BOOK
Pulmonary Circulation: From Basic Mechanisms To Clinical Practice
(2001)
Additional Information
Book Details
Abstract
This new book with 35 chapters is a comprehensive account of the important features of the pulmonary circulation which will appeal to (1) clinical and non-clinical students who want a broad-based introduction to the subject, (2) postgraduates involved in or contemplating research on the pulmonary circulation, (3) specialists in chest medicine, cardiology and intensive and critical care whose clinical work concerns diseases affecting the pulmonary blood vessels.Pulmonary circulation is well illustrated with 132 figures, 43 tables and learning points highlighted at the end of each chapter. There are two main sections: “Basic Mechanisms” and “Clinical Practice”. All the important features of the pulmonary circulation are reviewed — genetics, cell biology, vascular remodelling, anatomy, physiology, pharmacology, pulmonary hypertension, pulmonary oedema, etc.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| CONTENTS | xvii | ||
| ACKNOWLEDGEMENTS | xi | ||
| FOREWORD | xiii | ||
| PREFACE | xv | ||
| Section I The Pulmonary Circulation: Basic Mechanisms | 1 | ||
| CHAPTER 1 HISTORICAL INTRODUCTION | 3 | ||
| 1.1 BEFORE THE TWENTIETH CENTURY | 3 | ||
| 1.2 THE TWENTIETH CENTURY | 5 | ||
| 1.2.1 Cardiac catheterisation | 5 | ||
| 1.2.2 Hypoxic vasoconstriction | 6 | ||
| 1.2.3 Distribution of blood flow | 7 | ||
| 1.2.4 Pulmonary haemodynamics | 8 | ||
| 1.2.5 Diffusion | 9 | ||
| 1.2.6 Ventilation–perfusion (VA/Q) ratios | 9 | ||
| 1.2.7 Lung liquid | 10 | ||
| 1.3 1970 TO THE PRESENT DAY | 11 | ||
| REFERENCES | 12 | ||
| CHAPTER 2 VASCULAR STRUCTURE AND FUNCTION | 14 | ||
| 2.1 ORGANISATION, BRANCHING PATTERN AND STRUCTURE | 14 | ||
| 2.1.1 General arrangement of pulmonary arteries and veins | 14 | ||
| 2.1.2 The organisation of branching trees | 14 | ||
| 2.1.3 A map of the human pulmonary arterial tree | 16 | ||
| 2.1.4 Wall structure of pulmonary arteries and veins | 16 | ||
| 2.1.5 The capillary network | 19 | ||
| 2.1.6 Learning points | 21 | ||
| REFERENCES | 22 | ||
| 2.2 MECHANICS OF PULMONARY BLOOD VESSELS | 23 | ||
| 2.2.1 Distinction between alveolar and extra-alveolar vessels | 23 | ||
| 2.2.2 Forces acting on extra-alveolar vessels | 24 | ||
| 2.2.3 Perivascular pressure for different types of extra-alveolar vessel | 26 | ||
| 2.2.4 Recruitment and distension in the septal capillaries (alveolar vessels) | 27 | ||
| 2.2.5 Vascular compliance | 28 | ||
| 2.2.6 Learning points | 29 | ||
| REFERENCES | 29 | ||
| 2.3 STRESS FAILURE IN CAPILLARIES | 31 | ||
| 2.3.1 Definition | 31 | ||
| 2.3.2 Blood gas barrier: anatomy | 31 | ||
| 2.3.3 Blood gas barrier: pathophysiology | 32 | ||
| 2.3.4 Clinical implications | 34 | ||
| 2.3.5 Learning points | 35 | ||
| REFERENCES | 36 | ||
| 2.4 MICROVASCULAR FLUID EXCHANGE | 37 | ||
