Chapter 18: The Cardiovascular System: The Heart

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Pearson Human Anatomy & Physiology, Marieb/Hoehn

Cardiac Output is

- the amount of blood pumped out of each ventricle in one minute.
- the number of impulses fired by the SA node in one minute.
- the amount of blood pumped out of the heart during every ventricular contraction.
- the number of times the heart beats in one minute.
- the amount of blood filling each ventricle at the end of diastole.

- the amount of blood pumped out of each ventricle in one minute.

Choose the correct sequence of current flow through the heart wall.

- AV node, SA node, Purkinje fibers, AV bundle of His, right and left bundle branches
- SA node, AV node, AV bundle of His, right and left bundle branches, Purkinje fibers
- SA node, Purkinje fibers, AV node, AV bundle of His, right and left bundle branches
- AV node, Purkinje fibers, AV node, AV bundle of His, right and left bundle branches
- Purkinje fibers, AV node, AV bundle of His, right and left bundle branches, SA node

- SA node, AV node, AV bundle of His, right and left bundle branches, Purkinje fibers

During pulmonary circulation blood leaves the

- right ventricle and goes directly to the aorta.
- right ventricle and moves to the lungs.
- right atrium and goes directly to the left ventricle.
- right atrium and goes directly to the lungs.
- left ventricle and moves to the lungs.

- right ventricle and moves to the lungs.

During systemic circulation, blood leaves the

- left ventricle and goes directly to the aorta.
- right ventricle and goes directly to the aorta.
- right ventricle and moves to the lungs.
- lungs and moves to the left atrium.
- right atrium and goes directly to the lungs.

- left ventricle and goes directly to the aorta.

During the spike of an action potential in a cardiac muscle cell

- there is a rapid influx of Na+ into the cell.
- Ca2+ moves out of the cell into the extracellular fluid.
- K+ channels open to let K+ move into the cell.
- both Na+ and Ca2+ move into the cell at the same time.
- Na+ moves out of the cell into the extracellular fluid.

- there is a rapid influx of Na+ into the cell.

Identify the correct sequence of blood flow through the chambers of the heart.

- Lungs, right ventricle, left ventricle, right atrium, left atrium
- Right ventricle, left ventricle, left atrium, lungs, right atrium
- Left atrium, left ventricle, right ventricle, right atrium, and lungs
- Right atrium, right ventricle, lungs, left atrium, left ventricle
- Left ventricle, left atrium, lungs, right ventricle, right atrium

- Right atrium, right ventricle, lungs, left atrium, left ventricle

The absolute refractory period refers to the time during which

- the muscle cell is ready to respond to a threshold stimulus.
- a skeletal muscle cannot respond to any stimulus and lasts about 250 ms.
- a cardiac muscle cannot respond to any stimulus and lasts only 1 to 2 milliseconds.
- the muscle cell is ready to respond to any stimulus.
- the muscle cell is NOT in a position to respond to a stimulus of any strength.

- the muscle cell is NOT in a position to respond to a stimulus of any strength.

The cardiac cycle includes all of the following events EXCEPT

- the movement of impulse from the SA node to all regions of the heart wall.
- the closing and opening of the heart valves during each heart beat.
- the number of times the heart beats in one minute.
- the changes in pressure gradients in all chambers of the heart.
- the changes in blood volume in all chambers of the heart.

- the number of times the heart beats in one minute.

The coronary arteries arise from the

- aorta.
- inferior vena cava.
- superior vena cava.
- right atrium.
- pulmonary trunk.

- aorta.

The endocardium is composed of

- simple cuboidal epithelium.
- simple squamous epithelium.
- cardiac muscle cells.
- simple columnar epithelium.
- stratified squamous epithelium.

- simple squamous epithelium.

The inferior vena cava brings blood from the lower regions of the body and empties into the

- left atrium.
- right atrium.
- Aorta.
- left ventricle.
- right ventricle.

- right atrium.

The inner lining of the fibrous pericardium is formed by the

- pericardial cavity.
- myocardium.
- diaphragm.
- endocardium.
- parietal layer of serous pericardium.
- epicardium.

