Ventilation/ Perfusion Ratio (V/Q) and V/Q Mismatch - Respiratory Physiology & Pulmonology

[@MedicosisPerfectionalis]

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Dear you are the common sense doctor I like and I wish I would know you more and share a lot.You said." medicine makes sense when you explain ." I liked you so much I like reading Guyton,medical physiology text book for it really make you sensible doctor.I call a bit out of fashion for I despise these question and answer type of study purly directed at passing an exam,I know some times it hurts but honestly medicine is so great that way.Thank you for your superflowing explanation with ease.

[@MedicosisPerfectionalis]

You’re welcome 😇 Good luck! 👍

[@vangelisantoninis9065]

Your explanation is amazing and simultaneously funny! After that i will remember v/q mismatch for a decade!

[@MedicosisPerfectionalis]

Thank you!

[@kipkipour4507]

Thank you from the bottom of my heart! You are a savior!!! I have a question in 19:14 isn't that supposed to be BRONCOconstriction instead of VASOconstriction??? As you explain in the next sentence, the purpose is to narrow the BRONCHUS (not the VESSEL), when hypoperfussion takes place... Or am I wrong??? I dont know, thats why I ask my savior! Thaaaaaaanks again!

[@worldaround6520]

I am sorry as I didn't properly understand your question. But.. When the ventilation is decreased the body often tries to cut off blood supply to that region to prevent Ventilation perfusion mismatch, this happens through vasoconstriction - this explains why no blood flows into Fetal lungs during intra-uterine life, furthermore this vasoconstriction is responsible for right heart failure that is seen in COPD. Interestingly during sleep if someone has sleep apnea the lung overall recieve less oxygen, therefore there is vasoconstriction this applies stress on the right heart. You may know that in heart failure we give diuretics - so the heart secretes it' s own diuretic or ANP, this causes nocturia in patients of sleep apnea.

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[@MedicosisPerfectionalis]

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[@MedicosisPerfectionalis]

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[@NicholasTXTV]

Can you provide a few references for this information? Not saying your incorrect but would help me tremendously for my essay

[@MedicosisPerfectionalis]

See Guyton’s, Ganong’s and Boron’s Physiology textbooks. They have a lot of citations.

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[@MedicosisPerfectionalis]

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[@Evilslayer6969]

Please add refrences and further reading if possible .. thanks🔥

[@milymaj]

3:25 - I think there is an error in "in the base" line. Shouldn't it be: "increased V, but Q increased even more"?

[@odalisogum749]

Yeah thought same

[@TanTan-ch3vq]

Same with you, he confused us also at 9:29 , there he said there is increased ventilation in apex. Should be decreased ventilation in apex

[@nil5147]

You are genius..all doubts thoughts solved

[@MedicosisPerfectionalis]

Thank you so much!

[@nil5147]

@@MedicosisPerfectionalis waiting for more videos

[@hussam7033]

hello dr. I hope you do answer questions here. I am having a bit of a problem in understanding why in obstructive lung diseases there is decreased ventilation. I know that it is very intuitive to understand why but I clearly recall that the problem in obstructive lung diseases was in expiration not in inspiration. Perhaps it is wrong to associate inspiration and ventilation together but for some reason I am associating them.

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[@MedicosisPerfectionalis]

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[@salmanawab7303]

Well explained. Thankyou so much. 🤩

[@MedicosisPerfectionalis]

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[@MedicosisPerfectionalis]

Awesome 👏 Thank you so much for watching!

[@CarlosPires-du3ps]

my professor asked the exact same question: "Is it worse to have high V/Q or low V/Q?" I know both are bad, but which one is worse if you had to choose one?

[@abulmuslimchartaev8017]

5:34 there is maybe a mistake. Part where “normal apex”. If I’m not right, explain pls

[@MohammadYounos]

Yes, you are right. At the apex of the lung both perfusion (Q) and ventilation (V) are decreased, but the decrease in Q exceeds the decrease in V, making the V/Q ratio relatively high. Otherwise, it is really a perfect video.

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[@MedicosisPerfectionalis]

Thank you!

