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BB - Respiratory Review > 3 Pulmonary Circulation > Flashcards

3 Pulmonary Circulation Flashcards

1
Q

CVP

A

Central Venous Pressure

2-8 mmHg

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2
Q

Pulmonary Artery (systolic)

A

15-30 mmHg

25 mmHg

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3
Q

Pulmonary Artery (diastolic)

A

4-12 mmHg

8 mmHg

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4
Q

Pulmonary Artery (mean)

A

9-16 mmHg

15 mmHg

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5
Q

PCWP

A

Pulmonary Capillary Wedge Pressure

measure for L ventricular failure

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6
Q

PWP

A

Pulmonary Wedge Pressure
2-5 mmHg
useful to measure LA pressure

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7
Q

Pulmonary Circulation Anatomy

A 
PA 1/3 thickness of aorta
high flow, low pressure, low resistance
very compliant, drive by CO
R aorta
pulmonary arteries
pulmonary capillaries
pulmonary veins
L atrium
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8
Q

Pulmonary capillaries pressure

A

7-10 mmHg

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9
Q

R atrium pressure

A

3-5 mmHg

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10
Q

R ventricle pressure

A

25 mmHg

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11
Q

pulmonary arteries pressure

A

25/10

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12
Q

Fick’s Principle

A

method to determine cardiac output (flow/min through lungs)

CO = O2 consumption / ateriovenous O2 difference

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13
Q

What determines pulmonary vascular resistance?

A

alveolar resistance + extra-alveolar resistance

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14
Q

Alveolar vessels

A
  • alveolocapillary network for gas exchange

- can be compressed to contain no blood - mismatch

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15
Q

Extra-Alveolar vessels

A

supply blood to respiratory units

  • oxygenated blood from systemic supply
  • 1-2% of CO, empties to L atrium
  • not compressed during positive pressure
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16
Q

Capillary Resistance

A

-dependent on lung conditions
-alveolar vessels = longitudinal resistance
(network dimensions & distensibility resist pulm blood flow)
-PASSIVE regulation of blood flow through capillaries in response to changes in CO

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17
Q

How do pulmonary capillaries accomodate increased blood flow?

A

**recruitment (primary mechanism)
distention
pulm driving pressure increase

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18
Q

Recruitment

A

-opening closed segments (capillaries)
-chief mechanism to decrease PVR
Increased CO raises pulmonary vascular pressure but decreases pulmonary vascular resistance

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19
Q

Distention

A
  • widening capillaries capacity

- high L atrial pressure leads to distention (bad)

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20
Q

Bronchial Circulation

A

high pressure, low flow, high resistance

  • flows at systemic pressures, 1-2% of CO
  • provides oxygenated blood, empties to L atrium
  • 50% returns via azygos vein to R atrium
  • anastomoses w/ pulm veins (R-L shunt)
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21
Q

Pulmonary Lymphatic System

A
  • critical for keeping alveoli free of fluid from capillaries
  • slight, continual flow from capillaries to interstitium
  • ~20 ml/hr moved
  • interstitium @ slight negative pressure
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22
Q

PVR & Lung Volume

A
  • lung volume close to FRC = minimal PVR

- lung volume higher or lower = increased PVR

23
Q

Gravity & Pulmonary Circulation

A
  • degree of change according to level of the heart (systemic)
  • postural dependent
  • effects pulmonary more d/t lower pressure of system
24
Q

Hydrostatic Pressure & Pulmonary Circulation

A
  • alters potential energy of column
  • R atrium & middle of lung = zero reference points
  • base of lung received more than apex d/t gravity
  • leads to recruitment & distention @ lung base
25
Q

What causes transmural pressures to be greater at base of lung than apex?…

A
  • distention of blood vessels at base
  • decrease resistance at base
  • greater blood flow to base
26
Q

What creates Lung Zones?

A

pulmonary arterial pressures
pulmonary venous pressures
alveolar pressures

27
Q

What are lung zone pressures dependent on?

