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BB - Respiratory Review > 3 Pulmonary Circulation > Flashcards

3 Pulmonary Circulation Flashcards

(53 cards)

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1
Q

CVP

A

Central Venous Pressure

2-8 mmHg

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2
Q

Pulmonary Artery (systolic)

A

15-30 mmHg

25 mmHg

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3
Q

Pulmonary Artery (diastolic)

A

4-12 mmHg

8 mmHg

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4
Q

Pulmonary Artery (mean)

A

9-16 mmHg

15 mmHg

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5
Q

PCWP

A

Pulmonary Capillary Wedge Pressure

measure for L ventricular failure

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6
Q

PWP

A

Pulmonary Wedge Pressure
2-5 mmHg
useful to measure LA pressure

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7
Q

Pulmonary Circulation Anatomy

A 
PA 1/3 thickness of aorta
high flow, low pressure, low resistance
very compliant, drive by CO
R aorta
pulmonary arteries
pulmonary capillaries
pulmonary veins
L atrium
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8
Q

Pulmonary capillaries pressure

A

7-10 mmHg

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9
Q

R atrium pressure

A

3-5 mmHg

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10
Q

R ventricle pressure

A

25 mmHg

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11
Q

pulmonary arteries pressure

A

25/10

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12
Q

Fick’s Principle

A

method to determine cardiac output (flow/min through lungs)

CO = O2 consumption / ateriovenous O2 difference

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13
Q

What determines pulmonary vascular resistance?

A

alveolar resistance + extra-alveolar resistance

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14
Q

Alveolar vessels

A
  • alveolocapillary network for gas exchange

- can be compressed to contain no blood - mismatch

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15
Q

Extra-Alveolar vessels

A

supply blood to respiratory units

  • oxygenated blood from systemic supply
  • 1-2% of CO, empties to L atrium
  • not compressed during positive pressure
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16
Q

Capillary Resistance

A

-dependent on lung conditions
-alveolar vessels = longitudinal resistance
(network dimensions & distensibility resist pulm blood flow)
-PASSIVE regulation of blood flow through capillaries in response to changes in CO

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17
Q

How do pulmonary capillaries accomodate increased blood flow?

A

**recruitment (primary mechanism)
distention
pulm driving pressure increase

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18
Q

Recruitment

A

-opening closed segments (capillaries)
-chief mechanism to decrease PVR
Increased CO raises pulmonary vascular pressure but decreases pulmonary vascular resistance

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19
Q

Distention

A
  • widening capillaries capacity

- high L atrial pressure leads to distention (bad)

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20
Q

Bronchial Circulation

A

high pressure, low flow, high resistance

  • flows at systemic pressures, 1-2% of CO
  • provides oxygenated blood, empties to L atrium
  • 50% returns via azygos vein to R atrium
  • anastomoses w/ pulm veins (R-L shunt)
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21
Q

Pulmonary Lymphatic System

A
  • critical for keeping alveoli free of fluid from capillaries
  • slight, continual flow from capillaries to interstitium
  • ~20 ml/hr moved
  • interstitium @ slight negative pressure
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22
Q

PVR & Lung Volume

Study These Flashcards
A
  • lung volume close to FRC = minimal PVR

- lung volume higher or lower = increased PVR

23
Q

Gravity & Pulmonary Circulation

Study These Flashcards
A
  • degree of change according to level of the heart (systemic)
  • postural dependent
  • effects pulmonary more d/t lower pressure of system
24
Q

