DPT 6240 Cardiopulmonary Study Notes

Cardiopulmonary

Objectives

  1. Describe the pericardium and its relationship to the heart

  2. Identify the heart structures and functions

  3. Describe the major blood supply to the heart

  4. Identify the autonomic nervous system including anatomical location, structure, and characteristics

  5. Identify the pleura and their relationship to the lungs

  6. Identify the structures and function of the lungs

  7. Identify the major blood supply and lymphatic drainage of the lungs

  8. Discuss the components of the cardiopulmonary screen

  9. Identify the areas to auscultate lung sounds for each lobe/segment

  10. Identify the areas to auscultate for heart sounds

  11. Discuss the importance of heart and lung anatomy to PT intervention

Heart

Surfaces

  • Apex: The tip of the heart, oriented downwards and to the left.

  • Base: The broader top part of the heart from which major vessels emerge.

Pericardium

  • The heart is encased in the pericardium, a double-walled sac that contains pericardial fluid to reduce friction during heartbeats.

  • Phrenic nerve: Supplies sensation to the pericardium.

Views

(A) Anterior view

  • Boundary between right and left ventricles: Notable for surface anatomy and auscultation points.

(B) Postero-inferior view

  • Identifies the major structural aspects of the heart from the back and below.

Key Anatomical Features

  • Aorta (A)

  • Arch of aorta (AR)

  • Inferior vena cava (IVC)

  • Left brachiocephalic vein (LBV)

  • Left pulmonary artery (LPA)

  • Left pulmonary vein (LPV)

  • Pulmonary trunk (PT)

  • Right brachiocephalic vein (RBV)

  • Right pulmonary vein (RPV)

  • Superior vena cava (SVC)

  • Location of the transverse pericardial sinus and the oblique pericardial sinus.

Heart Surfaces

  • Diaphragmatic Surface: The underside of the heart, adjacent to the diaphragm.

  • Sternocostal Surface: The anterior aspect of the heart facing the sternum.

  • Pulmonary Surfaces: Areas that accommodate adjacent lung structures.

  • Borders:

    • Right border

    • Superior border

    • Left border

    • Inferior border

Vascular Supply

  • Aorta: Divided into sections including Ascending, Arch, and Descending/Thoracic.

  • Right coronary artery (RCA): Supplies the right side of the heart, including the posterior interventricular septum.

  • Left coronary artery (LCA): Branches into the anterior interventricular artery (Left Anterior Descending, LAD) and the circumflex artery, which supplies the left side of the heart.

  • Coronary Sinus: Major vein that collects venous blood from the heart muscle and drains into the right atrium.

Heart Chambers

  • Right Atrium: Receives deoxygenated blood from the superior vena cava, inferior vena cava, and coronary sinus.

  • Right Ventricle: Pumps deoxygenated blood to the lungs via pulmonary arteries; contains the tricuspid valve and leads to the pulmonary trunk.

  • Left Atrium: Receives oxygenated blood from pulmonary veins.

  • Left Ventricle: Largest chamber, pumps oxygenated blood to the rest of the body; contains the mitral (bicuspid) valve and the aortic valve.

Autonomic Function of the Heart

  • Sinoatrial node (SA node): Primary pacemaker of the heart, located in the right atrium.

  • Atrioventricular node (AV node): Connects the atria and ventricles, conducting impulses through the cardiac conduction system.

  • Cardiac Plexus: Composed of sympathetic and parasympathetic fibers that regulate heart rate and contractility.

Lung Anatomy

Pleura

  • Visceral pleura: Covers the lungs directly.

  • Parietal pleura: Lines the thoracic cavity.

  • Parts of Parietal Pleura:

    • Cervical: Covers the apex of the lung.

    • Costal: Lies adjacent to the ribs.

    • Diaphragmatic: Covers the diaphragm.

    • Mediastinal: Lines the mediastinum.

Bronchi

  • Main (Primary) Bronchi: The initial branches of the trachea that lead into the lungs.

  • Lobar Bronchi: Branch into secondary bronchi that supply each lobe of the lung.

Lung Lobes (Right and Left)

Right Lobes:

  • Superior lobe: Contains apical, posterior, anterior segments.

  • Middle lobe: Includes lateral and medial segments.

  • Inferior lobe: Consists of superior and basal segments.

Left Lobes:

  • Superior lobe: Contains apical, posterior, anterior, and lingular segments.

  • Inferior lobe: Includes superior and basal segments.

Thoracic Movements

  • Bucket-handle motion: Refers to the lateral movements of the ribs during inspiration.

  • Pump-handle or pendulum motion: Describes the anterior-posterior movements of the upper ribs.

Heart Auscultations

  • Aortic Region: Right 2nd intercostal space, parasternal.

  • Pulmonic Region: Left 2nd intercostal space, parasternal.

  • Erb’s Point: Left 3rd intercostal space, Left Lower Sternal Border.

  • Tricuspid Region: Left 4th intercostal space, parasternal.

  • Mitral Region: Left 5th intercostal space, midclavicular line.

Lung Auscultation

  • Anterior apical segments: Auscultate at the clavicle (superior segment of upper lobe).

  • Middle lobe: Posteriorly from T3 spinal level using the spine of scapula as a reference.

  • Basal segments of lower lobe: Located from the xyphoid inferiorly and laterally.