Pulmonary Circulation Flashcards
The bronchial circulation supplies the __________.
supplies the conducting airways
The bronchial arteries arise from the _________.
aorta and intercostal arteries
Typical pulmonary pressure is _______. Mean pulmonary arterial pressure is ______.
25/8; 14
The lungs can be thought of as a circuit. Give Ohm’s law for the lungs.
PAP - LAP = CO x PVR PAP: pulmonary arterial pressure LAP: left atrial pressure CO: cardiac output PVR: pulmonary vascular resistance
The large elastic arteries absorb __________.
pulsatile flow
The muscular pulmonary arterioles __________.
regulate blood pressure
The pulmonary veins and lymphatics run in the ____________.
interlobular septa
The pulmonary circulation has _______ compliance.
greater
What is unique about Swan-Ganz catheters?
They are flow-directed; an inflated balloon on the end of the catheter bends it.
On a pressure diagram (gathered from a Swan-Ganz catheter), the RV and PA should be __________.
the same
Pulmonary pressure does not increase as much as would be predicted by increased cardiac output. Why?
The vessels are more distensible and unperfused capillaries can be recruited.
Blood only flows when ___________.
pulmonary arterial pressure is greater than alveolar air pressure
There are three lung zones: ___________.
1: P(A) > P(a) > P(v)
2: P(a) > P(A) > P(v)
3: P(a) > P(v) > P(A)
How does mechanical ventilation affect the lungs?
It increases pulmonary vascular resistance and increases zone 1 area.
Normally in the pulmonary capillares, the hydrostatic pressure is _________ than the oncotic pressure. As such, ______________.
much greater; lymphatics must pull fluid back from the alveoli
Pulmonary edema is most often caused by ____________.
increased hydrostatic pressure
Because the capillaries and veins reside in the __________, these often enlarge in pulmonary edema.
interlobular septa (seen on x-ray as Kerley B lines)
Non-cardiogenic pulmonary edema is due to ____________.
increased permeability of the blood vessels
What are the criteria for ARDS?
1) Bilateral alveolar infiltrates
2) P(a[O2])/FiO2 less than 300 when given 100% O2; less than 200 for ALI
People can develop acute respiratory failure in response to sudden release of ____________.
inflammatory cytokines (which leads to increased permeability)
Pulmonary hypertension is defined as ___________.
mean pulmonary arterial pressure greater than 25 mmHg
The equation for pulmonary arterial pressure is ____________.
PAP = CO x PVR + LAP PAP: pulmonary arterial pressure CO: cardiac output PVR: pulmonary vascular resistance LAP: left atrial pressure
Pulmonary hypertension is said to arise from a pre-capillary source if the __________.
post-capillary wedge pressure is less than 15 mmHg
Pulmonary hypertension is said to arise from a post-capillary source if the ____________.
post-capillary wedge pressure is greater than 15 mmHg
What are three causes of pre-capillary pulmonary hypertension?
Hypoxia, pneumonia, and pulmonary embolism
Define paresis.
(n.) a condition of muscular weakness caused by nerve damage or disease; partial paralysis
The most common ECG sign of pulmonary embolism is __________; less common signs include ___________.
sinus tachycardia; SI, QIII, and TIII
What are the WHO’s five pulmonary hypertension groups?
1) Pulmonary arterial hypertension
2) PH secondary to left heart disease
3) PH secondary to lung diseases and hypoxia
4) Thromboembolic
5) Multifactorial
PH is defined as mean PAP > 25 mmHg. PAH is defined as ____________.
mean PAP > 25 mmHG; PCWP less than 15 mmHg, PAP greater than 25 mmHg, and greater than 3 Wood units
Demographically, idiopathic pulmonary arterial hypertension preferentially affects _________.
women in their 3rd and 4th decades of life
Median survival of those with idiopathic pulmonary hypertension without treatment is _______; with treatment it is ________.
2.8 years; 7 years
PAH by itself will not produce _______ on physical exam.
abnormal lung sounds
Before treating a patient for suspected PAH, you need to obtain a ____________.
right-heart catheterization to determine what kind
Why should you not use PAH treatments in those with PVH?
Because you will increase volume flowing to a high-resistance area, leading to more overload
Much of the bronchial circulation drains directly into ___________.
the left atrium
The pulmonary circuit has ______ elastance and _______ compliance.
less; more
What is hypercapnia?
High arterial CO2
Non-cardiogenic pulmonary edema is characterized by a PWCP less than ___.
18
What is the mmHg PCWP level that separates pre-capillary from post-capillary pulmonary hypertension?
15 mmHg
__________ are the gold standard in detecting pulmonary emboli, but they are rarely performed.
Angiograms
Histologically, PAH is characterized by early __________.
intimal thickening
Lung auscultation will be ______ in those with PAH.
normal
The ideal treatment for chronic pulmonary emboli is __________.
endarterectomy
Pulmonary venous hypertension treatment is similar to treatment for ___________.
heart failure
Why are the bronchial arteries the most common source of hemoptysis?
Because they increase the most in inflammatory states