- parietal layer of serous pericardium.

The interventricular septum forms a dividing wall between the

- left atrium and left ventricle.
- left atrium and right atrium.
- right ventricle and left atrium.
- right atrium and right ventricle.
- left and right ventricles.

- left and right ventricles.

The P-wave is a measure of

- ventricular depolarization.
- ventricular hyperpolarization.
- atrial repolarization.
- ventricular contraction.
- atrial depolarization.

- atrial depolarization.

The pacemaker of the heart is the

- Purkinje fibers.
- the bundle branches.
- Bundle of His.
- AV node.
- SA node.

- SA node.

The tricuspid valve is located between the

- right and left atria.
- right and left ventricles.
- right atrium and right ventricle.
- left atrium and left ventricle.
- right ventricle and the aorta.

- right atrium and right ventricle.

When the mitral valve closes, it prevents the backflow of blood from the

- left atrium into the left ventricle.
- left ventricle into the left atrium.
- right atrium into the right ventricle.
- left ventricle into the aorta.
- right ventricle into the pulmonary trunk.

- left ventricle into the left atrium.

Which is the correct sequence of layers in the heart wall, starting with the outer layer?

- Parietal pericardium, myocardium, endocardium
- Endocardium, epicardium, myocardium
- Myocardium, pericardium, endocardium
- Endocardium, smooth muscle, epicardium
- Epicardium, myocardium, endocardium

- Epicardium, myocardium, endocardium

Which of the following statements is NOT true about the shape, position and location of the heart?

- The heart is located between the two lungs within the mediastinum.
- Approximately two-thirds of the heart is found to the left of the midline.
- The heart is enclosed in a double-layered sac called the pleural membrane.
- The heart is shaped like a cone with the base facing the right shoulder.

- The heart is enclosed in a double-layered sac called the pleural membrane.

Which statement about the extrinsic innervation of the heart is NOT true?

- Sympathetic nerve stimulation of the heart increases the rate and force of the heart.
- The cardiac centers are located in the medulla oblongata of the brain stem.
- Parasympathetic nerve stimulation reduces the heartbeat.
- Sympathetic impulses travel through the vagus nerve.
- The vagus nerve is the tenth cranial nerve.

- Sympathetic impulses travel through the vagus nerve.

The vessels that carry oxygen to the myocardial cells are called

- aortic arteries.
- pulmonary arteries.
- pulmonary veins.
- coronary veins.
- coronary arteries.

- coronary arteries.

The cells of the myocardium behave as a single coordinated unit called a

- pacemaker.
- functional syncytium.
- contractile unit.
- sarcomere.
- cardiac cycle.

- functional syncytium.

The ability of some cardiac muscle cells to initiate their own depolarization and cause depolarization of the rest of the heart is called

- absolute refractory period.
- fibrillation.
- a functional syncytium.
- an action potential.
- automaticity.

- automaticity.

Guided by powerful signaling molecules, the human heart develops from

- ectoderm and endoderm.
- ectoderm.
- blood cells.
- mesoderm.
- endoderm.

- mesoderm.

Which of the following is an age-related change of the heart that affects function?

- Stretching of myocardium due to overuse
- Thinning of the valve flaps
- Loss of elasticity of cardiac muscle
- Increase in cardiac reserve
- Fibrosis of cardiac muscle

- Fibrosis of cardiac muscle

Which of the following vessels is most likely to supply the anterior left ventricular myocardium?

- Marginal artery
- Posterior interventricular artery
- Circumflex artery
- Left anterior descending artery
- Right coronary artery

- Left anterior descending artery

Which of the following drains blood DIRECTLY from the myocardium?

- Right coronary artery
- Middle cardiac vein
- SVC
- IVC
- Coronary sinus

- Middle cardiac vein

Which of the following is the cause of the "plateau" in cardiac muscle action potentials?

