Exam

Name___________________________________

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 18.1

Using Figure 18.1, match the following:

1) Subendocardial conducting network (Purkinje fibers). 1)

2) Sinoatrial (SA) node. 2)

3) Atrioventricular (AV) bundle. 3)

4) Atrioventricular (AV) node. 4)

5) Bundle branches. 5)

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Figure 18.2

Using Figure 18.2, match the following:

6) Atrial depolarization. 6)

7) Point after which pressure begins to rise in the aorta. 7)

8) Ventricular repolarization. 8)

9) Point that represents the "dup" sound made by the heart. 9)

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Figure 18.3

Using Figure 18.3, match the following:

10) Ventricular fibrillation. 10)

11) Second-degree heart block. 11)

12) Junctional rhythm. 12)

13) Normal sinus rhythm. 13)

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MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

14) The inner lining of the heart. A) Endocardium

14)

15) Heart muscle. B) Epicardium

15)

16) Serous layer covering the heart C) Parietal layer

16)
muscle.
D) Myocardium
17) The outermost layer of the serous
17)
pericardium.

Match the following:

18) Heart rate at rest under both A) Tachycardia

18)
autonomic divisions signaling.
B) Bradycardia
19) An abnormally fast heart rate.
19)
C) Vagal tone
20) An abnormally slow heart rate.
20)
D) Cardiac reserve
21) Difference between resting and
21)
maximal cardiac output.

Match the following:

22) Prevents backflow into the left A) Tricuspid valve

22)
ventricle.
B) Pulmonary semilunar valve
23) Prevents backflow into the right
23)
atrium. C) Aortic semilunar valve

24) Prevents backflow into the left atrium. D) Mitral (bicuspid) valve 24)

25) Prevents backflow into the right

25)
ventricle.

26) Atrioventricular (AV) valve with two

26)
flaps.

27) Atrioventricular (AV) valve with three

27)
flaps.

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SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 18.4

Using Figure 18.4, match the following:

28) Tricuspid valve. 28)

29) Mitral (bicuspid) valve. 29)

30) Right atrium. 30)

31) Left ventricle. 31)

32) Pulmonary veins. 32)

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MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

33) Heart muscle is deprived of oxygen. A) Ectopic focus

33)

34) Death of heart muscle cells. B) Quiescent period

34)

35) A condition of rapid and irregular or C) Ischemia

35)
out-of-phase contraction of
ventricular heart muscle cells. D) Fibrillation

36) An abnormal pacemaker. E) Infarction 36)

37) Total heart relaxation.

37)

TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false.

38) The myocardium receives its blood supply from the coronary arteries. 38)

39) Cardiac muscle has more mitochondria and depends less on a continual supply of oxygen than 39)
does skeletal muscle.

40) Anastomoses among coronary arterial branches provide collateral routes for blood delivery to the 40)
heart muscle.

41) If blood volume decreased dramatically due to massive bleeding, the autonomic nervous system 41)
will attempt to maintain cardiac output by increasing the heart rate.

42) Tissues damaged by myocardial infarction are replaced by fibrous connective tissue. 42)

43) The left side of the heart pumps the same volume of blood as the right. 43)

44) When released in large quantities, thyroxine, a thyroid gland hormone, causes a sustained increase 44)
in heart rate.

45) Arterial blood supply to heart muscle is continuous whether the heart is in systole or diastole. 45)

46) Auricles slightly increase blood volume in the ventricles. 46)

47) The "lub" sounds of the heart are valuable in diagnosis because they provide information about the 47)
function of the heart's pulmonary and aortic semilunar valves.

48) Autonomic regulation of heart rate is via two reflex centers found in the pons. 48)

49) The papillary muscles contract after the other ventricular muscles so that they can take up the slack 49)
on the chordae tendineae before the full force of ventricular contractions sends blood against the
atrioventricular (AV) valve flaps.

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 50) An electrocardiogram (ECG) provides direct information about valve function. 50)

51) As pressure in the aorta rises due to atherosclerosis, more ventricular pressure is required to open 51)
the aortic valve.