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Extraordinary.. full content thoroughly touched with clear explanation…

[@MedicosisPerfectionalis]

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you made a very hard subject into freaking 😆easy 😘thank you very much doc

[@MedicosisPerfectionalis]

My pleasure!

[@TanTan-ch3vq]

At 4:22, you said there is decreased Ventilation in apex; At 9:29, you said there is more ventilation in apex. Which statement is correct?

[@MedicosisPerfectionalis]

The apex has less ventilation than the base. However, the apex has a higher ventilation-to-perfusion ratio than the base.

[@TanTan-ch3vq]

Thanks for clarification

[@shiroatsuki520]

Why does Wikipedia say emphysema is high vq

[@hadyhadyhady03]

10:46 shouldnt emphysema have a high v q ratio ??

[@adityapaudel6016]

Emphysema has low V/Q right? Damaged Alveoli causes loss in ventilation with same perfusion which will result in low V/Q.

[@MedicosisPerfectionalis]

Excellent

[@zishanahmad7089]

Hi thankyou❤ Lower lobe infarction common due to more diffusion or more purfusion In your notes written diffusion while in your video speaking perfusion? Please explain

[@gayathrijinesh3004]

15:28 why is it 40? Can't it be any number less than 105?

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Superb explanation

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[@MedicosisPerfectionalis]

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Very easy to understand. Thanks a lot.

[@MedicosisPerfectionalis]

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[@MedicosisPerfectionalis]

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[@MedicosisPerfectionalis]

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[@MedicosisPerfectionalis]

Thank you 🙏

[@svetlanakhaimchayev7894]

The V/Q mismatch will always be mismatched, the closest that we will be to attaining 100% is in the middle of the lung? @ the apex we will have a higher ratio, and @ the base a lower, ratio? So when does this become a problem if it is always mismatched?

[@worldaround6520]

To a certain degree we can tolerate VQ mismatch.

[@giovanniielapi9296]

Hi sir, Hope you can answer me back!, if we have dead space, so no gas exchange, why pO2 is nearly 100 mmHg like normal situation? I was expecting like "shunting".

[@Mikesco10]

i have a question; i always see the equation written like this: Co2 + H2O H2co3 Hco3 + H ... y does it say co2 + water if CA is removing the water to form carbonic acid? another question; in decreased ventilation shouldn't the PaCO2 go up? or is normal because its corrected by increased respiratory rate?

[@worldaround6520]

I think on the contrary CA adds water to CO2. I remember once I was in something like a ferry at the end when I was leaving I saw that the CO2 that was coming out from the ferry was mixing with water to form this white colour Carbonic acid - if my observation is correct.

[@worldaround6520]

Let me try to answer your second question - Low Ventilation is not the same as low Ventilation perfusion ratio. Carbon dioxide theoretically doesn't have a dipole, but it does contain polar units. This makes carbon dioxide more soluble in water, which is polar-like dissolves like. On the other hand, oxygen is made up of similar atoms and, therefore, is nonpolar. Because of its solubility, carbon dioxide doesn't need a specialized transporter such as hemoglobin. Furthermore, the presence of carbon dioxide in water means that it can be converted into bicarbonate and act as a buffer molecule to maintain a stable pH. Carbon dioxide can freely travel in the blood, but oxygen needs a specialized protein molecule called hemoglobin. Proteins, by nature, are very complex, and the oxygen dissociation curve follows cooperative binding. You can think of ventilation-perfusion mismatch as a form of faulty division of labor. Ideally, you would want the areas where ventilation is high to have high perfusion to load the right amounts of oxygen. Therefore, ventilation-perfusion mismatch is a form of faulty division of labor and is more likely to affect the oxygen dissociation curve, as it follows cooperative binding.

