cardiovascular system

R&C
1. E
2. C
3. A
4. B
5. C
6. E
7. A
8. C
9. D
10. A
11. B
12. A
13. A
14. E
15. B
16. C
17. D
18. A
19. A
20. D
21. C
22. C
23. C
24. C
25. C

1. Explain why the walls of the ventricles are thicker than the walls of the atria.

The walls of the ventricles are thicker than the walls of the atria because the ventricles must
produce a greater pressure to pump blood into the arteries. Only a small pressure is required to
pump blood from the atria into the ventricles during diastole. The wall of the left ventricle is
thicker than the wall of the right ventricle because the left ventricle produces a much
greater pressure to force blood through the aorta than the right ventricle produces to move
blood through the pulmonary trunk and pulmonary arteries.

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 this difference.

During systole, the cardiac muscle in the right and left ventricles contracts, which
compresses the coronary arteries. During diastole, the cardiac muscle of the ventricles relaxes,
and blood flow through the coronary arteries increases. The diastolic pressure is sufficient to
cause blood to flow through the coronary arteries during diastole.
 3. Explain why it is more efficient for contraction of the ventricles to begin at the apex of
the heart than at the base.

Contraction of the ventricles, beginning at the apex and moving toward the base of the heart,
forces blood out of the ventricles and toward their outflow vessels—the aorta and pulmonary
trunks. The aorta and pulmonary trunks are located at the base of the heart.

4. Predict the consequences for the heart’s pumping effectiveness if numerous ectopic foci
in the ventricles produce action potentials.

Ectopic foci cause various regions of the heart to contract at different times. Ectopic action
potentials in the ventricles cause the areas in which the action potentials develop to contract
independently of all other areas of the ventricles. As a result, the coordinated contraction of
ventricular cardiac muscle is interrupted, and pumping effectiveness is reduced. The normal
filling and emptying of the ventricles during the cardiac cycle is also interrupted.

5. A patient has tachycardia. Would you recommend a drug that prolongs or shortens the
plateau of cardiac muscle cell action potentials?
A drug that prolongs the plateau of cardiac muscle cell action potentials prolongs the time
each action potential exists and increases the refractory period. Therefore, the drug slows the
heart. A drug that shortens the plateau shortens the length of time each action potential exists and
shortens the refractory period. Therefore, the drug can allow the heart rate to increase further

6. Many endurance-trained athletes have a decreased resting heart rate, compared with
that of non-athletes. Explain why an endurance-trained athlete’s resting heart rate
decreases rather than increases.

Endurance-trained athletes have a decreased resting heart rate because their cardiac
muscle undergoes hypertrophy in response to exercise. The hypertrophied cardiac muscle
causes the stroke volume to increase substantially. The increased stroke volume is sufficient to
maintain an adequate cardiac output and blood pressure even though the heart rate is slower.

7. 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 (the number of pulse beats
felt is fewer than the number of heartbeats heard). Explain why a pulse deficit occurs.

The two heartbeats occurring closely together can be heard through the stethoscope
because the heart valves open and close normally during each of the heart- beats even if
they are close together. The second heartbeat, however, produces a greatly reduced stroke
volume because there is not enough time for the ventricles to fill with blood between the first and
second contractions. Thus, the preload is reduced. Because the preload is reduced, the second
heartbeat has a greatly reduced stroke volume, which fails to produce a normal pulse. The pulse
deficit results from the reduced stroke volume of the second of the two beats that are very close
together.

8. Explain why it is sufficient to replace the ventricles, but not the atria, in artificial heart
transplantation.

Atrial contractions complete ventricular filling, but they are not primarily responsible for
ventricular filling. Therefore, even if the atria are fibrillating, blood can still flow into the
ventricles, and ventricular contractions can occur. As long as the ventricles contract
rhythmically, the heart can pump an adequate amount of blood, even though the atria are not
effective pumps. However, if the ventricles fail to contract forcefully and rhythmically, they
cannot functionas pumps. Thus, the stroke volume will become too low to maintain adequate
blood flow to tissues. Therefore, atria transplants are not essential, but ventricle transplants are.

