Applied Cardiac Anatomy

Dray Song Hong, MD, FACC, FAHA

Professor of Medicine,
China Medical University

Taichung, Taiwan

www.LQQOPERA.com
Applied Anatomy and Physiology
of Respiratory System

Dray Song Hong, MD, FACC, FAHA

China Medical University

Taichung, Taiwan

www.LQQOPERA.com

Applied Cardiac Anatomy

Dray Song Hong, MD, FACC, FAHA

Professor of Medicine,
China Medical University

Taichung, Taiwan

www.LQQOPERA.com
Anatomy of Respiratory System
Anatomy of Respiratory System

Pulmonsry
eins

Left Atrium
 Gross Anatomy of Respiratory System
Computer controlled respiratory machinery

Dray Song Hong, MD, FACC,

Professor of Medicine,

China Medical University
Taichung, Taiwan

Taichung, Taiwan

www.lqqopera.com
 Anatomy of Respiratory System
Computer controlled respiratory machinery
Ventilation Cerebral cortex
Central control system
Respiratory centers
Cerebral cortex
Nerves (wires) Pons
Neuromuscular junction Medulla
(socket)
Respiratory apparatus
(hardwares)
Thorax ()
Pleural cavity
Lungs parenchyma
Airways
Perfusion
Vessels (pulmonary and bronchial arteries)
 Central Regulation of Breathing
(rate, depth and rhythm)
Feedback systems
Respiratory Centers Cerebral cortex

(Control rate, depth/rhythm ) Chemical sensors

Pons 1) Central
Medulla
upper pons Pons
dosal nuclenus
pneumotaxic center Medulla
H+ sensor
inhibits inspiration/
control rate 2) Peripheral
lower pons Chemoreceptors
apneustic center Carotid body
Medulla rhythm control pO2/pCO2 sensors
(Cerebral cortex)
Aortic body
pO2 sensor
Thorax
Stretch receptor
 Physical Examination and Lung Volumes

IRV
IC

TV TV VC
(tidal volume)
TLC

ERV
FRC

RV

Minute ventilation = tidal volume x respiratory rate/min

ERV: expiratory reserve volume; FRC: functional residual capacity;

IC: inspiratory capacity; IRV: inspiratory reserve volume; RV: residual voulme;
TLC: total lung capacity; TV: tidal volume; VC: vital capacity;
 Observation of Breathing
Not only rate (quantity)
cortex
Cerebral cortex
but also patterns (quality)
()

Pons
Medulla

Rate/depth

Rhythm

Wikimedia 2008
 Assessment of
Inspiratory Capacity (IC) Forced
inspiration

3)

IC
1) TV

2)

End-expiration

Tidal breathing
 Respiratory Patterns
Normal Slow breathing (Bradypnea)
14-18/min in adult I : E = 1 : 1.5 ~ 2

Obstructive Breathing
Ataxic Breathing (Biots breathing)
Prolonged expiration

Pons
Sighing Respiration
Rapid Shallow Breathing
Sigh Sigh Medulla

Rapid and Deep Respiration

Cheyne-Stokes
Hyperpnea Apnea
 Hyperventilaion Syndrome (differential diagnoses)

Rapid and Deep Respiration (Kussmaul Respiraion)

1) Psychogenic Cerebral cortex Feedback systems

e.g.panic Chemical sensors
disorder Central (pons)
Pons H+ sensor
2) Metabolic
Symptoms Medulla
acidosis
Paresthesia Peripheral
Digiatal Chemoreceptors
Circumoral Carotid body
Dizziness
pO2/pCO2 sensors
Signs
Carpal spasm 3) Acute pulm
Aortic body embolism
Chevostek sign pO2 sensor (V/Q mis-match)
Stretch receptor PO2
Thorax