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Week 6 - Anatomy of the Thorax
w6
160
Pharmacology
Undergraduate 1
01/15/2016

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Term
What 3 bones make up the sternum? What joint is in the sternum?
Definition
Manubrium
Mesosternum (body)
Xiphoid process

Xiphisternal joint
Term
What are the 3 skeletal components of the thoracic cage?
Definition
Thoracic vertebrae and IVDs
Ribs and intercostal cartilages
Sternum
Term
Name the muscles in the thoracic cage
Definition
Intercostal muscles
Term
What are the neurovascular components of the thoracic cage?
Definition
Intercostal nerves, arteries and veins
Term
What is the thoracic inlet?
Definition
where the thoracic cavity communicates with the neck
Term
What is the thoracic outlet?
Definition
where the thoracic cavity communicates with the abdomen
Term
What are the functions of the thoracic cavity?
Definition
- protecting vital organs (including upper abdominal organs)
- chancging volume to facillitate movement of air into and out of lungs
Term
What is the diaphragm? What does it contain?
Definition
- muscular partition between the abdominopelvic and thoracic cavity that closes off the thoracic outlet.
- contains arpetures that allow passage of structures (vessels, nerves, oesophagus) to and from abdomen
- innervated by the Phrenic nerve
Term
What are the 3 apertures in the diaphragm and what vertebrae do they correspond to?
Definition
Caval opening T8/9
Oseophagus hiatus T10
Aortic opening T12
Term
What are the external intercostal muscles, which direction do they go in and what effect do they have on the ribs?
Definition
- complete sheet of muscles in the direction as if you were putting hands in pockets
- elevates ribs
Term
What are the internal intercostal muscles, which direction do they go in and what effect do they have on the ribs?
Definition
- complete sheet of muscles in the direction as if you were putting hands in back pockets
- depresses ribs
Term
What are found between the internal and external intercostal muscles?
Definition
Intercostal nerve
Intercostal artery
Intercostal vein
Term
How do the upper ribs change the volume of the thoracic cage?
Definition
Increase diameter via a pump handle movement
superior and anterior movement of sternum
Term
How do the lower ribs change the volume of the thoracic cage?
Definition
Increase transverse diameter via a bucket handle movement
Elevation of lateral shaft of rib.
Term
What are the subdivisions of the thoracic cavity?
Definition
- Trachea divides into 2 primary bronchi
- 2 x pulmonary cavities (lined by a layer of parietal pleura)
- Midline region (mediastinum)
Term
What does the mediastinum enclose?
Definition
encloses heart, major vessels and nerves, trachea and osephagus)
Term
What is each lung surrounded by?
Definition
2 membranous layers: parietal and visceral pleura (together they make the visceral sac)
between the two is the pleural cavity
Term
What does the pleural cavity contain and what is its function?
Definition
a thin film of serous pleural fluid:
-reduced friction
-creates surface tension between the parietal and visceral layers to aid inspiration
Term
What causes a collapsed lung?
Definition
air in the pleural cavity
Term
Which pleura is in contact with the lung surface?
Definition
Visceral
Term
How many lobes do each lung have?
Definition
Right has 3:
- Superior, middle and inferior
Left has 2:
- superior and inferior
Term
What hangs off the superior left lobe?
Definition
Lingula
Term
Describe the subdivisions of the mediastinum and where they are seperated
Definition
horizontal plane passing through the sternal angle and the lower border of the 4th thoracic vertebra.
Split into superior and inferior mediastinum.
Inferior is further split into posterior, middle and anterior.
Term
Structures within the superior mediastinum include:
Definition
Arch of the Aorta
Superior Vena Cava
Brachiocephalic Trunk
Left Subclavian Artery
Left Common Carotid Artery
Trachea
Oesophagus
Term
What is the heart enclosed in?
Definition
a pericardial sac which consists of 2 layers: Fibrous and Serous Pericardia
Term
What does the serous pericardium consist of?
Definition
2 layers. The parietal and visceral layers are reflected at the base of the heart (great vessel roots)
Term
What is the role of the fibrous pericardium?
Definition
surrounds the serous pericardium, and serves a protective function
Term
What are the 3 layers of the hear? Inner to outer
Definition
Endocardium
Myocardium
Epicardium
Term
What is the endocardium?