9. 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.

Venous return declines markedly in hemorrhagic shock because of the lossof blood volume.
With decreased venous return, stroke volume decreases (Starling law of the heart). The
decreased stroke volume results in a decreased cardiac output, which produces decreased blood
pressure. In response to the decreased blood pressure, the baroreceptor reflex causes an increase
in heart rate in an attempt to restore normal blood pressure. However, with inadequate venous
return, the increased heart rate is not able to restore normal blood pressure.

10. A friend tells you an ECG revealed that her son has a slight heart mur-mur. Should you
be convinced that he has a heart murmur? Explain.

An ECG measures the electrical activityof the heart and would not indicate a slight heart
murmur. Heart murmurs are detected by listening to the heart sounds. The boy may have a heart
murmur, but the mother does not understand the basis for making such a diagnosis.
R&C

1.) B 2. A 3. A 4. D 5. D
6. C 7. D 8. A 9. A 10. D
11. E 12. C 13. A 14. B 15. B
16. A 17. E 18.D 19. B 20. B
21. D 22. D 23. C 24. B 25. E

1. a. aorta, left coronary artery, circumflex artery, posterior interventricular artery or aorta, right
coronary artery, posterior interventricular artery

b. aorta, brachiocephalic artery, right common carotid artery, right internal carotid artery, or
aorta, left common carotid artery, left internal carotid artery

c. aorta, brachiocephalic artery, right subclavian artery, right vertebral artery, basilar artery, or
aorta, left subclavian artery, left vertebral artery, basilar artery

d. aorta, left or right common carotid artery, left or right external carotid artery

e. aorta, left subclavian artery, axillary artery, brachial artery, radial or ulnar artery, deep or
superficial palmar arch, digital artery (on the right: the brachiocephalic artery would be included)

f. aorta, common iliac artery, external iliac artery, femoral artery, popliteal artery, anterior tibial
artery

g. aorta, celiac artery, common hepatic artery h. aorta, superior mesenteric artery, intestinal
branches

i. aorta, left or right internal iliac artery

2.

a. great cardiac vein, coronary sinus, or anterior cardiac vein

b. transverse sinus, sigmoid sinus, internal jugular vein, brachiocephalic vein, superior vena cava
c. retromandibular vein, external jugular vein, subclavian vein, brachiocephalic vein, superior vena cava
d. deep: vein of hand, radial or ulnar vein, brachial vein, axillary vein, subclavian vein, brachiocephalic vein,
superior vena cava
e. superficial: vein of hand, radial or ulnar vein, cephalic or basilic vein, axillary vein, subclavian vein,
brachiocephalic vein, superior vena cava
f. deep: vein of foot, dorsalis veins of foot, anterior tibial vein, popliteal vein, femoral vein, external iliac vein,
common iliac vein, inferior vena cava superficial: vein of foot, great saphenous vein, external iliac vein, common
iliac vein, inferior vena cava; or vein of foot, small saphenous vein, popliteal vein, femoral vein, external iliac
vein, common iliac vein, inferior vena cava
g. f. gastric vein or gastroepiploic vein, hepatic portal vein, hepatic sinusoids, hepatic vein, inferior vena cava renal
vein, inferior vena cava
h. hemiazygous vein or accessory, hemiazygous vein, azygous vein, superior vena cava
3. A superficial vessel is easiest, such as the right cephalic or basilic vein. The catheter is passed through the cephalic (or
brachial) vein and the superior vena cava to the right atrium. Because the pulmonary veins are not readily accessible,
dye is not normally placed directly into them. Instead, the dye is placed in the right atrium using the procedure just
described. The dye passes from the right atrium into the right ventricle, the pulmonary arteries, the lungs, the
pulmonary veins, and the left atrium. If the catheter has to be placed into the left atrium, it can be inserted through an
artery, such as the femoral artery, and passed via the aorta to the left ventricle and then into the left atrium.