- Sodium ion influx
- Calcium ion influx
- Calcium ion outflux
- Chloride ion outflux
- Potassium ion influx

- Calcium ion influx

Which of the following structures lies on the outside surface of the heart and is an integral part of the cardiac wall?

- the epicardium
- The parietal layer of serous pericardium
- the fibrous pericardium
- the pericardial sac

- the epicardium

Which of the following structures is continuous with the inner lining of blood vessels?

- the pectinate muscles
- the pericardial sac
- the epicardium
- the endocardium

- the endocardium

The fossa ovalis is located in the

- interventricular septum.
- atrium.
- ventricle.
- interatrial septum.

- interatrial septum.

The trabeculae carneae are located in the

- endocardium.
- atrium.
- epicardium.
- ventricles.

- ventricles.

What part of the heart is considered the systemic circuit pump?

- the right atrium
- the right ventricle
- the left atrium
- the left ventricle

- the left ventricle

If the circumflex artery of the heart was blocked, the myocardium in the _________________ would be ischemic.

- the left atrium and the posterior wall of the left ventricle
- the apex
- the lateral aspects of the heart
- interventricular septum and the anterior wall of the ventricles

- the left atrium and the posterior wall of the left ventricle

Attached to the AV valve flaps are the

- trabeculae carneae.
- papillary muscles.
- chordae tendineae.
- pectinate muscles.

- chordae tendineae.

Blood spurts back into the _____________ when the right atrium contracts.

- aorta
- pulmonary trunk
- venae cavae
- pulmonary veins

- venae cavae

Which of the following valves is most often faulty in the heart?

- the aortic semilunar valve
- the tricuspid valve
- the pulmonary semilunar valve
- the mitral or bicuspid valve

- the mitral or bicuspid valve

The myocardium functions as a functional syncytium due to

- the presence of striations in the myocardium.
- branching of myocardial cells.
- the presence of gap junctions.
- the presence of desmosomes.

- the presence of gap junctions.

Which of the following factors gives the myocardium its high resistance to fatigue?

- the presence of intercalated discs
- a very large number of mitochondrion in the cytoplasm
- gap junctions
- the coronary circulation

- a very large number of mitochondrion in the cytoplasm

All but which of the following statements about autorhythmic myocardial cells are correct?

- They do not maintain a stable resting membrane potential.
- They have special ion channels in their sarcolemma.
- They are the first myocardial cells to contract.
- They make up the intrinsic cardiac conduction system.

- They are the first myocardial cells to contract.

Autorhythmic cardiac cells are found in all the following location except the

- SA node.
- interatrial septum.
- Purkinje cells.
- AV node.

- interatrial septum.

Which of the following is clinically significant as an ectopic pacemaker of the heart?

- drinking several cups of caffeinated coffee
- extrasystole contractions associated with angina pectoris
- excessive smoking
- anxiety

- extrasystole contractions associated with angina pectoris

The _________ nerve carries parasympathetic fibers to the SA node.

- hypoglossal
- facial
- accessory
- vagus

- vagus

The cardioacceleratory center fibers are part of the

- cranial peripheral nervous system.
- somatic peripheral nervous system.
- sympathetic nervous system.
- parasympathetic nervous system.

- sympathetic nervous system.

An enlarged R wave on an ECG would indicate

- a myocardial infarction.
- an enlarged ventricle.
- cardiac ischemia.
- repolarization abnormalities.

- an enlarged ventricle.

The pacemaker potential produced in autorhythmic cells is due to the presence of

- a continuously depolarizing membrane that slowly reaches threshold.
- intercalated discs at cell junctions.
- desmosomes.
- many large mitochondria in the cytoplasm.

- a continuously depolarizing membrane that slowly reaches threshold.

Which of the following ions has the greatest affect on the autorhythmic capabilities of the myocardium?

- Ca2+
- K+
- Na+
- Cl-

- Ca2+

Which of the following events would cause the gap junctions between cardiac cells to close?

- ischemia
- atrial fibrillation
- premature ventricular contractions (PVCs)
- arrhythmia

- ischemia

A doctor puts his stethoscope on a patient's chest over the location of the heart and hears a swishing sound. Which of the following conditions is the best diagnosis for the patient's condition?