| 2.4.1 Starling's Filtration–Absorption Equation | 37 | ||
| 2.4.2 Oedema safety factors | 37 | ||
| 2.4.3 Sites of filtration and absorption | 40 | ||
| 2.4.4 Learning points | 43 | ||
| REFERENCES | 43 | ||
| CHAPTER 3 DEVELOPMENT, GROWTH AND INJURY | 44 | ||
| 3.1 VASCULOGENESIS AND ANGIOGENESIS | 44 | ||
| 3.1.1 Introduction | 44 | ||
| 3.1.2 The development of the pulmonary circulation | 44 | ||
| 3.1.3 Mechanisms controlling lung angiogenesis and vasculogenesis | 48 | ||
| 3.1.4 Learning points | 50 | ||
| REFERENCES | 51 | ||
| 3.2 PERINATAL CHANGES IN VASCULAR RESISTANCE | 53 | ||
| 3.2.1 Introduction | 53 | ||
| 3.2.2 The fetal pulmonary circulation | 53 | ||
| 3.2.3 The transition at birth | 54 | ||
| 3.2.4 Contractile and cytoskeletal protein expression | 55 | ||
| 3.2.5 Oxygen responsiveness in the fetal pulmonary circulation | 55 | ||
| 3.2.6 Mediators of fetal pulmonary vascular tone | 57 | ||
| 3.2.7 Learning points | 60 | ||
| REFERENCES | 60 | ||
| 3.3 INTERSTITIUM AND EXTRACELLULAR MATRIX | 62 | ||
| 3.3.1 Definition | 62 | ||
| 3.3.2 Cells of the interstitium | 62 | ||
| 3.3.3 Extracellular matrix | 64 | ||
| 3.3.4 Lymphatic system | 68 | ||
| 3.3.5 Integrins | 68 | ||
| 3.3.6 Transforming growth factor-β | 68 | ||
| 3.3.7 Learning points | 69 | ||
| REFERENCES | 69 | ||
| 3.4 PULMONARY VASCULAR REMODELLING | 71 | ||
| 3.4.1 Definition | 71 | ||
| 3.4.2 Morphological features | 72 | ||
| 3.4.3 Pulmonary vascular remodelling in animal models | 75 | ||
| 3.4.4 Cellular changes in pulmonary vascular remodelling | 76 | ||
| 3.4.5 Matrix deposition | 79 | ||
| 3.4.6 Role of endogenous vascular elastases and proteases | 79 | ||
| 3.4.7 Apoptosis | 81 | ||
| 3.4.8 Growth factors and other mediators | 81 | ||
| 3.4.9 Learning points | 83 | ||
| REFERENCES | 83 | ||
| CHAPTER 4 PULMONARY BLOOD FLOW | 86 | ||
| 4.1 PULMONARY VASCULAR RESISTANCE | 86 | ||
| 4.1.1 Definition | 86 | ||
| 4.1.2 Determinants of pulmonary vascular resistance | 87 | ||
| 4.1.3 Distensibility | 88 | ||
| 4.1.4 Recruitment | 89 | ||
| 4.1.5 The vascular waterfall | 89 | ||
| 4.1.6 Pressure flow relationships | 91 | ||
| 4.1.7 Lung volume | 92 | ||
| 4.1.8 Longitudinal distribution of vascular pressures | 92 | ||
| 4.1.9 Rheology and blood flow | 95 | ||
| 4.1.10 Pulsatile pressure and flow | 95 | ||
| 4.1.11 Learning points | 96 | ||
| REFERENCES | 96 | ||
| 4.2 DISTRIBUTION OF PULMONARY BLOOD FLOW | 98 | ||
| 4.2.1 Blood flow heterogeneity: overview | 98 | ||
| 4.2.2 Methodology | 98 | ||
| 4.2.3 The role of gravity | 99 | ||
| 4.2.4 Zone IV: flow decrease in the gravity direction | 102 | ||
| 4.2.5 Other flow patterns not in accord with the Zone I, II, III model | 103 | ||
| 4.2.6 Fractal analysis of blood flow distribution | 105 | ||
| 4.2.7 Intra-acinar distribution of blood flow | 106 | ||
| 4.2.8 Gravity-dependence versus non gravity-dependence | 107 | ||
