Cardiovascular Physiology ( Lecturio)

Membrane Potential Phase 4 Phase 0 Phase 3

• Membrane potential is determined by: HCN Primary

o Ion concentration gradients Transient or T- Active Deactivating
(maintained by ion transport system) type Ca2+
o Ion conductance (g) channels 9CAV
o Electrogenic pumps 3.1/3.2)
• Time dependent changes in ion conductances L-type Ca2+ Primary Deactivating
result in depolarization and repolarization. channels (CAV
1.2)
Cardiac Myocyte Interstitial space Delayed K+ Active Primary
K+ 150 mM K+ 4 mM channels (e.g.
Na+ 20 mM Na+ 145 mM HERG/miRP1,
KvLQT1/ minK
Ca+ 0.0001 Ca+ 2.5 mM
mM
-90 mV Location of Pacemaker Cells

Opening and closing of ion channels alters the membrane

potential

1. Resting Potential
• K+ channels open
• Na+ and Ca2+ closed
• HYPERPOLARIZED CELL
2. Action Potential
• Na+ and Ca2+ channels open
• K+ closed
• DEPOLARIZED CELLS
1. Sinoatrial (SA) node
Pacemaker Action Potential 2. Atrioventricular (AV) node
3. Purkinje fibers
Phase 4 (Pacemaker Potential) 4. Abnormal myocytes
• Funny currents ( If: via HCN+ channels) are the Para and Sympathetic Nerves Primarily Control the SA
primary mechanism behind spontaneous Node rate
depolarization.
• Ca2+ (permeability of increase gCa2+) and K (low • Parasympathetic (vagal) activation decreases nodal
gK+) currents also contribute. rate (negative chronotropy)
o Muscarinic (M2) receptors
Phase 0 (Depolarization) • Sympathetic activation increases nodal rate (positive
• Primary Ca2+ dependent (Increase gCa++) chronotropy)
o Β-adrenergic receptors
Phase 3 (Repolarization)
Heart Rate Ranges
• Primary K+ dependent (increase gK+)
Resting

• Tachycardia (>100/min)
• Bradycardia (>60/min)

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 Maximal Slowest Conduction

• Decrease with age - AV node

• Estimated: 220.min- age of patient +/- 15/min
Factors that modulate conduction velocity
• Measured during stress test
1. Sympathetic activation (via β1-adrenergic receptors)
Non-pacemaker Action Potential
increases conduction velocity via positive
Phase 4 dromotropy)
2. Parasympathetic activation (via M2 receptors)
• Resting Potential decreases conduction velocity especially at the AV
node (negative dromotropy)
Phase 0
Positive Sites of Conduction Blocks
• gNa: gCa2+, hK+
AV blocks
Phase 1-3 (Repolarization)
- AV Node
• Phase 1: gK+ and gNa+
- Bundle of His
• Phase 2: plateau phase: gCa+
• Phase 3: gK+ Bundle Branch Blocks

Cardiac Channels Accounting for Myocyte Currents - Left bundle branch

- Right bundle branch
Phas Phase Phase 1 Phase Phase 3
e4 0 2 AV Block
Voltage- Primary Deactivating
gated 1st degree AV Block
Na+
- Delayed conduction through AV Node
channels
(NAV 1.5) - Still has sinus rhythm
Fast K+ Primary
2nd degree AV block
channels
(Kv 4.3) - Some atrial action potentials fail to be conducted into
L-type Active Primary Deactivatin ventricles
Ca2+ g - There may be 2 or 3 atrial depolarizations/ ventricular
channels depolarization.
(CAV 1.2) - Ventricular bradycardia
Delated Primary
K+ 3rd degree AV block
channels
(e.g. - Complete dissociation between atrial and ventricular
HERG/ depolarizations and contractions
miRP1, - Ventricular bradycardia
KvLQT1/
Abnormal Conduction Caused by Ectopic Foci
mink)
• Ectopic foci generate action potential that do not
follow normal conduction pathways.
Myocyte Conduction Pathways
o Ventricles take longer to depolarize
Fastest Conduction • Ventricular ectopic foci cause a wide QRS complex/
o Premature ventricular complex/ contraction
- Purkinje Fibers (PVC)
- Bundle Branches
What does the ECG measure?
Moderate Conduction
- Electrodes are placed on the skin in standardized
- Atrial muscle location to take multiple-angled electrical “pictures”
- Ventricular muscle of the heart.
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 QRS Complex

