Cardiology

Question 1

Why is the heart considered a double pump?

Answer 1

The heart, while only a single organ, works as a double pump. It propels blood though the lungs (pulmonary circulation) and the rest of the body (systemic circulation) simultaneously.

Question 2

How much blood does the heart pump per day?

Answer 2

At rest the heart pumps about 1,800 gallons of blood per day through about 60,000 miles of blood vessels.

Question 3

Describe the heart’s location

Answer 3

The heart rests on the muscular diaphragm separating the thoracic and abdominal cavities. The thoracic space in which it sits is known as the mediastinum.

Question 4

apex of the heart

Answer 4

About 2/3 of the heart mass lies to the left of the midline, with its
apex, formed by the tip of the left ventricle, lying 9cm (3.25 inches) from the midline, deep to the 5th intercostal space.

Question 5

base of the heart

Answer 5

Opposite to the apex is the base of the heart. It lies superior and
posterior in the mediastinum and is formed mostly by the left atrium.

Question 6

pericardium

Answer 6

The pericardium is a triple-layered bag that surrounds and
protects the heart, confining it to its position within the mediastinum, yet allowing it freedom of movement for contraction. The pericardium consists of two main portions

Question 7

fibrous pericardium

Answer 7

The outer fibrous pericardium is a tough, inelastic, fibrous
connective tissue attached to the great vessels associated with the heart, the diaphragm, and at the roots of the lungs. It serves to anchor the heart within the mediastinum, prevent over-stretching of the heart during exercise, and offers some degree of protection.

Question 8

Serous pericardium

Answer 8

The inner serous pericardium is a

thinner and more delicate membrane that forms a double layer around the heart. It is subdivided into to layers

Question 9

Serous pericardium - parietal layer

Answer 9

The outer portion of the serous pericardium, the

parietal layer, is fused to the inside surface of the fibrous pericardium.

Question 10

Viseral layer of the serous pericardium

Answer 10

The inner visceral layer of the serous pericardium,
also known as the epicardium or the outer wall of the heart itself, adheres tightly to the surface of the heart muscle (the myocardium).

Question 11

pericardial cavity

Answer 11

Between the parietal and visceral layers is a small
space called the pericardial cavity. It contains a small amount of pericardial fluid, secreted by the serous pericardium that is used for lubrication to reduce friction as the heart moves.

Question 12

epicardium

Answer 12

The wall of the heart itself is subdivided into three layers.
The epicardium, the outermost layer, is also known as the visceral layer of the serous pericardium. It is a thin, transparent membrane that imparts a slippery texture to the outer surface of the heart

Question 13

myocardium

Answer 13

The myocardium, the middle layer, consists of cardiac
muscle cells and is responsible for the pumping action of the heart. The cardiac muscle fibers are involuntary, striated, and branched, swirling diagonally around the heart in interlacing bundles to form two large networks, the atria and the ventricles.

Question 14

intercalated discs

Answer 14

Each cardiac muscle cell contacts neighboring cells
by transverse thickenings of the sarcolemma called intercalated discs, within which are gap junctions that electrically couple the cells so that they work as a unit (cardiac muscle is a functional syncytium).

Question 15

cardiac skeleton

Answer 15

The two muscle masses, atria and ventricles, are
separated from each other by the cardiac skeleton, dense fibrous connective tissue in the form of a figure-8 separating the two masses. This fibrous tissue uncouples the electrical activity of the atria from that of the ventricles so that the two can work independently.

Question 16

endocardium

Answer 16

The innermost layer of the heart wall is the endocardium,
a simple squamous epithelium overlying a thin connective tissue. The endocardium becomes continuous with the endothelium of the blood vessels.

Question 17

heart chambers

Answer 17

The interior of the heart is divided into four compart-
ments that receive the circulating blood.

The two superior chambers are the right atrium and the left atrium, each of which has an appendage called the auricle that increases the volume of the atrium and is used during exercise.

The two lower chambers are the right ventricle and the left ventricle.

Question 18

coronary sulcus and interventricular sulci

Answer 18

Externally, the heart cham-
bers are delineated from one another by a series of grooves within which lie the coronary arteries and coronary veins.

The coronary sulcus separates the atria from the ventricles.

The anterior and posterior interventricular sulci separate the two ventricles front and back.

Question 19

role of cardiac skeleton

Answer 19

The connective tissue of the cardiac skeleton

effectively separates the upper atria from the lower ventricles so that they work independent of one another.

Question 20

interatrial septum

Answer 20

Internally the chambers of the heart are separated by
muscular walls called septa.

