Tag Archives: Lungs

BLOOD VESSELS: HUMAN “PULMONARY CIRCULATION”

Humans have a high energy requirement. Like a sports car we need to be turbosupercharged. We need an entirely separate Pulmonary circulation to handle our great oxygen demand.

Fish can get by on a single heart and circulation. They are “cold-blooded” and have no elevation of temperature above that in the environment. The water buoys them up, and they don’t need to constantly fight gravity.

Birds, and by extension, therapod dinosaurs, need more efficiency, and have a separate pulmonary circulation, just like we do. They share with us a DOUBLE CIRCULATION, a 4-chambered heart, with 2 entirely separate circuits.

In my residency, I saw a lot of congenital heart disease. In the process of development, the very early human embryo has a single circulation, just like “early” vertebrates, like fish.

In the process of development, the Systemic and Pulmonary circulations divide the previously unitary system into 2 separate systems, by a continuous spiral of partitions, or “septae”.

Ontogeny recapitulates Phylogeny: Development recaps Evolution. If this process of separation fails to happen in a given child, Congenital Heart Disease is the result:

  • IASD. Interatrial Septal Defect is failure to separate the Atria, the upper chambers of the heart;
  • IVSD, Interventricular Septal Defect, is failure to separate the Ventricles, the lower chambers of the heart;
  • AV Communis is both of the above, plus failure of Atria and Ventricles, the upper and lower chambers, to separate, giving one big inefficient chamber.

When you listen to the hearts of these children, there are prominent murmurs, or noises, which betray the presence of turbulence and inefficiency, the very thing that evolution “tried” to prevent.

In the normal Human Heart, the blood returns from it’s systemic circuit through the capillaries, depleted of oxygen, into the vena cava. It passes to the Right Atrium, through the tricuspid valves, to the right ventricle.

With the contraction of the heart, the blood goes through the pulmonary artery, into the pulmonary capillaries, into close contact with air-containing alveoli. The oxygen passes through the alveolar membrane into the capillary blood, which becomes red. The oxygenated blood then passes into the pulmonary veins and on into the left atrium, and the systemic circulation.

It is interesting, and essential that the systemic arteries contain red, oxygenated blood, and the Pulmonary artery contains blue, oxygen-depleted blood. The “tired” blood, returning from the body must be “pepped up” by passing through the pulmonary circuit, picking up oxygen in the process.

Similarly a clot, originating in a quiet vein, perhaps a dilated, or varicose vein, is pumped into the Pulmonary circuit, where it lodges in the tiny capillaries and produces a PULMONARY EMBOLISM.

The embolus clogs the pulmonary circuit, increasing resistance, raises the normally-low pulmonary artery pressure and produces PULMONARY HYPERTENSION, placing more load and strain on the Right Ventricle.

Pulmonary Hypertension is also caused by a variety of Lung, heart, inherited and kidney diseases, as well as by certain drugs, high altitude, and Obstructive Sleep Apnea.

Please check the Mayo Clinic discussion that follows.

–Dr. C

Pulmonary Hypertension Article

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #1 – THE “CHRONIC COUGH”

In my 88 years, I have had at least a dozen medical problems. Some have gone away on their own, some have been removed surgically, and a few have become CHRONIC, lasting for years, ultimately becoming a part of my life.

I have compiled a list of these and other SYMPTOMS & CONDITIONS I have seen as a physician. Over the next year, I will discuss them one by one, appending these vetted articles for further reading.

The ‘CHRONIC COUGH’ will be the first discussed.

As an Allergist, I was involved with coughing all of my adult life. If my patients did NOT have asthma, they usually coughed from mucus pouring down the back of their throat (post-nasal drip), from their allergic nasal condition (allergic rhinitis), or sometimes from the associated SINUSITIS drainage.

Asthma was a much more common cause of Chronic Cough for my Patients, sometimes theIr main problem. All asthmatic have a chronic inflammation of their breathing tubes(bronchi), and the resulting BRONCHITIS irritates the airway nerve endings, causing Cough.

Without enough narrowing of the airways to cause wheezing, this is called “cough equivalent asthma”. With the addition of airway narrowing (constriction) to the above situation, ASTHMA results.

There is added shortness of breath (dyspnea), and the cough becomes the “tight” wheezy cough of full-blown Asthma.

COPD (chronic obstructive pulmonary disease) may be a residue of long-term asthma, but commonly results from cigarette  smoking. Where loss of alveolae (air sacs) predominates, dyspnea (shortness of breath) is more common.

Where bronchial tube inflammation is more prominent, mucus and cough result. This cough is useful in clearing the mucus; a USEFUL COUGH (although my Patients did not always appreciate their friend, which could be bad enough to cause hernias or incontinence). 

Gastro-esophageal reflux is a chronic condition where stomach contents are not retained in the stomach by the G-E Sphincter ( a type of “purse-string” Gate), but spill(reflux) up, when not restrained by gravity, at NIGHT. The ACIDIC STOMACH CONTENTS burn the esophagus on the way up(heart burn), and are often aspirated into the airways during sleep, causing inflammation and COUGH.

There are many other less common CHRONIC LUNG ( pulmonary) DISEASES (conditions) such as sarcoidosis, bronchiectasis, interstitial pneumonitis, TB, and cancer, that can be diagnosed by imaging (X-Ray, etc.). Heart failure can also cause cough, as can blood pressure medication (ACE inhibitors). 

Smoking is an obvious cause; chronic smoking, chronic cough. Smokers know what is causing their cough, and usually don’t bother coming to the Doctor unless they cough up some blood, or develop one of the myriads of diseases caused by their habit.

If you have a chronic cough, check with your Primary Care Doctor, who may refer you to an Allergist or Pulmonologist. The following article will be useful to your understanding of cough, and will provide a LIST OF QUESTIONS the DOCTOR will likely ask you.

—Dr. C.

Further reading #1

Further reading #2