- QRS shape depends on

o Sequence (1-4) and timing of ventricular
depolarization
▪ Abnormal conduction increases
QRS duration.
o Ventricular mass
o Relative position of recording electrode
When normal mean electrical axis
o Mean electrical axis (MEA) is the next vector
depolarization. AVR Negative
AVL Biphasic
ECG Tracing- Definition
AVF Positive
P wave Atrial depolarization
PR Interval Atrial depolarization
- Limb leads are on a single frontal plane.
AV nodal delay
- The arrowhead represents the positive pole.
Bundle of His and branches
- A wave of depolarization parallel to a lead axis and in
QRS Ventricular Depolarization
QT Interval Ventricular Action Potential Duration the direction of the arrow will give maximal positive
ST Segment Depolarized state of ventricles deflection.
(isoelectric) - A wave perpendicular to a lead axis will generate no
T wave Ventricular Repolarization deflection.

Determining the axis on ECG

ECG Tracing- Normal Intervals
1. Determine the lead that is equally biphasic
P Wave 0.08- 0.10 s 2. The mean axis is ~90 from this lead in the direction of
PR Interval 0.12-0.20 s the lead with the greatest net QRS amplitude.
QRS 0.06-0.10 s • If the Lead I is biphasic and AVF is most
QT Interval ≥ 0.44 s positive, then the mean electrical axis is ~90.
• If Lead AVL, is biphasic and II is most positive,
then the mean electrical axis is ~60.
Bipolar Standard Limb Lead I
Leads Lead II
Lead II
Unipolar Augmented Leads AVL
AVR
AVF
Unipolar Chest Leads V1-V6

Common ECG Abnormalities

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 - During the contraction of the left ventricles there is a
transient pressure reverberation into the atria
LV Systole
(creating the c-wave)
2) Isovolumetric Contraction - AV valves suddenly open when ventricular pressure
falls below atrial pressure (creating the v-wave)
- Prior to contraction= left ventricular (LV) end
diastolic volume (LVEDV)
- Electrical LV depolarization (QRS Complex)
- Pressure LVP increases
- MITRAL VALVE CLOSE
- LV volume is maintained
3. and 4 Ejection
- AORTIC VALVES OPEN
- Pressure LVP increases and then decreases
- Electrical: LV repolarization (T wave) - EF is the fraction of blood ejected from the ventricle
- Volume: after ejection= left ventricular end systolic relative to the end diastolic volume (EDV)
volume (LVESV) - In a normal heart, the EF is about 55-60%.
o LV volume decreases rapidly then at a - In a weakened, failing heart, the Ef is < 50% and may
reduced rate. be as low as 15%
5. Isovolumetric relaxation
- AORTIC VALVED DISCLOSURE
- Pressure: LVP decreases
- Volume: LV Volume is maintained Cardiac Cycle
- Electrical: Isoelectric
6. & 7 Filling
- MITRAL VALVE OPENS
- Volume: LV Volume increases rapidly and then at a
reduced rate
- Pressure: LVP decreases and then maintained
- Electrical: Isoelectrical

LV Diastole

1. Atrial contraction and Ventricular filling

- Pressure: LVP maintained with slight increase with
atrial contraction
- Volume: LV volume increases Left ventricular pressure-volume relations
- Electrical: Atrial depolarization (P-wave)
- Valve: No change from the other components of
diastole
1. Atrial systole
- Electrical: Atrial depolarization (P wave)
- Mechanical: Transient increase in LAP (a wave) to
force additional blood into ventricles.
o Accounts for ~10% of ventricular filling at
resting conditions
o Accounts for up to 40% of ventricular filling
during exercise conditions. • Taking time out of the equation in the
2. & 7 Atrial filling cardiac cycle- the construction of
- Blood continuously enters atria except when pressure-volume curves.
transiently impeded during atrial systole (creating
the a-wave)

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 Average, normal intracardiac and vascular pressure Flow, Pressure and Resistance Theory
(mmHg)
SV = EDV – ESV

SV= Stroke Volume

EDV= End Diastolic Volume (PRELOAD)

ESV= End Systolic Volume (AFTERLOAD)

Preload

- Preload is related to ventricular filling just prior

to contraction left-ventricular end-diastole
Heart Sounds volume (LVEDV)
- At the cellular level, preload is related to the
S1: Mitral and Tricuspid Closure
cardiac fiber length that occurs at LVEDV.
- Follows QRS and occurs at onset of (2)
Effects of increased inotropy on ventricular function
isovolumetric contraction.
- Mitral precedes tricuspid.

