Ventilation-perfusion mismatch pathophysiology: Difference between revisions

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==Overview==
==Overview==
Any disruption between blood flow and [[ventilation]] is called V/Q mismatch.
Any discrepancy between blood flow and [[ventilation]] is called V/Q mismatch.


==Pathogenesis==
==Pathogenesis==
In the upright position of the normal [[lung]], the amount of [[ventilation]] and [[perfusion]] is higher in the [[Base of lung|base of the lung]] compare to [[Apex of lung|apex of the lung]]<ref name="pmid7818053">{{cite journal |vauthors=Schaffartzik W |title=[Ventilation-perfusion ratios] |language=German |journal=Anaesthesist |volume=43 |issue=10 |pages=683–97 |date=October 1994 |pmid=7818053 |doi= |url=}}</ref>. Although ventilation and perfusion are low in the apex of the lung, the perfusion is lower than ventilation in the apex. So, the V/Q is higher in the apex of the lung compare to the base <ref name="pmid25063240">{{cite journal |vauthors=Petersson J, Glenny RW |title=Gas exchange and ventilation-perfusion relationships in the lung |journal=Eur. Respir. J. |volume=44 |issue=4 |pages=1023–41 |date=October 2014 |pmid=25063240 |doi=10.1183/09031936.00037014 |url=}}</ref>. In a normal lung V/Q is 0.8 which means 4 liters of oxygen and 5 liters of blood transfer in the lung per minute. V/Q mismatch is one of the common reason of hypoxemia in patients with [[lung]] disease like [[Obstructive lung disease|obstructive lung]] diseases, pulmonary vascular diseases, and [[Interstitial lung disease|interstitial diseases]] . Usually hypoxemia due to V/Q mismatch will resolve by [[Oxygen therapy|oxygen therapy.]]<ref name="pmid26545142">{{cite journal |vauthors=Baumgardner JE, Hedenstierna G |title=Ventilation/perfusion distributions revisited |journal=Curr Opin Anaesthesiol |volume=29 |issue=1 |pages=2–7 |date=February 2016 |pmid=26545142 |doi=10.1097/ACO.0000000000000269 |url=}}</ref>  
In the upright position of the normal [[lung]], the amount of [[ventilation]] and [[perfusion]] is higher in the [[Base of lung|base of the lung]] compare to [[Apex of lung|apex of the lung]]. Although ventilation and perfusion are low in the apex of the lung, the perfusion is lower than ventilation in the apex. So, the V/Q is higher in the apex of the lung compare to the base . In a normal lung V/Q is 0.8 which means 4 liters of oxygen and 5 liters of blood transfer in the lung per minute. V/Q mismatch is one of the common reason of hypoxemia in patients with [[lung]] disease like [[Obstructive lung disease|obstructive lung]] diseases, pulmonary vascular diseases, and [[Interstitial lung disease|interstitial diseases]] . Usually hypoxemia due to V/Q mismatch will resolve by [[Oxygen therapy|oxygen therapy.]]   


In normal condition when there is a low ventilation, the body tries to keep this ratio in a normal range by restricting the perfusion in that specific area of the lung. This unique mechanism is called hypoxic pulmonary vasoconstriction. If this process continues for a long time it can cause pulmonary hypertension .  
In normal condition when there is a low ventilation, the body tries to keep this ratio in a normal range by restricting the perfusion in that specific area of the lung. This unique mechanism is called hypoxic pulmonary vasoconstriction. If this process continues for a long time it can cause pulmonary hypertension .  


==Associated Conditions==
==Associated Conditions==
Some conditions that cause decrease in V/Q are:<ref name="pmid28144061">{{cite journal |vauthors=Sarkar M, Niranjan N, Banyal PK |title=Mechanisms of hypoxemia |journal=Lung India |volume=34 |issue=1 |pages=47–60 |date=2017 |pmid=28144061 |pmc=5234199 |doi=10.4103/0970-2113.197116 |url=}}</ref> <ref name="pmid2763227">{{cite journal |vauthors=Ballester E, Reyes A, Roca J, Guitart R, Wagner PD, Rodriguez-Roisin R |title=Ventilation-perfusion mismatching in acute severe asthma: effects of salbutamol and 100% oxygen |journal=Thorax |volume=44 |issue=4 |pages=258–67 |date=April 1989 |pmid=2763227 |pmc=461786 |doi= |url=}}</ref><ref name="pmid22140626">{{cite journal |vauthors=Burrowes KS, Clark AR, Tawhai MH |title=Blood flow redistribution and ventilation-perfusion mismatch during embolic pulmonary arterial occlusion |journal=Pulm Circ |volume=1 |issue=3 |pages=365–76 |date=2011 |pmid=22140626 |pmc=3224428 |doi=10.4103/2045-8932.87302 |url=}}</ref><ref name="pmid116491">{{cite journal |vauthors=Biello DR, Mattar AG, McKnight RC, Siegel BA |title=Ventilation-perfusion studies in suspected pulmonary embolism |journal=AJR Am J Roentgenol |volume=133 |issue=6 |pages=1033–7 |date=December 1979 |pmid=116491 |doi=10.2214/ajr.133.6.1033 |url=}}</ref>
Some conditions that cause decrease in V/Q are:  
* [[Bronchitis]]
* [[Bronchitis]]
* [[Asthma]]
* [[Asthma]]

Revision as of 02:13, 13 November 2018

Template:Ventilation-perfusion mismatch

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aida Javanbakht, M.D.

Overview

Any discrepancy between blood flow and ventilation is called V/Q mismatch.

Pathogenesis

In the upright position of the normal lung, the amount of ventilation and perfusion is higher in the base of the lung compare to apex of the lung. Although ventilation and perfusion are low in the apex of the lung, the perfusion is lower than ventilation in the apex. So, the V/Q is higher in the apex of the lung compare to the base . In a normal lung V/Q is 0.8 which means 4 liters of oxygen and 5 liters of blood transfer in the lung per minute. V/Q mismatch is one of the common reason of hypoxemia in patients with lung disease like obstructive lung diseases, pulmonary vascular diseases, and interstitial diseases . Usually hypoxemia due to V/Q mismatch will resolve by oxygen therapy.

In normal condition when there is a low ventilation, the body tries to keep this ratio in a normal range by restricting the perfusion in that specific area of the lung. This unique mechanism is called hypoxic pulmonary vasoconstriction. If this process continues for a long time it can cause pulmonary hypertension .

Associated Conditions

Some conditions that cause decrease in V/Q are:

Some conditions that cause increase in V/Q are:

Genetics

The association between V/Q mismatch and genetic depends on the etiology of the mismatch. For example ORMDL3 and GSDML genes play a role in causing asthma .

Gross Pathology

The gross pathology depends on the exact reason for the V/Q mismatch.

Microscopic Pathology

The microscopic pathology depends on the exact reason for the V/Q mismatch. For example in asthma there are extracellular Charcot-Leyden crystals and increased mucosal goblet cells.