Definition
continuous with the endothelium of the vessels
Term
What is the myocardium?
Definition
composed of cardiac muscle
Term
What is the epicardium?
Definition
consists of visceral serous pericardium
Term
What the valves in the heart?
Definition
Aortic
Pulmonary
Tricuspid
Mitral
Term
Where does the Right atrium receive blood from?
Definition
VENOUS blood
IVC
SVC
Coronary sinus
Term
Where does blood exits the right atrium to?
Definition
Right ventricle via the tricuspid valve
Term
Describe the internal structure of the right atrium?
Definition
Posterior: smooth thin wall at which SVC, IVC and coronary sinus drain
Anterior: rough muscular wall composed of pectinate muscles
Atrioventricular orifice: deoxygenated blood flows to RV
Term
What divides the smooth and rough parts?
Definition
a ridge called the crista terminalis
Term
What is the fossa ovalis?
Definition
a depression between the atria
Term
Where does blood exit the right ventricle?
Definition
Blood exits to the Pulmonary Trunk via the Pulmonary Valve
Term
What are trabeculae carneae?
Definition
irregular muscular projections in the RV
Term
What does the RV narrow into superiorly? and what is it bordered by?
Definition
the conus arteriosus which leads to the pulmonary trunk. This is bordered by a muscular ridge: the supraventricular crest.
Term
Where does the LA receive blood from?
Definition
Receives OXYGENATED blood from the valve-less Pulmonary Veins
Term
Which atria has a thicker wall?
Definition
LA
Term
Describe the internal structure of the left atrium?
Definition
- large smooth wall and a muscular auricle containing pectinate muscles
- four pulmonary entering the smooth posterior wall
- atrioventricular orifice: oxygenated blood moved to the LV via mitral valve
Term
Where does the LV discharge blood to?
Definition
aorta via the aortic valve
Term
What are the LV walls covered by?
Definition
a network of delicate trabeculae carneae (finer and more numerous than found in the RV)
Term
What do pulmonary arteries do?
Definition
carry blood away from the heart. These are the only arteries in the body that carry DEOXYGENATED blood.
Term
What do pulmonary veins do?
Definition
carry blood towards the heart. These are the only veins in the body that carry OXYGENATED blood.
Term
Describe the thoracic aorta
Definition
Descends through the thorax in the posterior mediastinum
Passes through diaphragm at T12
Term
Where does the Cardiac AP originate from?
Definition
SAN (right atrium)
The cells in the SAN exhibit autorhythmicity and are called pacemaker cells
Term
Describe a pacemaker cells resting membrane potential
Definition
unsteady
Term
What happens to the membrane after an AP?
Definition
After an AP, the membrane immediately begins to depolarise until threshold is reached and another AP is triggered
Term
Describe the Electrical Activity in Pacemaker Cells of the Heart
Definition
1. slow depolarisation until threshold is reached
2. rapid depolarisation (AP is reached)
3. repolarisation
Term
Describe the ions involved?
Definition
1. Decreased K, Increased sodium and calcium (slow repolarisation)
2. Increased calcium (rapid deplarisation)
3. Decreased calcium and increased K (repolarisation)
Term
Describe the initiation and conduction of an impulse during a heartbeat
Definition
1. From the SAN the AP spreads through the atrial tissue to the AVN via INTERNODAL TRACT
2. Impulse sperads into the ventricles via the AV bundle (bundle of his)
3. AV bundle divides into left and right branches (supplying ventricles)
5. impulses spread through the ventricles via the Purkinje fibres
Term
Which nodal cells transmit APs slower and how long is the delay?
Definition
AVN
100 ms
Term
What are the electrical connections between cardiac muscle cells?
Definition
Adjacent cells are coupled electrically- via gap junctions in the intercalated disk
This allows an action potential in one cell to spread rapidly to adjacent cells
Term
Describe phase 4 of Ventricular AP
Definition
At rest (phase 4) K+ permeability is high- this falls during phase 0
When an action potential arrives from a neighbouring cell – membrane becomes more positive and Na+ channels open
Term
Describe phase 0 of ventricular AP
Definition
A rapid influx of Na+ ions underlies the depolarising (phase 0)
Term
Describe phase 1 of ventricular AP
Definition
The upstroke of the action potential is caused by an increase in the permeability of the cells to Na (P Na). These channels close rapidly (2-3 ms) which limits the extent of the depolarisation. Once depolarised (above -40 mV), this opens up L-type Ca channels in the cell membranes increasing the permeability to Ca ions.
