Pulmonary Circulation

Question 1

What are the test findings of precapillary pulmonary HTN disorders?

Answer 1

• abnormally low DLCO with normal lung function otherwise
• no PE or evidence of disease on CXR

Question 2

What is the pulmonary capillary wedge pressure approximately equal to?

Answer 2

the left atrial pressure and the left ventricle end-diastolic pressure

Question 2

Since pre-capillary causes of pulmonary hypertension do not increase pressure in the microcirculation (i.e. pulmonary capillary bed), ______ does not develop.

Answer 2

pulmonary edema

Question 3

When standing upright at rest, most of the cardiac output goes to ______ due to _____.

Answer 3

the bases of the lung; gravity

Question 4

In chronic pulmonary inflammatory states (like chronic bronchitis and bronchiectasis), the bronchial arteries _______.

Answer 4

enlarge and provide increased blood flow

Question 5

What is a normal RA pressure?

Answer 5

2-5

Question 5

Mean pulmonary arterial pressure can be elevated by what three mechanisms?

Answer 5

1. PLA (such as in heart failure or mitral stenosis)
2. PVR
3. cardiac output (not usually causative)

Question 7

The lung has two arterial blood supplies: _____ and the ______.

Answer 7

the bronchial circulation; pulmonary circulation

Question 7

What do the bronchial arteries supply?

Answer 7

• the trachea
• the airways down to the terminal bronchioles
• parts of the esophagus
• the vaso-vasorum of the aorta

Question 7

What gene mutation is associated with idiopathic pulmonary arterial HTN (IPAH)?

Answer 7

bone morphogenic protein receptor type 2 (BMPR2)

Question 8

The hydrostatic pressure gradient is opposed by _____.

Answer 8

the oncotic pressure gradient

Question 9

What is a normal PAOP pressure?

Answer 9

10-12

Question 11

This measurement is approximately equal to the left atrial pressure and the left ventricle end-diastolic pressure.

Answer 11

pulmonary capillary wedge pressure

Question 12

How is idiopathic pulmonary arterial hypertension (IPAH) treated?

Answer 12

• vasodilators such as calcium channel blockers
• endothelin-1 blockers
• phosphodiesterase-5 inhibitors
• prostanoids

Question 13

A difference of more than 5 mmHg between the PA diastolic pressure and the PCWP suggests ______.

Answer 13

pulmonary vascular disease

Question 15

The source of most bleeding in the lung (hemoptysis) is ______.

Answer 15

the bronchial circulation

Question 16

Use of ______ is contraindicated in post-capillary pulmonary hypertension.

Answer 16

pulmonary arterial vasodilators

Question 18

The presence of a wedge pressure less than 15 mmHg with coexistent pulmonary edema is consistent with ______ pulmonary edema.

Answer 18

non-cardiogenic

Question 19

What are the main subcategories of Group 1 PAH? (5)

Answer 19

• idiopathic
• heritable
• drugs/toxins
• connective tissue disease
• portal hypertension

Question 20

Use of pulmonary arterial vasodilators is contraindicated in ______.

Answer 20

post-capillary pulmonary hypertension

Question 21

Since ______ causes of pulmonary hypertension do not increase pressure in the microcirculation (i.e. pulmonary capillary bed), pulmonary edema does not develop.

Answer 21

pre-capillary

Question 22

What is the tx for hydrostatic pulmonary edema?

Answer 22

diuretics inotropic drugs (increase C.O.)

Question 23

With exercise, cardiac output increases and the increased flow goes to the _____ in the lung.

Answer 23

upper lobe vessels

Question 24

What is the tx for non-cardiogenic pulmonary edema?

Answer 24

• mainly supportive care
• supplemental O2

Question 25

The bronchial circulation is important in ______ and also protects the lung against _____.

Answer 25

fetal lung development; the infarcting effects of pulmonary emboli

Question 26

The hydrostatic pressure gradient (Pmv-Pi) drives fluid from the pulmonary microcirculation into the _____.

Answer 26

interstitium

Question 27

What is a normal PA pressure?

Answer 27

30/10

Question 28

What is a normal RV pressure?

Answer 28

30/2