Physical Therapy Respiratory and Cardiovascular System Overview (Ch. 10)

Physical Therapy

Respiratory and Cardiovascular System

Overview (Ch. 10)

Respiratory System

The respiratory system facilitates the exchange of gases between the air and the blood.

1. Providing a large area for gas exchange between air and the circulating blood.

2. Moving air to and from the exchange surfaces of the lungs.

3. Protecting respiratory surfaces from dehydration, temperature changes, or other environmental variations.

Functions of the Respiratory System:

Functions of the Respiratory System:

4. Defending the respiratory system and other tissues from invasion by pathogenic microorganisms.

5. Producing sounds involved in speaking, singing, or non-verbal communication.

6. Assisting in the regulation of blood volume, blood pressure, and the control of body fluid pH.

Organization of the Respiratory System: The Upper Respiratory

System = the nose, nasal cavity, paranasal sinuses, and pharynx

These passageways filter, warm, and humidify the air, protecting the more delicate conduction and exchange surfaces in the lower respiratory system from debris, pathogens, and environmental extremes.

The Lower Respiratory System = larynx, trachea, bronchi, and lungs

The Respiratory Tract = airways that carry air to and from the exchange surfaces to the lungs.

Organization of the Respiratory System:

The delicate air sacs where gas exchange occurs are called alveoli.

Organization of the Respiratory System:

Upper Respiratory Structures:1. The Nose and Nasal Cavities:

The nose is the primary passageway for air entering the respiratory system. Air enters the respiratory system

through the paired external nares.

The vestibule is the portion of the nasal cavity contained within the flexible tissue of the external nose.

The nasal septum divides the nasal cavity into left and right portions.

To flow from the vestibule into the internal nasal cavity, air must flow between the 3 sets of nasal conchae (superior, medial, and inferior), which cause turbulence in the air in order to catch airborne particles in the mucus and prevent it from traveling further into the system.

Upper Respiratory Structures:

2. The pharynx (Fair-inks): the common passageway formed by the combination of the nose, mouth, and throat.

The pharynx is shared by the digestive and respiratory systems.


3 portions of the pharynx: The nasopharynx = the superior portion,

connected to the posterior portion of the nasal cavity

The oropharynx = extends from the posterior portion of the oral cavity, between the soft palate and the base of the tongue

The laryngopharynx = the portion of the pharynx between the hyoid bone and the entrance to the esophagus


Lower Respiratory Structures: 1. The larynx (Lar-inks):

surrounds and protects the narrow opening connecting the pharynx with the lower respiratory system, called the glottis.

3 large cartilages form the body of the larynx: The thyroid cartilage: a.k.a. Adam’s

apple The cricoid cartilage: ring-shaped;

combines with the thyroid cartilage to protect the glottis

The epiglottis: a shoehorn shaped cartilage located just above the glottis. When you swallow, it folds over the glottis to prevent the entry of liquids or solid food into the respiratory pathways.

Lower Respiratory Structures:

2. The trachea: a.k.a. windpipe Connects directly with the larynx It branches to form the right and left primary

bronchi.


3. The primary bronchiThe right primary

bronchus is larger in diameter than the left, and descends at a steeper angle.


4. The lungs: Right lung: 3 lobes = superior, middle, and

inferior Horizontal fissure separates superior and

middle lobesOblique fissure separates the superior and

inferior lobes


Left lung: 2 lobes = superior and inferior (separated by oblique fissure)


Why is the right lung larger than the left lung?

Because the heart and great vessels are located in the left pleural cavity

Descending size of respiratory structures:

Trachea Bronchi Bronchioles Alveoli


Common Respiratory Conditions

1. Sinusitis = An inflammation of the paranasal sinuses

Cause: Upper respiratory infection caused by bacteria; causes swelling and blockage of paranasal sinuses and pressure due to the accumulation of mucus.