- angina pectoris
- myocardial infarction
- incompetent cardiac valve
- cardiac tamponade

- incompetent cardiac valve

The end diastolic volume is the

- volume of blood in the atria at the end of atrial relaxation.
- volume of blood in the ventricle at the end of ventricular relaxation.
- volume of blood in the ventricle at the end of ventricular contraction.
- volume of blood in the atria at the end of atrial contraction.

- volume of blood in the ventricle at the end of ventricular relaxation.

The phase in the cardiac cycle in which the ventricles are completely closed and the volume of blood in them is constant is referred to as the

- quiescent period.
- isovolumetric relaxation phase.
- ventricular ejection phase.
- isovolumetric contraction phase.

- isovolumetric contraction phase.

The dicrotic notch observed on tracing of blood pressure recording is due to

- mitral valve closure.
- aortic semilunar valve closure.
- pulmonary semilunar valve closure.
- tricuspid valve closure.

- aortic semilunar valve closure.

Positive inotropic agents

- decrease the contractility of the heart.
- cause hemolysis of blood clots.
- prevent blood clotting.
- increase the contractility of the heart.

- increase the contractility of the heart.

Which of the following is not a role of the pericardium?


- It facilitates heart contraction.
- It prevents overfilling of the heart with blood.
- It anchors the heart to surrounding structures.
- It protects the heart.

- It facilitates heart contraction.

The lining of the heart chambers is called the:


- myocardium.
- epicardium.
- pericardium.
- endocardium.

- endocardium.

The superior chambers of the heart are called the:


- ventricles.
- superior sulci.
- atria.
- coronary chambers.

- atria.

Freshly oxygenated blood is delivered to the _____ and then it passes into the _______, to be pumped to the entire body.


- left ventricle; left atrium
- right ventricle; right atrium
- left atrium; left ventricle
- right atrium; right ventricle

- left atrium; left ventricle

Into which chamber of the heart do the pulmonary veins deliver blood?


- Left ventricle
- Left atrium
- Right atrium
- Right ventricle

- Left atrium

The most muscular chamber of the heart is the ________.


- right atrium
- left atrium
- right ventricle
- left ventricle

- left ventricle

Which of the following is a difference between cardiac muscle and skeletal muscle?


- Unlike skeletal muscle cells, cardiac muscle cells do not rely on an influx of calcium ions for depolarization.
- Unlike skeletal muscle, cardiac muscle does not use a sliding filament mechanism for contraction.
- Unlike skeletal muscle, cardiac muscle is not striated.
- Unlike skeletal muscle cells, cardiac muscle cells can be autorhythmic.

- Unlike skeletal muscle cells, cardiac muscle cells can be autorhythmic.

The role of the atrioventricular node (AV node) is to:


- initiate a sinus rhythm.
- initiate ventricular depolarization.
- slow down impulses so that the atria can contract to fill the adjacent ventricles with blood.
- conduct impulses to the sinoatrial node (SA node).

- slow down impulses so that the atria can contract to fill the adjacent ventricles with blood.

Which is correctly paired?


- Arrhythmia: AV node failure
- Fibrillation: premature contraction
- Heart block: uncoordinated atrial and ventricular contraction
- Ectopic focus: an abnormal pacemaker

- Ectopic focus: an abnormal pacemaker

The P wave of an electrocardiogram represents:


- ventricular depolarization.
- atrial depolarization.
- atrial repolarization.
- ventricular repolarization.

- atrial depolarization.

The second heart sound (the 'dup' of 'lub-dup') is caused by:


- opening of the atrioventricular valves.
- closure of the atrioventricular valves.
- opening of the semilunar valves.
- closure of the semilunar valves.

- closure of the semilunar valves.

Which of the following would lead to a decrease in heart rate?


- Exercise
- Norepinephrine
- Sharply decreased blood volume
- Parasympathetic stimulation

- Parasympathetic stimulation

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