Pulmonary Vascular Resistance (PVR)

PULMONARY
VASCULAR
RESISTANCE (PVR)
◦ Pulmonary vascular resistance (PVR) is the difference between the mean pulmonary
arterial pressure (mPAP/P1) and mean left atrial pressure (mLAP/P2) divided by the
PBF (PBF/Q), i.e., PVR = P1−P2/Q. PVR is directly proportional to mPAP and inversely
proportional to mLAP and blood flow
Technique for measurement of left
atrial pressure
Parameters that determine PVR
Passive factors such as :
◦ gravity,
◦ position of the body,
◦ transmural pressure difference,
◦ lung volume, and
◦ CO and
Active factors such as :

◦ hormonal-catecholamines,
◦ histamine,
◦ prostaglandins,
◦ nitric oxide,
◦ isoproterenol,
◦ hypoxia and hypercapnia, and
◦ autonomic nervous system for vessels >30 microns
◦ And another conditions like…
◦ High lung volumes result in a stretching/elongation of the alveolar vessels resulting
in an increased PVR
◦ The extra-alveolar vessels are subject to radial traction and negative pleural
pressure resulting in a decreased PVR
◦ Mechanical ventilation with positive end expiratory pressure (PEEP) results in
increased alveolar pressure as well as intrapleural pressure, and therefore
increases PVR at both alveolar and extra-alveolar levels throughout the
respiratory cycle
Pathophysiology and clinical correlation
◦ Exercise
Pulmonary arterial pressure demonstrates only slight increase with exercise in normal
individuals secondary to decrease in PVR from additional arterial recruitment and
arterial distension
◦ High altitude/hypoventilation
Generalized hypoxic vasoconstriction secondary to decreased PO 2 results in increased
arterial pressure and recruitment/distension of alveolar capillaries for better gaseous
exchange. However, increased pulmonary arterial pressure also increases capillary
hydrostatic pressure and thereby resulting in pulmonary edema. Increased PVR and
right heart work load can present as right heart failure
Airway obstruction or atelectasis
◦ Decreased PO2 (possible contributions from low pH and increased PCO2) results in a
not so robust hypoxic precapillary vasoconstriction and locally increased PVR (at the
level of small arteries and arterioles) with shunting of blood to better ventilated
areas.
Pulmonary arterial hypertension (PAH)
◦ A mPAP >25 mmHg is defined as PAH, and can be primary from pulmonary
vasculature involvement or secondary to lung disease. Increased pulmonary arterial
pressure could be due to increased PVR, left atrial pressure (pulmonary venous
hypertension) or PBF
◦ Hypoxia should be avoided (for example, air travel) due to concern for hypoxemic
pulmonary vasoconstriction and sudden increase in PVR
◦ Calcium channel blockers, endothelin receptor antagonists, phosphodiesterase
inhibitors, and prostanoid treatments decrease the PVR and PAH, forming the main
stay of medical treatment
◦ Pulmonary embolism
Pulmonary embolism is secondary to venous thromboembolic disease from venous
stasis, endothelial injury, and hypercoagulable state (Virchow’s triad)
◦ Small and chronic emboli result in gradual increase of PVR and PAH.
Closing
◦ Changes in PVR, pressure and blood flow predominantly determine the physiologic
response to various respiratory and metabolic demands as well as contribute to
pathological disease states.
References
◦ Levitzky MG. Pulmonary physiology. 8th edition. New York: McGraw Hill Education, 2013. [Google Scholar]
◦ 2. Weinberger SE, Cockrill BA, Mandel J. 6th edition. Principles of pulmonary medicine. Saunders, 2013. [Google Scholar]
◦ 3. Waxman AB. Exercise physiology and pulmonary arterial hypertension. Prog Cardiovasc Dis2012;55:172-9. 10.1016/j.pcad.2012.07.003 [PubMed] [CrossRef] [
Google Scholar]
◦ 4. Watanabe S. Pathophysiology of hypoxaemic pulmonary vascular diseases. Bull Eur Physiopathol Respir 1987;23 Suppl 11:207s-9s. [PubMed] [Google Scholar]
◦ 5. Wilkins MR, Ghofrani HA, Weissmann N, et al. Pathophysiology and treatment of high-altitude pulmonary vascular disease. Circulation 2015;131:582-90.
10.1161/CIRCULATIONAHA.114.006977 [PubMed] [CrossRef] [Google Scholar]
◦ 6. West JB, Luks AM. West's Pulmonary Pathophysiology. 9th edition. LWW, 2017. [Google Scholar]
◦ 7. Patel D, Lakhkar A, Wolin MS. Redox Mechanisms Influencing cGMP Signaling in Pulmonary Vascular Physiology and Pathophysiology. Adv Exp Med
Biol 2017;967:227-40. 10.1007/978-3-319-63245-2_13 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
◦ 8. Taguchi K, Hattori Y. Unlooked-for significance of cardiac versus vascular effects of endothelin-1 in the pathophysiology of pulmonary arterial hypertension. Circ
Res 2013;112:227-9. 10.1161/CIRCRESAHA.112.300623 [PubMed] [CrossRef] [Google Scholar]
◦ 9. Wolin MS, Gupte SA, Mingone CJ, et al. Redox regulation of responses to hypoxia and NO-cGMP signaling in pulmonary vascular pathophysiology. Ann N Y Acad
Sci 2010;1203:126-32. 10.1111/j.1749-6632.2010.05557.x [PubMed] [CrossRef] [Google Scholar]
◦ 10. Kobayashi K. Pathophysiology of adult respiratory distress syndrome-- with special reference to pulmonary vascular structure and hemodynamics. Kokyu To
Junkan 1981;29:495-501. [PubMed] [Google Scholar]
◦ 11. Elliott CG. Pulmonary physiology during pulmonary embolism. Chest 1992;101:163S-71S. 10.1378/chest.101.4_Supplement.163S [PubMed] [CrossRef] [
Google Scholar]
◦ 12. Nelson JR, Smith JR. The pathologic physiology of pulmonary embolism. A physiologic discussion of the vascular reactions following pulmonary arterial
obstruction by emboli of varying size. Am Heart J1959;58:916-32. 10.1016/0002-8703(59)90114-0 [PubMed] [CrossRef] [Google Scholar]
◦ 13. Melot C, Naeije R. Pulmonary vascular diseases. Compr Physiol 2011;1:593-619. [PubMed] [Google Scholar]
◦ 14. Krowka MJ, Fallon MB, Kawut SM, et al. International Liver Transplant Society Practice Guidelines: Diagnosis and Management of Hepatopulmonary Syndrome
and Portopulmonary Hypertension.Transplantation 2016;100:1440-52. 10.1097/TP.0000000000001229 [PubMed] [CrossRef] [Google Scholar]

Pulmonary Vascular Resistance (PVR)

Uploaded by

Copyright:

Available Formats

Pulmonary Vascular Resistance (PVR)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pulmonary Vascular Resistance (PVR)

Uploaded by

Copyright:

Available Formats

PULMONARY

Active factors such as :

You might also like