S2: Aortic and Pulmonic Closure

- Follows T wave and occurs at onset of

isovolumetric relaxation.
- Aortic precedes pulmonic producing a split
sound.

S3: Early Diastolic Filling Factors determining preload

- Caused by rapid expansion of ventricle during 1. Venous blood volume
early rapid filling phase. a. Total blood volume
- Normal in children. b. Venous return
- Pathologic in adults associated with dilated 2. Venous compliance
ventricles. 3. Venous pressure
S4: Associated with Atrial Contraction 4. Ventricular compliance
5. Atrial inotropy
- Caused by atrial contraction forcing blood into 6. Afterload
stiff ventricle. 7. Heart rate
- Heard in hypertrophied hearts and hearts of 8. Ventricular inotropy
older people.
Frank-starling Law
What determines the Cardiac Output and How it is
regulated? - Increased ventricular filling increase stroke
volume.
- The relationship between SV and preload
CO = SV x HR (measured as LVEDP or LVEDV) is called
o Frank starling relation
CO= Cardiac Output o Frank-starling mechanism
o Starling’s law of the heart
SV= Stroke Volume
o Length dependent activation
HR= Heart Rate

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 o Lowering arterial (aortic) pressure
enhances ventricular stroke volume)
2. Afterload and velocity of muscle fiber
shortening are inversely related reducing
afterload increases
o Muscle shortening velocity and ejection
velocity
o Muscle shortening and therefore
decreases the end systolic volume
Effects of preload on PV loops o Stroke volume

What is Inotropy?

- Ability of the heart to regulate the force of

contraction independent of changes in preload
(length-independent activation)
- At a given preload, increased inotropy increases
SV by increasing the force of contraction.

Regulation of Inotropy
Ventricular afterload
1. Increased sympathetic activation
- Ventricular afterload is related to the pressure 2. Increased circulating catecholamines
the ventricle must generate in order to eject (Norepinephrine (NE), Epinephrine (Epi) and
blood into the aorta. Dopamine.
- Theoretically, afterload is the ventricular wall 3. Increased heart rate (Bowditch effect)
stress at this point. 4. Increased afterload (Anrep effect)
Effects of afterload on ventricular function Effects of increased inotropy on ventricular function

1. Increasing afterload ( A → B)
a. Decreased SV
1. Increasing inotropy ( A → C)
b. Increased preload (compensatory
a. Increased SV
response)
b. Increases rate of ventricular pressure
2. Decreasing afterload ( A → C)
development o (dP/dt) and ejection
a. Increased SV
fraction (EF)
b. Decreases preload (compensatory
2. Decreasing inotropy (A → B)
response)
a. Decreases SV
Other effects of Afterload b. Decreases dP/dt and EF
c. Increases preload (compensatory
1. Atrial (Aortic) pressure impedes Ventricular
response)
ejection

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 d. Decreased inotropy (A→ B) has opposite
effects

Combined increase in Inotropy and Preload

1. Peripheral veins constrict during SNS activation,

and their contents are forced forward to the
heart. EDV increases (A to B).
2. SNS stimulation of the myocardium increases
inotropy. The ESPVR shifts to the left.
3. Combination of increase preload and inotropy
causes increases stroke volume (C to D). cardiac
output is increased.

Atrial Dynamics

- Atria responds to preload, afterload and

inotropic intervention similar to the way
ventricles do
o Force of atrial contraction increases
with increased atrial volume (preload)
caused by:
▪ AV Valve regurgitation and
stenosis
- Sympathetic nerve stimulation and increased
circulating catecholamines increases atrial
inotropy and therefore atrial force of
contraction and ejection/
- Vagal stimulation decreases atrial inotropy,
unlike ventricles.

