Cardiocirculatory and Cardiovascular Perfusion techniques

PULMONARY CIRCULATION CHARACTERISTICS, PULMONARY COMPLIANCE – DEFINITION OF AIRWAY RESISTANCE DIAGNOSTIC TESTS • Pulmonary function tests (Spirometry – flow/volume loop, nitrogen washout, plethysmography, DLCO, MIP MEP, methacholine challenge, etc.) • Diagnostic imaging (Chest X-ray, chest CT, MRI, scintigraphy, etc.) • Laboratory tests (arterial blood gas analysis, blood chemistry, sputum, etc.) • Invasive tests (Fiberbronchoscopy (FBS) and BAL, thoracentesis, videothoracoscopy, FNAB) • Other tests (allergy testing, walking test, nocturnal pulse oximetry, exercise stress test, polysomnography, etc.) MAIN RESPIRATORY SYMPTOMS: COUGH, Dyspnea, Chest Pain, Hemoptysis, Cyanosis, Pathological Breathing, ALVEOLAR DIFFUSION – determining factors in VENTILATION AND LUNG PERFUSION LUNG VOLUMES • Tidal volume (VC): air that is inhaled and exhaled during eupnea (approximately 500 ml) • Functional residual capacity (FRC): amount of air remaining in the lung at the end of expiration (approximately 3 liters). Includes: – a) expiratory reserve volume (ERV), air that can be exhaled with a forced expiration and – b) Residual volume (RV), air that is eliminated only during lung collapse. • Inspiratory Reserve Volume (IRV): Air inhaled with a forced inspiration following a eupneic inspiration (approximately 2.5 L) • Vital Capacity (VC): sum of REV, RIV, and VC (approximately 4.5 L) PULMONARY VENTILATION AND ALVEOLAR VENTILATION AIRWAY FLOW, AIRWAY RESISTANCE VOLUME-FLOW CURVE (SIMPLE SPIROMETRY) PARTIAL GAS PRESSURE VENTILATION/PERFUSION RATIO, DEAD SPACE AND SHUNT DIFFERENCE BETWEEN THE APEX AND BASE OF THE LUNGS, ALVEOLAR GAS EQUATION RESPIRATORY FAILURE DEFINITION TYPE I AND TYPE II BLOOD GAS ANALYSIS OXYGEN THERAPY ACID-BASE BALANCE AND BLOOD GAS ANALYSIS ARTERIAL RESPIRATORY FUNCTION TESTS: OBSTRUCTIVE AND RESTRICTIVE DEFICIENCY, DEGREE OF OBSTRUCTION – FEV1 LUNG VOLUMES – NITROGEN WASHOUT DLCO – CO2 DIFFUSION CAPACITY ACID-BASE BALANCE: RESPIRATORY ACIDOSIS – INCREASE IN CO2 RESPIRATORY ALKALOSIS – REDUCTION IN CO2 METABOLIC ACIDOSIS – REDUCTION IN BICARBONATE ANION GAP (normal due to base loss, increased due to increased acid production) METABOLIC ALKALOSIS – INCREASE IN BICARBONATE RENAL COMPENSATION OBSTRUCTIVE RESPIRATORY DISEASES ASTHMA, COPD, BRONCHIECTASIS (definition) DIAGNOSIS (spirometry and symptoms) REVERSIBILITY TEST (reversible or (irreversible) METHACHOLINE TEST (assess bronchial hyperresponsiveness) RESTRICTIVE RESPIRATORY DISEASES INTERSTITIAL DISEASES (definition) PULMONARY FIBROSIS, PNEUMOCONIOSIS, SARCOIDOSIS SECONDARY TO SYSTEMIC DISEASES (autoimmune rheumatologic) DRUG-RELATED (e.g., amiodarone) DIAGNOSIS (symptoms and spirometry, nitrogen washout – all lung volumes reduced, reduced DLCO) BRONCHOSCOPY RIGID AND FLEXIBLE BRONCHOSCOPE EXAMINATION INDICATIONS (TUMORS, PNEUMONIA, INTERSTITIAL DISEASES) BAL (cytogram) NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIV) VENTILATORS AND ACCESSORIES (tubes, masks, helmets, filters) VENTILATION PARAMETERS (PEEP)

- Lecture presentations. - West - Essential Pulmonary Pathophysiology. John B. West, Andrew M. Luks, Piccin. - ERS Handbook of Respiratory Medicine, Paolo Palange Anita K. Simonds.