Pneumotaxic centre ( pons).
■ Apneustic centre ( pons).
Follow:
The respiratory center is responsible for generating and maintaining the rhythm of respiration, and
also of adjusting this in homeostatic response to physiological changes.
The respiratory center receives input from chemoreceptors, mechanoreceptors, the cerebral cortex,
and the hypothalamus in order to regulate the rate and depth of breathing.
Input is stimulated by altered levels of oxygen, carbon dioxide, and blood pH, by hormonal changes
relating to stress and anxiety from the hypothalamus, and also by signals from the cerebral cortex to give
a conscious control of respiration.
Injury to respiratory groups can cause various breathing disorders that may require mechanical
ventilation, and is usually associated with a poor prognosis.
The pathway of a breath:
When breathe, air enters through mouth and nose and travels:
• down the throat into the trachea
• into the lungs through the right and left main bronchi
• into the smaller bronchi airways
• into the even smaller bronchiole tubes
• into the alveoli
Each alveolus is covered by a net of tiny blood vessels called capillaries.
Oxygen and carbon dioxide exchange happens here.
Then heart sends deoxygenated blood to the lungs. This is blood that is carrying carbon
dioxide rather than oxygen.
The muscles of respiration:
The muscles of respiration are those muscles that contribute to
inhalation and exhalation, by aiding in the expansion and
contraction of the thoracic cavity. The diaphragm and the
intercostal muscles drive respiration during quiet breathing. The
elasticity of these muscles is crucial to the health of the
respiratory system and to maximize its functional capabilities.
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Respiratory Diseases:
• Chronic obstructive pulmonary disease (COPD). This long-term condition gets worse over time. It includes
bronchitis and emphysema.
• Pneumonia. An infection causes inflammation in the alveoli.
• Tuberculosis. A bacterium causes this dangerous infection. It usually affects the lungs but might also involve
your kidney, spine, or brain.
• Lung cancer. Cells in your lung change and grow into a tumor. This often happens because of smoking or
other chemicals you’ve breathed in.
• Cystic fibrosis. This disease is caused by a problem in your genes and gets worse over time. It causes lung
infections that don’t go away.
• Pleural effusion. Too much fluid builds up between the tissues that line your lungs and chest.
• Idiopathic pulmonary fibrosis. Your lung tissue becomes scarred and can’t work the way it should.
• Sarcoidosis. Tiny clumps of inflammatory cells called granulomas form, often in your lungs and lymph nodes.
Overview chest physical therapy modalities:
1-Relaxation (mental and physical).
2-Massage (muscles, skin traction, reflexology).
3-Respiratry exercises.
4-Cough and huff. 10-aerobic training.
5-Hydrotherapy.
6-Electrotherapy.
7-Stretching exercises.
8-Poture correction exercises.
9-Burgers exercises.