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 Questions
1. Which of the following is the primary pacemaker d. 90 mV
of the heart? e. 75 mV
a. Bundle of His 6. What is the primary current responsible for
b. SA node phase 0 of the action potential in a nodal cell?
c. Right and left bundle branches a. I Ca (T)
d. AV node b. I K
e. Purkinje fibers c. I f
2. Which of the following are classified as non- d. I Ca (L)
pacemaker cells? 7. Which of the following is the depolarization
a. Ventricular myocytes phase of the action potential in pacemaker cells?
b. Cells in the AV node a. Phase 0
c. None of the options listed b. Phase 3
d. Cells in the Bundle of His c. Phase 2
e. Cells in the SA node d. Phase 4
3. Which of the following are classified as non- e. Phase 1
pacemaker cells? 8. What is the beating frequency of the SA node?
a. Ventricular myocytes a. 60-90 bpm
b. Cells in the AV node b. 60-100 bpm
c. None of the options listed c. 30-40 bpm
d. Cells in the Bundle of His d. 40-60 bpm
e. Cells in the SA node e. 40-100 bpm
4. In resting conditions, which of the following 9. Which of the following is the mechanism by
channels is most likely open in a cardiac which the sympathetic nervous system increases
myocyte? the heart rate?
a. Chloride channels a. Increasing the threshold potential to a
b. Potassium channels less negative value
Explanation: Open K channels allows K to move from b. Lower or more negative shift in resting
inside the cell to outside the cell (from higher membrane potential
concentration to lower concentration), creating the c. Greater absolute amount of
hyperpolarized state of a resting membrane potential repolarization
(-90) d. Increasing rate of phase 4 depolarization
c. Calcium channels 10. To which of the following muscarinic receptors
d. Sodium channels on the SA node does acetylcholine bind to?
5. What is the usual resting membrane potential a. M5 receptors
for ventricular myocytes? b. M4 receptors
a. -90 mV c. M2 receptors
d. M1 receptors
Explanation: Open K channels allows K to move from
e. M3 receptors
inside the cell to outside the cell (from higher
11. Which of the following adrenergic receptors
concentration to lower concentration), creating the
does norepinephrine bind to in order to speed up
hyperpolarized state of a resting membrane potential
the heart?
(-90)
a. β3 adrenergic receptors
b. -60 mV b. β2 adrenergic receptors
c. -75 mV c. β1 adrenergic receptors
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 d. α1 adrenergic receptors e. Calcium and sodium move out of the cell
e. α2 adrenergic receptors 18. The conductance of which ion results in phase 2
12. Which of the following is FALSE regarding the characteristics in a ventricular myocyte action
effect of sympathetic stimulation of the heart? potential?
a. Increased Na influx a. Magnesium
b. Decreased rate of phase 4 b. Chloride
depolarization c. Potassium
c. Increased HCN activity d. Calcium
d. Increased cyclic adenosine e. Sodium
monophosphate 19. Which of the following non-pacemaker action
e. Increased phosphorylation of Ca potential phases involves fast sodium channels?
channels a. Phase 2
13. Which of the following will most likely lead to an b. Phase 0
increase in heart rate? c. Phase 1
a. Hyperkalemia d. Phase 4
b. Decrease in all catecholamines e. Phase 3
c. Hypothyroidism 20. Which of the following phases of the non-
d. Increase in epinephrine pacemaker action potential involves an influx of
14. Which of the following decreases the heart rate? calcium?
a. Low levels of thyroid hormones a. Phase 2
b. Adrenaline b. Phase 1
c. Noradrenaline c. Phase 4
d. High T3 d. Phase 0
e. Hypokalemia e. Phase 3
15. Which of the following drug classes can increase 21. Which of the below elements of the cardiac
the heart rate? electrical pathway are the fastest conductors?
a. Calcium channel blockers a. Purkinje fibers
b. Adrenergic agonists b. AV node
c. Digoxin c. Atrial muscle
d. K channel blockers d. Ventricular muscle fibers
e. Beta blockers e. Bundle branches
16. Which component of the intercalated disks that 22. Which of the following elements of the cardiac
hold cardiomyocytes together allows for rapid electrical pathway are the slowest conductors?
passage of electrical impulses? a. Ventricular muscle
a. Tight junctions b. Atrial muscle
b. Anchoring junctions c. Bundle branches
c. Hemidesmosomes d. Purkinje fibers
d. Gap junctions e. AV node
e. Desmosomes 23. Which of the following terms is associated with
17. Which of the following occurs during the activation of the heart by the sympathetic
cardiomyocyte depolarization? nervous system?
a. Potassium and calcium move into the a. Negative chronotropy
cell b. Positive lusitropy
b. Sodium and potassium move out of the c. Positive dromotropy
cell d. Negative inotropy
c. Sodium moves out of the cell e. Hypertrophy
d. Sodium and calcium move into the cell