The interatrial septum separates the atria and bears a prominent feature called the fossa ovalis, the remnant of the fetal foramen ovale, an opening that allowed blood to pass from right atrium to left atrium.

Question 21

interventricular septum

Answer 21

The interventricular septum separates the

ventricles and is divided into two portions: the superior membranous and inferior muscular interventricular septum.

Question 22

atrial wall thickness

Answer 22

The myocardium of the atria is relatively thin since

it has only to move blood into the ventricles, and therefore needs to generate only a small amount of pressure.

Question 23

ventricular wall thickness

Answer 23

The myocardium of the ventricles is
considerably thicker since it must move blood to the lungs (right ventricle) or to the rest of the body (left ventricle). The left ventricle wall is thickest since it must generate the largest amount of pressure.

Question 24

Describe the basic pattern of blood flow from the body through three veins: superior vena cava, inferior vena cava, and the coronary sinus.

Answer 24

The superior vena cava brings blood from most of the upper body to the heart (head, neck, upper extremity, and thorax).

The inferior vena cava brings blood from all parts of the body inferior to the diaphragm.

The coronary sinus receives blood from the coronary veins draining the heart itself and delivers it to the right atrium.

From the right atrium blood moves into the right ventricle, is pumped into the pulmonary trunk, which divides into right and left pulmonary arteries, each of which carries deoxygenated blood to its respective lung.

Oxygenated blood from the lungs passes to the left atrium via 4 pulmonary veins.

Blood then passes from the left atrium into the left ventricle, from which it is pumped into the aorta for distribution throughout the systemic circulation.

Question 25

What are heart valves?

Answer 25

As each chamber of the heart contracts, it pushes a portion of its blood into a ventricle or into a great artery. To prevent backflow of blood, the heart is equipped with valves, formed from the connective tissue of the cardiac skeleton and covered with endocardium. They open and close by pressure changes.

Question 26

Describe atrioventricular valves?

Answer 26

Atrioventricular (AV) valves lie between the atria and the ventricles. The tricuspid valve is on the right side, and the bicuspid (mitral) valve is on the left. Each cusp of an AV valve is roughly shaped like a triangle; the base is attached to the heart wall and the apex is pointed down into the ventricle.

Question 27

What are the chordae tendineae and papillary muscles?

Answer 27

Attached to the apices of the cusps are tendon-like cords of connective tissue called the chordae tendineae, which anchor the valves down inside the ventricle wall by attaching to papillary muscles.

Question 28

Describe the mechanism by which the atrioventricular valves open and close. Be sure to include the pressure changes that occur?

Answer 28

In order for blood to pass from atrium to ventricle, the AV valve must be open with its pointed ends extending into the ventricular cavity, the papillary muscles relaxed, and the chordae tendineae slackened.

Contraction of the ventricular myocardium increases the pressure within the ventricle, forcing the blood toward the opening between atrium and ventricle.

The pressure change and the force of the blood drive the cusps of the AV valve upward until their edges meet and close the opening, thus preventing backflow of blood into the atrium.

At the same time, the papillary muscles contract, adding further tension to the chordae tendineae, preventing the cusps from everting or swinging upward into the atrium and thus allowing blood to flow back into the atrium.

Question 29

Describe semilunar valves on location shape and functioning

Answer 29

located in the pulmonary trunk and aorta just as each vessel emerges from its respective ventricle.

shape – Each of these valves consists of three half-moon shaped
cusps that are attached to the artery wall like a pocket is attached to a shirt, with a free upper margin.

functioning – When blood is ejected from the ventricle into the
artery, the cusps are pushed flat against the artery wall, allowing blood to pass. After contraction, when arterial pressure becomes greater then ventricular pressure, blood begins to flow back to the ventricle. As it does so, blood backfills the SL valve cusps, filling the pockets and causing the free margins to bulge outward from the wall of the vessel. When the edges of the three bulging cusps meet each other, the valve is closed and blood cannot return to the heart.

Question 30

What is coronary circulation?

Answer 30

The myocardium has its own blood supply and does not rely upon diffusion of nutrients from the blood circulating through the chambers to meet its needs. Two coronary arteries branching from the ascending aorta, right and left, are responsible for the total blood flow to the myocardium.

Question 31

left coronary artery

Answer 31

The left coronary artery emerges from the
aorta to the left of the pulmonary trunk and almost immediately divides into two branches: anterior interventricular artery (left anterior descending or LAD) circumflex artery.

supply area – The left coronary artery, via its branches is
responsible for most of the blood supply to the anterior myocardium of both ventricles and to the left atrium.