Sx/Signs: Skin over sinuses may be swollen and painful to the touch, headache and malaise (a vague feeling of discomfort) may be present, and greenish or yellow nasal discharge may occur.

Tx: Antibiotics are needed if mucus is purulent. Steam inhalation and other nasal sprays (like Afrin) can help with drainage.

1. Sinusitis

a.k.a. Sore throat Cause: viral (if it’s mono) or bacterial

(strep. throat) infection, or tonsillitis Transmission is usually occurs through

direct contact with an actively infected person or one who is a carrier.

Can also be caused by ingestion of contaminated food (strep. infection).

2. Pharyngitis

Sx/Signs: Characterized by pain with swallowing, fever, inflamed or swollen lymph glands, swollen tonsils, malaise, weakness, and anorexia (loss of appetite). The mucous membranes of the throat may be severely inflamed with a covering of purulent matter. A throat culture may be necessary is a strep. infection is suspected.

Tx: Topical gargles and rest may be warranted. Antibiotic therapy is given for a strep. infection.

Complications: Scarlet fever or rheumatic fever

2. Pharyngitis

a.k.a. Inflamed tonsils Tonsils are pieces of lymphatic tissue

at the entrance to the pharynx. Cause: Ingested or inhaled pathogens

that collect in the pits of the tonsils or penetrate the epithelial tissue can come into contact with the lymphocytes and cause acute inflammation and bacterial infection.

3. Tonsillitis

Complications: sinusitis, middle ear infections (otitis media), or tonsillar abscess

Sx/Signs: Tonsils appear red, inflamed, and swollen, often with yellowish exudates. The athlete has difficulty swallowing and may have associated fever and chills. Headache and neck or back pain may also be associated.

3. Tonsillitis

Tx: If there is a white or yellowish exudates, the throat should be cultured for strep., and if positive, it should be treated with antibiotics. Gargling with warm salt water, a liquid diet, and anti-pyretics should all be recommended.

Frequent bouts of tonsillitis may necessitate surgical removal.

3. Tonsillitis

a.k.a. Hay fever or seasonal allergies (due to airborne pollens)

Cause: Hay fever usually occurs in the spring as a reaction to pollens from trees (oak, elm, maple, cottonwood). In the summer, grass and weed pollens are the main causes, and in the fall, ragweed. All these substances cause an allergic reaction in susceptible people.

The body’s immune system produces allergic antibodies that release the chemical histamine, which produces symptoms.

4. Seasonal Atopic (Allergic) Rhinitis

Sx/signs: Early = eyes, throat, mouth, and nose will itch. Next watery eyes, sneezing, headache, irritability, trouble sleeping, red/swollen eyes and nasal mucous membranes, and a wheezing cough.

Tx: Usually relief comes through use of antihistamines, but unfortunately one of the side-effects is drowsiness (because they have a sedating effect). The use of decongestants may produce a stimulating effect.

4. Seasonal Atopic (Allergic) Rhinitis

Inflammation of the mucous membranes of the bronchial tubes.

Cause: usually an infectious disease in the winter. It often follows a common cold or other viral infection. It may be worsened by overexposure to air pollution.

Predisposing factors: fatigue, malnutrition, or becoming chilled

5. Acute Bronchitis

Sx/signs: Usually start with symptoms of an upper respiratory infection, nasal inflammation and profuse discharge, slight fever, sore throat, and back and muscle pains. A cough signals the beginning of bronchitis. The cough is dry at first, but after a few hours or days, it may produce clear or yellow secretions, indicating infection. The fever lasts 3-5 days, and the cough lasts 2-3 weeks or longer.

Pneumonia can complicate bronchitis.

5. Acute Bronchitis

To avoid bronchitis, the athlete should not sleep or exercise in an extremely cold area without wearing a facemask that warms the inhaled air.

Tx: Rest until fever subsides, drink 3-4 quarts of water per day, and ingest an anti-pyretic and an analgesic, a cough suppressant, and an antibiotic (if infection is present).