| 4.2.9 Learning points | 108 | ||
| REFERENCES | 108 | ||
| 4.3 BLOOD FLOW AND PULMONARY GAS EXCHANGE | 110 | ||
| 4.3.1 The gas exchange unit | 110 | ||
| 4.3.2 Anatomy of the acinus | 110 | ||
| 4.3.3 Physiology of the acinus | 110 | ||
| 4.3.4 Overview of acinar gas exchange | 111 | ||
| 4.3.5 Alveolar gas to blood partial pressure equilibration | 116 | ||
| 4.3.6 Ventilation – perfusion (VA/Q) ratios | 118 | ||
| 4.3.7 Heterogeneity of VA/Q | 118 | ||
| 4.3.8 Causes of hypoxaemia | 120 | ||
| 4.3.9 Learning points | 121 | ||
| REFERENCES | 121 | ||
| APPENDIX | 123 | ||
| CHAPTER 5 ENDOTHELIUM | 124 | ||
| 5.1 ENDOTHELIAL-DERIVED VASOACTIVE FACTORS | 124 | ||
| 5.1.1 Introduction | 124 | ||
| 5.1.2 Endothelin | 124 | ||
| 5.1.3 Angiotensin II | 127 | ||
| 5.1.4 Nitric oxide | 130 | ||
| 5.1.5 Prostacyclin | 133 | ||
| 5.1.6 Learning points | 134 | ||
| REFERENCES | 134 | ||
| 5.2 ADHESION MOLECULES: NEUTROPHIL TRAFFICKING | 137 | ||
| 5.2.1 Functions of the neutrophil and adhesion molecules | 137 | ||
| 5.2.2 Pulmonary and whole body kinetics of neutrophils | 138 | ||
| 5.2.3 Extravascular migration of neutrophils at inflammatory sites | 139 | ||
| 5.2.4 Granulocyte kinetics in health and disease | 140 | ||
| 5.2.5 Learning points | 142 | ||
| REFERENCES | 143 | ||
| 5.3 COAGULATION | 144 | ||
| 5.3.1 Introduction | 144 | ||
| 5.3.2 Anticoagulant properties of the endothelium | 144 | ||
| 5.3.3 Procoagulant properties of the endothelium | 145 | ||
| 5.3.4 Fibrinolytic properties of the endothelium | 146 | ||
| 5.3.5 Endothelial activation and injury in disease states | 147 | ||
| 5.3.6 Intravascular coagulation promotes inflammation and scarring | 148 | ||
| 5.3.7 Learning points | 148 | ||
| REFERENCES | 149 | ||
| 5.4 METABOLIC AND ENDOCRINE FUNCTIONS | 150 | ||
| 5.4.1 Introduction | 150 | ||
| 5.4.2 Pulmonary eicosanoid metabolism | 151 | ||
| 5.4.3 Metabolism of adenine nucleotides | 153 | ||
| 5.4.4 Amine metabolism | 154 | ||
| 5.4.5 Amino acid metabolism | 155 | ||
| 5.4.6 Peptide metabolism | 155 | ||
| 5.4.7 Learning points | 157 | ||
| REFERENCES | 158 | ||
| CHAPTER 6 SMOOTH MUSCLE | 159 | ||
| 6.1 ION CHANNELS | 159 | ||
| 6.1.1 Introduction | 159 | ||
| 6.1.2 Ion channels in the pulmonary vasculature | 159 | ||
| 6.1.3 Ion channels and the regulation of resting tone | 161 | ||
| 6.1.4 Role of ion channels in acute hypoxic pulmonary vasoconstriction | 162 | ||
| 6.1.5 Ion channels and tone in the fetal pulmonary circulation | 164 | ||
| 6.1.6 Ion channels and clinical pulmonary hypertension | 165 | ||
| 6.1.7 Learning points | 166 | ||
| REFERENCES | 167 | ||
| 6.2 VASOACTIVE MEDIATORS: EFFECTS ON TONE AND GROWTH | 169 | ||
| 6.2.1 Introduction | 169 | ||
| 6.2.2 Effect of vasoconstrictors on vascular tone and growth | 169 | ||
| 6.2.3 Mechanism of action of vasoconstrictors | 170 | ||