Question 32

right coronary artery

Answer 32

The right coronary artery emerges from the
aorta to the right of the pulmonary trunk and passes in the groove between the right atrium and right ventricle. It gives rise to two arteries: marginal artery and posterior interventri-cular artery.

supply area – The right coronary supplies blood to the right
atrium and the posterior myocardium of the ventricles.

Question 33

anastomoses of the heart

Answer 33

There are a great many interconnec-
tions (anastomoses) between the branches of the coronary arteries, particularly where the anterior and posterior interventricular arteries meet. Anastomoses provide a number of alternate routes for blood flow should one path become blocked.

Question 34

great cardiac veins

Answer 34

The great cardiac vein is located in the
anterior interventricular sulcus, alongside the anterior interventricular branch of the left coronary artery. It drains blood from the myocardium of the anterior aspect of the heart.

Question 35

middle cardiac vein

Answer 35

The middle cardiac vein lies in the posterior
interventricular sulcus, alongside the posterior interventricular branch of the right coronary artery. It drains blood from the myocardium of the posterior aspect of the heart.

Question 36

small cardiac vein

Answer 36

The small cardiac vein is found in the groove

between the right atrium and right ventricle. It drains blood from the myocardium of both areas.

Question 37

coronary sinus

Answer 37

The coronary sinus lies in the groove between
the left atrium and the ventricles. It receives venous blood from the great, middle, and small cardiac veins, and then opens into the right atrium.

Question 38

The heart is responsible for stimulating itself to beat. How does it accomplish this feat?

Answer 38

The heart stimulates itself to beat by using an inherent and rhythmic electrical activity.

Question 39

What is the role of the autonomic nervous system and the endocrine system in regulation of heart beat?

Answer 39

The autonomic nervous system and the endocrine system can only modify the heartbeat, but they DO NOT ESTABLISH THE FUNDAMENTAL RHYTHM.

Question 40

Certain cardiac muscle cells repeatedly create spontaneous action potentials that then trigger contractions. Name these cells.

Answer 40

autorhythmic cells

Question 41

Describe the development of the autorhythmic cells.

Answer 41

During heart development about 1 % of the forming cardiac muscle cells lose the ability to contract and become instead autorhythmic (self-excitable)

Question 42

Name the two essential functions of the autorhythmic cells.

Answer 42

1. They act as a pacemaker, setting the basic rhythm for the entire
   heart.
2. They form the conduction system, the route for conducting the
   impulses throughout the heart muscle. The conduction system assures that the cardiac chambers contract in a coordinated and timely fashion, thus making the heart an effective pump.

Question 43

In correct order of functional appearance, name and describe each of the components of the cardiac conducting system.

Answer 43

1. The sinoatrial (SA) node is a collection of autorhythmic cells in the
   posterior right atrial wall, just inferior to the opening of the superior vena cava. It is the primary pacemaker, setting the basic rhythm of the heart at about 90-100 beats/minute.
2. The atrioventricular (AV) node is a collection of autorhythmic cells
   at the junction of the four chambers, within the cardiac skeleton. It is the secondary pacemaker, setting the basic rhythm of the heart at about 40-50 beats/minute.
3. The atrioventricular (AV) bundle extends from the AV node into the
   membranous interventricular septum.
4. At the muscular septum the AV bundle divides into the right and left
   bundle branches, each traveling through its respective ventricle.
5. Extending from the bundle branches are Purkinje fibers, which pass
   the action potentials to the ventricular myocardium and cause the muscle cells to contract.

Question 44

Why are the cells of the SA node and AV node autorhythmic?

Answer 44

SA and AV nodes are autorhythmic because the cells maintain a mem-brane potential, like all muscle cells, but they are “leaky” to Na+ ions. As Na+ leaks into the cells, they reach threshold and create an action potential. This occurs at a certain rate for each node, so each creates its own rhythm (SA node =90-100/minute; AV node=40-50/minute.)

Question 45

How do the action potentials of the SA node influence the rest of the atrial muscle cells?

Answer 45

Since SA node cells are a part of the atrial myocardium and all of the cells are “connected” by intercalated discs, the action potentials spread away from the SA node, sweeping across the atrial muscle via gap junctions, and causing the cells to contract.

Question 46

Describe the timing of events that occur in the conduction system as depolariz-ation sweeps across the heart muscle.

Answer 46

At the beginning of a cardiac cycle, the SA node generates an action potential (0.00 sec). This action potential moves across the atrial muscle like a wave, reaching the AV node at 0.04 sec.

The AV node, which depolarizes more slowly, passes the action potential into the AV bundles at 0.16 sec. This 0.12 sec delay at the AV node allows the atria to finish their contraction sequence before the ventricles can begin theirs.

