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Файл:Pathophysiology of breathing and cardiovascular pathology. Educational and methodological manual
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Topic 4. Pathophysiology of internal respiration. Hypoxia
Fig. 25. Mechanisms of long-term adaptation during hypoxia
Hemic hypoxia
2. Haemic due to poisoning in the formation of Hb
CO
and
MetHb.
GEF — carbon monoxide or oxidant poisoning.
MLP — ↓blood oxygen capacity: ↓VaO2 at the rate of PaO2.
Compensation — no compensation.
Consequences — ↓pHrN, ↓VvO2, ↓pvO2.
Shift of the oxyhemoglobin dissociation curve to the left,
↓AVD (arterio-venous difference) in O2 due to an increase in the
affinity of hemoglobin for oxygen (Fig. 23, 24).
91
Pathophysiology of breathing and cardiovascular pathology
3. Tissue hypoxia (Normal values PaO2, SaO2, VaO2).
GEF — impaired oxidation and phosphorylation in mitochondria.
MLP — inhibition of the activity of biological oxidation enzymes.
Compensation — no compensation.
Consequences — ↑PvO2, ↑SvO2, ↑VvO2, ↓ AVD for O2, ↓pH.
4. Substrate type of hypoxia (Normal values PaO2, SaO2, VaO2).
GEF biooxidation substrate deficiency in cells.
MLP — suppression of biological oxidation.
Compensation — no compensation.
Consequences — ↑Pv O2, ↑Sv O2, ↑Vv O2, ↓ ATS for O2,
↓rN (Fig. 23).
5. Overload type of hypoxia.
GEF — a significant and/or prolonged increase in the function
of tissues, organs or their systems (Fig. 23).
MLP — deficiency of oxygen and substrate delivery.
Compensations — shortness of breath, tacchicardia.
Consequences — ↓pv O2, ↓Sv O2, ↑ ATS for O2, ↑ra SO2,
↓rN.
Left Curve Offset Factors
1. ↓[H+], ↑PH2.
2. ↓PCO2.
3. ↓Temperatury.
4. ↓2, 3-DFG:
a. Hypothyroidism;
b. Blood transfusion.
5. Some congenital hemoglobinopathies.
6. Carboxyhemoglobin.
Factors that shift the curve to the right.
1. ↑[H+], ↓pH.
2. ↑PCO2.
3. ↑Temperature.
92
Topic 4. Pathophysiology of internal respiration. Hypoxia
4. ↑2, 3-DFG:
a. Hyperthyroidism;
b. Anemia;
c. Chronic hypoxemia — high altitude, congenital heart disease.
5. Some congenital hemoglobinopathies.
SITUATIONAL TASKS
Task: to establish a type of a hypoxia.
Task №
1 to Characterize type of oxygen insufficiency if it is
known that at the patient the oxyhemoglobin content in arterial blood
is of 98
%, in venous — 30 %, the oxygen capacity of blood — 23
about of %, minute volume of heart — 3.2 l, BP — 110/70 mm Hg.
Answer. A hypoxia circulator (cardiovascular) of what the reduced minute volume of heart testifies to (it is normal of 4—5 liters) and a big arteriovenous difference on oxygen (is normal to of
%). The arteriovenous difference on oxygen is explained by de-
40
crease in content of oxyhemoglobin in blue blood at his normal
content in arterial blood.
Task №
known that oxyhemoglobin content in arterial blood is of 80
venous blood — 51
2 to Characterize type of oxygen insufficiency if it is
%, in
%, the oxygen capacity of blood — 24 about of
%, minute volume of heart — 6 l.
Answer. A respiratory hypoxia what decrease in content of oxyhemoglobin and in arterial blood (because of violation of her oxygenation in lungs) and, as a result, in blue blood testifies to. Increase in minute volume of heart and oxygen capacity of blood
have compensatory character.
Task №
3 to Characterize type of oxygen insufficiency if it is
known that at the patient the oxyhemoglobin content in arterial
blood is of 100
blood — 15 about of %, minute volume of heart — 8 l, quantity of
erythrocytes in peripheral blood — 2
%, in venous blood — 65 %, oxygen capacity of
12
× 10
/l, there are no reticulo-
cyte.
