Blood Flow to the Lungs

Kirana Gudi, MD
February 4, 2020
As faculty of Weill Cornell Medical College, we are committed to providing transparency for
any and all external relationships prior to giving an academic presentation.
I do not have a financial interest in commercial products or services related to the subject of
this lecture.

-Kirana Gudi, M.D.

 The lungs are unique because they have a dual blood
supply: a Bronchial Artery circulation and the
Pulmonary Circulation. Arises the systemic circulation
from
2
RU LU
t b
palm trunk aorta
t
L intercostal
brings deoxygenated arteries
blood to the Wings ty
for gas exchange Bronchial artery
bronchial
arteries
d
venous return goes RA
The Bronchial artery circulation arises from the
systemic circulation and carries out two main
functions. bring 02 nutrients to the wings
the
pleura
participate in the humidification
to
of
the
air cold air 9 blood flow wings
to help heat up the
air so that it can
effectively
participate
in gas exchange

Some Bronchial veins drain into the azygos

vein and into the right atrium; some drain
into the pulmonary veins and then carry
deoxygenated blood to the left side of the
heart, resulting in a shunt.
*there are some bronchopulmonary anastomoses
The main function of the Pulmonary Arterial Circulation
is to circulate the entire cardiac output into the lungs to
participate in gas exchange.
extensivecapillary
network for gas
exchange

very close
to one
another to
allow for
gas exchange
 The staggering notion that the ENTIRE
cardiac output goes to the lungs reminds
us of the reason we all had to take physics.
CO
r
V=IR
k W
BP across palm vascular
the circuit resistance
V= voltage or pressure differential
I= current or flow (cardiac output)
R= resistance (Pulmonary Vascular
Resistance)
The Pulmonary Arterial Circulation is a low pressure
low resistance system which circulates the entire
cardiac output at 4-6 fold lower pressures than the
systemic circulation.
balloon stops
in the palm
aneng RIGHT HEART
CATHERISAMON

V=IR R=V/I

PVR= TPG/CO
2
Transpulmonary Pressure Gradient (TPG)= mPAP-mPCWP
Egging TIME bppyimmongnso
gnsiogfusfonda.edu've
a
Pulmonary pressures are lower 2
than systemic pressures
pulmonary resistance has to be approx pressure of LA

EFF Ir
L MPAP mean palm anerial
L
pressure
the pulmonary circulation is a
low pressure low resistance mpowp meanpalm capillary
system that circulates the wedge pressure
entire co
At baseline, the Pulmonary Vascular Resistance is low due
to an extensive network of thin-walled, distensible arteries
that have much less smooth muscle than the arteries in
systemic circulation. Tcompliant
as blood 9 the lumen
flow Artery size 9
Systemic Pulmonary Artery

Increased
Lumen

This keeps the pressure low

I
I
Because the pulmonary vessels are distensible and
compressible, they are more affected by external physical
pressures like lung volume and gravity (transmural
pressures) as opposed to systemic vessels.
 PULMONARY VESSELS
as alveolar 2
extra alveolar

line the resp bronchioles around the alveoli

is involved in gas exchange

these vessels experience different changes in pressure

resistance
high at both low high
lung volumes

when there is N
lung volume the
deep breath my
extra alveolar
vessels are alveolus expands
compressed d
resistance 9 the alveolar
capillaries get
squished
less resistance where we spend d
or most of our nme resistance
qegggqqw.gg
there is less tidal breathing
air Vol In
the alveoli breath M
f
the wings expand so the
lowest resistance where extra alveolar vessels expand
we spend most of our resistance
time at tidal volume
FRC
the mechanics of breathing
effect the resistance is
the
pulmonary vascular bed
 Because of gravity, the height of the lung, and
differential pressures caused by lung volumes, the
regional distribution of blood flow within the lung
varies considerably.
APEX

There is a regional
Net result: at
distribution of blood
in the lungs baseline, there is
a substantial
blood flow is amount of
unfilled
gravity dependest
pulmonary
THEREFORE capillaries
Blood will flow in
the pathway of
least resistance Pa arterial pressure
most of the blood Pv venous pressure
goes to the base Pa alveolar pressure
of the wings BASE
 The apex of the lungs has a
higher 9distribution of air there
9 Pa is a Pa
Pas Pa the capillaries are
Pa squished so there is too
blood flow

qq.gq.gg nzqa.qesn
gggognon

higher distribution of blood

9Pa
Pa Spa vessels are
open
blood flow happens through
MAIN POINT the difference the vessels
between PA E Pa determines
easily
now open the palm capillaries
are how much blood flow
there is
At rest there is a significant amount of unfilled palm
capillaries
Zone 1

SUMMARY
pulmonary vascular resistance is affected by two things
1 desensibility or compliance of the vessels
2 gravity
 Recruitment of these under-filled
vessels is another mechanism for
maintaining a low Pulmonary Vascular
Resistance.
when the pressure 9 Pa 9 such
that it is greater than PA
i some of the capillaries that
where previously closed will open up

An increase in cardiac output (from exercise for example) will result in an increase in the
hydrostatic pressure in the pulmonary arteries which will then recruit open these
undistended vessels and result in a stable or even decreased PA pressure
allow for a rise in co without a palm resistance
 Hypoxemic vasoconstriction is a unique vascular
phenomenon that occurs only within the pulmonary
circulation and occurs in the precapillary vessels.
duringhypoxia the pre capillary The mechanism of
vessels hypoxic mediated
constrict vasoconstriction is not
all othervesselscompletely
in the body understood.
would dictate

I
disease state

In
the drop in Poa in
response
the alveolus lead
to constriction of
the capillarysupplying it
However, there are neurochemical and
hormonal mediators of vasoconstriction,
some similar to those in systemic
circulation.

• Constrictors: Sympathetic stimulation;

Thromboxane; endothelin; hypoxemia;
hypercapnea
nervous system plays a
small role

• Vasodilators: Parasympathetic stimulation;

Prostacyclin; Nitric Oxide
The second most important function of the
pulmonary circulation is to maintain fluid
balance within the lung .ROLES OF PULMONARY CIRCULATION
I participate in gas exchange
2 maintain fluid balance in
the wing

filtration out of the

this is problematic because vessels into intestial
will n the thickness of fluid
the alveolar capillary
barrier the fluid has to be removed
The net positive fluid filtration is removed from
the interstitial space via the lymphatics.
 The final function of the Pulmonary
q Circulation is of that as a filter, protecting
systemic circulation from these materials.
• Dual blood supply and
bronchopulmonary
anastomoses prevent
infarction in most
cases.
• Recruitment prevents
hemodynamic
sequelae
• Enzymes, alveolar
macrophages and
thrombolysis
eventually clear the
pulmonary
vasculature.
The small capillaries catch the small things in the blood
the lungs are unaffected because
recruitment allowsblood flow to other areas
for gas exchange due to 9 Pa
AND
the dual blood supply prevent infarctions in
palm system