The document discusses the pulmonary circulation, including the anatomy and flow of blood through the lungs. It covers topics like pulmonary arteries, capillaries, veins and their pressures. It also discusses regulation and functions of pulmonary circulation like gas exchange, blood flow control and fluid filtration.
The document discusses the pulmonary circulation, including the anatomy and flow of blood through the lungs. It covers topics like pulmonary arteries, capillaries, veins and their pressures. It also discusses regulation and functions of pulmonary circulation like gas exchange, blood flow control and fluid filtration.
The document discusses the pulmonary circulation, including the anatomy and flow of blood through the lungs. It covers topics like pulmonary arteries, capillaries, veins and their pressures. It also discusses regulation and functions of pulmonary circulation like gas exchange, blood flow control and fluid filtration.
The document discusses the pulmonary circulation, including the anatomy and flow of blood through the lungs. It covers topics like pulmonary arteries, capillaries, veins and their pressures. It also discusses regulation and functions of pulmonary circulation like gas exchange, blood flow control and fluid filtration.
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Pulmonary
Circulation Blood flow to lungs Pulmonary circulation - entire output of right ventricle ( cardiac output) - supplies lung with venous blood draining all tissues of body - undergoes gas exchange with alveolar air in pulmonary capillaries Pulmonary trunk Pulmonary trunk arises – right ventricle Divide into right and left branches Enters the lung Divides repeatedly – forming the capillaries Bronchial circulation -supplies tracheobronchial tree with systemic arterial blood - bronchial capillaries drain into - bronchial veins - anastomose with pulmonary capillary / veins Forms physiological shunt Lymphatic circulation- Present in walls of terminal bronchioles and in all supportive tissue allow unidirectional flow of lymph to subclavian veins
Use – removal of particulate matter Plasma protein leaking from lung capillaries removed , help to prevent pulmonary edema Characteristic features of pulmonary circulation Thin walled (1/3rd than sys. circulation) and distensible Hence low resistance low pressure circulation but high compliance Thickness of rt ventricle and pulm artery is 1/3rd of lft ventricle and aorta Pulmonary arteries – less amt of smooth muscles Pulmonary capillaries – larger diameter than systemic , have multiple anastomoses At rest 600 ml blood present in pulmonary vessels , but can accommodate about 200- 900ml of blood. Hence called capacitance vessels. Act as reservoir vessels
Pulmonary blood flow almost same as cardiac output
ARRANGEMENT OF BLOOD SUPPLY TO ALVEOLI The pulmonary arteries branch like that of airways so that each airway branch and arterial branch run parallel to each other. Pulmonary capillaries are large in diameter and have multiple anastomoses. The arrangement of capillaries is such that each alveolus is surrounded by a capillary basket.
Each bronchopulmonary segment supplied by
bronchial artery , pulmonary artery and vein Advantages of pulmonary circulation being a Low resistance system Accommodate more blood as person shift from standing to lying position
High compliance allows vessel to dilate in response to modest rise in
pulm arterial pressure
Pulse pressure in the pulmonary circulation is rather low
Pressures in the pulmonary system RV- Systolic- 25mmHg Diastolic – 0-1mmHg
Pulm artery- Syst- 25 mmHg Diast- 8mmHg Mean PAP – 15 mmHg
Pulm capillary- 7mmHg
Left atrium- abt 2- 5mm Hg Pulmonary capillary pressure Mean value – 7 mmHg Less than colloid osmotic pressure Suction forces – keep alveoli dry Rise in pulm capillary hydrostatic pressure can lead to pulm edema Pulmonary wedge pressure Left atrial pressure estimated with mod accuracy by measuring the pulm wedge pressure Measured by introducing catheter Pressure measured – wedge pressure – abt 5mmHg Wedge pressure abt - 2-3 mmHg greater than LAP Pulmonary blood volume Total vol- 450- 600ml 9 % of total blood volume Decrease in physiological condn – standing Decrease in pathological condn – hemorrhage Increase – failure of left side of heart mitral stenosis , mitral regurgitation Causes blood to dam up in pulmonary circulation Increase pulm blood flow Pulmonary blood flow Zonal blood flow Alveoli not created equal when it comes to PERFUSION (Q) and VENTILATION ( V) The perfusion varies because of 2 reasons – - posture - gravity We can divide upright lung into 3 zones based on relationship between following pressure- - PA – PRESSURE IN ALVEOLI Pa - PRESSURE IN arteries Pv - PRESSURE IN veins Pressure gradient between pulm artery n pulm vein driving pressure for blood flow Alveolar pressure should be less than pulmonary capillary pressure for blood to flow Effect of gravity on pulm blood flow – In erect posture – gravity affects due to hydrostatic pressure effect During supine post- all parts of lung equally perfused Zero reference plane is at the level of right atrium So pulmonary arterial pressure –
In middle of lungs – 15 mmHg
Apex of lung - 4 mmHg (15-11mmHg) Base of lungs – 26 mmHg (15+11 mm Hg) Pressure increases from apex to base of lung Perfusion zones of lung Zone 1 – PA> Pa>Pv AREA OF ZERO BLOOD FLOW NORMALLY NOT PRESENT IN LUNGS Alveoli naturally distended and exert pressure on blood to an extent blood vessels get collapsed Zone 2- Pa> PA>Pv AREA OF INTERMITTENT FLOW Arterial pressure more than alveolar pressure , but venous pressure is less Presence of arterial-alveolar pressure gradient Water fall effect Zone 3- Pa> Pv>PA AREA OF CONTINUOUS BLOOD FLOW Comprises majority of lungs in health Effect of exercise on the regional pulmonary blood flow : Pulm blood flow ses to 4-8 times during exercise. Increase is 3-4 times more at apex than at base of lung. Occurs due to reduction in resistance to blood flow because of distension and recruitment of capillaries. Advantage – inc in blood flow- more blood get oxygenated Reduce chance of dev of pulm edema Pulmonary capillary dynamics Capillary exchange of fluid in lung and pulmonary interstitial fluid : STARLING’s FORCES Functions of pulmonary circulation Respiratory gas exchange by pulm diffusion Reservoir for lft ventricle Filter for removal of emboli and other particles from blood Removal of fluid from alveoli Absorption of drugs Synthesis of angiotensin converting enzyme Regulation of pulmonary blood flow Neural regulation – Efferent sympathetic vasoconstrictor nerves Afferent control through vagus mediated through following receptors- - pulmonary baroreceptors - pulmonary volume receptors - J receptors Baroreceptors – tunica adventitia of pulm trunk –on stimulation reflex bradycardia , decreased HR , hypotension
Volume receptors – at the junction of pulm vein and LA - On stimulation
tachycardia and diuresis
J receptors – situated in alveolar walls adjacent to pulm capillaries –
Sensitive to increase in interstitial fluid , embolism Reflex tachypnoea , decreased HR , decrease in muscle tone Chemical control Major regulatory mechanism Local hypoxia – in systemic circulation – hypoxia – produce — VASODILATATION In pulm blood vessels – hypoxia – VASOCONSTRICTION Hypercapnia , acidosis also produce Vasoconstriction Chronic hypoxia – high altitude – increase pulm arterial pressure – RV hypertrophy Hypoxia induced vasoconstriction leads to diversion of blood from poorly ventilated alveoli to well – ventilated alveoli to ensure proper oxygenation.
Mechanism – hypoxia – closure of O2 sensitive K + channels in
smooth muscles of pulm vessels – vasoconstriction
Hypoxia – Vasodilatation -- due to opening of ATP sensitive K +
