FUNCTIONAL ANATOMY

AND BREATH CONTROL

DIAN MARTA SARI
CARDIORESPIRATION DIVISION
HASAN SADIKIN HOSPITAL
FACULTY OF MEDICINE, UNIVERSITY OF PADJADJARAN
THE THORAX
• A wide base, bounded by the diaphragm below
• A narrow opening, bounded by the first rib and the upper portion of the sternum

The thorax is formed by the rib cage, the thoracic vertebrae, the sternum. They serve
as points of origin and insertion for the respiratory muscles.
It contains Esophagus, Trachea, Lungs, Heart, Great vessels, and Lungs.

This cage has 2 purposes:

1. Its bony structures protect the vital organs inside
2. The thoracic bones and muscles interact to vary its volume, so the gas can flow into
and out of the lungs.
Respiratory system consist of:
1. Upper airway tract
2. Lower airway tract, which usually
called tracheobronchial tree
RIB MOVEMENT

• The 1st rib moves slightly, raising,

and lowering the sternum. Its small
motion increases the AP diameter
of the chest  active on exercise
• The 2nd-7th ribs move
simultaneously about two axes (see
Pic)
RESPIRATORY MUSCLES

• Primary muscles  active during both quiet breathing and exercise.

• Diaphragm and intercostal muscles
• Accessory muscles  assist under conditions of increased ventilatory demand.
• Scalenes, sternomastoids, pectoralis major, and abdominals muscles. Other abdominal
and chest wall muscles may also function as accessory muscles.
THE DIAPHRAGM
• A thin musculotendinous dome-shaped structure,
separates the thoracic and abdominal cavities.
• Muscles fiber type: 55% slow oxidative (type 1),
21% fast oxidative (type 2A) and 24% fast
glycolytic (type 2B).
• Innervates by the phrenic nerves (C3-C5)
• About 75% of the change in thoracic volume during
quiet inspiration
• Tidal breathing  moves ± 1,5 cm
• 350 ml volume change in every cm of vertical
movement
• May move 6-10 cm at high levels of ventilation
 MECHANICAL ACTION
1. Contraction draws the central tendon down
• Flattens the diaphragm
• Increasing the thoracic volume
• Lowering intrathoracic pressure
2. Contraction of its costal fibers
• Raises and everts the lateral costal margins
As a result, gas from the atmosphere flows into the lungs.

Pic. As the normal diaphragm contracts, it descends, building up pressure in the abdomen until
the intraabdomen pressure acts as a fulcrum against which continued contraction everts the costal margin,
enlarging the thorax further.
EXPIRATION

• the diaphragm relaxes (passive process) and moves upward into the thoracic
cavity. It is increases the intra alveolar and intrapleural pressures, causing gas
to flow out of the lungs.
• During forced exhalation : abdominal pressure increase, push upward the
diaphragm
• Aids : vomiting, coughing, defecation,
 INTERCOSTAL MUSCLES PARASTERNAL MUSCLES
• Rib cage stabilizer • Always active in normal tidal breathing
• External intercostal muscles • Assist in lifting the upper rib cage
• Inspiratory muscles
• Lift the ribs upward and enlarge the
thorax (Hamberger’s mechanism)
• Internal intercostal muscles
• Expiratory muscles
SCALENE MUSCLE

• Anterior, medial, and posterior scalene muscles

• Primary function : flexed the neck
• Accessory muscles for inspiration: elevate the 1st and 2nd ribs, expands the rib
cage
STERNOCLEIDOMASTOID MUSCLES

• Primary function: rotate the head to opposite side and turn it upward
• Accessory muscle of inspiration: elevates the sternum
 increase AP diameter
• Active at rest in diaphragmatic dysfunction (quadriplegia, poliomyelitis, and
COPD)
PECTORALIS MAJOR MUSCLES

• Primary function: pulling the upper arms into the body in a hugging position
• Accessory muscles of ventilation: the arms and shoulders are fixed, use its
insertion as an origin  lift the ribs and sternum  increase AP diameter
TRAPEZIUS MUSCLE

• Primary function: rotate the scapula, lift the shoulders, flex the head up and
back (shrugging the shoulder)
• Accessory muscle of inspiration: elevate the thoracic cage
ABDOMINAL MUCLES

