AP2: Lab 3- Cardiovascular Physiology
Which of the statements describes the proper way to measure a radial pulse? A: Lightly press the tips of your index and middle finger over the lateral wrist, in line with the patient's thumb B: Tightly press the tip of your thumb over the lateral wrist, in line with the patient's index and middle fingers C: Tightly press the tips of your index and middle finger over the lateral wrist, in line with the patient's thumb D: Lightly press the tip of your thumb over the lateral wrist, in line with the patient's index and middle fingers
A: Lightly press the tips of your index and middle finger over the lateral wrist, in lime with the patient's thumb *The radial pulse point is easily palpated on the lateral aspect of the wrist, in line with the patient's thumb. It may help to compress the artery firmly at first, but it is important to release some of the pressure quickly so that you don't occlude the radial artery.
Which portion of the electrocardiogram represents the wave-like change in charge in the positive direction received by the atria from the sinoatrial (SA) node? A: P wave B: QRS complex C: S-T segment D: T wave
A: P wave *The P wave represents the depolarization of the left and right atria and the beginning of atrial systole.
A graph illustrating the pressure and volume changes during one heartbeat is called the __________. A: cardiac cycle B: electrical events of the heartbeat C: blood pressure D: conduction system of the heart
A: cardiac cycle
Which of the following accounts for the heart sounds "lubb-dubb"? A: closing of the atrioventricular and semilunar valves, respectively B: opening of the atrioventricular and semilunar valves, respectively C: opening of the semilunar and atrioventricular valves, respectively D: closing of the semilunar and atrioventricular valves, respectively
A: closing of the atrioventricular and semilunar valves, respectively
The term ________ means "relaxation," and the term ________ means "contraction." A: diastole; systole B: systole; conduction C: systole; diastole D: diastole; conduction
A: diastole; systole
Abnormal heart sounds called __________ can indicate valve problems. A: murmurs B: stroke
A: murmurs
Which of the following tools are most commonly used to measure blood pressure indirectly? More than one answer A: sphygmomanometer B: stethoscope C: thermometer D: clock or watch
A: sphygmomanometer, B: stethoscope *Blood pressure can also be measured using automatic or digital monitors. These monitors are battery-operated and use a microphone to detect blood flow in the artery. The cuff automatically inflates when you press the start button and automatically deflates after the blood pressure is measured. An automatic or digital monitor is especially useful for individuals who are hearing impaired, visually impaired, or unable to physically squeeze the bulb.
The typical ECG has __________ normally recognizable deflection waves. A: three B: six
A: three
The event that happens immediately following the P wave but is not shown due to the amplitude of the QRS wave.
Atrial systole
There are various techniques to manually calculate the heart rate based on the ECG readout. However, there are certain standard features that one should note, such as that the paper/monitor travels at the speed of 25 mm/sec and the gird is made up of little squares of 1 mm × mm , each representing 0.04 sec . The distance between the R wave of one cycle to another R wave is composed of 20 small squares on an ECG strip. What is the heart rate in bpm ? A: 70 bpm B: 75 bpm C: 80 bpm D: Can't be determined based on the given data.
B: 75 bpm
Mean arterial pressure is important to understand, as this is the pressure that actually assures proper blood delivery to the organs and tissues. It is not a mere average of systolic and diastolic pressures. Recall that the heart is in diastole much longer than it is in systole. What is the MAP for a blood pressure of 120/60? A: 140 B: 80 C: 95 D: 75
B: 80
Is blood pressure higher in arteries or in veins? Why? A: Veins, because they have larger lumens B: Arteries; because they are closer to the pumping action of the heart C: Veins; because they are farther away from the pumping action of the heart
B: Arteries; because they are closer to the pumping action of the heart
Recall from the video the procedure to auscultate (listen to) heart sounds. Which of the following is NOT part of auscultating normal first and second heart sounds? A: Disinfect the earpieces and diaphragm of the stethoscope. B: Position the earpieces so they are angled backward in the ears. C: Place the diaphragm of the stethoscope over the apex of the heart. D: Listen carefully for lub - dup.