[@Mikesco10]

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[@worldaround6520]

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[@Mikesco10]

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[@thecharming473]

It's a humble request pls make some videos on immunology as well... Please... Thank you

[@MedicosisPerfectionalis]

Ok 👍

[@manarabdelaziz6302]

What happens to alveolar ventillation in theses cases 1- testrictive lung disease 2 -obstructive lung disease 3- airway collapse 4 increasing compliance ?!! Can you give me the answer as Unfortunately I cannot answer that

[@worldaround6520]

I believe it is quite complex... Both emphysema and chronic bronchitis are part of COPD therefore obstructive lung disorder. In emphysema the inflammation is quite close to the blood vessels, so blood vessels get destroyed, this leads to VQ mismatch. In Pulmonary embolism blood flow stops so there is VQ mismatch. The topic is very vast I think. But let me give you a Mnemonic. In type I respiratory failure there deranged level of one gas and in type II there is deranged levels of two gases. How is it possible to have deranged level of only gas shouldn't the levels of two gases always be affected. If there is fluid CO2 being somewhat polar(although theoritically it has zero net dipole) is soluble in water than O2 that is non polar as it is made up of two similar atoms - the low solubility of O2 means oxygenated drinks are not popular like carbonated drinks because CO2 solubility is high. Okay let me try to tell you why V/Q mismatch causes type 1 respiratory failure. Carbon dioxide theoretically doesn't have a dipole, but it does contain polar units. This makes carbon dioxide more soluble in water, which is polar-like dissolves like. On the other hand, oxygen is made up of similar atoms and, therefore, is nonpolar. Because of its solubility, carbon dioxide doesn't need a specialized transporter such as hemoglobin. Furthermore, the presence of carbon dioxide in water means that it can be converted into bicarbonate and act as a buffer molecule to maintain a stable pH. Carbon dioxide can freely travel in the blood, but oxygen needs a specialized protein molecule called hemoglobin. Proteins, by nature, are very complex, and the oxygen dissociation curve follows cooperative binding. You can think of ventilation-perfusion mismatch as a form of faulty division of labor. Ideally, you would want the areas where ventilation is high to have high perfusion to load the right amounts of oxygen. Therefore, ventilation-perfusion mismatch is a form of faulty division of labor and is more likely to affect the oxygen dissociation curve, as it follows cooperative binding. Type II respiratory failure is a lot more intuitive I believe. All the best. 🙌🙌🙌🙌🙌 One more thing.... Why does in obstructive lung diseases expiration is more difficult?? This is because during inspiration lungs expand so the obstruction is somewhat relieved.

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Thanks ❤❤

[@MedicosisPerfectionalis]

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Thank you so much for the great explanation. You're the best!!!

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[@vildanak2489]

can ventilation defect cause hypercapnia? less o2 is in the alveoli so i thought Paco2 would be higher

[@MedicosisPerfectionalis]

Hypoventilation can cause hypercapnia. Also, hyperoxia can cause hypercapnia.

[@GZH88]

thanks for ur effort,but in obstructive lung disease with low v/q ratio,i think u should have hypercapnea not normocapnea,what do u think?

[@MedicosisPerfectionalis]

Give me an example.

[@GZH88]

@@MedicosisPerfectionalis Thanks for answering me,i mean all type 2 respiratory faliure is hypoxic hypercapnic or at least thats how they teach us.

[@umerbinshabir6561]

@@MedicosisPerfectionalis In COPD problem is in expiration so CO2 is retained leading to hypercapnia

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[@gayathrijinesh3004]

When the vessel is closed, close the bronchus... Does that happen? There is bronchoconstriction?

[@MedicosisPerfectionalis]

I am sorry, I don’t understand your question

[@gayathrijinesh3004]

@@MedicosisPerfectionalis The last statement of the video Decreased perfusion. Does it cause closing of bronchus?

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[@worldaround6520]

I think your analogy, where you said that the base is more likely to suffer from infarction because it is more dependent on the blood supply, is inaccurate. The base has a higher blood supply and, therefore, is less likely to suffer if you apply the logic of higher perfusion. It is like saying a loss of $50 is a bigger issue for a rich man than for a poor man. In my opinion, the real reason the base is more likely to suffer from infarction is because it has higher perfusion. Coupled with the fact that, due to gravity, the weight of everything above it leads to more turbulence, higher turbulence is more likely to damage the endothelium. Therefore, there is a higher chance of clot formation, which can even embolize. This is my understanding; I may be wrong, but in any case, your lectures are a boon.

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