52) If the aorta and pulmonary trunk were switched, oxygen rich blood would be pumped from the 52)
left ventricle to the lungs.

53) Heart tissue is supplied with nutrients primarily by diffusion from the heart chambers through the 53)
myocardium.

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

54) Normal heart sounds are caused by which of the following events? 54)
A) closure of the heart valves
B) opening of the heart valves
C) friction of blood against the chamber walls
D) excitation of the sinoatrial (SA) node

55) During the isovolumetric relaxation phase of the cardiac cycle, _______. 55)
A) atrioventricular valves are open; aortic and pulmonary valves are closed
B) atrioventricular valves are closed; aortic and pulmonary valves are open
C) atrioventricular, aortic, and pulmonary valves are closed
D) atrioventricular, aortic, and pulmonary valves are open

56) Hemorrhage with a large loss of blood causes ________. 56)

A) a lowering of blood pressure due to change in cardiac output
B) no change in blood pressure but a change in respiration
C) no change in blood pressure but a slower heart rate
D) a rise in blood pressure due to change in cardiac output

57) The left ventricular wall of the heart is thicker than the right wall in order to ________. 57)
A) accommodate a greater volume of blood B) pump blood with greater pressure
C) expand the thoracic cage during diastole D) pump blood through a smaller valve

58) Which chambers of the heart contain oxygenated blood? 58)

A) right and left ventricles B) left atrium and ventricle
C) right and left atria D) right atrium and ventricle

59) If the SA node is not functioning, an ECG will show ________. 59)
A) higher P waves
B) no QRS waves
C) no P waves with a HR between 40-60 bpm
D) more P waves than QRS waves

60) The receiving chambers of the heart include the ________. 60)
A) right and left atria B) right atrium and ventricle
C) left atrium and ventricle D) right and left ventricles

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61) The condition where fluid compresses the heart and limits its ability to contract is called ________. 61)
A) cardiac tamponade B) myocardial infarction
C) pericarditis D) angina pectoris

62) The term for pain associated with deficient blood delivery to the heart that may be caused by the 62)
transient spasm of coronary arteries is ________.
A) ischemia B) angina pectoris
C) pericarditis D) myocardial infarct

63) To auscultate the aortic semilunar valve, you would place your stethoscope in the ________. 63)
A) fifth right intercostal space
B) fifth intercostal space inferior to the left nipple
C) second intercostal space to the left of the sternum
D) second intercostal space to the right of the sternum

64) The source of blood carried to capillaries in the myocardium would be the ________. 64)
A) coronary veins B) coronary arteries
C) coronary sinus D) fossa ovalis

65) The fact that the left ventricle of the heart is thicker than the right ventricle reveals that it ________. 65)
A) pumps blood against a greater resistance B) sends blood through a smaller valve
C) pumps a greater volume of blood D) expands the thoracic cage

66) The parietal pericardium ________. 66)

A) is also called the epicardium
B) lines the internal surface of the fibrous pericardium
C) is separated from the fibrous pericardium by serous fluid
D) is found within the pericardial cavity

67) Which of the following is NOT an age-related change affecting the heart? 67)
A) atherosclerosis B) thinning of the valve flaps
C) decline in cardiac reserve D) fibrosis of cardiac muscle

68) If cardiac muscle is deprived of its normal blood supply, damage would primarily result from 68)
________.
A) an inadequate supply of lactic acid
B) decreased delivery of oxygen
C) a decrease in the number of available mitochondria for energy production
D) a lack of nutrients to feed into metabolic pathways

69) If the length of the absolute refractory period in cardiac muscle cells was the same as it is for 69)
skeletal muscle cells, ________.
A) contractions would last as long as the refractory period
B) pacemaker cells would cease to spontaneously depolarize
C) tetanic contractions might occur, which would stop the heart's pumping action
D) it would be much longer before cardiac cells could respond to a second stimulation

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70) Norepinephrine acts on the heart by ________. 70)
A) causing a decrease in stroke volume
B) causing threshold to be reached more quickly
C) decreasing heart contractility
D) blocking the action of calcium

