The Systemic circulation and pulmonary circulation order with valves, veins, atriums, ventricles and arteries, , pulmonary capillary bed spreads __-__mL of blood over __m^2 area, pulmonary capillary bed spreads 75-100mL of blood over 70m^2 area, Pulmonary arteries have more smooth muscle than systemic arteries, so they are more able to constrict. T or F, F. Pulmonary arteries have less smooth muscle than systemic arteries, so they are less able to constrict, pulmonary arteries carry ____ blood. And pulmonary veins carry _____ blood, pulmonary arteries carry deoxygenated blood. And pulmonary veins carry oxygenated blood, explain the anatomical shunt?, Bronchial veins the carry deoxygenated blood because the bronchial circulation delivers O2 to the lung tissue itself, mixes with the oxygenated blood in the pulmonary veins that was exposed to ventilated alveoli, what percent of cardiac output is the anatomical shunt?, 1-2% of cardiac output, How do the pulmonary and systemic pressures & resistances compare to each other?, , Pulmonary blood flow has a more continuous blood flow and Systemic blood flow has more pulsatile blood flow. T or F, F., Pulmonary circulation = __% of the total circulating blood volume at any given time, Pulmonary circulation = 9% of the total circulating blood volume at any given time, The capillary volume of 70ml is approx. equal to the volume ejected from the RV per contraction and is therefore almost completely replaced each heart beat. T or F, T, Swan-Ganz catheter, how does it work? where is it inserted? when are pressures recorded?, , what does the PCWP measure? how is it obtained?, , how is Pulmonary artery pressure(PAP) obtained?, , how is Right atrial pressure(RAP) measured? , CVP is measured when the proximal port is in the superior vena cava, When does PCWP not reflect LAP?, when alveolar pressure exceeds pulmonary venous pressure, it compresses the pulmonary capillaries, why is a true mixed venous sample not taken from RA through proximal port but instead taken from the Pulmonary artery through distal port?, , Why would a narrowed(stenotic) mitral valve affect the PCWP?, If the mitral is narrowed, blood cannot easily leave the LA so LA pressure rises and it no longer accurately reflects LV end-diastolic pressure, because we need the preload of LV, what is PVR? which ventricle pumps against this resistance? what happens to that ventricle if PVR increases?, , what is the formula for PVR?, , what is PVR measured in? what is the conversion factor for PVR?, , what is the normal PVR? and how much smaller is PVR than SVR?, , what is SVR? which ventricle pumps against SVR?, , formula for SVR? what is the normal?, , why does the LV have a greater muscle mass?, , Which of the following does an increased PVR influence more: PAP or PCWP?, PAP because PCWP measures LAP and LVED which is after, what are the two factors affecting PVR?, , PVR = Alveolar vessel resistance + Extra alveolar vessel resistance, but what happens as lung inflates and the alveoli inflates?, This constricts the alveolar vessels and dilates the extraalveolar vessels by stretching & dilating the corner vessels. Passive factor, Why is PVR the lowest at FRC?, because the pulmonary vascular resistance is U-shaped where before FRC, the elastic recoil forces and subatm pressures are weak causing extravascular vessels to narrow(increasing PVR). Above FRC increased PVR is caused by vessel compression , In what circumstance may a decreased cardiac output be associated with increased pulmonary vascular pressures and pulmonary capillary distension?, congestive heart failure(LV failure), is vascular pressure a factor affecting PVR? if so how?, It is a passive factor, How is blood volume a factor affecting PVR?, It is a passive factor, What are the 3 active factors affecting PVR?, 1. Neurogenic stimuli 2. humoral agents and nitric oxide 3. Chemical factors, Neurogenic stimuli has minimal effect on PVR. T or F, T, What does Humoral agents mean?, substances carried in blood that affect vessel tone., what is an EDRF? what is an example we talked about in class?, , describe the benefits of NO as an EDRF in terms of reducing PVR?, , NO is inhaled in low concentrations to treat pulmonary hypertension. T or F, T, explain the steps of how NO leads to pulmonary smooth muscle relaxation(vasodilating), reducing PVR, 1st NO is released through humoral agents like Actylcholine,etc., that activate the endothelial surface receptors, what is a chemical factor that could change PVR?, , how does Hypoxic pulmonary vasoconstriction(HPV) affect PVR? what affect does it have on systemic vessels?, , what is HPV inhibited by?, , how does HPV reduce the shunt effect(where poorly ventilated alveoli get too much blood flow and highly ventilated alveoli get little blood flow), , what can cause the loss of HPV response? list all the causes, , Because NO is inhaled, it is a selective pulmonary vasodilator that only works in areas of the lungs that are well ventilated to help match the ventilation with perfusion. T or F, T, Despite the reduced effectiveness of HPV in acute lung injury, overall PVR is still reduced. T or F, F. because overall PVR increases due to edema compressing vessels, capillary destruction, inflammatory vasoconstrictors, Clinically, inhaled vasodilators are used to reduce PVR in ARDS, what are some examples?, Flolan most common, effects of gravity creates __ distinct zones or sometimes called the ____zones. List all of them, , In a healthy spontaneous breathing upright zone 1 exists. T or F, does not exist in healthy lungs, poor blood flow which causes deadspace ventilation(air reaches alveoli but no blood flowing past those alveoli), For healthy spontaneous breathing where is Zone 2 usually located? describe the blood flow? how does Systole & Diastole change blood flow?, , For healthy spontaneous breathing where is Zone 3 usually located? describe the blood flow, , For healthy spontaneous breathing where is Zone 3 located in the lungs? describe blood flow, , in PPV describe the order of PA, Pa, Pv for each zone, and its blood flow, , Are blood flow zones fixed? if not then what are the different factors affecting zones of blood flow?, , Apical alveoli at FRC are less distended and less compliant. T or F, F. more distended, Gravity causes increased Q(perfusion) in bases(gravity dependent). T or F, T, V/Q increases from lung base to lung apex. T or F. and explain why, T, describe the V/Q ratio in apical regions compared to Basal regions, , define Hydrostatic pressure, , define osmotic pressure, , oncotic pressure, , In capillary fluid dynamics(starling equation) name the two hydrostatic pressures, , why is pulmonary capillary HP 7mmHg whilst Interstitial HP is -8mmHg? why do we combine them?, so we combine these two and get the outward push as 15mmHg out of the capillary, In capillary fluid dynamics(starling equation) name the one Oncotic pressure, due to plasma proteins(mainly albumin), the net filtration pressure =_mmHg, so the net filtration pressure =1mmHg, favors fluid movement out of the capillary. T or F, T, what is pulmonary edema, , what is pulmonary edema caused by, , what happens in regards to fluid movement across alveolar capillary membrane if the HP increases too much?, ex. Left ventricular failure causing pulmonary capillary pressures to increase, what happens in regards to fluid movement across alveolar capillary membrane if the interstitial fluid volume increases too much(>100cc)?, fluid overload, what happens in regards to fluid movement across alveolar capillary membrane if there lung injuries that damage the Alveolar capillary membrane? List some causes, , What are some clinical problems that related to Hydrostatic pressures being too high?, , What are some clinical problems that related to increased capillary permeability?, , What are some clinical problems that related to decreased Oncotic pressure?, , What are some clinical problems that related to decreased lymphatic drainage?, , , The best answer is increased capillary permeability as the result of inflammation. Because if PCWP is normal then PCP is normal, and oncotic pressure is normal because you have normal plasma protein, so as a process of elimination it is increased capillary permeability, , C, , A, , A, , C, , A, , C, , C.

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