93
Pathophysiology of breathing and cardiovascular pathology
Answer. A hypoxia hemic anemia what the reduced quantity of
erythrocytes in blood and the oxygen capacity of blood testifies to.
Task №
4 to Characterize type of oxygen insufficiency if it is
known that at the patient the oxyhemoglobin content in arterial
blood is of 79
%, in venous blood — 70 %, the oxygen capacity of
blood — 23 about of %, minute volume of heart of — 4.5 l.
Answer. A hypoxia of the mixed genesis: exogenous and fabric what decrease the maintenance of an oxyhemoglobin in arterial
blood and decrease to an arterio-arterial difference on oxygen
demonstrates to that can be caused by increase in affinity of hemoglobin on oxygen owing to development of an alkalosis, increasing
affinity of hemoglobin to oxygen.
Task №
known that oxyhemoglobin content in arterial blood is of 78
venous — 35
5 to Characterize type of oxygen insufficiency if it is
%, in
%, the oxygen capacity of blood — 23 about of %,
minute volume of heart — 3 l, quantity of erythrocytes in peripheral blood — 5.8 T/l, breath frequency — 26 in min.
Answer. The respiratory hypoxia what decrease in oxyhemoglobin in arterial and blue blood testifies to, but at the same time an
arterio-venous difference on oxygen is normal.
Task №
6 Characterize type of oxygen insufficiency if it is
known that at the patient the oxyhemoglobin content in arterial
blood is of 57
%, in venous blood — 46 %, the minute volume of
heart — 4 l, quantity of erythrocytes in peripheral blood — 5.5 T/l,
the oxygen capacity of blood — 15 about of %, the presence of
carboxyhemoglobin is noted in the blood.
Answer. A hypoxia hemic (blood), caused by strong linking of
hemoglobin with carbon monoxide (the maintenance of HbCO —
%). The remained hemoglobin is saturated with oxygen, howev-
40
er oxyhemoglobin content in arterial blood doesn't exceed of 57
and in venous — 46
% of that is much lower than norm. The arte-
%,
rio-venous difference on oxygen is lowered that is explained by the
increased affinity of hemoglobin to oxygen.
94
Topic 4. Pathophysiology of internal respiration. Hypoxia
Task № 7 to Characterize type of oxygen insufficiency if it is
known that at the patient the oxyhemoglobin content in arterial
blood is of 82
%, in venous blood — 30 %, the oxygen capacity of
blood — 26 about of %, minute volume of heart — 2.5 l, BP —
100/60 mm Hg.
Answer. The hypoxia mixed: respiratory and circulator. Decrease in content of oxyhemoglobin in arterial blood demonstrates
about violations of her oxygenation in lungs, i. e. presence of a res-
piratory hypoxia. However considerable decrease in MOS speaks
about disorder of hemo dynamics and is characteristic of a circulator hypoxia what increase in an arterio-venous difference on oxygen testifies to.
Task №
tent in arterial blood — 97
8 to Characterize hypoxia type if oxyhemoglobin con-
%, in venous blood — 92 %, the minute
volume of heart — 7 l, the oxygen capacity of blood — 23 about of
%. Prove the conclusion.
Answer. Normal content of oxyhemoglobin in arterial blood
speaks about the normal content of oxygen in the inhaled air and
normal oxygenation of blood in lungs, i. e. allows to exclude exogenous and respiratory hypoxias. The lack of reduced CO and lack
of decrease in content of oxyhemoglobin in blue blood allows to
exclude a circulator hypoxia. Normal BOC excludes a hemic hypoxia. There is a hypoxia fabric what sharply reduced arteriovenous difference on oxygen (AVD) of at the normal content of oxyhemoglobin in arterial blood testifies to.
References
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Pathophysiology of breathing and cardiovascular pathology
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zova. Vol. 1. M., 2015.
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V. Novitsky, O. I. Urazova. Vol. 2. M.,
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96
Учебное издание
Kirienkova Elena
Tursunov Ruslan
Litvinova Larisa
PATHOPHYSIOLOGY OF BREATHING
AND CARDIOVASCULAR PATHOLOGY
Educational and methodological manual
Редактор Е. Т. Иванова
Компьютерная верстка Г.
Подписано в печать 27.02.2025 г.
Дата выхода в свет 12.03.2025 г.
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