71) If the vagal nerves to the heart were cut, the result would be that ________. 71)
A) parasympathetic stimulation would increase, causing a decrease in heart rate
B) the heart rate would increase by about 25 beats per minute
C) the atrioventricular (AV) node would become the pacemaker of the heart
D) the heart would stop, since the vagal nerves trigger the heart to contract

72) The foramen ovale ________. 72)

A) is a shallow depression in the interventricular septum
B) is a condition in which the heart valves do not completely close
C) is a connection between the pulmonary trunk and the aorta in the fetus
D) connected the two atria in the fetal heart

73) Which vessel(s) of the heart receive(s) blood from the right ventricle? 73)
A) aorta B) pulmonary veins
C) venae cavae D) pulmonary trunk

74) Which of the following receive(s) blood during ventricular systole? 74)
A) aorta only B) pulmonary veins only
C) pulmonary arteries only D) both the aorta and pulmonary trunk

75) Which of the following is NOT part of the intrinsic conduction system of the heart? 75)
A) sinoatrial (SA) node B) bundle branches
C) atrioventricular (AV) valve D) atrioventricular (AV) node

76) The atrioventricular (AV) valves are closed ________. 76)

A) while the atria are contracting
B) by the movement of blood from atria to ventricles
C) when the ventricles are in diastole
D) when the ventricles are in systole

77) Pectinate muscles are found in the ________. 77)

A) atria only B) right atrium and right ventricle only
C) ventricles only D) atria and ventricles

78) Select the correct statement about the heart valves. 78)
A) The tricuspid valve divides the left atrium from the left ventricle.
B) Aortic and pulmonary semilunar valves control the flow of blood into the heart.
C) The atrioventricular (AV) valves prevent backflow of blood added into the atria during
ventricular contraction.
D) The mitral (bicuspid) valve separates the right atrium from the right ventricle.

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79) Select the correct statement about the function of myocardial cells. 79)
A) The influx of potassium ions from extracellular sources is the initiating event in cardiac
muscle contraction.
B) Cardiac muscle cells are innervated by sympathetic, parasympathetic, and somatic nerve
fibers so that the nervous system can increase heart rate.
C) The refractory period in skeletal muscle is much longer than that in cardiac muscle.
D) The entire heart contracts as a unit or it does not contract at all.

80) Select the correct statement about the structure of the heart wall. 80)
A) The heart chambers are lined by the endomysium.
B) The myocardium is the layer of the heart that actually contracts.
C) Connective tissue in the heart wall aids in the conduction of the action potential.
D) The fibrous cardiac skeleton forms the bulk of the heart.

81) Compared to skeletal muscle, cardiac muscle ________. 81)

A) has gap junctions that allow it to act as a functional syncytium
B) cells are larger than skeletal muscle cells
C) has more nuclei per cell
D) lacks striations

82) During the period of ventricular filling, ________. 82)

A) the aortic and pulmonary semilunar valves are open
B) pressure in the heart is at its peak
C) blood flows mostly passively from the atria through the atrioventricular (AV) valves into the
ventricles
D) the atria remain in diastole

83) The second heart sound is heard during which phase of the cardiac cycle? 83)
A) ventricular filling B) isovolumetric contraction
C) ventricular ejection D) isovolumetric relaxation

84) Which is most responsible for the synchronized contraction of cardiac muscle tissue? 84)
A) gap junctions B) desmosomes
C) small motor units D) branching cells

85) Select the correct statement about cardiac output. 85)

A) If a semilunar valve were partially obstructed, the end systolic volume in the affected
ventricle would be decreased.
B) A slow heart rate increases end diastolic volume, stroke volume, and force of contraction.
C) Stroke volume increases if end diastolic volume decreases.
D) Decreased venous return will result in increased end diastolic volume.

