Pulmonary Circulation Flashcards
What are the test findings of precapillary pulmonary HTN disorders?
- abnormally low DLCO with normal lung function otherwise
- no PE or evidence of disease on CXR
What is the pulmonary capillary wedge pressure approximately equal to?
the left atrial pressure and the left ventricle end-diastolic pressure
Since pre-capillary causes of pulmonary hypertension do not increase pressure in the microcirculation (i.e. pulmonary capillary bed), ______ does not develop.
pulmonary edema
When standing upright at rest, most of the cardiac output goes to ______ due to _____.
the bases of the lung; gravity
In chronic pulmonary inflammatory states (like chronic bronchitis and bronchiectasis), the bronchial arteries _______.
enlarge and provide increased blood flow
What is a normal RA pressure?
2-5
Mean pulmonary arterial pressure can be elevated by what three mechanisms?
- PLA (such as in heart failure or mitral stenosis)
- PVR
- cardiac output (not usually causative)
The lung has two arterial blood supplies: _____ and the ______.
the bronchial circulation; pulmonary circulation
What do the bronchial arteries supply?
- the trachea
- the airways down to the terminal bronchioles
- parts of the esophagus
- the vaso-vasorum of the aorta
What gene mutation is associated with idiopathic pulmonary arterial HTN (IPAH)?
bone morphogenic protein receptor type 2 (BMPR2)
The hydrostatic pressure gradient is opposed by _____.
the oncotic pressure gradient
What is a normal PAOP pressure?
10-12
This measurement is approximately equal to the left atrial pressure and the left ventricle end-diastolic pressure.
pulmonary capillary wedge pressure
How is idiopathic pulmonary arterial hypertension (IPAH) treated?
- vasodilators such as calcium channel blockers
- endothelin-1 blockers
- phosphodiesterase-5 inhibitors
- prostanoids
A difference of more than 5 mmHg between the PA diastolic pressure and the PCWP suggests ______.
pulmonary vascular disease
The source of most bleeding in the lung (hemoptysis) is ______.
the bronchial circulation
Use of ______ is contraindicated in post-capillary pulmonary hypertension.
pulmonary arterial vasodilators
The presence of a wedge pressure less than 15 mmHg with coexistent pulmonary edema is consistent with ______ pulmonary edema.
non-cardiogenic
What are the main subcategories of Group 1 PAH? (5)
- idiopathic
- heritable
- drugs/toxins
- connective tissue disease
- portal hypertension
Use of pulmonary arterial vasodilators is contraindicated in ______.
post-capillary pulmonary hypertension
Since ______ causes of pulmonary hypertension do not increase pressure in the microcirculation (i.e. pulmonary capillary bed), pulmonary edema does not develop.
pre-capillary
What is the tx for hydrostatic pulmonary edema?
diuretics inotropic drugs (increase C.O.)
With exercise, cardiac output increases and the increased flow goes to the _____ in the lung.
upper lobe vessels
What is the tx for non-cardiogenic pulmonary edema?
- mainly supportive care
- supplemental O2