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24. Which of the following conditions results in 29. Which direction will the ECG deflect when a
complete dissociation of atrial and ventricular depolarization travels toward a negative
activity? electrode?
a. Third-degree AV block a. Downward
b. Atrial defibrillation b. Outward
c. Type I second-degree AV block c. Upward
d. First-degree AV block d. Inward
e. Type 2 second-degree AV block e. No deflection
25. Which of the following ECG abnormalities is seen 32. Which of the following corresponds to the QRS
with premature ventricular complexes? complex?
a. Irregular ventricular response a. Atrial repolarization
b. Variation in P wave contour b. Ventricular depolarization
c. Absent QRS complex c. Atrial depolarization
d. Wide QRS complex d. Left ventricular repolarization
e. P wave after QRS complex e. Right ventricular repolarization
26. Which of the following test is meant to create a 33. Which part of the cardiac cycle corresponds to
record of the heart's electrical activity at rest? the ST segment?
a. Echocardiography a. Ventricular repolarization
b. Electrocardiogram (ECG) b. The interval between ventricular
c. Exercise stress test depolarization and repolarization
d. MUGA Scan c. Atrial repolarization
e. Cardiac MRI d. Ventricular depolarization
27. Which of the following statements characterizes e. Atrial depolarization
the ECG electrical activity between a pair of 34. Which electrocardiogram interval is used to
positive and negative electrodes? calculate the heart rate?
a. If the depolarization wave travels a. PR interval
toward a negative electrical pole you will b. ST interval
get a positive deflection on the ECG. c. T wave interval
b. A single pair of positive and negative d. QRS interval
electrodes can give multiple electrical e. RR interval
views of the heart without repositioning 35. Which of the following is the definition of the ST
the electrodes. segment?
c. The ECG is not concerned with the a. End of the S wave to the beginning of the
polarity of the electrodes. T wave
d. It represents the average of the many b. End of the QRS complex to the end of the
depolarization vectors “seen” in the T wave
heart taken by those electrodes. c. Start of the QRS complex to the start of
e. The positive and negative electrodes can the T wave
be switched without affecting the ECG. d. Start of the S wave to the beginning of
28. Which of the following likely causes the small the T wave
downward deflection in the QRS complex of the e. End of the S wave to the end of the T
ECG? wave
a. Base depolarization 36. What is the length of a normal PR interval?
b. Apex depolarization a. 0.12 to 0.2 seconds
c. Right atrial depolarization b. 0.08 to 0.1 seconds
d. Septal depolarization c. 0.08 to 0.2 seconds
e. Left atrial depolarization d. 0.06 to 0.1 seconds