The action potential moves down the AV bundle, the bundle branches, and the Purkinje fibers, causing the interventricular septal muscle to begin contracting first (0.17 sec).

The apex region of the ventricles contracts (0.18 sec) and the contraction sequence continues to move superiorly until finally the superior-most parts of the ventricles contract at 0.21-0.22 sec.

This arrangement allows the atria to move blood into the ventricles before the ventricles begin to contract, and then causes the ventricles to contract in such a way as to eject blood into the great arteries.

Question 47

What is an electrocardiogram?

Answer 47

Impulse conduction through the heart generates electrical currents that can be detected at the body surface. A recording of the electrical changes that accompany each cardiac cycle is called an electrocardiogram (ECG). The ECG is a composite of action potentials produced by all the heart muscle fibers during each heartbeat. In a typical recording, there are several clearly recognizable and named parts.

Question 48

P wave

Answer 48

The P wave is the first small upward deflection that represents
atrial depolarization as it spreads from the SA node and across both atria.

Question 49

QRS complex

Answer 49

The QRS complex, the second wave, begins as a small
deflection down, followed by a large deflection upward, and ends with a small deflection down. It represents ventricular depolarization, the spread of excitation through the ventricles

Question 50

T wave

Answer 50

The T wave, the third wave, is a small dome-shaped upward

deflection that represents ventricular repolarization. The T wave appears just before the ventricles begin to relax.

Question 51

P-R interval

Answer 51

The P-R interval is measured from the beginning of the P
wave to the beginning of the QRS complex. It represents the conduction time from the beginning of the atrial excitation to the beginning of ventricular depolarization`

Question 52

S-T segment

Answer 52

The S-T segment begins at the end of the S wave and

ends at the beginning of the T wave. It represents the time when ventricular contractile fibers are fully depolarized.

Question 53

quiescent period

Answer 53

The quiescent period is the time period between the

end of the T wave and the beginning of the next P wave. It represents that time when all heart muscle is at rest.

Question 54

Identify the two phenomena that control blood flow through the heart.

Answer 54

1. contraction and relaxation of the myocardium, controlled by the
   conduction system
2. opening and closing of the AV and SL valves, controlled by
   pressure changes in the heart chambers and the great arteries

Question 55

Blood flows from an area of high pressure to an area of low pressure. The pressure developed within a heart chamber is related to what two things?

Answer 55

1. The volume of blood within the chamber exerts a fluid pressure.
2. The size of the chamber: as a chamber contracts its size gets
   smaller and therefore the pressure within increases.

Question 56

Venous pressure

Answer 56

the fluid pressure exerted by blood in the veins of the body.

Question 57

Atrial pressure

Answer 57

related to two things: the fluid pressure exerted by the volume of blood the atrium contains, and the size of the atrial chamber as it contracts and relaxes.

Question 58

Ventricular pressure

Answer 58

related to two things: the fluid pressure exerted by volume of blood the ventricle contains, and the size of the ventricular chamber as it contracts and relaxes.

Question 59

Arterial pressure

Answer 59

the fluid pressure exerted by blood in the arteries of the body.

Question 60

What happens during a normal cardiac cycle?

Answer 60

In a normal cardiac cycle, the two atria contract while the two ventricles relax, then the two ventricles contract while the atria relax.

Question 61

What do the terms systole and diastole mean?

Answer 61

The term systole refers to the contraction phase.

The term diastole refers to the relaxation phase.

Question 62

One complete cardiac cycle consists of what?

Answer 62

One complete cardiac cycle consists of a systole and a diastole of both atria, plus a systole and diastole of both ventricles.

Question 63

The cardiac cycle of a normal resting adult is divided into three phases. Describe the relaxation phase to begin.

Answer 63

Relaxation phase – at the end of a heart beat when the ventricles
start to relax, all four chambers are in diastole. This is known as the quiescent period.

As the ventricles relax, ventricular pressure drops and blood begins to flow from the great arteries back toward their respective chamber. This results in closure of the SV valves, giving the second heart sound.

At this point, the volume of blood within the ventricles does not change because the AV valves are also closed. This period is called isovolumetric relaxation.

As the ventricles continue to relax, their chamber size continues increasing until ventricular pressure drops below atrial pressure. As a result the AV valves open.

Blood from the atria begins to move into the ventricles, passing through the open AV valves, following the pressure gradient, and the ventricles begin to fill.

Question 64

Describe the second phase of the cardiac cycle: ventricular filling.

Answer 64

Ventricular filling – 70% of ventricular filling occurs just after the AV
valves open because of blood that had been filling the atria from the venous circulation while they were in diastole and the AV valves were closed.