B: Position the earpieces so they are angled backward in the ears. *Correct! The earpieces should be angled forward in the ears, toward the external acoustic meati (ear canals). When the diaphragm of a stethoscope is placed over the apex of the heart, the first heart sound (S1) is normally a louder, longer, and lower-pitched sound compared to the second heart sound (S2).
Suppose a patient develops a myocardial infarction that disables the sinoatrial node. Would the heart still pump blood to the aorta and the pulmonary trunk? A: No, because there would be no more connection between the atrioventricular node and the bundle branches. B: Yes, because the atrioventricular node will still stimulate ventricular systole. C: Yes, because the ventricles will depolarize on their own without nodal stimulation at a rate of 50 times per minute. D: No, because there will be no contraction of the atria.
B: Yes, because the atrioventricular node will stimulate ventricular systole. *The atrioventricular node spontaneously depolarizes similarly to the sinoatrial node, but more slowly. It can lead to the ventricles pumping blood to the aorta and pulmonary trunk around 50 times per minute.
Absence of a P wave on an electrocardiogram would likely indicate the absence of __________. A: atrial diastole B: atrial systole C: ventricular systole D: ventricular diastole
B: atrial systole
What is the period during the cardiac cycle when the valves leading to and from the ventricles are completely closed and blood volume in the ventricles remains constant as the walls contract? A: ventricular ejection B: isovolumetric contraction phase C: isovolumetric relaxation phase D: ventricular filling
B: isovolumetric contraction phase *The prefix -iso means "equal," so during any isovolumetric stage the volume does not change.
The pulse is most often taken at the lateral aspect of the wrist, above the thumb, by compressing the __________ artery. A: popliteal B: radial
B: radial
On an electrocardiogram, the wave associated with __________ is hidden by the much larger QRS complex. A: atrial systole B: repolarization of the atria C: ventricular systole D: repolarization of the ventricles
B: repolarization of the atria
A heart rate over 100 beats/minute is known as __________. A: bradycardia B: tachycardia
B: tachycardia
Systolic blood pressure represents ________. A: the electrical activity in the heart B: the highest blood pressure generated in arteries during ventricular systole when the artery is maximally stretched C: the expansion and recoil of the artery walls D: the resistance to blood flow in the arteries
B: the highest blood pressure generated in arteries during ventricular systole when the artery is maximally stretched
_______ is the force per unit area exerted on a blood vessel wall by the blood, and it fluctuates with the alternating contraction and relaxation of the ventricles.
Blood pressure
_____________ is the force per unit area exerted on a blood vessel wall by the blood, and it fluctuates with the alternating contraction and relaxation of the ventricles.
Blood pressure
Slower-than-normal heart rate.
Bradycardia
Which portion of the electrocardiogram represents the time during which the ventricles are in systole? A: P wave B: T wave C: Q-T interval D: QRS complex
C: Q-T interval *The Q-T interval is the period from the beginning of ventricular depolarization through ventricular repolarization, during which the ventricles are in systole.
Define blood pressure. A: The movement of lungs forcing blood toward the heart B: The quantity of blood flowing through the heart C: The force exerted on the blood vessels by the blood D: The quantity of blood in the body
C: The force exerted on the blood vessels by the blood
During which of these stages are the aortic and pulmonary valves open? A: phase 1 B: phase 2a C: phase 2b D: phase 3
C: phase 2b *During phase 2b, the pressure in the ventricles exceeds that of the aorta and pulmonary trunk, so their valves open and allow blood to be ejected.
Because it sets the rate of depolarization for the normal heart, the __________ node is known as the pacemaker of the heart. A: atrioventricular B: Purkinje C: sinoatrial
C: sinoatrial
A heartbeat begins with an electrical impulse generated by the ________. A: atrioventricular (AV) node B: atrioventricular (AV) bundle C: sinoatrial (SA) node D: Purkinje fibers
C: sinoatrial (SA) node
Specifically, what part of the intrinsic conduction system stimulates the atrioventricular (AV) node to conduct impulses to the atrioventricular bundle? A: subendocardial conducting network (Purkinje fibers) B: interventricular septum C: sinoatrial (SA) node D: bundle branches
C: sinoatrial (SA) node *The sinoatrial node, by spontaneously depolarizing faster than the atrioventricular node, initiates heart contraction.