Term
Describe phase 2 of ventricular AP
Definition
long plateau phase (2) of the ventricular action potential caused by influx of Ca2+ ions caused by opening of L-type calcium channels
Term
Describe phase 3 of ventricular AP
Definition
Repolarisation due to delcining Ca2+ influx and increased K+ permeability due to opening of delayed K+ channels and closure of L-type calcium channels
Term
How do ECGs work?
Definition
spread of excitation through the myocardium creates small currents flowing through the ECF which can be detected on the body surface
Term
Describe Einthovens triangle
Definition
- 3 electrodes are placed on the limbs/chest to forma a triangle around the heart. Most common lead used is lead II
Term
What does lead II measure?
Definition
the surface electrical potential difference between LL and RA
Term
What does lead II reflect?
Definition
the spread of excitation from a longitudal aspect from base to apex of heart
Term
Define systole
Definition
contraction and ejection
Term
Define diastole
Definition
relaxation and filling
Term
What does the left side pump?
Definition
Blood to the body via the systematic circulation
Term
What does the right side pump?
Definition
Blood to the lungs via the pulmonary circulation
Term
Describe the P wave
Definition
Atrial systole begins and atrial contraction forces blood into the relaxed ventricles. Atrial diastole begins
Term
Describe the QRS complex
Definition
as ventricles contract, ventricular pressure exceeds atrial and the AV valves close. Pressure rises and semilunar valves are forced open, blood is ejected.
Term
Describe the T wave
Definition
Ventricular diastole causes ventricular pressure to drop and semilunar valves shut
Term
What is the lub heart sound
Definition
first sound: closure of the AV valves
Term
What is the dup heart sounds
Definition
second sound: closure of the semilunar valves
Term
What does the P-Q interval represent
Definition
measure of delay between atrial and ventricular depolarisation
Term
What does the Q-T interval represent
Definition
measure of duration of ventricular systole
Term
What does the T-Q interval represent
Definition
measure of duration of ventricular diastole
Term
Define cardiac output and the equation of how it is calculated
Definition
volume of blood pumped by each ventricle per unit of time (Lmin-1)
CO = heart rate x stroke volume
Term
What is the standard heart rate and stroke volume for a 70kg male at rest
therefore what is CO
Definition
heart rate: 75bpm
stroke volume: 75ml
co: 5.25Lmin-1
Term
What is the SAN innervated by?
Definition
both sympathetic and parasympathetic brances of the autonomic nervous system
Term
Which neurotransmitters and released and by what?
Definition
Noradrenaline by postganglionic S fibres
acetylcholine released by P fibres
Term
What are para/sympathetic effects mediated by?
Definition
P: muscarinic receptors
S: beta1-adrenoreceptors
Term
What is the resting and intrinsic frequency of the SAN?
Definition
r: 70bpm
I: 100bpm
Term
define TACHYCARDIA
Definition
an abnormally rapid heart rate.
Term
define BRADYCARDIA
Definition
abnormally slow heart action.
Term
Heart rate is increased by...
Definition
thyroxine, hyperthermia and drugs which mimic the effects of S stimulation or block the dominant P tone (e.g. atropine)
Term
What does parasympathetic stimulation lead to?
Definition
the release of acetylcholine (ACh).

ACh decreases If (inhibits adenylate cyclase and reduces cAMP)- pacemaker potential is slowed and takes longer to reach threshold.

ACh increases the K+ permeability of the SA node cells (via IK-ACh) which hyperpolarises the maximum diastolic potential.
Term
What does sympathetic stimulation lead to?
Definition
Stimulating the SNS leads to the following:
Rise in cAMP increases If so pacemaker potential rate accelerated
Reduction in K+ permeability so MDP more positive
Increased L-type Ca2+ current, so upstroke faster- more action potentials per unit time- tachycardia.
Term
What is stroke volume?