4. The resistance to blood flow is less in the venae cavae for two reasons: First, the diameter of one vena cava is greater
than the diameter of the aorta; second, an increased diameter of a blood vessel reduces resistance to flow (Poiseuille’s
law). In addition, there are two venae cavae, the superior vena cava and the inferior vena cava, but only one aorta. The
blood flow through the aorta and the venae cavae is about equal, but the velocity of blood flow is much higher in the
aorta than it is in the venae cavae.

5. According to Laplace’s law, as the diameter of a blood vessel increases, the force applied to the vessel wall increases,
even if the pressure remains constant. The increased connective tissue in the walls of the large blood vessels makes the
wall of those vessels stronger and more capable of resisting the force applied to the wall.

6. The nursing student’s diagnosis is incorrect. Blood pressure measurements are normally made in either the right or the
left arm, both of which are close to the level of the heart. Blood pressure taken in the leg is influenced by pressure
created by the pumping action of the heart, but the effect of gravity on the blood, as it flows into the leg, also influences
the blood pressure in a substantial way. In this case, gravity increases blood pressure from about 120 mm Hg systolic to
200 mm Hg.

7. Decreased liver function includes a decrease in the synthesis of plasma proteins. Consequently, the concentration of
plasma proteins decreases, and the colloid osmotic pressure of the blood decreases. Less water moves by osmosis into
the capillaries at the venous ends, and edemas result.

8. Chemoreceptors in the medulla oblongata detect carbon dioxide and the pH of the blood. The normal blood levels of
CO2 and pH stimulate these chemoreceptors, which in turn stimulate the vasomotor center. The vasomotor center keeps
blood vessels partially constricted under resting conditions. This basal level of activity is called vasomotor tone.
Blowing off CO2 reduces the blood levels of carbon dioxide and increases the pH of the body fluids. These changes
reduce vasomotor tone and result in vasodilation. If a person hyperventilates and blows off CO 2, the stimulus to the
vasomotor center decreases, which results in a decrease in vasomotor tone. The decrease in vasomotor tone results in a
decrease in systemic blood pressure. If the blood pressure decreases enough, the blood flow to the brain decreases and
can cause a sensation of dizziness or even loss of consciousness.

9. Epinephrine is secreted from the adrenal medulla in response to stressful stimuli. The responses it stimulates are
consistent with increased physical activity. Vasoconstriction of the blood vessels in the skin shunts blood away from
the skin to skeletal muscles. Vaso- dilation occurs in blood vessels of exercising skeletal muscles. Blood flow through
the exercising skeletal muscles increases. Because epinephrine causes vasodilation of the blood vessels of cardiac
muscle, blood flow through the cardiac muscle increases. This response is consistent with the increased work
performed by the heart under conditions of increased physical activity.
10. Answer b is correct. Shortly after Dick was wounded, the loss of blood caused his blood pressure to decrease. Rapidly,
the baroreceptor and adrenal medullary mechanisms were activated. His heart rate increased, and peripheral
vasoconstriction increased as a result. There is no indication that the CNS ischemic response was activated because it
requires a severe decrease in blood flow to the brain. The renin-angiotensin-aldosterone mechanism is activated as the
systemic blood pressure decreases. Angiotensin II is a potent vasoconstrictor that helps the baroreceptor mechanism
increase peripheral resistance. The increase in aldosterone secretion increases Na + and, consequently, water
reabsorption in the kidneys, but it requires approximately 24 hours to be active. The fluid shift mechanism operates, but
it takes several hours to function. The ADH mechanism is activated in response to a substantial decrease in blood
pressure; it helps maintain blood volume by reducing the amount of urine produced

11. The answer is e. It is possible that Mr. Wilson had a stroke, which activated the CNS ischemic response. The fact that
he was unconscious is consistent with a stroke, and his rapid heart rate and high blood pressure are consistent with
activation of the CNS ischemic response. A heart attack would not necessarily cause Mr. Wilson to be unconscious and
would be associated with decreased blood pressure rather than increased blood pressure, especially if it caused
unconsciousness. Shock would also be associated with a decrease in blood pressure.