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 e. 0.06 to 0.3 seconds e. -30° to +100°
37. here is unipolar chest lead V4 placed? 43. What is the mean electrical axis if standard limb
a. 4th intercostal space at the right lead I is biphasic, and aVF is the most positive?
midclavicular line a. -120°
b. 5th intercostal space at the left b. +30°
midclavicular line c. +120°
c. 3rd intercostal space right of the d. +90°
sternum e. +70°
d. 2nd intercostal space left of the sternum 44. A patient's ECG shows a PR interval that is
e. 6th intercostal space at the left lengthened to 0.3 seconds throughout the
midaxillary line tracing but still captures a normal QRS complex.
38. Which of the following findings is TRUE regarding Which of the following ECG abnormalities does
the unipolar limb lead AVR? this describe?
a. Tall R wave a. Mobitz type I
b. Negative P wave b. 3rd-degree AV block
c. The QRS complex is always upright. c. Atrial fibrillation
d. Small P wave d. Ventricular fibrillation
e. Small S wave e. 1st-degree AV block
39. Which of the following influences the corrected 45. Which of the following describes a random QRS
QT (QTc)? > 0.1s seen in normal sinus rhythm?
a. Blood oxygenation a. Premature Ventricular Complex
b. Blood pressure b. Premature atrial complex
c. Heart rate c. Ventricular fibrillation
d. Mean arterial pressure d. Sinus arrhythmia
e. Respiratory rate e. Ventricular tachycardia
40. Which frontal plane lead would have the 46. Which of the following changes are seen on an
greatest (tallest) r-wave if the mean electrical ECG when transmural ischemia is present?
axis is 60°? a. Normal P wave, ST-segment depression,
a. Lead I inverted T wave
b. aVL b. Notched P wave, Normal ST-segment,
c. Lead III inverted T wave
d. Lead II c. Normal P wave, ST-segment elevation,
e. aVR absent T wave
41. What would the mean electrical axis be if aVR is d. Normal P wave, ST-segment elevation,
the most biphasic, and standard limb lead III is normal T wave
the most positive? e. Absent P wave, ST-segment elevation,
a. +120° normal T wave
b. +60° 47. Which of the given phases is seen both in systole
c. -150° and diastole?
d. 0° a. Ventricular ejection & active contraction
e. -30° b. Active relaxation
42. What is the normal range for the mean electrical c. Active contraction
axis? d. Ventricular ejection
a. -50° to +90° e. Ventricular filling
b. -90° to +100°
c. -10° to +50°
d. -20° to +110°

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48. Which of the following is TRUE regarding the e. Phase 5-6
cardiac cycle? 53. What percentage of ventricular filling can atrial
a. Systole is exclusively the contraction of systole account for during exercise conditions?
the atria. a. 10%
b. Both the contraction and relaxation b. 40%
phases are termed systole. c. 50%
c. Systole is the contraction phase and d. 60%
diastole is the relaxation phase. e. 30%
d. Diastole is the contraction phase and 54. Which of the following is used to express stroke
systole is the relaxation phase. volume?
e. Both the contraction and relaxation a. End systolic volume (ESV) ÷ End-diastolic
phases are termed diastole. volume (EDV)
49. Which of the following stages of the cardiac cycle b. End diastolic volume (EDV) - End systolic
does the ventricular volume curve drop sharply? volume (ESV)
a. Passive filling c. Cardiac output × Heart rate
b. Isovolumic contraction d. End systolic volume (ESV) + End diastolic
c. Ejection volume (EDV)
d. Isovolumic relaxation e. End systolic volume (ESV) - Cardiac
e. Atrial contraction output
55. Which stage of the cardiac cycle do the
atrioventricular valves open?
50. Where do you measure left ventricular end- a. Atrial filling
diastolic volume and left ventricular end-systolic b. Atrial contraction
volume, respectively? c. Isovolumetric contraction
a. The last point of the ejection phase and d. Ventricular filling
isovolumic relaxation e. Ventricular ejection
b. Mid-filling phase and the last point of 56. Why are the pressures inside the right side of the
the ejection phase heart lower than those of the left side of the
c. Isovolumic relaxation and mid-ejection heart?
phase a. The aortic valve is easier to open so the
d. Isovolumic contraction and the last point left ventricle can create more pressure.
of the ejection phase b. The right side of the heart only receives
e. Both can be measured in the filling half the blood volume that the left
phase. receives.
51. What is the normal range of the ejection c. The right side of the heart only has to
fraction? pump blood to the lungs, and the left
a. 30-40% side has to pump blood to the whole
b. 15-25% body.
c. 25-35% d. The right side of the heart has to
d. 80-90% overcome more pressure from the
e. 55-60% pulmonic valve.
52. Which phase of the cardiac cycle does the a- e. There is no difference in the pressure of
wave occur? the right and left sides of the heart.
a. Phase 3-4
b. Phases 5-7
c. Phase 6-7
d. Phase 1-2