Definition
defined as the volume of blood ejected by each ventricle per heartbeat
SV equals the volume of blood in the ventricle at the end of diastole (end-diastolic volume, EDV) minus the volume of blood remaining at the end of systole (end-systolic volume, ESV)
Term
What is the ejection fraction?
Definition
the fraction of the EDV ejected during the subsequent ventricular contraction
EF = SV / EDV
Term
What regulation is SV subject to?
Definition
both intrinsic and extrinsic
Term
What is the Frank Starling Law
Definition
the strength of contraction depends on the initial degree of stretch: increased EDV leads to increased stoke volume
Term
WHat does end-diastolic volume depend on?
Definition
venous return, which in turn depends on the pressure in the large veins returning blood to the heart: the central venous pressure (CVP)
Term
What are the factors that affect the CVP?
Definition
Blood volume: increased blood volume → increased CVP
Postural changes
Respiratory and skeletal muscle ‘pumps’: these aid venous return and increased CVP
Venoconstriction (via increased sympathetic activity) → increased CVP
Term
Describe the autonomic regulation of SV?
Definition
Sympathetic control
Effects are mediated by beta1-adrenoreceptors, this increases the influx of ca2+ into the ventricular myocyte during an AP
Term
Where is systematic blood pressure greatest?
Definition
in the aorta and declines throughout the circulation to reach 0 mmHg in the right atrium
Term
Where does the steepest drop in systematic blood pressure occur?
Definition
The steepest drop in pressure occurs in the arterioles, which offer the greatest resistance to flow
Term
What is systematic systolic pressure (BPs)
Definition
Highest arterial pressure, corresponds to the systolic phase of the cardiac cycle
(Typical value: 120 mmHg)
Term
What is systematic diastolic pressure (BPd)
Definition
Lowest arterial pressure, corresponds to the diastolic phase of the cardiac cycle (Typical value: 80 mmHg)
Term
What is systematic pulse pressure?
Definition
(BPs - BPd) Typically 40 mmHg
Term
What is Mean Arterial Pressure (MAP)
Definition
Calculated as:
BPd + (Pulse Pressure/3)
Typically (80 + 40/3) = 93 mmHg
Term
What is Darcy's Law
Definition
Fluid flow between 2 points is equal to the difference in pressure between the 2 points divided by the resistance to flow
Term
How is flow calculated?
Definition
Flow = (P1 – P2) / R
Term
How is CO, MAP and TPR related?
Definition
CO = MAP/TPR
Term
What is vasodilation?
Definition
increased local blood flow and increased rates of O2 delivery and CO2 removal
Term
What are baroreceptors?
Definition
receptors that are sensitive to pressure
Term
What does a rise in arterial pressure lead to?
Definition
stretches the arterial wall increasing the discharge rate of the baroreceptors
Term
What does an increase in baroreceptor discharge lead to?
Definition
Increased parasympathetic and decreased sympatheic stimulation of the heart
Decreased CO
Decreased MAP
Term
How much O2 do cells of the body consume each minute? total
Definition
250ml
Term
How much CO2 do cells of the body produce each minute? total
Definition
200ml
Term
How much air does an average male inhale per minute and how much of this reaches the alveoli?
How much is O2?
Definition
6L
4.2L
880ml (21%)
Term
Out of 880ml of O2, how much diffuses into the blood and how much is exhaled?
Definition
250ml in blood
630 expired
Term
How do gases move through cell?
Definition
Active diffusion
Lipid soluble
Term
What does Daltons Law state?
Definition
the pressure exerted by a mixture of gases is equal to the sum of the pressures that would be exerted by the individual gases occupying the same volume alone
Term
What happens to atmospheric air when it is inhaled?
Definition
1. It is mixed with air in the respiratory ‘dead space’, which is relatively rich in CO2 and deficient in O2
2. It becomes saturated with water vapour (PH2O = 47 mmHg at 37OC)
Term
What does this result in?
Definition
The result is that alveolar air has a higher PCO2 and a lower PO2 than atmospheric air:
PAO2 = 100 mmHg and PACO2 = 40 mmHg
Term
The rate at which a gas diffuses across the respiratory membrane is directly proportional to:
Definition
(i) The concentration gradient across the membrane
(ii) The surface area of the membrane
(iii) The permeability of the membrane to the gas
Term
The rate at which a gas diffuses across the respiratory membrane is inversely proportional to:
Definition
the thickness of the membrane
Term
What is Henry Law?
