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1. The fibrous pericardium is in contact with the heart. b. a sarcoplasmic reticulurn. e. all of the
a. is a serous membrane. c. transverse tubules.
b. is also known as the epicardium.
10. Action potentials pass from one cardiac muscle cell to
c. forms the outer layer of the pericardial sac.
d. all of the above.
2. Which of these structures returns blood to the right a. through gap junctions.
atrium? b. by a special cardiac nervous system.
c. because of the large voltage of the action potentials.
a. coronary sinus d. both b and c d. because of the plateau phase of the action
b. inferior vena cava ' e. all of the above potentials.
c. superior vena cava e. by neurotransmitters.
3. The valve located between the right atrium and the 11. During the transmission of action potentials through
right ventricle is the the conducting system of the heart, there is a
temporary delay at the
a. aortic semilunar valve. c. tricuspid valve.
b. pulmonary semilunar valve. d. bicuspid a. bundle branches. d. SA node.
(mitral) valve. b . P u r k i n j e fi b e r s . e . AV b u n d l e .
4. The papillary muscles c. AV node.
12. Given these structures of the conduction system of
a. are attached to chordae tendineae.
the heart:
b. are found in the atria.
c. contract to close the foramen ovale. 1. atrioventricular bundle
d. are attached to the semilunar valves. 2. AV node
e. surround the openings of the coronary arteries. 3. bundle branches
4. Purkinje fibers
5. Given these blood vessels: 5. SA node
Choose the arrangement that lists the structures
1. aorta in the order an action potential passes through
2. inferior vena cava them.
3. pulmonary trunk
4. pulmonary vein a. 2,5,1,3,4 c. 2,5,4,1,3 e.
Choose the arrangement that lists the vessels in the 5,2,4,3,1
order a red blood cell would encounter them in going b. 2,5,3,1,4 d. 5,2,1,3,4
from the systemic veins to the systemic arteries. 13. Purkinje fibers

a . 1 , 3 , 4 , 2 d . 3 , 2 , 1 , 4 a. are specialized cardiac muscle cells.

b . 2 , 3 , 4 , 1 e . 3 , 4 , 2 , 1 b. conduct impulses much more slowly than
c. 2,4,3,1 ordinary cardiac muscle.
6. Which of these does not correctly describe the skeleton c. conduct action potentials through the atria.
of the heart? d. connect between the SA node and the AV node.
e. ensure that ventricular contraction starts at the
a. electrically insulates the atria from the ventricles base of the heart.
b. provides a rigid source of attachment for the cardiac 14. T waves on an ECG represent
c. reinforces or supports the valve openings a. depolarization of the ventricles.
d. is composed mainly of cartilage b. repolarization of the ventricles.
7. The bulk of the heart wall is c. depolarization of the atria.
d. repolarization of the atria.
a. epicardium. d. endocardium. 15. Which of these conditions observed in an
b. pericardium. e. exocardium. electrocardiogram suggests that the AV node is not
c. myocardium. conducting action potentials?
8. Muscular ridges on the interior surface of the auricles
are called a. a complete lack of the P wave
b. a complete lack of the QRS complex
a. trabeculae carneae. d. c. more QRS complexes than P waves
endocardium. d. a prolonged PR interval
b. crista term inalis. e. papillary muscles. e. P waves and QRS complexes that are not
c. musculi pectinati. synchronized
9. Cardiac muscle has 16. The greatest amount of ventricular filling occurs
a. sarcomeres. d. many
mitochondria. a. the first one-third of diastole.
b. the middle one-third of diastole.
c. the last one-third of diastole. a.
increased stroke volume. c. decreased
d. ventricular systole. heart rate.
17. While the semilunar valves are open during a normal b. increased cardiac output. d. both a and b.
cardiac cycle, the pressure in the left ventricle is 26. Parasympathetic nerve fibers are found in the__

a. greater than the pressure in the aorta. nerves and release_________at the heart.
b. less than the pressure in the aorta.
c. the same as the pressure in the left atrium. a. cardiac, acetylcholine c. vagus, acetylcholine
d. less than the pressure in the left atrium. b. cardiac, norepinephrine d. vagus,
18. The pressure within the left ventricle fluctuates norepinephrine
between 27. Increased parasympathetic stimulation of the heart

