PULMONARY CIRCULATION

By Dr Vineetha; MD
Senior Resident
Department of Physiology
 Learning objectives
1. Functional Anatomy
2. Characteristic features of pulmonary circulation
3. Functions of pulmonary circulation
4. Regulation of pulmonary blood flow
5. Applied aspect
 Functional Anatomy

Lungs have 3 types of circulations:-

1. Pulmonary circulation
2. Bronchial circulation
3. Lymphatic circulation
Pulmonary circulation
Bronchial circulation

Physiological shunt
Which is the other vessel that cause
physiological shunt?

Coronary vessel –
Thebesian vein
Lymphatic circulation

Prevents – pulmonary edema

Characteristic features of pulmonary circulation
Pulmonary circulation – low pressure, low resistance and high
capacitance system

1. Thin walled and distensible – large compliance – 7ml/mmhg –

accommodate the stroke volume output of the right ventricle.

2. Pulmonary artery including smaller artery and arterioles – very little

smooth muscles --- larger diameter

3. Pulmonary capillaries – larger diameter and has multiple anastomosis.

4. Each alveolus is enclosed in basket of capillaries.

Pressures in Pulmonary system

Mean pulmonary arterial pressure

– 15mmhg
Mean aortic arterial pressure –
93mmhg
 Left atrial pressure can
be estimated by
measuring pulmonary
wedge pressure

Ballon tipped , Swan – Ganz catheter

Continued………Characteristic features of pulmonary circulation

5. Driving pressure for pulmonary flow = Mean pressure in pulmonary

artery – mean pressure in pulmonary vein = 15-5 = 10 mmHg.

6. The pulmonary capillary pressure must be above the alveolar pressure

for the blood flow to continue.

7. Low pulmonary capillary pressure – keeps the alveoli dry.

Continued………Characteristic features of pulmonary circulation

7. R – 1 of the systemic circulation.

10

8. Pulmonary vascular resistance falls with increasing cardiac output.

This is accomplished by 2 mechanism:-

1. Recruitment- Opening up of previously closed capillaries

2. Distension - Increase in the diameter of the capillaries resulting in more blood flow
Advantage:
1. Conserves the energy of the right side of the heart
2. Prevents development of pulmonary Edema during the
increased cardiac output
 Blood volumes of the lung
• The blood volume of the lung – 450ml
• Lung serve as a reservoir

1. Pulmonary blood volume decrease on standing (gravity)

2. Pathological – haemorrhage results in shift of blood
some cardiac pathology

Left sided heart failure / mitral stenosis /

mitral regurgitation
• Low oxygen tension in the alveoli induces pulmonary vasoconstriction

• Hypoxia-induced vasoconstriction – unique feature of pulmonary

circulation

So what's the consequence of hypoxia in

systemic circulation ?

vasodilation
Effect of gravity on pulmonary blood flow
Perfusion zone of the lung
 Zone 1 Zone 2 Zone 3
Zero blood flow Intermittent blood flow Continuous blood flow
Pa < PA Pa> PA>Pv Pa>Pv>PA
Capillaries are collapsed Occurs during systole Occurs from hilum to base
– does not exist in normal
lungs
Eg : low Pa – PE, Blood flow depends on
hypovolemic shock arterial-alveolar gradient
and not the arteriovenous
gradient – Waterfall effect
Low PA – severe Blood flows linearly from
obstructive lung d/s. apex to bottom of zone 2

Lungs are underperfused at the apex and over perfused at the base because of
the effect of gravity
Effect of gravity on regional distribution of
pulmonary blood flow in standing posture
 Regulation of pulmonary blood flow
1. Neural control
1. Efferent control through sympathetic vasoconstrictor nerves
a) Baroreceptors (P. vasodilation)
b) Chemoreceptors (P. vasoconstriction)
2. Afferent control through vagus
a) Pulmonary baroreceptors
b) Atrial stretch reflex
c) J receptors
2. Chemical control
1. Local hypoxia – O2 sensitive K channels – vasoconstriction
2. Hypercapnia and acidosis
 Functions of pulmonary circulation
Primary function

1. gas exchange

Secondary function

2. Filter – protects the systemic circulation from thrombi and emboli

3. Metabolic organ – metabolize vasoactive hormones like Angiotensin-

I by the ACE

4. Blood reservoir – 10% of the total circulating volume is in the lungs

Dynamics of fluid exchange through
pulmonary capillaries
Balance of starling force
Outward force:-
1. Interstitial oncotic pressure =14mmhg
(pulls fluid out)
2. Interstitial hydrostatic pressure = -8mmhg
(pulls fluid out)
3. Capillary hydrostatic pressure = 7mmhg
(push fluid out)
Total outward force = 29mmhg
Inward force:-
Plasma oncotic pressure = 28mmhg

Net mean filtration= 29 – 28 = 1mmhg

 Pulmonary edema
• Any factor that increases fluid filtration out of the pulmonary
capillaries or that impedes the pulmonary lymphatic function results
in raised pulmonary interstitial fluid pressure from negative range to
positive range that tend to cause filling in the pulmonary interstitial
spaces and alveoli with free fluid.

• Most common cause is rise in capillary hydrostatic pressure.

• Acute safety factor against pulmonary edema – 21mmhg

Causes :

1. Left heart failure/ mitral valve disease

2. Damage of pulmonary blood capillaries – infection /breathing

irritating gases

3. Pulmonary fibrosis

4. Exercise in high altitude

Signs and symtoms :-
Dyspnoea, orthopnoea
Sputum – pinkish and frothy
Difficulty to speak

Treatment
Use diuretics , oxygen therapy and other supportive measures.
 Effect of gravity
• Linear reduction of blood flow and alveolar ventilation from base to
apex of the lung. This means the basal alveoli is over perfused and
over ventilated and apical alveoli is under perfused and under
ventilated.
• But gravity affects perfusion more than ventilation
• Increased V/Q ratio – Ventilation exceeds perfusion

• Decreased V/Q ratio – Perfusion exceeds ventilation

• Perfusion – more at the base than the apex

• Ventilation – more at the base than the apex

• Ventilation-perfusion ratio is less at base than the apex

• V/Q ratio is high at apex

 Applied Aspect

Focus of
infection –
myocobacterium
tuberculosis
"When the
breath is
unsteady, all is
unsteady; when
the breath is
still; all is
still".

THANK YOU