5. Acute Bronchitis

Cause: an infection of the alveoli and bronchioles that may be cause by viral, bacterial, or fungal microorganisms. May also be caused by irritation from chemicals, aspiration of vomit, or other agents. The alveolar spaces become filled with exudates, inflammatory cells, and fibrin.

6. Pneumonia

Sx/signs: If it is bacterial, there will be a rapid onset. High fever with chills, pain on inspiration, decreased breath sounds, and coughing up yellow-colored sputum are all associated with bacterial infection.

Tx: Antibiotics are required. Deep breathing and the removal of sputum through productive coughing are helpful. Analgesics and antipyretics may also be used.

6. Pneumonia

Cause: stressors such as viral respiratory tract infection, emotional upset, changes in barometric pressure or temperature, exercise, inhalation of harmful odors, or exposure to a specific allergen.

Sx/Signs: characterized by a spasm of the bronchial smooth muscles, edema, and inflammation of the mucous membrane. Additionally, a large amount of mucous is produced. Difficulty breathing may result in hyperventilation, which may cause the athlete to become dizzy.

7. Bronchial Asthma

■ Tx: Attempt to relax and reassure the athlete. If they have medication, have them use it (but not to borrow from someone else). Encourage the athlete to drink water, and perform controlled breathing or relaxation exercises. If an environmental trigger is suspected, remove the athlete from the area. If none of this works, seek immediate medical attention.

7. Bronchial Asthma

a.k.a. Exercise Induced Asthma This condition can be present without

any other form of asthma. Cause: an attack can be caused by

exercise in some people. The exact cause is unclear. Loss of heat and water causes the greatest loss of airway reactivity. Sinusitis can trigger an attack in those with chronic asthma.

8. Exercise Induced Bronchial Obstruction

Sx/signs: The athlete with EIA often displays an airway narrowing caused by bronchial-wall spasm and excess mucous production. Athletes with a chronic inflammatory asthmatic condition characteristically have a constant dilation of the bronchi and bronchioles. There is chest tightness, breathlessness, coughing, and wheezing. The athlete with EIA may show signs of nausea, hypertension, fatigue, respiratory stridor (high-pitched wheezing), headaches, and skin redness. Symptoms may occur within 3-8 minutes of strenuous activity.

8. Exercise Induced Bronchial Obstruction

Tx: Swimming produces the fewest bronchospasms, probably because of the warm, moist environment. A regular exercise program can benefit asthmatics, including conditioning and running longer distances. Exercise is best performed in warm, humid conditions. A mask or scarf may be beneficial in avoiding cold, dry air. Slow nasal breathing is suggested, and athletes should avoid exercise in areas with high levels or air pollution or pollen. The most commonly prescribed B2 agonist for EIA is albuterol, which acts for about 2 hours. It should be given 15 minutes before exercise. Metered dose inhalers are the preferred method of administration. It has been found that use of bronchodilators fifteen minutes prior to exercise can delay the onset of symptoms by two to four hours.

Cause: a genetic disorder that can affect many different body systems. It can manifest as a type of COPD, increased electrolytes in sweat, or other dysfunctions. It usually begins in infancy, and is a major cause of severe chronic lung disease in children. Maximum life expectancy is 30 years.

9. Cystic Fibrosis

Sx/signs: Physical symptoms may include bronchitis, pneumonia, respiratory failure, gallbladder diseases, diabetes, and nutritional deficiencies. There is an abnormally high production of mucus secretions in the lungs.

9. Cystic Fibrosis

Tx: Drug therapy, including ibuprofen, can help slow the progress of the disease. Antibiotics are used to control pulmonary disease. The patient must undergo consistent postural drainage, using a cupping or hacking massage technique followed by deep breathing and coughing to mobilize secretions. High fluid intake and breathing humidified air are also recommended.

