PULMONARY
CIRCULATION
FUNCTIONAL ANATOMY
Lungs have 3 circulation.
Pulmonary
circulation
Bronchial
circulation
Lymphatic
circulation.
PULMONARY CIRCULATION
Pulmonary trunk
Right & left pulm
artery
Right & left lungs
Capillaries lining of
alveoli
Get oxygenated &
return back via pul
veins to left atrium.
BRONCHIAL CIRCULATION
1-2 % of total cardiac output.
Descending thoracic aorta
give right & left bronchial
arteries
Supply oxygenated blood to lungs
(connective tissue, septa &
bronchi) & after joins pulm veins
without (Bypass) oxygenation.
So forms Physiological
shunt.
OTHER EXAMPLE OF
PHYSIOLOGICAL SHUNT
Drainage of Coronary vessel in to left side of
heart.
Effects of shunts –
Reduce oxygenation of arterial blood slightly.
Increase left ventricular output by 1-2% than right.
LYMPHATIC CIRCULATION.
Present in walls of
terminal bronchioles
& supportive tissues
of lung.
Removes particulate
matter, plasma
proteins – thus
prevents pulmonary
oedema
Thursday, December 5, 2019
LYMPHATIC CIRCULATION.
Drainage pathway
Deep lymphatic
Pulmonary nodes
Bronchopulmonary
nodes
Tracheobronchial
nodes
Bronchomediastinal
trunk.
PULMONARY CIRCULATION
CHARACTERISTIC FEATURES.
Pulmonary circulation is low pressure, low
resistance & high capacitance system.
Thickness of Right ventricle and pulmonary
artery 1/3rd of left ventricle & aorta
Pulmonary capillaries are larger in diameter
than systemic capillaries.
Each alveolus is enclosed in basket of
capillaries.
PRESSURES IN PULMONARY
SYSTEM.
Right ventricular pressure.
Pulmonary artery pressure.
Left atrial pressure.
Pulmonary capillary pressure.
RIGHT VENTRICULAR
PRESSURE.
During each cardiac cycle,
During Systole – reaches peak 25 mm
Hg.(120 mm Hg in Left ventricle)
During Diastole – 0-1 mm Hg (5 mm Hg in
left ventricle)
LEFT ATRIAL PRESSURE.
Major pulmonary veins pressure avg 5 mm
Hg
So Pressure gradient in pulmonary system
Mean pulmonary artery pressure – mean
pulmonary vein pressure
15-5 = 10 mm Hg.
PULMONARY CAPILLARY
PRESSURE.
10 mm Hg.
Colloidal osmotic pressure is 25 mm Hg
So net suction force of 15 mm Hg draw fluid
from pulmonary interstitial fluid into
pulmonary capillary
So keeps Alveoli dry
SIGNIFICANCE OF LOW PULMONARY
CAPILLARY PRESSURE
So if pulmonary capillary pressure rises above
25 mm Hg
Fluid escapes into interstitial spaces
Lead to pulmonary oedema
Conditions raising this pressue
Exercise at high altitude
Left heart failure
Mitral stenosis
Pulmonary fibrosis.
PULMONARY WEDGE
PRESSURE
Estimate left atrial
pressure.
Measured by passing a
catheter through right
ventricle, pulmonary artery
up to smallest branch of
pulmonary artery.
PULMONARY BLOOD VOLUME
Pulmonary vessels contains – 600 ml; its
capacitance vary from 200-900 ml
Pulmonary blood volume decreases during
standing & during haemorrhage to
compensate , so acts as Reservoir.
PULMONARY BLOOD FLOW
Pulmonary blood flow
nearly equal to cardiac
output.
Blood flow through lung
depend on –
Relationship between
pressures of
Pulmonary artery,
pulmonary vein &
alveolar artery.
EFFECT OF GRAVITY ON REGIONAL
PULMONARY BLOOD FLOW.
In supine position
mean arterial pressure
is same all over lung
so all regions equally
perfused.
In erect position
gravity affects due to
hydrostatic pressure
effect.
EFFECT OF GRAVITY ON REGIONAL
PULMONARY BLOOD FLOW.