A

hydrostatic pressure
gravity
transmural pressure (compressive)
lung volume

28
Q

Zone 1

A

PA > Pa>Pv
no blood flow, capillaries compressed by PA
-expand (worsen) = decrease PAP, increased PA, occlusion of vessels
-reduce (improve) = increased PAP, reduced hydrostatic tension (pt positioning)

29
Q

Zone 2

A

Pa> PA> Pv

-porportional to difference between Pa - PA

30
Q

Zone 3

A

Pa>Pv>PA – ideal relationship

  • flow proportional to difference between Pa & Pv
  • increased blood flow
31
Q

Zone 4

A

Abnormal state, LV backup

high vascular resistance, reduced local blood flow

32
Q

Vascular Smooth Muscle Tone in Pulmonary Vasculature

A

-active regulation – altering vascular smooth muscle in pulmonary vessels

33
Q

Pulmonary Bed Vasoconstrictors

A

reduced PaO2
increased PCO2
histamine
thromboxane A2

34
Q

Pulmonary Bed Vasodilators

A

Increased PaO2
nitric oxide
acetylcholine
prostacyclin

35
Q

Thromboxane A2

A

potent vasoconstrictor

  • product of arachidonic acid metabolism
  • produced by macrophages, leukocytes and endothelia cells after lung injury
  • super short half life- seconds
36
Q

Prostacyclin

A

Prostaglandin 12 - potent vasodilator

  • also inhibits platelet activity
  • produced by endothelial cells
  • product of arachidonic acid metabolism
37
Q

Nitric Oxide

A

Epithelial, endogenous vasodilator

  • localized effect only
  • effect d/t synthesis of cyclic GMP
  • diffuses into circulation immediately, irreversibly binds to heme (>200,000 x > then oxygen)
38
Q

Hypoxic Pulmonary Vasoconstriction

A

-localized - shunts away from hypoxic region
enhanced by hypercapnia & acidosis
-lung-wide -> high PVR ->chronic pulm HTN
important for balancing V/Q ratio

39
Q

Pulmonary Hypertension & Causes

A

serious condition high PVR, elevated PAP

causes: generalized alveolar hypoxemia (increases PVR), hypoventilation, low inspired PO2, increased PCO2, pain, histamine, high altitudes

40
Q

What are some things that can happen d/t Pulmonary Hypertension…

A
  • R ventricular hypertrophy (not designed for high pressure)
  • tricuspid regurgitation
  • R heart failure (cor pulmonale)
  • -only effective treatment = lung transplant
41
Q

Regional Ventilation Distribution

A
  • lower portion of lung tends to be more ventilated than apex
  • nonuniform distribution of TV d/t gravitational effects
  • compliance at base > compliance at apex
42
Q

Local Ventilation Distribution

A
  • airway resistance & lung compliance differences among terminal units cary depending on alveolar time constant
  • longer time means slower ventilation
43
Q

V/Q mismatch

A
  • Ventilation Perfusion Mismatch

- most common cause of inefficient O2 & CO2 exchange

44
Q

V/Q - Normal PA - Pa differences…

A

10-15 mmHg

45
Q

V/Q - Larger PA - Pa differences…

A

indicative of intrinsic pulmonary disease –> shunting

46
Q

Right - Left Shunting

A
  • non-oxygenated (R side) blood jumps to L side
  • leads to venous admixture
  • small shunts are normal
47
Q

True Anatomical Shunts

A

bronchopulmonary anastomoses
intercardiac thesbian veins
mediastinal veins
pleural veins

48
Q

Left - Right Shunts

A
  • oxygenated blood gets cycled again

- portion of CO that returns to R heart without being consumed

49
Q

Inspiration & Pulmonary Blood Flow

A
  • vessel compression
  • greater atmospheric pleural pressure
  • RV receives greater blood vol in diastole
  • LV ejects less blood (increased pressure gradient between LV & systemic pressure)
50
Q

Expiration & Pulmonary Blood Flow

A
  • reduced gradient allows increased stroke volumes

- lower pleural pressure gradient

51
Q

Mechanical Ventilation

A
  • artificially increased alveolar pressure
  • increases Zone 2
  • can decrease CO or increase V/Q mismatch
52
Q

Pulmonary Emboli

A

obstruction –> increased PVR

53
Q

Pulmonary Edema

A
  • excessive pulmonary capillary pressure –> fluid leak –>interstitium –> alveoli
  • anticipated w/ high LV filling pressures

BB - Respiratory Review (5 decks)

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