Definition
The amount of a gas that dissolves in a liquid at equilibrium depends on both the partial pressure of the gas in the gas mixture to which the liquid is exposed, and on the specific solubility of that gas in that particular liquid
Term
Which is more soluble, O2 or CO2?
Definition
This is because O2 is about 20 times less soluble than CO2
Term
What occurs in pulmonary capillaries?
Definition
O2 diffuses from blood to cells (via interstitial fluid) and CO2 diffuses in opposite direction
Term
What occurs in systematic capillaries?
Definition
O2 diffuses from blood to cells (via interstitial fluid) and CO2 diffuses in opposite directions.
Term
State the Partial Pressures of O2 and CO2 in air
Definition
O2 : 160mmHg
CO2: 0.3mmHg
Term
State the Partial Pressures of O2 and CO2 in systematic arteries
Definition
O2 : 100mmHg
CO2: 40mmHg
Term
State the Partial Pressures of O2 and CO2 in pulmonary arteries
Definition
O2 : 40mmHg
CO2: 46mmHg
Term
What is haemoglobin?
Definition
a protein found in erythrocytes (red blood cells) which is capable of binding O2 in an easily-reversible manner
Term
Describe the structure of haemoglobin
Definition
Hb consists of 4 sub-units, each of which contains a haem group (which contains an iron ion: Fe2+)
Each haem group is capable of binding one O2 molecule, so each Hb molecule can transport 4 O2 molecules
Term
What is the difference between oxyhaemoglobin and deoxyhaemoglobin?
Definition
The complex of Hb and O2 is called oxyhaemoglobin (Hb.O2);
Hb without bound O2 is called deoxyhaemoglobin
Term
What does the binding or release of O2 by Hb depend on?
Definition
the PO2 in surrounding fluid: High PO2 facilitates binding; Low PO2 facilitates release
Term
When 100% saturated, 1 g of Hb carries ___ mL of O2
Definition
1.34ml
Term
What is the O2-carrying capacity of Hb in the blood?
Definition
200 mL O2 per litre of bloo
Term
What is the result of one o2 molecule biding to one of the Hb subunits?
Definition
changes its conformation, which increases the affinity of the other sub-units for O2, making it more likely that another O2 molecule will bind due to the conformational change to the molecule: positive co-operativity
Term
What affect does decreasing the affinity for Hb and O2 do to the curve?
Definition
shifts the curve to the right: this favours the unloading of O2 in the systemic capillaries (but inhibits O2-loading in the pulmonary capillaries)
Term
What affect does increasing the affinity for Hb and O2 do to the curve?
Definition
shifts the curve to the left: this favours O2 loading in the lungs, but inhibits O2 unloading in the systemic capillaries
Term
What would be ideal?
Definition
there would be factors that increase affinity in the pulmonary capillaries, and factors that decrease affinity in the systemic capillaries
Term
How does temp affect the affinity for Hb to O2?
Definition
An increase in temperature decreases the affinity of Hb for O2.
Term
How does ph affect the affinity for Hb to O2?
Definition
(Bohr effect): A decrease in pH decreases the affinity of Hb for O2.
Term
How does PCO2 affect the affinity for Hb to O2?
Definition
(Carbamino effect): CO2 reacts reversibly with certain amino acids in Hb to form carbaminohaemoglobin:
Term
How is CO2 transported in the blood?
Definition
Almost 90% as HCO3-, the rest dissolved in blood plasma or bond to Hb
Term
CO2 Exchange and Transport
Definition
Cellular respiration produces around 200 mL of CO2 per minute
CO2 diffuses, via the ISF, into the plasma in the systemic capillaries, increasing the PCO2
CO2 diffuses into the erythrocytes, where it is converted to HCO3- and H+, a a reaction catalysed by the enzyme carbonic anhydrase
To prevent ‘product inhibition’ of this reaction, HCO3- is exchanged for Cl- ions from the plasma (the chloride shift) and the H+ ions are buffered by Hb (promoting the unloading of O2 from Hb.O2, which is an added benefit)
In the pulmonary capillaries, CO2 diffuses from the plasma into the alveolar gas, reducing the PCO2 in the blood
The series of reactions outlined above now proceeds in the reverse direction
Term
Describe the Haldane effect
Definition
The binding of O2 to Hb reduces the affinity of Hb for CO2
therefore increases the rate of co2 elimination in the lungs
Term
What are the 3 major tasks physical exercises impose on the cardiovascular system?