| 6.2.4 Effect of vasodilators on pulmonary vascular tone and growth | 172 | ||
| 6.2.5 Mechanism of action of pulmonary vasodilators | 173 | ||
| 6.2.6 Vasoactive mediators: pathogenesis of pulmonary hypertension | 176 | ||
| 6.2.7 Learning points | 178 | ||
| REFERENCES | 178 | ||
| 6.3 NEURAL REGULATION OF PULMONARY VASCULAR TONE | 180 | ||
| 6.3.1 Introduction | 180 | ||
| 6.3.2 Autonomic supply to the pulmonary vascular bed | 181 | ||
| 6.3.3 Adrenergic control of pulmonary vascular tone | 183 | ||
| 6.3.4 Cholinergic control of pulmonary vascular tone | 184 | ||
| 6.3.5 Non-adrenergic, non-cholinergic (NANC) vascular tone | 186 | ||
| 6.3.6 Central nervous system effects on pulmonary vascular tone | 186 | ||
| 6.3.7 Learning points | 187 | ||
| REFERENCES | 187 | ||
| CHAPTER 7 HYPOXIA | 189 | ||
| 7.1 CELLULAR EFFECTS OF HYPOXIA | 189 | ||
| 7.1.1 Introduction | 189 | ||
| 7.1.2 Cellular respiration during hypoxia | 189 | ||
| 7.1.3 Hypoxia-inducible gene expression | 190 | ||
| 7.1.4 Oxygen sensing | 194 | ||
| 7.1.5 Learning points | 195 | ||
| REFERENCES | 195 | ||
| 7.2 ACUTE HYPOXIC PULMONARY VASOCONSTRICTION | 197 | ||
| 7.2.1 Homeostatic vascular responses to hypoxia | 197 | ||
| 7.2.2 HPV and evolution | 198 | ||
| 7.2.3 Site of hypoxic vasoconstriction | 198 | ||
| 7.2.4 HPV: mechanism of action | 200 | ||
| 7.2.5 Acute versus chronic hypoxic vasoconstriction | 201 | ||
| 7.2.6 HPV and local control of ventilation-perfusion ratios | 202 | ||
| 7.2.7 Learning points | 205 | ||
| REFERENCES | 206 | ||
| 7.3 HIGH ALTITUDE | 208 | ||
| 7.3.1 Introduction | 208 | ||
| 7.3.2 Partial pressure of oxygen at high altitude | 208 | ||
| 7.3.3 Acclimatisation | 209 | ||
| 7.3.4 The pulmonary circulation at high altitude | 211 | ||
| 7.3.5 High altitude syndromes | 212 | ||
| 7.3.7 Pathophysiology of HAPE | 214 | ||
| 7.3.8 Learning points | 217 | ||
| REFERENCES | 217 | ||
| CHAPTER 8 GENETICS OF PULMONARY VASCULAR DISEASE | 219 | ||
| 8.1 INTRODUCTION | 219 | ||
| 8.2 IDIOPATHIC (\"PRIMARY\") PULMONARY HYPERTENSION | 219 | ||
| 8.3 HYPOXIA–INDUCED PULMONARY HYPERTENSION | 220 | ||
| 8.3.1 Animal studies | 220 | ||
| 8.3.2 Observations in man | 222 | ||
| 8.4 GENETICS OF HEREDITARY HAEMORRHAGIC TELANGIECTASIA | 224 | ||
| 8.4.1 Mutation analysis and pathogenesis | 225 | ||
| 8.5 LEARNING POINTS | 226 | ||
| REFERENCES | 226 | ||
| Section II Clinical Practice | 229 | ||
| CHAPTER 9 THE BRONCHIAL CIRCULATION IN HEALTH AND DISEASE | 231 | ||
| 9.1 ANATOMY | 231 | ||
| 9.2 REGULATION OF BRONCHIAL BLOOD FLOW | 231 | ||
| 9.2.1 Neural control | 232 | ||
| 9.3 FUNCTIONS OF THE BRONCHIAL CIRCULATION | 233 | ||
| 9.4 THE BRONCHIAL CIRCULATION IN PATHOLOGICAL CONDITIONS | 234 | ||
| 9.4.1 Pulmonary artery obstruction | 234 | ||
| 9.4.2 Lung transplantation | 234 | ||
| 9.4.3 Bronchiectasis | 234 | ||
| 9.5 BRONCHIAL ARTERIOGRAPHY | 235 | ||