86) Which is NOT a vessel that brings blood directly into the right atrium? 86)
A) pulmonary vein B) coronary sinus
C) inferior vena cava D) superior vena cava

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87) Isovolumetric contraction ________. 87)
A) occurs only in people with heart valve defects
B) occurs immediately after the aortic and pulmonary semilunar valves close
C) occurs while the atrioventricular (AV) valves are open
D) refers to the short period during ventricular systole when the ventricles are completely closed
chambers

88) Given an end diastolic volume (EDV) of 120 ml / beat and an end systolic volume (ESV) of 50 ml / 88)
beat, the stroke volume (SV) would be ________.
A) 70 ml / beat B) 170 ml / beat C) 120 ml / beat D) 50 ml / beat

89) If the mitral valve is unable to close properly, ________. 89)

A) blood could flow back into the right ventricle
B) blood could flow back into the left ventricle
C) blood could flow back into the left atrium
D) blood could flow back into the right atrium

90) During exercise, which of the following would occur on an electrocardiogram (ECG) compared to 90)
an individual at rest?
A) the time from one R to the R of the next heartbeat would decrease
B) the S-T segment would decrease
C) the T wave would decrease
D) the P-R interval would decrease

91) Which coronary artery is most responsible for supplying blood to the myocardial tissue of the left 91)
atrium?
A) circumflex artery B) posterior interventricular artery
C) right marginal artery D) anterior interventricular artery

92) What is the expected heart rate when a heart is removed from a living body? 92)
A) the heart would immediately stop beating
B) 100 beats / minute
C) 50 beats / minute
D) 75 beats / minute

93) While auscultating heart sounds during a checkup, Andy's doctor hears a high -pitched sound 93)
during ventricular contraction. Which type of valve could cause this?
A) incompetent tricuspid valve B) deficient pulmonary semilunar valve
C) stenotic aortic semilunar valve D) insufficient mitral (bicuspid) valve

94) Exercise results in skeletal muscles compressing veins which encourages blood to return to the 94)
heart. In this scenario, which of the following is correct?
A) stroke volume decreases B) preload increases
C) end diastolic volume (EDV) decreases D) venous return decreases

95) The "pacemaker potential" of pacemaker cells is produced by the opening of ________ at the end of 95)
an action potential.
A) slow Na+ channels B) slow Ca2+ channels
C) fast Ca2+ channels D) K+ channels

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 96) The plateau phase of an action potential in cardiac muscle cells is due to the ________. 96)
A) efflux of K+ through K+ channels
B) influx of Ca2+ through slow Ca2+ channels
C) efflux of Ca2+ through fast Ca2+ channels
D) influx of Na+ through fast Na+ channels

97) The Frank-Starling Law states that, if other factors are constant, a ________. 97)
A) higher stroke volume will produce a higher end diastolic volume
B) higher end diastolic volume will produce a higher stroke volume
C) higher stroke volume will produce a lower end diastolic volume
D) higher end diastolic volume will produce a lower stroke volume

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

98) Define systole and diastole. Which heart chambers are usually referenced when these terms 98)
are used?

99) Define the terms end diastolic volume (EDV) and end systolic volume (ESV) and relate them to 99)
the calculation of stroke volume.

100) What is the difference between the auricles and the atria? 100)

101) The heart is called a "double pump" because there are two functionally separate 101)
circulations. Trace the pathway of each of these circulations and include the following
information: heart chambers involved, major blood vessels involved, and general areas
through which the blood flows. Begin with the right atrium.

102) What two important functions does the intrinsic cardiac conduction system perform? 102)

103) Explain the role of pacemaker cells in cardiac tissue. 103)

104) Why is oxygen so much more critical to the heart muscle than to skeletal muscles? 104)

105) What is the functional importance of the intercalated discs of cardiac muscle? What is the 105)
functional importance of the fibrous cardiac skeleton of the heart?

106) List the three vessels that bring oxygen-poor blood to the right atrium. Which regions of 106)
the body do they serve?

107) List and define the three most important factors that affect stroke volume. 107)

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

108) A 14-year-old girl undergoing a physical examination prior to being admitted to summer camp was found to
have a loud diastolic murmur at the second intercostal space to the left side of the sternum. Explain the reason
for the loud heart murmur associated with this girl's condition.

