1. Chapter: 38 Pulmonary Circulation, Pulmonary Edema, Pleural FluidBy
Dr. Mudassar Ali Roomi (MBBS, M.Phil.)
Assist. Prof. Physiology

2. Physiological anatomy of pulmonary circulatory system
The pulmonary vessels
the pulmonary arterial tree has a large compliance
Bronchial blood vessels
1 to 2 % of the total cardiac output.
the left ventricular output is about 1 to 2 % greater than the right ventricular output.
Lymphatic from the lungs enter into right thoracic lymph duct

3. Blood volume of the lungs
500 milliliters
9 % of the total blood volume of the entire circulatory system.
Approximately 70 ml in the pulmonary capillaries
Lungs as a Blood Reservoir ( ml)

4. Automatic Control of Pulmonary Blood Flow Distribution
Hypoxia vasoconstriction
When concentration of oxygen in the air of the alveoli decreases below 70 % of normal ,the adjacent blood vessels constrict.
This is opposite to effect observed in systemic vessels
Undiscovered vasoconstrictor substance to be released from the lung tissue
Important function: to distribute blood flow to most oxygenated alveoli.

5. Pressure Pulse Curve in the Right Ventricle.
Systolic: 25 mm Hg
Diastolic: about 0 to 1 mm Hg

6. Pressures in the Pulmonary Artery.
Systolic: 25 mm Hg
Diastolic: 8 mm Hg.
Pulse pressure: 17 mm Hg.

7. Pulmonary Capillary Pressure: 7 mmHg
Left Atrial and Pulmonary Venous Pressures:
The mean pressure in the left atrium and the major pulmonary veins averages about 2 mm Hg
estimated with moderate accuracy by measuring the pulmonary wedge pressure (5 mm Hg). It is 2 to 3 mm Hg greater than the left atrial pressure

8. Comparison of pressures in systemic and pulmonary circulations.

9. Length of Time Blood Stays in the Pulmonary Capillaries (0.3-0.8 sec).

10. This extra flow is accommodated in the lungs in three ways:
Effect of Increased Cardiac Output on Pulmonary Blood Flow and Pulmonary Arterial Pressure During Heavy Exercise
During heavy exercise, blood flow through the lungs increases fourfold to sevenfold.
This extra flow is accommodated in the lungs in three ways:
(1) by increasing the number of open capillaries,
(2) by distending all the capillaries
(3) by increasing the pulmonary arterial pressure.

11. Shift of Blood Between the Pulmonary and Systemic Circulatory Systems as a Result of Cardiac Pathology (left heart failure).
affects the pulmonary system greatly but usually has only mild systemic circulatory effects.

12. Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow
Hydrostatic pressure is affected by gravity
Pulmonary arterial pressure at the apex of lung of a standing person is about 15 mm Hg less than the pulmonary arterial pressure at the level of the heart
The pressure in the base of the lungs is about 8 mm Hg greater than the pulmonary arterial pressure at the level of the heart.

13. Zones of Pulmonary Blood Flow
Zone 1 blood flow
No blood flow during all portions of the cardiac cycle
Zone 1 Blood Flow Occurs Only Under Abnormal Conditions.
occurs when either the pulmonary systolic arterial pressure is too low or the alveolar pressure is too high to allow flow
Too high alveolar pressure e.g. Breathing against a positive air pressure
After severe blood loss.

14. Zones of Pulmonary Blood Flow
Zone 2 (intermittent fblood low) in the apices.
In normal lungs, this zone is about 10 centimeters above the midlevel of the heart and extends from there to the top of the lungs
Blood flows during systole but not during diastole.
Zone 3 (continuous blood flow throughout the cardiac cycle) in all the lower areas.
from about 10 centimeters above the level of the heart all the way to the bottom of the lungs,

15. In lying posture, all lung has got zone 3 .

16. Effect of exercise on pulmonary blood flow

17. Capillary Exchange of Fluid in the Lungs, and Pulmonary Interstitial Fluid Dynamics

18. STARLING FORCES: Capillary Exchange of Fluid in the Lungs, and Pulmonary Interstitial Fluid Dynamics

19. Negative Pulmonary Interstitial Pressure and the Mechanism for Keeping the Alveoli “Dry.”

20. Pulmonary Edema CAUSES Left-sided heart failure mitral valve disease
Damage to the pulmonary blood capillary membranes
Infections (pneumonia)
Breathing noxious substances such as chlorine gas or sulfur dioxide gas

22. Pulmonary Edema Safety Factor
pulmonary capillary pressure must rise from the normal level of 7 mm Hg to more than 28 mm Hg
Safety factor against pulmonary edema of 21 mm Hg.

23. Safety Factor in Chronic Conditions (>2 weeks) e. g
Safety Factor in Chronic Conditions (>2 weeks) e.g. Chronic mitral stenosis
No lethal edema in chronic lung conditions. This is because Lymph vessels expand greatly and increase the drainage of fluid (upto 10 fold).
Pulmonary capillary pressures may rise upto 40 to 45 mm Hg even without development of pulmonary edema.

24. Rapidity of Death in Acute Pulmonary Edema
A medical emergency
Cause: Acute left-sided heart failure
Pulmonary capillary pressure may rise more than 50 mmHg
Death frequently ensues in less than 30 minutes in severe cases

25. Pleural Cavity
the pleural space—the space between the parietal and visceral pleurae
It is a potential space only
It contains only a few ml fluid.
a thin layer of mucoid fluid lies between the parietal and visceral pleurae for easy slippage of moving lungs.

26. The pleural membrane
serous membrane through which small amounts of interstitial fluid transude continually into the pleural space.
Pumping of fluid from the space by the lymphatics provides negative pressure in pleural cavity (–7 mm Hg).

27. Pleural Effusion
Definition: Pleural effusion means the collection of large amounts of free fluid in the pleural space.
The effusion is analogous to edema fluid in the tissues and can be called “edema of the pleural cavity.”
Causes:
Blockage of lymphatic
Cardiac failure
Greatly reduced plasma colloid osmotic pressure
Infection or any other cause of inflammation