Zero reference plane is
at level of right
atrium.
So pulmonary arterial
pressure
In middle of lung –is 15
mm Hg
At apex – 4 mm Hg
At the base 26 mm Hg.
Thursday, December 5, 2019
PERFUSION ZONES OF LUNG
Depending on relationship
between alveolar
pressure (PA),
Pulmonary arterial
pressure (Pa) &
Pulmonary venous
pressure (Pv) 3 zones
Zone 1
Zone 2
Zone 3
PERFUSION ZONES OF LUNG
Zone 1- area of zero
flow. (Pa<Pv)
Does not exist in normal
lung.
In hypovolaemic shock,
pulmonary embolism.
Zone 2 – Intermittent
blood flow.(Pa>PA>Pv)
Occurs during systole.
PERFUSION ZONES OF LUNG
Blood flow is
determined by arterial-
alveolar pressure
gradient not arterio-
venous gradient. so
called Waterfall effect.
Thursday, December 5, 2019
PERFUSION ZONES OF LUNG
Zone 3
Continuous high blood
flow. (Pa>Pv>PA)
Generally occurs near
bottom of the lung.
Thursday, December 5, 2019
EFFECT OF GRAVITY ON
ALVEOLAR VENTILATION
In Supine Position – alveolar ventilation evenly
distributed
In Upright Position –
Alveolar pressure is zero throughout lung
Intrapleural pressure – at apex -10 mmHg & at base -2
mm Hg.
So transpulmonary pressure -10 & -2 at apex & base
respectively.
So linear reduction in regional alveolar ventilation from
base to apex.
CLINICAL SIGNIFICANCE
So arterial
oxygenation in
unilateral lung
diseases is improved
by keeping good lung
in Dependent
Position.
Opposite is done in
INFANT.
EFFECT OF GRAVITY
Linear Reduction of blood flow and
alveolar ventilation from base to
apex.
But gravity affects perfusion more than
ventilation.
So as we go up from middle VA/Q goes on
increasing , about 3 at apex.
At the base it is over perfused than over
ventilated so at the base is 0.6
CAUSES OF ALTERATION.
Causes of altered
Causes of altered
alveolar ventilation pulmonary perfusion.
Bronchial asthma
Anatomical shunts
Emphysema
Pulmonary embolism
Pulmonary fibrosis
Decrease in pulmonary
vascular bed in
Pneumothorax emphysema
Congestive heart Increase pulmonary
failure resistance in pulmonary
fibrosis, Pneumothorax,
CHF
Thursday, December 5, 2019
PULMONARY OEDEMA
Occur due to increase capillary filtration
from pulmonary capillary.
Conditions –
Increase capillary hydrostatic pressure from 7 mm
Hg to 28 mm Hg (safety factor of 21 mm Hg)
Capillary permeability increase – due to infection,
irritant gases.
Acute left heart failure – increase in capillary
pressure to 50 mm Hg.
FUNCTIONS
Respiratory gas exchange
Other functions
Reservoir for left ventricle
Filter for removal of emboli & other particles from
blood.
Removal of fluid from alveoli.
Role in absorption of drugs.
Synthesis of Angiotensin converting enzyme.
REGULATION OF PULMONARY
BLOOD FLOW.
Neural control.
Efferent sympathetic vasoconstrictor
nerves
Innervates pulmonary blood vessels.
Participate in vasomotor reflexes.
Baroreceptor stimulation – causes reflex
dilatation of pulmonary vessels
Chemoreceptor stimulation – causes pulmonary
vasoconstriction.
Afferent control through vagus
is mediated through
receptors.
Pulmonary
baroreceptors
pulmonary volume
receptors
J receptors.
Thursday, December 5, 2019
CHEMICAL CONTROL
Local Hypoxia – causes
change in blood flow by
vasoconstriction.
Hypercapnia &
acidosis – causes
vasoconstriction.(Vasod
ilatation in systemic
circulation)
CHEMICAL CONTROL
Chronic Hypoxia
Occurs in high altitude dwellers associated with
pulmonary hypertension followed by right
ventricular hypertrophy, right heart heart failure &
pulmonary oedema.
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