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109) A man enters the hospital complaining of chest pain. His history includes smoking, a stressful job, a diet heavy
in saturated fats, lack of exercise, and high blood pressure. Although he is not suffering from a heart attack, his
doctor explains to him that a heart attack is quite possible. What did the chest pain indicate? Why is this man a
prime candidate for a heart attack?

110) An older woman complains of shortness of breath and intermittent fainting spells. Her doctor runs various
tests and finds that the atrioventricular (AV) node is not functioning properly. What is the suggested
treatment?

111) A Doppler ultrasound was performed on an infant who had symptoms of breathlessness and it was found that
he had a patent ductus arteriosus. Discuss the location and function of the ductus arteriosus in the fetus and
relate it to the reason for the infant's breathlessness.

112) A patient takes a nitroglycerin tablet sublingually for chest pain. Nitroglycerin acts directly on smooth muscle,
producing relaxation and vessel dilation. How would this relieve chest pain?

113) A patient was admitted to the hospital with chest pains. On admission, his pulse was 110 and blood pressure
was 96/64. According to his history, his normal pulse rate is usually between 80 and 88 and his blood pressure
runs from 120/70 to 130/80. Explain why these changes in BP and HR occur.

114) A 55-year-old male was admitted to the hospital with heart failure. He complains of increasing shortness of
breath on exertion and needing to sleep on three pillows at night. On physical assessment, the nurse
determines that his ankles and feet are very swollen. Which of these symptoms reflect left -sided heart failure
and which reflect right-sided heart failure?

115) Asystole is the total absence of ventricular electrical activity. Explain why defibrillation would not be effective
in this situation.

116) A patient is prescribed a calcium channel blocker to prevent angina (chest pain), by decreasing the demand for
oxygen. Explain why.

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Answer Key
Testname: UNTITLED18

1) E
2) A
3) C
4) B
5) D
6) A
7) D
8) E
9) E
10) D
11) C
12) B
13) A
14) A
15) D
16) B
17) C
18) C
19) A
20) B
21) D
22) C
23) A
24) D
25) B
26) D
27) A
28) B
29) D
30) A
31) E
32) C
33) C
34) E
35) D
36) A
37) B
38) TRUE
39) FALSE
40) TRUE
41) TRUE
42) TRUE
43) TRUE
44) TRUE
45) FALSE
46) FALSE
47) FALSE
48) FALSE
49) FALSE
50) FALSE
14
Answer Key
Testname: UNTITLED18

51) TRUE
52) TRUE
53) FALSE
54) A
55) C
56) A
57) B
58) B
59) C
60) A
61) A
62) B
63) D
64) B
65) A
66) B
67) B
68) B
69) C
70) B
71) B
72) D
73) D
74) D
75) C
76) D
77) A
78) C
79) D
80) B
81) A
82) C
83) D
84) A
85) B
86) A
87) D
88) A
89) C
90) A
91) A
92) B
93) C
94) B
95) A
96) B
97) B
98) Systole is contraction of the muscle. Diastole is relaxation of the muscle. The contraction and relaxation of the
ventricles are normally described with the terms systole and diastole.