9. Cystic Fibrosis

The Heart and Circulatory System

All functions of the Cardiovascular System ultimately depend on the heart.

Movement of blood through the Heart:Right Atrium = Receives blood from the

systemic circuit.Right Ventricle = Discharges blood into

the pulmonary circuit for oxygenation.Left Atrium = Collects blood from the

pulmonary circuit.Left Ventricle = Ejects blood into the

systemic circuit.

The Heart

The Heart

Anatomy of the Heart:1. The Right Atrium: Receives blood from

the systemic circuit via the two great veins: The superior vena cava: Returns blood

from the head, neck, upper extremities and chest.

The inferior vena cava: Carries blood from the rest of the trunk, the viscera, and the lower extremities.

2. The Right Ventricle: Blood travels from the right atrium to the right ventricle through a broad opening bound by 3 flaps, or cusps, known as the tricuspid valve.

Blood is ejected out the top of the right ventricle into the pulmonary trunk, then into the right and left pulmonary arteries where it receives oxygenation in the lungs.

Anatomy of the Heart:

3. The Left Atrium: Receives blood from right and left pulmonary veins.

Blood leaves the atrium through the bicuspid, or mitral valve.


4. The Left Ventricle (The largest and thickest of the heart chambers)

Why is it so large? Because it has to pump blood to the

entire body. Blood leaves the left ventricle and enters the

ascending aorta.


A network of blood vessels that carry blood between the heart and peripheral tissues.

2 Subdivisions: Pulmonary Circuit =

Carries blood to and from the exchange surfaces of the lungs.

Systemic Circuit = Transports blood to and from the rest of the body.

Each circuit begins and ends at the heart.

The Circulatory System

Types of Blood Vessels: Arteries: Carry

blood away from the heart.

Veins: Return blood to the heart.

Capillaries: Small, thin-walled vessels that interconnect the smallest arteries and veins.

How do you tell the difference between arteries and veins??

In general, arteries have thicker walls than veins (because they have more smooth muscle and elastic fibers than veins).

When not opposed by blood pressure, arterial walls contract, and retain their circular shape. Veins that have no blood supply tend to collapse and become flat.

Anatomy of the Blood Vessels:Arteries: Elastic Arteries: Examples = pulmonary artery,

aortic trunk Muscular Arteries: Examples = the carotid artery, the

brachial arteries, the femoral arteries

Arterioles: considerably smaller than medium-sized arteries.

What important reaction occurs in the arterioles?

Vasoconstriction/dilation

Veins: collect blood from all tissues and organs and return it to the heart.

Large Veins: e.g. superior and inferior venae cavae

Medium-sized Veins: Contain relatively few smooth muscle fibers.

Venules: resemble expanded capillaries.

Anatomy of the Blood Vessels:

Capillaries: The only blood vessels whose walls permit exchange between the blood and the surrounding interstitial fluids.

The walls are relatively thin, providing small diffusion distances so that exchanges can occur quickly.


2 forms: Continuous = complete

lining connected with tight junctions

Fenestrated = capillaries that have pores or “windows” due to an incomplete or perforated endothelial lining

Locations brain, various glands, & filtration sites of the kidneys


The human body contains about 5 liters of blood:

1.5 liters (30-35%) in the heart, arteries, and capillaries, and about 3.5 liters in the venous system (65-70%).

Distribution of Blood

Functions of the Heart and Circulatory System:

Organ Primary Function

Heart Propels blood, maintains blood pressure

Blood Vessels Distribute blood around the body

Arteries Carry blood from the heart to the capillaries

Capillaries Site of diffusion between blood and interstitial fluid

Veins Return blood from capillaries to the heart

Blood Transports oxygen and carbon dioxide, delivers nutrients and hormones, removes waste

products, assists in defense against disease

Any questions????

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Physical Therapy Respiratory and Cardiovascular System Overview (Ch. 10)