| 9.6 BRONCHIAL ARTERY EMBOLIZATION FOR MASSIVE HAEMOPTYSIS | 236 | ||
| 9.7 LEARNING POINTS | 237 | ||
| REFERENCES | 237 | ||
| CHAPTER 10 METHODS OF INVESTIGATION | 239 | ||
| 10.1 INVESTIGATION OF THE PULMONARY CIRCULATION IN PULMONARY HYPERTENSION | 239 | ||
| 10.2 HISTORY AND EXAMINATION | 239 | ||
| 10.3 THE INITIAL WORK-UP, FOCUSING ON THE PULMONARY CIRCULATION | 240 | ||
| 10.3.1 Chest x-rays, CT and MRI scanning | 240 | ||
| 10.3.2 Electrocardiogram (ECG) | 240 | ||
| 10.3.3 Pulmonary function tests | 240 | ||
| 10.3.4 Exercise capacity | 241 | ||
| 10.3.5 Obstructive sleep apnoea (OSA) | 241 | ||
| 10.4 ECHOCARDIOGRAPHY AND DOPPLER TECHNIQUES | 241 | ||
| 10.4.1 M mode \"pulse\" echo | 241 | ||
| 10.4.2 Continuous wave Doppler | 242 | ||
| 10.5 NUCLEAR MEDICINE | 244 | ||
| 10.5.1 Ventilation–perfusion (V/Q) lung scanning | 244 | ||
| 10.5.2 White cell scans | 244 | ||
| 10.5.3 Right ventricular function | 245 | ||
| 10.6 CARDIAC CATHETERIZATION | 245 | ||
| 10.6.1 Catheter design | 246 | ||
| 10.6.2 Assessment of left to right shunts | 246 | ||
| 10.6.3 Assessment of right to left shunts | 246 | ||
| 10.6.4 Haemodynamic monitoring | 246 | ||
| 10.6.5 Pulmonary and bronchial arteriography | 247 | ||
| 10.6.6 Complications | 249 | ||
| 10.7 LEARNING POINTS | 249 | ||
| References | 249 | ||
| CHAPTER 11 PULMONARY HYPERTENSION | 251 | ||
| 11.1 IDIOPATHIC (PRIMARY) PULMONARY HYPERTENSION | 251 | ||
| 11.1.1 Classification of severe pulmonary hypertensive disease | 251 | ||
| 11.1.2 Pathology | 252 | ||
| 11.1.3 Pathogenesis | 253 | ||
| 11.1.4. Epidemiology | 253 | ||
| 11.1.5 Clinical features | 253 | ||
| 11.1.6 Investigation of the patient with suspected IPH | 254 | ||
| 11.1.6 Management of the patient with IPH | 256 | ||
| 11.1.7 Learning points | 258 | ||
| REFERENCES | 258 | ||
| 11.2 PAEDIATRIC PULMONARY HYPERTENSION | 260 | ||
| 11.2.1 Introduction | 260 | ||
| 11.2.2 Investigation of the paediatric patient with PHT | 260 | ||
| 11.2.3 Persistent pulmonary hypertension of the newborn (PPHN) | 262 | ||
| 11.2.4 Congenital heart disease | 265 | ||
| 11.2.5 Learning points | 269 | ||
| REFERENCES | 269 | ||
| 11.3 THROMBOEMBOLIC DISEASE | 271 | ||
| 11.3.1 Introduction | 271 | ||
| 11.3.2 Predisposing factors | 271 | ||
| 11.3.3 Cardiopulmonary effects or acute thromboembolism | 272 | ||
| 11.3.4 Diagnosis of pulmonary embolism | 276 | ||
| 11.3.5 Confirmation of the diagnosis | 278 | ||
| 11.3.6 Chronic thromboembolic pulmonary hypertension | 281 | ||
| 11.3.7 Treatment of thromboembolism | 281 | ||
| 11.3.8 Learning points | 283 | ||
| REFERENCES | 283 | ||
| 11.4 VASCULITIS, CAPILLARITIS AND ALVEOLAR HAEMORRHAGE | 285 | ||
| 11.4.1 Definition and classification | 285 | ||
| 11.4.2 Pathogenesis of vasculitis | 287 | ||
| 11.4.3 Diagnosis of pulmonary vasculitis | 288 | ||
| 11.4.4 Connective tissue disease | 289 | ||
