Week 3 - Cystic Fibrosis, OSA, Restrictive & Vascular Pulmonary Disorders Flashcards
What is Vascular Disease?
Diseases involving the pulmonary arteries and veins and are characterized by obstruction to circulation (embolism) or disruption of alveolar-capillary (edema), therefore causing pulmonary HYPERTENSION and RIGHT HEART FAILURE
Someone with a pulmonary respiratory disease has a classification of:
Normal with value of diffusion lower than normal (DL, CO
How is pulmonary hypertension diagnosed when referring to arterial pressure?
when PA > 25mmHg at rest of > 30mm during exercise
What are 5 classifications of pulmonary hypertension?
- Pulmonary Arterial HPT
- Pulmonary Venous HPT
- PHPT due to respiratory disease or hypoxemia
- PHPT due to thrombotic or embolic disease
- PHPT due to diseases of pulmonary vasculature
What are the 5 classification of severity of PHPT?
Class I = Asymptomatic, no physical limitation
Class II = Mild limitation of PA, comfortable at rest + breathlessness on exertion
Class III = Marked limitation of PA, comfortable at rest + unduly breathless on exertion
Class IV = Unable to perform any PA, symptomatic at rest + RHF
Embolism can occur from what 3 things?
- Venous stasis (veins don’t work properly in lower limb)
- Vessel injury
- Hypercoaguability (tendency to form thrombus due to inherited condition)
Dislodgement of part of thrombus can cause:
Occlusion of part of pulmonary circulation
What are the 5 effects of embolism in PHPT?
- Hypoxic vasoconstriction
- Decreased surfactant
- Release of neurohumoral + inflammatory substances
- Pulmonary edema
- Atelectasis (collapse of lung)
Hypertension can occur as a result of what 3 conditions:
- COPD
- Interstitial fibrosis
- Obesity hypoventilation syndrome
C. I. O (COPD, Interstitial fibrosis & OHS) can lead to chronic what?
- Chronic Hypoxemia
2. Chronic Acidosis
Chronic hypoxemia and chronic acidosis causes p___ a____ v___ which causes an increase in p____ a___ p____.
pulmonary artery vasoconstriction - pulmonary artery pressure
Elevated pressure in pulmonary arteries overtime can cause what?
- Fibrosis of intimal layers
2. Hypertrophy of medial smooth muscle layers
Chronic pulmonary hypertension results due to blood flow into narrowed arteries causing cor pulmonale which is
significant overload and enlargement of the ventricle of the right side of heart
What are 3 factors that favours embolism?
- Alterations in blood coagulation
- Stasis of blood (i.e. long haul flights or recent surgery)
- Abnormalities in vessel wall (trauma)
What is chronic thromboembolic?
When the embolism is never reabsorbed resulting in multiple small vessel damage
List 3 arterial causes of hypertension and what venous condition does it result in?
Arterial = lung disease, autoimmune disease and HF Venous = congestive heart failure
What are clinical manifestations of hypertension?
Dyspnea Cough Tachycardia, arrhythmias, palpitations Angina Fatigue Syncope Edema Cyanosis
Blood flow through a healthy lung = ___ resistance and ____ compliance.
Low resistance High compliance
Exercise response: In pulmonary hypertension we will observe increased d___ s____ and decreased c____ o____. This will cause a v___ p____ m_____. Which means ventilation demand will _____.
dead space - cardiac output - ventilatory perfusion mismatch - increase
During hypertension, V:Q mismatch causes a reduction in what?
Reduction in perfusion to ventilated alveoli
In occluded capillary or remodeling of vascular compartment, blood flow is d____. Alveoli will be v____ but there won’t be capability of t_____ g___. This results in h___ v_____ p____.
Difficult - ventilated - transferring gas - high ventilation perfusion
Occlusion or remodeling makes it harder for c___ o____ to ____ with exercise as we would normally expect. As the right heart is trying to push sufficient blood through the pulmonary vascular system which is restricted, p____ b____ f____ is _____.
cardiac output - increase - pulmonary blood flow - decreased
Decreased pulmonary blood flow to left side of the heart will ____ blood flow to s____ m____. Resulting in decreased in a____ c____ and a____ t_____.
reduce - skeletal muscle - aerobic capacity (VO2 max) - anaerobic threshold
Right to left shunt in PHPT can cause deoxygenated blood to be passed through the left side. It can cause elevated levels of c___ d____ and h____ i__ (making it more acidic so lower pH) and thus increase v____ d____.
carbon dioxide (because not offloading) - hydrogen ions (this drives peripheral chemoreceptors to increase - ventilation demand
E___ and A___ T____ T___ can both reduce d____ c___ and thus reduced o____ a____ causing increase in v____ d____ and exercise limitation.
Edema - Abnormal Transfer Time - diffusion capacity - oxygen amount - ventilation demand
E___ and A___ T____ T___ can both reduce d____ c___ and thus reduced o____ a____ causing increase in v____ d____ and exercise limitation.
Edema - Abnormal Transfer Time - diffusion capacity - oxygen amount - ventilation demand