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57. Which of the following represents the normal b. Increased heart rate
systolic pressure in the right ventricle? c. Increased ventricular inotropy
a. 70-105 mmHg d. Decreased afterload
b. 6-12 mmHg e. Decreased ventricular compliance
c. 15-25 mmHg 64. Which of the following parameters decreases
d. 2-6 mmHg ventricular preload?
e. 0-8 mmHg a. Decreased ventricular inotropy
58. Which heart sound is heard in early diastolic b. Decreased atrial inotropy
filling and may be an indicator of pathology? c. Increased afterload
a. S1 d. Decreased venous compliance
b. S4 e. Increased ventricular compliance
c. S5 65. Which of the given parameters is related to the
d. S2 Frank-Starling law of the heart?
e. S3 a. Venous pressure and ventricular
59. Which of the following contributes to 2nd heart compliance
sound? b. Preload and afterload
a. The flow of blood from atria c. Heart rate and preload
b. Contraction of ventricles d. Stroke volume and end-systolic volume
c. Contraction of atria e. Stroke volume and end-diastolic volume
d. Closure of aortic and the pulmonary 66. Why does the Valsalva maneuver initially
valves decrease blood pressure?
e. Closure of AV valves a. The decreased intrathoracic pressure
60. Which of the following contributes to 1st heart leads to increased venous return and
sound during systole? then decreased preload.
a. Contraction of ventricles b. The decreased intrathoracic pressure
b. Closure of AV valves leads to decreased venous return and
c. Closure of semilunar valves then decreased preload.
d. Contraction of atria c. The increased intrathoracic pressure
e. The flow of blood from atria leads to increased venous return and an
61. Which of the following is a primary factor that increase in preload.
affects end-diastolic volume? d. The increased intrathoracic pressure
a. Preload leads to increased venous return. This
b. Stroke volume leads to increased preload.
c. Inotropy e. The increased intrathoracic pressure
d. Dromotropy leads to decrease venous return. This
e. Afterload leads to decreased preload.
62. Which of the given formulas calculates cardiac 67. Which of the following factors affects the
output? velocity of myocardial contraction?
a. End diastolic volume × Heart rate a. Quality of blood flow.
b. End systolic volume ÷ Heart rate b. The surface area of the valve.
c. Stroke volume × Heart rate c. BMI of an individual.
d. End diastolic volume – End systolic d. Available energy in the form of ATP.
volume e. Ease of valvular opening.
e. End diastolic volume – Heart rate 68. Which of the following will decrease with a
63. Which of the following parameters increases decrease in the afterload?
ventricular preload? a. End-systolic volume
a. Increased atrial inotropy b. Blood Volume

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 c. Cardiac output 74. Which of the following cardiac changes will
d. The velocity of muscle shortening increase stroke volume?
e. Stroke volume a. Decreased cardiac contractility
69. Which of the following is CORRECT regarding the b. Increased end-systolic volume
effect of afterload on ventricular function? c. Decreased inotropy
a. Increasing the afterload would decrease d. Increased preload
the end-diastolic volume. e. Increased afterload
b. Increasing the afterload would decrease 75. Which of the following physiological conditions
preload. causes a greater atrial contraction?
c. Decreasing the afterload would increase a. An increase in parasympathetic nervous
preload. system stimulation
d. Reducing the afterload would increase b. An increase in venous return
the stroke volume. c. A decrease in sympathetic nervous
e. Reducing the afterload would increase system stimulation
end-systolic volume. d. Atrial fibrillation
70. Which of the following effects on ventricular e. An increase in premature ventricular
function happen with a decrease in inotropy? contractions
a. Increase EF
b. Decreases stroke volume
c. Increases stroke volume
d. Increase dP/dt
e. Decrease preload
71. Which of the following calcium channels allow
for influx into the myocyte after beta-1
adrenergic stimulation?
a. N-type calcium channel
b. R-type calcium channel
c. L-type calcium channel
d. P-type calcium channel
e. T-type calcium channel
72. Which of the following factors will increase
ventricular inotropy?
a. Parasympathetic nervous system
stimulation
b. An increase in sympathetic nervous
system stimulation
Compiled by:
c. A decrease in circulating catecholamines
d. A decrease in heart rate Maria Clarisse R. Baldonado, RPm
e. A decrease in afterload
73. Which of the following ions contributes most to Trust but Verify
the myocyte strength of contraction?
a. Sodium
b. Potassium
c. Magnesium
d. Calcium
e. Chloride

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