Chapter 18: The Heart A&P II

Which of the following would increase stroke volume? (SV)

1. Activation of HCN Channels 2. Activation of Cardiac Nerve

Place the following structures in the order they would be encountered by a red blood cell leaving the left ventricle:

1. Aorta 2. Systemic capillary 3. Vena cava 4. Right atrium 5. Right ventricle 6. Pulmonary artery 7. Pulmonary vein 8. Left atrium

Decide whether blood traveling through each of the following vessels is oxygenated or deoxygenated: 1. Inferior vena cava 2. Superior vena cava 3. Coronary artery 4. Coronary vein 5. Pulmonary vein 6. Pulmonary artery

1. Deoxygenated 2. Deoxygenated 3. Oxygenated 4. Deoxygenated 5. Oxygenated 6. Deoxygenated

Place the following in the order that they would be encountered as you moved from the inside of the ventricular chamber to the thoracic cavity:

1. Endothelial cell layer 2. Cardiac skeleton 3. Epicardium 4. Pericardial fluid 5. Parietal pericardium 6. Fibrous pericardium

Using the diagram below, place the following events of the cardiac cycle in order, beginning with the first atrial systole.

1. First atrial systole 2. Atrial diastole/ Early ventricular systole 3. Late ventricular systole 4. Early ventricular diastole 5. Late ventricular diastole 6. Second atrial systole

Match the following with their description: 1. A mixed sodium and potassium current 2. A channel that opens at very negative potentials 3. The first calcium channel to open 4. The second calcium channel to open 5. Begins the pacemaker potential phase 6. Create rapid depolarization 7. Create rapid depolarization

1. Funny Current 2. HCN channels 3. T-Type calcium channel 4.L-Type Calcium channel 5. Funny current 6. L-Type calcium channel 7. Inward rectifier potassium

Under normal conditions, how would each of the following manipulations change cardiac output? 1. Increased stroke volume 2. Increased heart rate 3. Decreased EDV 4. Increased EDV

1. Increase 2. Increase 3. Decrease 4. Increase

State whether the following manipulations will increase or decrease cardiac output: 1. Generation of cAMP 2. Phosphorylation of RyR 3. Increase in SERCA activity 4. Activation of the cardiac nerve 5. Inhibition of the cardioinhibitory center 6. Increasing acetylcholine release 7. Inhibiting protein kinase A 8. Stimulation of the vagus nerve 9. Inhibiting the parasympathetic nervous system

1. Increase 2. Increase 3. Increase 4. Increase 5. Increase 6. Decrease 7. Decrease 8. Decrease 9. Increase

Sequence the following events of the cardiac myocyte action potential:

1. Inward rectifier potassium channels are open, creating high potassium permeability 2. Depolarization from resting membrane potential 3. Fast sodium channels increase sodium permeability 4. Refractory period beings 5. Calcium permeability increases 6. Delayed rectifier potassium channels open 7. L-type calcium channels close

1. The majority of ventricular of ventricular filling happens during this phase. 2. At the beginning of this phase, ventricles contain their end systolic volume. 3. This phase begins when the AV valves open 4. This phase begins when the SL valves open 5. Isotonic contraction occurs during this phase 6. Isometric contraction occurs during this phase 7. Isovolumic relaxtion occurs during this phase.

1. Late ventricular diastole 2. Early ventricular diastole 3. Late ventricular diastole 4. Late ventricular systole 5. Late ventricular systole 6. Early ventricular systole 7. Early ventricular diastole

Follow the correct path of blood through the heart, beginning at the left atrium.

1. Mitral Valve 2. Left Ventricle 3. Aorta 4. Left Anterior Descending Artery 5. Vena Cava 6. Right atrium 7. Tricuspid 8. Right Ventricle 9. Pulmonary Valve

Match the following with their descriptions: 1. Also known as the "pacemaker" 2. Creates a short delay in conduction 3. Conducts action potentials through the interventricular septum 4. Have a rapid conduction velocity due to many gap junctions 5. Capable of firing approximately 100 action potentials per second 6. Capable of firing 40-60 action potentials per second 7. Conduct electrical signals directly to contractile myocytes in ventricle

1. SA Nodes 2. AV Nodes 3. Bundle of His 4. Purkinje fibers 5. SA node 6. AV Node 7. Purkinje fibers

Place the following structures in the order they would receive an electrical stimulus:

1. SA node 2. Atrial contractile myocytes 3. AV node 4. Bundle of His 5. Left and right bundle branches 6. Purkinje fibers 7. Ventricular contractile myocytes

An increase in ESV (end systolic volume) represents:

A decrease in cardiac function

An ECG measures:

All electrical signals generated by the heart

A 63-year-old female presented to the emergency department with chest pains, fatigue, swelling of her legs, an irregular heartbeat, and unexplained cough. She stated that she was diagnosed with a heart murmur years ago, but her doctor told her not to worry about it. We started a series of tests on her to rule out several conditions. What we found is that she had aortic stenosis, which is a narrowing of the aortic heart valve. This causes a murmur that her doctor should have been worried about years ago. We also noticed that she had a significantly enlarged heart and we diagnosed her with left-sided heart failure. What was the primary underlying cause of the heart failure in this patient?

Aortic stenosis* Narrowing of the valve caused blood to back up, which caused the heart to work harder for years to push more blood through a narrowed space.

Anatomically, the inferior portion of the heart is also known as the:

Apex

Like skeletal muscle, cardiac muscle cells:

Are striated

Which of the following is similarity between cardiac and skeletal muscle?

Cardiac muscle has a refractory period

One difference between cardiac and skeletal muscle is that:

Cardiac myocytes have a single nucleus

How does the Frank-Starling mechanism equalize cardiac output between the left and right sides of the heart?

