Week 3 - Cystic Fibrosis, OSA, Restrictive & Vascular Pulmonary Disorders

Question 1

What is Vascular Disease?

Answer 1

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

Question 2

Someone with a pulmonary respiratory disease has a classification of:

Answer 2

Normal with value of diffusion lower than normal (DL, CO

Question 3

How is pulmonary hypertension diagnosed when referring to arterial pressure?

Answer 3

when PA > 25mmHg at rest of > 30mm during exercise

Question 4

What are 5 classifications of pulmonary hypertension?

Answer 4

1. Pulmonary Arterial HPT
2. Pulmonary Venous HPT
3. PHPT due to respiratory disease or hypoxemia
4. PHPT due to thrombotic or embolic disease
5. PHPT due to diseases of pulmonary vasculature

Question 5

What are the 5 classification of severity of PHPT?

Answer 5

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

Question 6

Embolism can occur from what 3 things?

Answer 6

1. Venous stasis (veins don’t work properly in lower limb)
2. Vessel injury
3. Hypercoaguability (tendency to form thrombus due to inherited condition)

Question 7

Dislodgement of part of thrombus can cause:

Answer 7

Occlusion of part of pulmonary circulation

Question 8

What are the 5 effects of embolism in PHPT?

Answer 8

1. Hypoxic vasoconstriction
2. Decreased surfactant
3. Release of neurohumoral + inflammatory substances
4. Pulmonary edema
5. Atelectasis (collapse of lung)

Question 9

Hypertension can occur as a result of what 3 conditions:

Answer 9

1. COPD
2. Interstitial fibrosis
3. Obesity hypoventilation syndrome

Question 10

C. I. O (COPD, Interstitial fibrosis & OHS) can lead to chronic what?

Answer 10

1. Chronic Hypoxemia

2. Chronic Acidosis

Question 11

Chronic hypoxemia and chronic acidosis causes p___ a____ v___ which causes an increase in p____ a___ p____.

Answer 11

pulmonary artery vasoconstriction - pulmonary artery pressure

Question 12

Elevated pressure in pulmonary arteries overtime can cause what?

Answer 12

1. Fibrosis of intimal layers

2. Hypertrophy of medial smooth muscle layers

Question 13

Chronic pulmonary hypertension results due to blood flow into narrowed arteries causing cor pulmonale which is

Answer 13

significant overload and enlargement of the ventricle of the right side of heart

Question 14

What are 3 factors that favours embolism?

Answer 14

1. Alterations in blood coagulation
2. Stasis of blood (i.e. long haul flights or recent surgery)
3. Abnormalities in vessel wall (trauma)

Question 15

What is chronic thromboembolic?

Answer 15

When the embolism is never reabsorbed resulting in multiple small vessel damage

Question 16

List 3 arterial causes of hypertension and what venous condition does it result in?

Answer 16

Arterial = lung disease, autoimmune disease and HF
Venous = congestive heart failure

Question 17

What are clinical manifestations of hypertension?

Answer 17

Dyspnea 
Cough 
Tachycardia, arrhythmias, palpitations
Angina
Fatigue
Syncope
Edema 
Cyanosis

Question 18

Blood flow through a healthy lung = ___ resistance and ____ compliance.

Answer 18

Low resistance High compliance

Question 19

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 _____.

Answer 19

dead space - cardiac output - ventilatory perfusion mismatch - increase

Question 20

During hypertension, V:Q mismatch causes a reduction in what?

Answer 20

Reduction in perfusion to ventilated alveoli

Question 21

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____.

Answer 21

Difficult - ventilated - transferring gas - high ventilation perfusion

Question 22

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 _____.

Answer 22

cardiac output - increase - pulmonary blood flow - decreased

Question 23

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_____.

Answer 23

reduce - skeletal muscle - aerobic capacity (VO2 max) - anaerobic threshold

Question 24

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____.

Answer 24

carbon dioxide (because not offloading) - hydrogen ions (this drives peripheral chemoreceptors to increase - ventilation demand

Question 25

E___ and A___ T____ T___ can both reduce d____ c___ and thus reduced o____ a____ causing increase in v____ d____ and exercise limitation.

Answer 25

Edema - Abnormal Transfer Time - diffusion capacity - oxygen amount - ventilation demand

Question 25

E___ and A___ T____ T___ can both reduce d____ c___ and thus reduced o____ a____ causing increase in v____ d____ and exercise limitation.

Answer 25

Edema - Abnormal Transfer Time - diffusion capacity - oxygen amount - ventilation demand