The __________ are characteristic sounds that indicate the resumption of blood flow to the artery being occluded when taking blood pressure. A: heart rhythms B: ectopic heartbeats C: sounds of Korotkoff D: heart murmurs
C: sounds of Korotkoff
Diastolic blood pressure represents ________. A: the force exerted by the left ventricle as blood is pumped into the aorta B: the expansion and recoil of the artery walls C: the lowest pressure during ventricular diastole when the artery recoils no farther D: the electrical activity in the heart
C: the lowest pressure during ventricular diastole when the artery recoils no farther
When measuring blood pressure, the Korotkoff sounds are generated as a result of ________. A: turbulent blood flow in the carotid arteries B: turbulent blood flow in the brachial vein C: turbulent blood flow in the brachial artery D: turbulent blood flow in the aorta
C: turbulent blood flow in the brachial artery
Trace the pathway of stimulation through the heart. Which of these pathways shows stimulation in the correct order? A: subendocardium, interventricular septum, AV bundle, AV node B: AV bundle, subendothelium, interventricular septum, SA node C: SA node, interventricular septum, AV node, papillary muscles D: AV node, AV bundle, interventricular septum, subendothelium
D: AV node, AV bundle, interventricular septum, subendothelium *This is the correct order of stimulation of the heart muscle. The signal to the AV node would begin in the SA node.
What is systole? A: Pressure in the veins B: Pressure in the arteries C: Relaxation phase of the heart D: Contraction phase of the heart
D: Contraction phase of the heart
Regarding the electrocardiogram, which of the following statements is correct? A: Depolarization of the atria and ventricles is indicated by the P wave. B: Depolarization of the ventricles is indicated by the QRS complex. C: Repolarization of the atria and ventricles is indicated by the T wave. D: Repolarization of the ventricles is indicated by the QRS complex.
D: Depolarization of the ventricles is indicated by the QRS complex.
Which of the following is the correct equation for the calculation of mean arterial pressure (MAP)? A: systolic pressure / diastolic pressure B: systolic pressure + 1/3 pulse pressure C: 1/2 (diastolic pressure + systolic pressure) D: systolic pressure - diastolic pressure E: diastolic pressure + 1/3 pulse pressure
E: diastolic pressure + 1/3 pulse pressure *Mean arterial pressure, or MAP, is the driving force for moving blood through the tissues. The normal range for MAP is 70-110 mm Hg. If the MAP falls below 60 mm Hg, the organs of an average person will not get enough blood and will become hypoxic.
True or False: During the cardiac cycle, the closing of the semilunar valves produces the first heart sound.
False
True or False: Stimulation by the nerves of the autonomic nervous system is essential for cardiac muscle to contract.
False
Sound of a turbulent blood flow.
Korotkoff sound
Heart sound made during ventricular ejection.
Lubb
_____________ can be calculated as diastolic pressure plus one-third the pulse pressure because the ventricles spend more time in diastole.
MAP
One-third of the pulse pressure plus the diastolic pressure.
Mean arterial pressure (MAP)
In a typical ECG, the __________ wave signals the depolarization of the atria immediately before they contract. P Q R T
P
Atrial depolarization seen on an ECG.
P wave
________ is the count of surges of pressure in an artery that occur with each contraction and relaxation of the left ventricle.
Pulse
___________ is the calculated as systolic pressure minus diastolic pressure and indicates the additional pressure in the artery when ventricles are contracting.
Pulse Pressure
______________ is calculated as systolic pressure minus diastolic pressure, and indicates the additional pressure in the artery when ventricles are contracting.
Pulse pressure
Ventricular depolarization seen on an ECG.
QRS complex
_______ is the pressure in the arteries at the peak of ventricular contraction, while ___________ is the pressure in the arteries during ventricular relaxation.
Systolic pressure; diastolic pressure
_________________ is the pressure in the arteries at the peak of ventricular contraction, while ______________ is the pressure in the arteries during ventricular relaxation.
Systolic pressure; diastolic pressure
Ventricular repolarization seen on an ECG.