a. 120 and 80 mm Hg. c. 80 and 0 mm Hg. a. increases the force of ventricular contraction.
b. 120 and 0 mm Hg. d. 20 and 0 mm Hg. b. increases the rate of depolarization in the SA node.
19. Blood flows neither into nor out of the ventricles c. decreases the heart rate.
during d. increases cardiac output.
29. A decrease in blood pH and an increase in blood
a. the period of isovolumic contraction. carbon dioxide levels result in
b. the period of isovolumic relaxation.
c. diastole. a. increased heart rate.
d. systole. b. increased stroke volume.
e. both a and b. c. increased sympathetic stimulation of the heart.
d. increased cardiac output.
20. Stroke volume is the
e. all of the above.
a. amount of blood pumped by the heart per minute. 16. The cells of the conducting system differ from
b. difference between end-diastolic and end-systolic the contractile cells of the heart in that
c. difference between the amount of blood pumped (a) conducting cells are larger and contain more
at rest and that pumped at maximum output. myofibrils
d. amount of blood pumped from the atria into the (b) contractile cells exhibit prepotentials
ventricles. (c) contractile cells do not exhibit automaticity
(d) both a and b are correct
21. Cardiac output is defined as
17. Tetanic muscle contractions cannot occur in a
a. blood pressure times peripheral resistance. normal cardiac muscle cell because
b. peripheral resistance times heart rate.
c. heart rate times stroke volume. (a) cardiac muscle tissue contracts on its own
d. stroke volume times blood pressure. (b) there is no neural or hormonal stimulation
e. blood pressure minus peripheral resistance. (c) the refractory period lasts until the muscle cell
22. Pressure in the aorta is at its lowest relaxes
(d) the refractory period ends before the muscle
a. at the time of the first heart sound. cell reaches peak tension
b. at the time of the second heart sound. 18. The amount of blood that is forced out of the heart
c. just before the AV valves open. depends on
d. just before the semilunar valves open.
(a) the degree of stretching at the end of
23. Just after the dicrotic notch on the aortic pressure ventricular diastole
curve, (b) the contractility of the ventricle
a. the pressure in the aorta is greater than the (c) the amount of pressure required to eject blood
pressure in the left ventricle. (d) a, b, and c are correct
b. the pressure in the left ventricle is greater than the 19. The cardiac output cannot increase indefinitely
pressure in the aorta. because
c. the pressure in the left atrium is greater than the
pressure in the left ventricle. (a) the available filling time becomes shorter as
d. the pressure in the left atrium is greater than the the heart rate increases
pressure in the aorta. (b) the cardiovascular centers adjust the heart rate
e. blood pressure in the aorta is 0 mm Hg. (c) the rate of spontaneous depolarization
24. The "lubb" sound (first heart sound) of the heart is
(d) the ion concentrations of pacemaker cell
caused by the
membranes decrease
a. closing of the AV valves. 1. The great cardiac vein drains blood from the heart muscle
b. closing of the semilunar valves. to the
c. blood rushing out of the ventricles. left ventricle
d. filling of the ventricles. right ventricle
e. ventricular contraction.
right atrium
25. Increased venous return results in
left atrium
2. The autonomic centers for cardiac function are located in 5. structure that permits blood flow from the right atrium to
the the left atrium while the lungs are developing before birth is
myocardial tissue of the heart the
cardiac centers of the medulla oblongata (a) foramen ovale (b) interatrial septum
cerebral cortex (c) coronary sinus (d) fossa ovalis
a, b, and c are correct 6. Blood leaves the right ventricle by passing through the
3. The serous membrane covering the inner surface of the (a) aortic valve (b) pulmonary valve
heart is the (c) mitral valve (d) tricuspid valve
(a) parietal pericardium (b) endocardium 7. The P wave of the ECG appears as the
( c ) m yo c a r d i u m (d) visceral pericardium (a) ventricles depolarize (b) atria depolarize
4. The simple squamous epithelium covering the valves of (c) ventricles repolarize (d) atria repolarize
the heart constitutes the 8. During diastole, a chamber of the heart
(a) epicardium (b) endocardium a) relaxes and fills with blood
b) contracts and pushes blood into an adjacent chamber
(c) myocardium (d) fibrous skeleton
c) experiences a sharp increase in pressure
d) reaches a pressure of approximately 120 mm Hg
1. Explain why the walls of the ventricles are thicker than the walls of the atria.
2. In most tissues, peak blood flow occurs during systole and decreases during diastole. In heart tissue, however,
the opposite is true, and peak blood flow occurs during diastole. Explain why this difference occurs.
3. A patient has tachycardia. Would you recommend a drug that prolongs or shortens the plateau of cardiac
muscle cell action potentials?
4. Endurance-trained athletes often have a decreased heart rate, compared with that of a nonathlete when both
are resting. Explain why an endurance-trained athlete'g heart rate decreases rather than increases.
5. A doctor lets you listen to a patient's heart with a stethoscope at the same time that you feel the patient's
pulse. Once in a while, you hear two heartbeats very close together, but you feel only one pulse beat. Later,
the doctor tells you that the patient has an ectopic focus in the right atrium. Explain why you hear two
heartbeats very close together. The doctor also tells you that the patient exhibits a pulse deficit (i.e., the
number of pulse beats felt is fewer than the number of heartbeats heard). Explain why a pulse deficit occurs.
6. Heart rate and cardiac output were measured in a group of nonathletic students. After 2 months of aerobic
exercise training, their measurements were repeated. It was found that heart rate had decreased, but cardiac
output remained the same for many activities. Explain these findings.
7. Explain why it is sufficient to replace the ventricles, but not the atria, in artificial heart transplantation.

8. During an experiment in a physiology laboratory, a student named Cee Saw was placed on a table that could
be tilted. The instructor asked the students to predict what would happen to Cee Saw's heart rate if the table
were tilted so that her head was lower than her feet. Some students predicted an increase in heart rate, and
others claimed it would decrease. Can you explain why both predictions might be true?