Hydrostatic Pressure & Pulmonary Circulation

Study These Flashcards
A
  • alters potential energy of column
  • R atrium & middle of lung = zero reference points
  • base of lung received more than apex d/t gravity
  • leads to recruitment & distention @ lung base
25
What causes transmural pressures to be greater at base of lung than apex?...
- distention of blood vessels at base - decrease resistance at base - greater blood flow to base
26
What creates Lung Zones?
pulmonary arterial pressures pulmonary venous pressures alveolar pressures
27
What are lung zone pressures dependent on?
hydrostatic pressure gravity transmural pressure (compressive) lung volume
28
Zone 1
PA > Pa>Pv no blood flow, capillaries compressed by PA -expand (worsen) = decrease PAP, increased PA, occlusion of vessels -reduce (improve) = increased PAP, reduced hydrostatic tension (pt positioning)
29
Zone 2
Pa> PA> Pv | -porportional to difference between Pa - PA
30
Zone 3
Pa>Pv>PA -- ideal relationship - flow proportional to difference between Pa & Pv - increased blood flow
31
Zone 4
Abnormal state, LV backup | high vascular resistance, reduced local blood flow
32
Vascular Smooth Muscle Tone in Pulmonary Vasculature
-active regulation -- altering vascular smooth muscle in pulmonary vessels
33
Pulmonary Bed Vasoconstrictors
reduced PaO2 increased PCO2 histamine thromboxane A2
34
Pulmonary Bed Vasodilators
Increased PaO2 nitric oxide acetylcholine prostacyclin
35
Thromboxane A2
potent vasoconstrictor - product of arachidonic acid metabolism - produced by macrophages, leukocytes and endothelia cells after lung injury - super short half life- seconds
36
Prostacyclin
Prostaglandin 12 - potent vasodilator - also inhibits platelet activity - produced by endothelial cells - product of arachidonic acid metabolism
37
Nitric Oxide
Epithelial, endogenous vasodilator - localized effect only - effect d/t synthesis of cyclic GMP - diffuses into circulation immediately, irreversibly binds to heme (>200,000 x > then oxygen)
38
Hypoxic Pulmonary Vasoconstriction
-localized - shunts away from hypoxic region enhanced by hypercapnia & acidosis -lung-wide -> high PVR ->chronic pulm HTN **important for balancing V/Q ratio**
39
Pulmonary Hypertension & Causes
**serious condition** high PVR, elevated PAP causes: generalized alveolar hypoxemia (increases PVR), hypoventilation, low inspired PO2, increased PCO2, pain, histamine, high altitudes
40
What are some things that can happen d/t Pulmonary Hypertension...
- R ventricular hypertrophy (not designed for high pressure) - tricuspid regurgitation - R heart failure (cor pulmonale) - -only effective treatment = lung transplant
41
Regional Ventilation Distribution
- lower portion of lung tends to be more ventilated than apex - nonuniform distribution of TV d/t gravitational effects - compliance at base > compliance at apex
42
Local Ventilation Distribution
- airway resistance & lung compliance differences among terminal units cary depending on alveolar time constant - longer time means slower ventilation
43
V/Q mismatch
- Ventilation Perfusion Mismatch | - most common cause of inefficient O2 & CO2 exchange
44
V/Q - Normal PA - Pa differences...
10-15 mmHg
45
V/Q - Larger PA - Pa differences...
indicative of intrinsic pulmonary disease --> shunting
46
Right - Left Shunting
- non-oxygenated (R side) blood jumps to L side - leads to venous admixture - small shunts are normal
47
True Anatomical Shunts
bronchopulmonary anastomoses intercardiac thesbian veins mediastinal veins pleural veins
48
Left - Right Shunts
- oxygenated blood gets cycled again | - portion of CO that returns to R heart without being consumed
49
Inspiration & Pulmonary Blood Flow
- vessel compression - greater atmospheric pleural pressure - RV receives greater blood vol in diastole - LV ejects less blood (increased pressure gradient between LV & systemic pressure)
50
Expiration & Pulmonary Blood Flow
- reduced gradient allows increased stroke volumes | - lower pleural pressure gradient
51
Mechanical Ventilation
- artificially increased alveolar pressure - increases Zone 2 - can decrease CO or increase V/Q mismatch
52
Pulmonary Emboli
obstruction --> increased PVR
53
Pulmonary Edema
- excessive pulmonary capillary pressure --> fluid leak -->interstitium --> alveoli - anticipated w/ high LV filling pressures

BB - Respiratory Review (5 decks)

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