T wave
Faster than normal heart rate.
Tachycardia
True or False: Blood pressure is measured in units of measure called millimeters of mercury.
True
True or False: Cardiac muscle cells are electrically connected by gap junctions and behave as a single unit.
True
True or False: The repolarization of the atria is usually masked by the large QRS complex.
True
True or False: Ventricular ejection is the period during the heart cycle when the ventricles pump blood into the great vessels.
True
True or False: When ventricular systole begins, intraventricular pressure increases rapidly, closing the atrioventricular (AV) valves.
True
Connect key events in the cardiac cycle with heart sounds.
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Contraction occurs after electrical stimulation of myocardium. One cardiac cycle takes about 0.8 second, which translates to 75 bpmbpm. During each cycle, atria contract (systole) to fill the ventricles. Ventricular contraction (systole) pumps the blood out of the heart. To replenish the energy and oxygen used during contraction, the heart has to rest (diastole) before the next cycle begins. Match the correct phase of the cardiac cycle by dragging and dropping them by the correct heart phase.
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Label the arteries where the pulse is most easily palpated.
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Label the auscultation areas for the heart
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Label the components of the cardiac conduction system
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Label the heart sound in the cardiac cycle
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Label the intrinsic conduction system
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Label the overview of the cardiac conduction system
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Label the structure of blood pressure being taken
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Label the waves, segments, and intervals of a normal ECG.
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Since the left ventricle is subjected to more mechanical forces and is the side of the heart that pumps the blood throughout systemic circulation, it is very important to understand the events that occur in this chamber during the cardiac cycle. Drag and drop the correct term with the proper event on the diagram.
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Relationship Between Normal Heart Sounds and the Events of the Cardiac Cycle Drag the events of the cardiac cycle to their associated heart sound.
[see image] *Both the first heart sound (S1) and second heart sound (S2) are normal heart sounds. The first heart sound is made by the tricuspid and mitral valve closures during the beginning of ventricular systole. The second heart sound is made by the closure of the aortic and pulmonary valves during the beginning of ventricular diastole.
Based on the information in the video, rank these blood vessels from predicted weakest pulse on the left to strongest pulse on the right.
[see image] *Pulse strength gets weaker in arterial blood vessels as you move away from the heart. Pulse strength is highest in large arteries and decreases with decreasing size of vessels carrying blood away from the heart. After capillary exchange, pulse strength decreases with increasing size of venous vessels.
Recall from the video the steps of how to measure blood pressure using a stethoscope and sphygmomanometer (blood pressure cuff). Note that before measuring blood pressure in lab, the subject should be in a seated position with his or her sleeve rolled up to expose the arm. Place the steps in the correct order from left to right.
[see image] *Blood pressure is calculated as systolic pressure over diastolic pressure and is measured in millimeters of mercury (mm Hg). The first number recorded is the systolic pressure, and the second number recorded is the diastolic pressure. The average normal blood pressure is 120/80, although normal blood pressure varies considerably from person to person.
Compute the MAP of a person with a BP of 120/90. Drag and drop the correct numbers to complete the calculation.
[see image] *Determination of MAP is important in proper treatment of serious conditions, such as sepsis, stroke, head trauma, and severe hypertension with signs of organ damage.
Individual heart valve sounds can be heard by positioning the stethoscope over specific areas of the thorax. Drag each of the heart valves to identify the location of where their sound is typically heard best.
[see image] *The aortic, pulmonary, tricuspid, and mitral areas are the most important sites when auscultating heart sounds. Even though the first and second heart sounds can technically be heard at all of these areas, the individual heart valve sounds are heard best at only one site.
Label the name of the artery that can be palpated at the marked pulse points.
[see image] *The brachial, radial, and common carotid pulse points will be the most frequently used pulse points for vital signs.
Compute the pulse pressure of a person with a BP of 120/90. Drag and drop the correct numbers to complete the calculation.
[see image] *The normal range for pulse pressure is 30 - 50 mm Hg. Lower pulse pressures may indicate poor heart function while higher pulse pressures can be related to arteriosclerosis of the aorta, increased risk of heart attack, or valve leakage.