9. After Cee Saw, the student in question 8 is tilted so that her head is lower than her feet for a few minutes.
Predict how her blood pressure will change in response to raising her head above her feet.
10. A friend tells you that her son had an ECG and it revealed that he has a slight heart murmur. Should you be
convinced that he has a heart murmur? Explain.
11. Predict the effect of an incompetent aortic semilunar valve on stroke volume, on the volume of blood in the left
ventricle at the end of diastole, and on heart sounds.
12. An experiment on a dog was performed in which the mean arterial blood pressure was monitored before and
after the common carotid arteries were partially clamped (at time A). The results are graphed below:
13. During hemorrhagic shock (caused by loss of blood), blood pressure may fall dramatically, although the heart
rate is elevated. Explain why blood pressure falls despite the increase in heart rate.
LEVEL 1 Reviewing Facts and Terms

10. What role do the chordae tendineae and papillary muscles play in the normal function of the AV valves?

11. Describe the three distinct layers that make up the heart wall.

12. What are the principal valves in the heart, and what is the function of each?
13. Trace the normal pathway of an electrical impulse through the conducting system of the heart.

14. What is the cardiac cycle? What phases and events are necessary to complete the cardiac cycle?

15...What three factors regulate stroke volume to ensure that the left and right ventricles pump equal volumes
of blood?

LEVEL 3 Critical Thinking and Clinical Applications

27. Most of the ATP produced in cardiac muscle is derived from the metabolism of fatty acids. During times of
exertion, cardiac muscle cells can use lactic acid as an energy source. Why would this adaptation be
advantageous to cardiac function?

28. A patient's ECG recording shows a consistent pattern of two P waves followed by a normal QRS complex
and T wave. What is the cause of this abnormal wave pattern?

30. Karen is taking the medication verapamil, a drug that blocks the calcium channels in cardiac muscle cells.
What effect should this medication have on Karen's stroke volume?

31. After a myocardial infarction, the cells surrounding the damaged tissue frequently become hyperexcitable
and act as ectopic pacemakers. This condition can lead to abnormal ventricular rhythms, with fatal
consequences. What would cause the excitability of the uninjured cells?
20. Describe the function of the SA node in the cardiac cycle. How does this differ from the function of the AV

21. What are the source and significance of heart sounds?

23. What factors influence cardiac output?

25. What effect does sympathetic stimulation have on the heart? What effect does parasympathetic stimulation
have on the heart?

Heart review
The epicardium is?
If the SA node is nonfunctional, which of the following is most likely to occur?
Which of the following layers forms the bulk of the heart wall?
The P wave of an ECG indicates
Contraction of the ventricles is referred to as ventricular
The procedure whereby a small balloon is placed into a partially occluded coronary artery and then inflated to increase
blood flow through the artery is called a(n)
The cardioregulatory center of the brain is located in the
The long refractory period observed in cardiac muscle
Ventricular contraction begins at the
Blood vessels enter and exit from the of the heart.
These vessels transport blood to the right and left lungs.
Which of the following sequences is correct?
In a normal electrocardiogram, the
Coronary artery disease can diminish myocardial blood flow resulting in the death of myocardial cells. This condition is
known as a myocardial
Which of the following will depolarize immediately after the AV node depolarizes?
The first and second heart sounds are most directly related to
As soon as left ventricular pressure exceeds the pressure in the aorta, the
Contraction of the papillary muscles would
Action potentials pass from one myocardial cell to another through areas of low electrical resistance called
Blood in the pulmonary veins returns to the
Angina pectoris is chest pain caused by reduced
Which of the following might increase the risk for cardiovascular disease?
Blood in the superior vena cava will enter the
When left atrial pressure exceeds left ventricular pressure,
The AV valve that is located on the same side of the heart as the origin of the aorta is the
The action potentials are slowed at the AV node to allow the
The right side of the heart acts as a pump for the
Turbulence of blood flow through the aortic valve would give rise to
This blood vessel carries blood from the left ventricle.
Pressure in the right ventricle must exceed pressure in the before the right ventricle can eject blood.
The "pacemaker" of the heart is the
During the ejection phase of the cardiac cycle, blood exits the left ventricle through the When ventricular pressure exceeds
atrial pressure, the
An incompetent mitral valve may cause blood to back up into the
- The period of time in which the myocardium is insensitive to further stimulation is called the
The cardiac electrical impulse normally begins spontaneously in the SA node because
Which of the following areas of the conduction system would produce spontaneous action potentials most frequently if the
SA node were not functioning?
An incompetent pulmonary semilunar valve could result in less blood reaching the
The valve located between the right ventricle and the pulmonary trunk is the
Occlusion of which of the following would primarily damage the left ventricle?
From the right ventricle, blood flows directly into the
which type of damage resulting from a myocardial infarction is most likely to cause the greatest increase in the Q-T interval?
The pericardial sac is lined with
The function of the pericardial fluid is to