Even a tiny volume of blood moving from the systemic to pulmonary circulation will create an increase in the pressure within the pulmonary circulation (and therefore the left atrium). This will increase EDV, increase pressure within the left ventricle, and increase the stroke volume to correct the imbalance.

A patient with a non-functional SA node will be unable to contract the ventricles of her heart

False

What is the name of the vessels that take blood to alternate routes in the fetus?

Fetal Shunts=bring blood to and from mother& protect immature fetus lungs

FILL IN THE BLANKS: During late ventricular systole, ventricular pressure is <BLANK> than atria and <BLANK> than great vessels.

Greater; greater

Which of the following would be observed in a ventricular myocyte of a patient taking a Beta-adrenergic receptor agonist?

Increased calcium loading into the sarcoplasmic reticulum

A partial conduction block, which delays conduction at the AV node, would produce which of the following changes in heart sounds?

Increased time between S1 and S2

While on a food tour in Asia, a traveler accidentally ingests TTX (a poison that blocks voltage-sensitive Na+ channels). This drug would:

Inhibit pacemaker potential

Pressure and Volume are

Inversely proportional

During this phase of the cardiac cycle, pressure inside the right ventricle increases until it becomes equal to the pressure inside the pulmonary artery.

Isovolumetric contraction

Which is not a feature of the cardiac muscle?

It uses mostly anaerobic metabolism

Rupture of the chordae tendinae sometimes occurs in patients with endocarditis (inflammation of the endocardium). This disorder would most likely require surgery on which of the following valves?

Mitral valve bc it has chordae tendinae

Pacemaker cells are located in the ______________; Contractile cells are located in the______________.

Myocardium; Myocardium

The intracellular kinase that is directly responsible for the changes in the strength and speed of cardiac contraction is ______________.

PKA (Protein Kinase A)

Contractile myocytes are different than pacemaker cells because:

Pacemaker cells are low in abundance

Electrical coordination of the atria and ventricles is due to:

Pacemaker cells in the atria being in the refractory period while ventricles are depolarizing

A 24-year-old male Ph.D. candidate was walking around across campus late one night when a mugger approached him. The student decided to fight rather than hand over his wallet. The mugger stabbed the student in the chest, penetrating the heart, and ran away with the knife. The student collapsed and was later found unresponsive by fellow students. He was rushed two blocks to the emergency room where he was pronounced dead on arrival. During an autopsy, the only abnormality noted was a large volume of blood found around the heart in the pericardial space. Cause of death?

Pericardial tamponade==the deadlier version of cardial effusion. Large vlm of blood within pericardial space that exerts pressure on heart, restricts mvmt and eventually stops it altogether. Cardial effusion is not immediately fatal. Pericardiocentesis is a good method for removing the fluid and restoring normal function.

The primary function of the papillary muscles is to:

Prevent the eversion of the tricuspid valve

Cardiac anastomoses

Provide alternate paths for blood flow

Atrial repolarization corresponds with the ______________wave.

QRS

This question refers to ECG traces in the figure below. If the trace in panel A depicts normal activity, which trace corresponds to a patient experiencing atrial fibrillation?

Quivering but not tachycardic

While preparing her patient for an ECG, a cardiologist accidentally switches the recording electrode of lead 1 with the reference electrode from lead 1. Which of the following results would be expected?

Repolarizing current will give a positive deflection.

What will be the result if the blood continues to back up?

Right-sided heart failure* The most common cause of right sided heart failure is left side heart failure. None of the other answer choices are as likely to occur before the right side of the heart starts to fail.

The correct path of the action potential traveling through the conductive system of the heart is:

SA node===internodal pathway===AV node===Bundle of His===R and L bundle branches===Purkinje Fibers

Which of the following pumps oxygenated blood?

Systemic Pump

Angina (the clinical term used to describe chest pain) and irregular heartbeat are occasionally treated using a class of drugs known as calcium channel blockers (e.g., Verapamil). What effects would you expect to see in a patient treated with verapamil? What would you predict to be potential side effects of this medication?

The calcium will inhibit the L and T type channels. This in turn relaxes the smooth muscle and decreases the heart rate.

A defibrillator is a medical device that delivers large electrical pulses to the myocardium from paddles that are placed on the chest. Why is a defibrillator effective at stopping fibrillation?

The defibrilator's main goal is to create a synchronized depolarization of cardiac tissue. When you use it, the sodium channels become inactivated and the contractile cells repolarize toward the resting membrane potential. This then helps the pacemaker cells restore the baseline electrical rhythm of the heart.

Though they exist, cardiac cancers are extremely rare. Why do you think this common disease is so rare in this tissue?

The majority of the heart is made up of non-mitotic cells, which minimizes the ability of transformed cells to replicate and form a tumor.

What does a blue tint to the skin tell you about your patient?

The patient is not getting enough oxygen to the tissues

A pathological accumulation of fluid in the pericardium is called Cardiac Tamponade.

True

The right side of the heart pumps ______________ blood through the ______________ circulation.

deoxygenated; pulmonary

The specific types of intercellular junctions found in the intercalated discs that create physical connections between cardiac myocytes are ______________.

desmosomes

Blood flows from regions of ______________ pressure to regions of ______________ pressure.

high; low

Flow and resistance are

inversely proportional

Increased flow through the vena cava would cause an increase in ______________.

preload

pressure and flow are

proportional

radius and flow are

proportional

Which phase of a cardiac action potential is primarily mediated through inward rectifier potassium channels (k[ir])

resting membrane potential

One-directional blood flow is due to ______________, which are located throughout the heart and veins.

valves