Definition
- Pulmonary blood flow must increase to enhance gaseous exchange in the lungs (obviously, ventilation must also increase)
- Blood flow through the working muscles must increase
- A reasonably stable blood pressure must be maintained
Term
In the case of exercise, O2 consumption may increase to up to about __ times its resting level.
Definition
13
Term
The corresponding 13-fold increase in O2 absorption by the pulmonary circulation is typically achieved by:
Definition
a 1.5X increase in Stroke Volume
a 3X increase in Heart Rate
a 3X increase in Arteriovenous O2 difference
Term
In an untrained adult, CO can increase from around ____ at rest to a maximum of _____(a ___ fold increase)
Definition
5 L.min-1
20-25 L.min-1
4-5
Term
Heart rate rises linearly with work rate up to a maximum of ____bpm in adults
Definition
180 – 200
Term
Increase in heart is a result of:
Definition
decreased vagal (parasympathetic) inhibition and increased sympathetic stimulation of the pacemaker cells in the sinoatrial node
Term
What does Sympathetic stimulation of the atrioventricular node do
Definition
speeds up action potential conduction and shortens the AV delay
Term
What is increased stroke volume achieved by?
Definition
partly by an increase in filling pressure (which increases ventricular EDV) and partly by an increase in ventricular contractility (which increases ejection fraction and decreases ventricular ESV)
Term
What changes in systolic pressure during dynamic exercise
Definition
Systolic pressure rises markedly (by up to 60 mmHg during maximal exercise). This reflects the increases in stroke volume and ejection velocity
Term
What changes in diastolic pressure during dynamic exercise
Definition
Diastolic pressure is a reflection of TPR, which may rise only slightly (or even fall), depending on the balance between metabolic vasodilation and sympathetic vasoconstriction
Term
What is the result?
Definition
there is a large increase in pulse pressure and a more modest increase in MAP (around 20 mmHg)
Term
What is The Central Command Hypothesis
Definition
Proposes that the cerebral cortex both initiates voluntary muscle contraction and ‘commands’ the autonomic (and respiratory) neurones of the brainstem
Term
What is the evidence for The Central Command Hypothesis
Definition
1. Heart rate may increase before the onset of exercise – an ‘anticipatory response’
2. After partial neuromuscular blockade, voluntary attempts to contract the partially paralysed muscle (requiring, presumably, a bigger central command signal) produce enhanced rises in heart rate and blood pressure
Term
What is The Peripheral Reflex Hypothesis
Definition
Proposes that both proprioceptor inputs from joints and muscle and chemoreceptor inputs from the muscle contribute to the cardiovascular responses to exercise, particularly the pressor response (i.e. the observed increase in MAP)
Term
What is the evidence for The The Peripheral Reflex Hypothesis
Definition
1.Heart rate continues to increase for 1-2 minutes after the onset of exercise, suggesting that the gradual interstitial accumulation of metabolites such as lactate and K+ ions could be driving the response
2. If a spygmomanometer cuff is used to occlude venous drainage from exercising muscles in a limb, these metabolites are retained in the muscle after exercise ceases: in these circumstances, the pressor response is partially maintained
Term
What is central command responsible for?
Definition
the initial increase in heart rate, mainly via a suppression of vagal outflow to the sinoatrial node
Term
O2 transport is limited by:
Definition
1. The maximal attainable cardiac output
2. Extracellular resistance to diffusion between the erythrocytes and muscle myoglobin
Term
The increased maximal attainable cardiac output is almost entirely due, both directly and indirectly, to changes in cardiac structure:
Definition
- The ventricular wall increases in thickness
- The ventricular cavities enlarge
- Myocardial vascularity increases
Term
The following adaptations improve the rate of O2 diffusion from the erythrocytes to the muscle mitochondria:
Definition
- The development of new capillaries within the skeletal muscle vascular beds reduces the average diffusion distance
- Muscle mitochondria increase in number, especially at subsarcolemmal sites close to the capillaries
- Muscle myoglobin concentration increases
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