CHAPTER 48 



Dynamics of the pulmonary circulation 



ALFRED P. FISHMAN 



Department of Medicine, Columbia University, 

 College of Physicians and Surgeons, New York City 



CHAPTER CONTENTS 



The Growth of Ideas 



Bridge Between Two Ventricles 

 Role in External Respiration 

 Analysis of Pulmonary Hemodynamics 

 Alveolar-Capillary Gas Exchange 

 Comparative Physiology 



Experimental Animals and Test Preparations 

 Functional Anatomy 

 Blood Vessels 



Overlap of distensibility and resistance characteristics 



Large pulmonary vessels 



Small muscular pulmonary vessels 



Capillaries 

 Extravascular Smooth Muscle 

 Systemic Blood Supply of the Lung 

 Venous Admixture 

 Pulmonary Vasomotor Nerves 

 Pulmonary Blood Flow 

 Normal Values 



Uneven Pulmonary Blood Flow 

 Pulmonary Vascular Pressures 

 Recording 



Hydrostatic Reference Level 

 Pulmonary Arterial Pressure 

 Pulmonary Venous and Left Atrial Pressures 

 Pulmonary Arteriovenous Pressure Gradient 

 Pulmonary Wedge Pressures 

 Influence of Intrathoracic Pressure on Pulmonary Vascular 



Pressure 

 Transmural Versus Luminal Pressures 

 Pulmonary Blood Volume 



Measurement of Pulmonary Blood Volume 



Stewart-Hamilton : indicator dilution 



Newman: exponential downslope 



Bradley: equilibration curves 

 Changes in Pulmonary Blood Volume 



Lung volumes 



Mechanics of breathing 



Radioactive tracers 



Miscellaneous 

 Normal Values for Pulmonary Blood Volume 



Variations in Pulmonary Blood Volume 



Partition of Pulmonary Blood Volume 

 Hemodynamic Interrelations 



Distensibility and Resistance 



Distensibility arid Capacity : Pressure -Volume Relationships 



Resistance: Pressure-Flow Relationships 



Meaning of Pulmonary Vascular Resistance 



Practical Recognition of Pulmonary Vasomotricity 



Blood Flow Through Each Lung Separately 



Critical Closure 



Potential and Kinetic Energy 

 Pulmonary Capillary Circulation 



Pulmonary Capillary Pressure 



Rate of Pulmonary Capillary Blood Flow- 

 Nature of Pulmonary Capillary Blood Flow 



Size of Pulmonary Capillary Bed 



Pulmonary Capillary Blood Volume 



Resistance and Distensibility 



Time Spent by Blood in Pulmonary Capillaries 



Pulmonary Capillary I lematocrit 



Transcapillary Exchange 

 Miscellaneous Hemodynamic Phenomena 



Pulmonary Arterial Pulse-Wave Velocity 



Pulmonary Circulation Time 

 Influence of Respiration on Pulmonary Circulation 



Spontaneous Breathing 



Inllation of the Lungs 



Positive Pressure Breathing 



Negative Pressure Breathing (Pleural) 



Negative Pressure Breathing (Intrapulmonary) 



Cough 



Prolonged Expiration 



Forced Expiration (Valsalva) 

 Occlusion of a Pulmonary Artery 

 Effects of Exercise on Pulmonary Circulation 



Pulmonary Blood Flow 



Blood Flow and Oxygen Uptake 



Arteriovenous Oxygen Difference 



Pulmonary Vascular Pressures 



Pulmonary Blood Volume 



Pulmonary Vascular Resistance 

 Miscellaneous Mechanical Influences 



Heart Rate 



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