| 11.4.5 Therapy | 289 | ||
| 11.4.6 Alveolar haemorrhage without capillaritis | 291 | ||
| 11.4.7 Learning points | 291 | ||
| REFERENCES | 292 | ||
| 11.5 CONGESTIVE HEART FAILURE | 293 | ||
| 11.5.1 Chronic elevation of pulmonary venous pressure | 293 | ||
| 11.5.2 Alveolar damage induced by high capillary pressure | 294 | ||
| 11.5.3 Remodelling of the microvasculature | 294 | ||
| 11.5.4 Remodelling of pulmonary arteries and veins | 295 | ||
| 11.5.5 Haemodynamics | 296 | ||
| 11.5.6 Alterations in lung function | 298 | ||
| 11.5.7 Effect of restoration of normal left ventricular function | 300 | ||
| 11.5.8 Learning points | 300 | ||
| REFERENCES | 301 | ||
| 11.6 COR PULMONALE | 302 | ||
| 11.6.1 Introduction | 302 | ||
| 11.6.2 Pathogenesis | 302 | ||
| 11.6.3 Pathology of pulmonary hypertension secondary to COPD | 304 | ||
| 11.6.4 Prevalence | 304 | ||
| 11.6.5 Natural history of pulmonary hypertension in COPD | 304 | ||
| 11.6.6 Fluid retention in severe COPD | 306 | ||
| 11.6.7 Management of cor pulmonale in COPD | 309 | ||
| 11.6.8 Learning points | 310 | ||
| REFERENCES | 311 | ||
| CHAPTER 12 PULMONARY OEDEMA | 313 | ||
| 12.1 HYDROSTATIC VERSUS PERMEABILITY OEDEMA | 313 | ||
| 12.1.1 Starling's Filtration-Absorption Principle | 313 | ||
| 12.1.2 Measurement of filtrate protein concentration | 315 | ||
| 12.1.3 Interstitial versus air space oedema | 317 | ||
| 12.1.4 Differentiation of hydrostatic from permeability oedema | 317 | ||
| 12.1.5 Combined hydrostatic and permeability oedema | 319 | ||
| 12.1.6 Resolution of pulmonary oedema | 320 | ||
| 12.1.7 Treatment of hydrostatic oedema | 321 | ||
| 12.1.8 Learning points | 322 | ||
| REFERENCES | 322 | ||
| 12.2 ADULT RESPIRATORY DISTRESS SYNDROME | 324 | ||
| 12.2.1 Pathogenesis of alveolar injury | 324 | ||
| 12.2.2 Release of pro-inflammatory cytokines | 325 | ||
| 12.2.3 Neutrophils as a cause of alveolar damage | 326 | ||
| 12.2.4 Ischaemia–reperfusion injury | 326 | ||
| 12.2.5 Treatment | 327 | ||
| 12.2.6 Learning points | 328 | ||
| REFERENCES | 328 | ||
| CHAPTER 13 INTRAPULMONARY SHUNTING | 329 | ||
| 13.1 PULMONARY ARTERIOVENOUS MALFORMATIONS | 329 | ||
| 13.1.1 Definition | 329 | ||
| 13.1.2 Causes | 329 | ||
| 13.1.3 Hereditary haemorrhagic telangiectasia (HHT) | 329 | ||
| 13.1.4 Genetics of hereditary haemorrhagic telangiectasia | 330 | ||
| 13.1.5 Clinical and pathophysiological features of PAVMs | 331 | ||
| 13.1.6 Diagnosis of PAVMs, including screening | 332 | ||
| 13.1.7 Treatment of PAVMs | 334 | ||
| 13.1.8 Learning points | 336 | ||
| REFERENCES | 336 | ||
| 13.2 HEPATOPULMONARY SYNDROME | 338 | ||
| 13.2.1 Definition | 338 | ||
| 13.2.2 Pathology and pathogenesis | 338 | ||
| 13.2.3 Physiology and pathophysiology | 339 | ||
| 13.2.4 Liver transplantation | 343 | ||
| 13.2.5 Learning points | 343 | ||
| REFERENCES | 344 | ||
| INDEX | 345 |