Thorax Clinical Correlations

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					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
      and respiration.

      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
           “tripod position”
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
      cardiac muscle?
   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?

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