• External oblique mucles, internal oblique muscles, transverse abdominis, and

rectus abdominis
• Normally inactive during quiet breathing
• Active when forcefull expiration
 UPPER AIRWAY MUSCLES
• Effective ventilation  depend on coordinated activity between the primary
muscles and upper airway muscles
• Maintains patency and stability of the upper airway, reduces upper airway
resistance, and decreases work of breathing
• Upper airway and respiratory muscles weakness  hypoventilation and
hypoxemia
• It is also important for protection of the lower respiratory tract.
Glossopharyngeal Breathing (“frog” breathing)
• The tounge, buccal, pharyngeal, and laryngeal mucles
•
• Repeated upward movement of the glottis to capture boluses of air and stack
them in the lungs.
• One breath consists of 6 to 9 gulps of 40 to 200 mL each.
• (video)
COORDINATION OF THE RESPIRATORY MUSCLES

Respiratory cycle sequence consists of:

• Upper airway muscle contraction to maintain patency of the upper airway
• Intercostal muscle contraction to prevent rib cage distortion
• Diaphragm contraction as the principal inspiratory muscle
• Inspiratory muscle relaxation
• Finally, passive expiration
When the ventilatory needs increase, the accessory inspiratory muscle and the
expiratory muscle are recruited.
REGULATION OF
PULMONARY VENTILATION
MEDULLA OBLONGATA

• Responsible for coordinating the intrinsic rhythmicity of

respirations
• Consist of:
• Dorsal respiratory groups (DRGs),
• Ventral respiratory groups (VRGs)
 DORSAL RESPIRATORY GROUP
• Consist mainly of inspiratory neurons
• Monitoring system: signal from
• Central chemoreceptors, Peripheral chemoreceptors, Stretch receptors,
Peripheral proprioceptors, and Higher brain centers
• Impulses to
• Diaphragm muscle
• External intercostal muscle
• Responsible for the basic rhythm of breathing
• Normal conditions : 12-15 breaths/min
VENTRAL RESPIRATORY GROUP

• Contain both inspiratory and expiratory neurons

• Impulses to
- laryngeal and pharyngeal muscles  causing airway resistance to decrease
- diaphragm and external intercostal muscles
- internal intercostal muscles abdominal muscles
• Normal quite breathing : VRG is dormant
• Heavy exercise or stress: VRG actively send impulses to the muscles of exhalation
and the accessory muscles of inspiration that are innervated by the vagus nerve.
 PONS
• Function to some degree to modify and fine-tune the rhythmicity of breathing.

• Consist of
- Apneustic center
- Pneumotaxic center.
APNEUSTIC CENTER
• Sends neural impulses that stimulate the inspiratory neurons of the
DRGs in the medulla.

PNEUMOTAXIC CENTER
• Sends inhibitory impulses to the inspiratory center of the medulla,
causing the inspiratory phase to shorten.
CHEMORECEPTORS IN VENTILATION
• Central Chemoreceptors (in medulla)
• Responsible for monitoring the H+ ion concentration in the CSF
• Peripheral Chemoreceptors  oxygen-sensitive cells that react to the
reductions of oxygen levels in the arterial blood.
• Aortic bodies
• Carotid bodies : play a much greater role in initiating an increased ventilatory rate in
response to reduced arterial oxygen levels.
How a low PaO2 stimulates the respiratory components of the medulla to increase alveolar ventilation
 The sensitivity of the peripheral
The effect of low PaO2 levels on ventilation chemoreceptors increases when the
PaCO2 value increases.
REFLEXES THAT INFLUENCES VENTILATION
Hering-Breuer (HB) reflex
• By stretch receptors in the walls of the bronchi and bronchioles
• The lung overinflation  vagus nerve  medulla (DRG neurons)  cease inspiration
• Important during moderate and strenuous exercise

Deflation reflex
• The mechanism is still unknown.
• By decreased stretch receptor activity or the stimulation of specific deflation receptors
• The lungs are deflated  increase rate of breathing (hyperpnea)
• Responsible for the hyperpnea observed with pneumothorax
Irritant reflex
• Stimulated irritant receptors in the epithelium in the trachea, bronchi, and
bronchioles.
• Inhaled irritants or mechanical factor may also produce
- reflex bronchoconstriction, coughing, sneezing, tachypnea

Juxtapulmonary capillary receptots

• By C-fibers in the lung parenchyma near the pulmonary capillaries and
alveolar walls.
• Certain chemicals and mechanical stimulation.
(alveolar inflammation, pulmonary capillary congestion and edema, and
emboli.)
- rapid, shallow breathing pattern
Peripheral proprioceptor reflexes

• By proprioceptors in the muscles, tendons, joints, and pain receptors in

muscles and skin.
• The proprioceptors in the joints and tendons
- initiate and maintain an increased RR during exercise.
- the more joints and tendons are involved, the greater the RR
• Pain
- sudden pain : a short period of apnea
- prolonged pain : increase RR
Hypothalamic control
• Strong emotions can alter respirations
• Excitement  RR increase
• Increase body temperature  RR increase
CONTROL OF VENTILATION