Thorax – Clinical Correlations
1. You examine a 58-year old white male who appears tense with a
strained expression on his face. He complains of shortness of breath
and increasing fatigue. The patient sits leaning forward with his hands
on his knees (tripod position). The ratio of the anterior-posterior
diameter to transverse diameter of his chest is 1:1 (Barrel Chest) and
his neck muscles are hypertrophied.
The diagnosis is COPD (Chronic Obstructive Pulmonary Disease).
Consider the following questions relative to the anatomy of the thorax
1. What is the state of the alveoli in the patient’s lungs?
2. Why is the patient “Barrel-Chested” ?
3. What is the orientation of the ribs in this case?
4. Why do the neck muscles hypertrophy?
5. Why would patients with respiratory difficulties often sit in the
2. A 74-year old man was playing golf and started to feel a tingling and
weakness in his left arm. He continued to play but 10 minutes later
began to have difficulty breathing and became dizzy and collapsed.
He was rushed to the emergency room where an electrocardiogram
showed irregular heart electrical activity. Some minutes later he
deteriorated markedly and an echocardiogram showed that his mitral
valve was not functioning and blood was regurgitating from the left
ventricle into the left atrium. He died a few minutes later.
An autopsy showed a total blockage of the left coronary artery and
partial blockage of the right coronary artery.
The Conducting system of the Heart Atrioventricular valves
Consider the following questions relative to what you know of the
anatomy of the heart.
1. When coronary arteries become blocked what is the effect on the
2. Why might pain from the heart be felt as weakness in the left arm?
3. Why would the heartbeat become irregular?
4. Which muscles are being affected when the valves begin to fail,
and why does blood flow back into the left atrium?