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Physiology > Pulmonary circulation > Flashcards

Pulmonary circulation Flashcards

1
Q

How compliant are the vessels of the pulmonary circulation?

A

Highly

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2
Q

What happens to blood flow in alveolar capillaries when PO2 drops? Why?

A

local vasoconstriction

To redistribute the blood to better aerated alveoli

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3
Q

What are the five scenarios mentioned in class that trigger abnormal hypoxic pulmonary vasoconstriction (HPV) response?

A 
Airway obstruction
Failure of ventilation
Acute lung damage
High altitude
COPD
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4
Q

What triggers hypoxic pulmonary vasoconstriction?

A

Alveolar hypoxia

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5
Q

How do PA, Pa, and Pv relate to each other in the upper part of the lungs?

(recall that PA = alveolar pressure, Pa = arterial pressure, and Pv = veins).

A

PA > Pa > Pv

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6
Q

How do PA, Pa, and Pv relate to each other in the middle part of the lungs?

(recall that PA = alveolar pressure, Pa = arterial pressure, and Pv = veins).

A

Pa > PA > Pv

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7
Q

How do PA, Pa, and Pv relate to each other in the lower part of the lungs?

(recall that PA = alveolar pressure, Pa = arterial pressure, and Pv = veins).

A

Pa > Pv > PA

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8
Q

Conditions that affect blood vasculature affect what part of the lungs more, the base or the apex?

A

Base

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9
Q

Blood flow is greater in the base or the apex of the lungs?

A

Base

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10
Q

What happens to hydrostatic pressure in CHF? What does this cause?

A

increases

Causes increase in edema in the interstitium

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11
Q

Why does ventilation have to match perfusion?

A

Need to have blood flow with oxygen

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12
Q

What is the average value of V/Q?

A

0.8

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13
Q

What happens to the ventilation and perfusion when going from the base to the apex of the lung?

A

Both decrease, but perfusion drops more

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14
Q

What happens to the V/Q ratio when moving from the base of the lungs, to the apex? Why?

A

Increases

Q drops faster than V

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15
Q

Why does TB reactivate in the upper lung zones?

A

Because there is more ventilation relative to perfusion (it is an aerobe)

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16
Q

What is the V/Q ratio in the dead space?

A

infinite ventilation, no blood flow

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17
Q

What is the V/Q ratio in a shunt?

A

0 (no ventilation, but tons of blood flow)

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18
Q

What happens to the V/Q as you progress down the airway tree? Why?

A

more perfusion, less ventilation, thus gets smaller

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19
Q

What is the physiological shunt?

A

The bronchial circulation

20
Q

If there is a communication between the left and right side of the heart, what always occurs? How?

A

Hypoxemia from RVH

21
Q

Why doesn’t hypoxemia occur with right to left shunts right away?

A

Blood flow from left to right due to pressure initially, but RVH eventually wins, and causes non oxygenated blood to shunt from the right to the left

22
Q

What happens to the V/Q ratio in PEs?

A

Infinite d/t normal ventilation, but 0 blood flow

23
Q

Which side of the heart is affected more in a PE?

A

Right d/t blockage

24
Q

What are the two major outcomes of a PE?

A
  1. Right to left shunting in areas of atelectasis

2. V/Q mismatch

25
Q

What is the gold standard for PE detection?

A

V/Q (ventilation) scan

26
Q

What is a ventilation scan?

A

Looking at lung perfusion with radioactive substance

27
Q

What is the V/Q ratio in normal patients?

A

1.0, thus usually the curves will superimpose over one another

28
Q

What is the function of the bronchial arteries? What effects does this have on systemic oxygen content?

A

Supply oxygen to the lung tissues.

This blood is then shunted to the left side of the heart, decreasing the overall oxygen content slightly

29
Q

What is the function of the pulmonary circulation (capacitors or resistors)?

A

Capacitors

30
Q

What happens to the bronchial arteries in CF?

A

Increase in size

31
Q

What is the effect of persistent hypoxic vasoconstriction?

A

Vascular structural remodeling, leading to pulmonary arterial HTN (PAH)

32
Q

In normal upright subjects at rest, blood flow
(BLANKS) from the apex of the lung to the base
of the lung.

A

In normal upright subjects at rest, blood flow INCREASES from the apex of the lung to the base
of the lung.

33
Q

Are the effects of gravity felt equally in pulmonary veins and arteries?

A

Yes

34
Q

Where is pulmonary edema seen in the lungs? Why?

A

Lower lobes d/t increase flow of blood there relative to the other parts

35
Q

What is the effect of positive pressure ventilation on the upper part of the lungs (zone 1) relative to the Pa and PA?

A

PA&raquo_space;>Pa, meaning that arteries could collapse

36
Q

How permeable are pulmonary capillaries to proteins? What is the consequence of this?

A

Very

Higher propensity to develop interstitial edema

37
Q

The capillary pressure in the pulmonary circulation favors what (filtration or reabsorption? What is the consequence of this?

A

Filtration

Thus lymphatics play a large role in pumping out this excess fluid

38
Q

Why is there a negative hydrostatic pressure in the pulmonary interstitium? When can this become positive?

A

Lung expansion lowers it

Can become positive if there is inflammation of the capillaries

39
Q

Which way does fluid flow between the alveoli and the interstitium? Why?

A

From alveoli to the interstitium d/t lower pressure in the interstitium

40
Q

What is the effect of an increase in intravascular hydrostatic pressure in the pulmonary circulation?

A

Pulmonary edema

41
Q

What is the effect of an decrease in capillary osmotic pressure in the pulmonary circulation?

A

Pulmonary edema

42
Q

What is the effect of an increase in capillary permeability in the pulmonary circulation?

A

Pulmonary edema

43
Q

In regions of dead space, alveolar gas has what composition relative to the inspire humidified air?

A

Same (all oxygen, no CO2)

44
Q

When do right to left shunts occur?

A

If there is a defect in the

wall between the right and left ventricles

45
Q

A defining characteristic of the hypoxemia caused by a right-to-left shunt is that it cannot be
corrected by having the person breathe a high O2 gas (e.g., 100% O2).

Why?

A

because the shunted

blood never goes to the lungs to be oxygenated.

46
Q

Do left to right shunts cause hypoxemia? Why or why not?

A

No, because oxygenated blood flows into right ventricle to be oxygenated again.

47
Q

What are the causes of a left-to-right shunt? (2)

A

Patent ductus arteriosus or traumatic injury

Physiology (75 decks)

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