15
Answer Key
Testname: UNTITLED18

99) EDV is the amount of blood that collects in a ventricle during diastole (filling of ventricles). ESV is the volume of
blood remaining in a ventricle after it has contracted. Stroke volume (ml / beat) equals EDV - ESV.
100) Auricles are the flaplike appendages attached to the atria that provides a reserve capacity to increase the atrial
volume. The atria are receiving chambers for blood returning to the heart from the pulmonary and systemic
circulation.
101) Right atrium to right ventricle to pulmonary trunk to pulmonary arteries to lungs to pulmonary veins (pulmonary
circuit pump); left atrium to left ventricle to aorta to body tissues to venae cavae (systemic circuit pump).
102) The important functions of the intrinsic cardiac conduction system are to initiate impulses (pacemaker) and to
distribute impulses throughout the heart so that it depolarizes and contracts in an orderly, sequential manner.
103) Pacemaker cells do not maintain a stable resting membrane potential. Instead, they have an unstable resting potential
that continuously depolarizes, drifting toward threshold for firing. These spontaneously changing membrane
potentials, called pacemaker potentials, initiate the action potentials that trigger the heart's rhythmic contractions.
104) Cardiac muscle cells are highly dependent on oxygen and rely almost exclusively on aerobic respiration. Thus, they
cannot tolerate lack of oxygen due to an inadequate blood supply. When there is a forced switch to anaerobic
respiration, lactic acid and rising H + levels impair heart function.
105) Intercalated discs contain anchoring desmosomes that prevent cell separation, and gap junctions that allow ions to
travel from cell to cell enabling greater communication by increasing the surface area, transmitting current across the
entire heart. The fibrous cardiac skeleton acts as a tendon, an insertion and insulator, giving the cardiac cells
something to pull or exert their force on and isolating atrial from ventricular contractions.
106) The superior vena cava returns oxygen-poor blood from body regions superior to the diaphragm. The inferior vena
cava returns oxygen-poor blood from body areas inferior to the diaphragm. The coronary sinus collects blood
draining from the myocardium.
107) 1. Preload – the degree to which heart muscle cells are stretched before they contract
2. Contractility – contractile strength achieved at a given muscle length
3. Afterload – pressure that must be overcome for the ventricles to eject blood
108) The heart murmur is due to incomplete closure of the pulmonary valve and regurgitation of pulmonary trunk blood
during diastole.
109) His symptoms indicate angina pectoris, possibly due to either atherosclerosis or stress-induced spasms of the
coronary arteries. If the arteries are occluded (atherosclerosis), the heart muscle could be deprived of blood, and
therefore oxygen. A heart attack could occur if the coronary vessels experience further (or progressive) occlusion.
110) The suggested treatment is surgery to implant an artificial pacemaker.
111) The ductus arteriosus is a shunt between the pulmonary trunk and the aorta in the fetus, which normally closes at
birth and becomes a ligament (ligamentum arteriosum). Breathlessness is due to the mixing of oxygenated and
deoxygenated blood because the connection between the aorta and the pulmonary trunk remains slightly open.
112) Angina pectoris is thoracic pain caused by a fleeting deficiency in blood delivery to the myocardium, with resulting
decreased oxygen being delivered to the cells. Because nitroglycerin acts as a vasodilator (similar to nitric oxide),
blood flow is increased, promoting the delivery of oxygen to the cells.
113) Increased heart rate (measured by taking his pulse) without maintaining his normal blood pressure is suggestive of
reduced stroke volume. Both a drop in blood volume and a weakened heart could cause this, but the chest pains
suggest heart damage. Failure of compensating mechanisms to maintain blood pressure suggests a serious decline in
cardiac output.
114) Because the heart is a double pump, each side can initially fail independently of the other. If the left side fails,
pulmonary congestion occurs. The right side of the heart continues to propel blood to the lungs, but the left side does
not adequately eject the returning blood into the systemic circulation. Thus, blood vessels in the lungs become
engorged with blood, pressure within them increases, and fluid leaks from the circulation into the lung tissue, causing
pulmonary edema. Shortness of breath and difficulty breathing in a prone position may occur. If the right side of the
heart fails, peripheral congestion occurs. Blood stagnates within body organs, and pooled fluids in the tissue spaces
impair the ability of body cells to obtain adequate nutrients and oxygen and to rid themselves of wastes. Edema is
most noticeable in the extremities (feet, ankles, and fingers).

16
Answer Key
Testname: UNTITLED18

115) Defibrillation is accomplished by electrically shocking the heart, which interrupts its chaotic twitching by depolarizing
the entire myocardium. In this case, the ventricles are at a total standstill and defibrillation would not be effective.
116) By preventing the influx of calcium ions into myocardial and vascular smooth muscle cells, calcium channel blockers
inhibit the intracellular release of additional stores of calcium ions. A drug that inhibits the release of intracellular
calcium ions decreases the force of myocardial contractility, thereby decreasing the oxygen demand. Calcium channel
blockers reduce the amount of calcium to bind to the troponin thereby reducing the work load on the heart.

17