The first third of ventricular filling is thus known as the period of rapid ventricular filling, and occurs without the benefit of atrial systole.

The middle third of ventricular filling is called diastasis. It occurs as blood flow from the atria slows and a much smaller volume of blood enters the ventricles.

Excitation of the SA node initiates atrial systole, marking the end of the quiescent period, and causing the last third of ventricular filling to occur (remaining 30%) as the atria completely empty themselves.

At the end of ventricular diastole, each ventricle contains about 130 ml of blood, the end-diastolic volume (EDV). Throughout this entire phase the AV valves are open and the SL valves are closed.

Question 65

Describe the third phase of the cardiac cycle: ventricular systole

Answer 65

Ventricular systole – As the excitation passes into the AV node
then throughout the rest of the conduction system, the ventricular myocardium enters systole.

Ventricular pressure, which was already increased by ventricular filling, now begins to rise even higher. As a result, when the ventri-cular pressure exceeds the atrial pressure, the AV valves close.

This is known as the period of isovolumetric contraction because the volume of blood within the ventricles remains the same (130ml).

When ventricular pressure finally exceeds arterial pressure, the SL valves open and blood is ejected from the ventricles into the appro-priate artery. This period is known as ventricular ejection and continues until the ventricles begin to relax.

Once the relaxation phase has begun again, arterial pressure exceeds ventricular pressure and the SL valves close again. At this time each ventricle contains about 60ml of blood, the end systolic volume (ESV).

The volume of blood moved from each ventricle during ventricular systole is known as the stroke volume (70 ml).

(SV = EDV – ESV) or (SV = 130 ml - 60 ml)

Question 66

Atrial diastole and ventricular systole and I occur at the same time. During this time, what events are occurring in the heart?

Answer 66

1. venous pressure > atrial pressure = venous return
2. ventricular pressure > atrial pressure = AV close
3. atria fill with blood, so atrial pressure increases
4. ventricular pressure > arterial pressure = SL valves open
5. ventricular ejection of blood into great arteries

Question 67

Atrial diastole II and ventricular diastole occur at the same time. During this time, what events are occurring in the heart?

Answer 67

1. ventricular pressure decreases
2. arterial pressure > ventricular pressure = SL valves close
3. atrial pressure > ventricular pressure = AV valves open
4. ventricular filling begins (70%), so ventricular pressure rises
5. venous pressure > atrial pressure = atrial filling

Question 68

What events occur during atrial systole?

Answer 68

1. atrial pressure > ventricular pressure = the other 30% of
   ventricular filling occurs
2. atrial pressure > venous pressure = atrial filling stops
3. as a result, the atrial empty completely into the ventricles

Question 69

Discuss the timing aspects of the cardiac cycle

Answer 69

Since the resting heart rate of a normal adult is about 75 beats/minute, each cycle takes about 0.8 sec.

During the first 0.4 seconds, all four chambers are at rest (quiescent period)/

During the next 0.4 seconds, the atria, then the ventricles are in systole.

When the heart rate is changed, it is the quiescent period that is altered accordingly.

Question 70

Define the concept of cardiac output.

Answer 70

the amount of blood ejected from the left ventricle into the aorta per minute. It would be the same for the right ventricle.

Question 71

Name, then describe, the two factors which determine cardiac output

Answer 71

stroke volume – Stroke volume (SV) is the amount of blood ejected from
the ventricle per beat.

heart rate – Heart rate (HR) is the number of heart beats per minute.

Question 72

Show mathematically how cardiac output is determined.

Answer 72

CO = SV x HR
CO = (70 ml/beat) x (75 beats/minute)
CO = 5,250 ml (5L)/minute

Question 73

A cardiac output of 5.25 L/minute, at rest, is virtually the entire volume of blood in the body flowing through the entire circulation once per minute. What happens if body demand for blood flow (exercise) increases?

Answer 73

If body demand increases cardiac output increases to meet the challenge.

Question 74

Name the two basic factors that alter cardiac output.

Answer 74

Stroke volume and heart rate. Therefore, factors that alter either will alter cardiac output.

Question 75

How much blood does a healthy heart pump out with each beat?

Answer 75

A healthy heart pumps out all of the blood that was moved into its chamber during the previous diastole. At rest this is 50-60% of the total volume because 40-50% remains in the ventricles.

Question 76

Define end-diastolic volume (EDV) and end-systolic volume (ESV).

Answer 76

End-diastolic volume (EDV) = the volume of blood in a ventricle at
the end of a diastole.

End-systolic volume (ESV) = the volume of blood remaining in the
ventricle after systole.

Question 77

How do you use EDV and ESV to determine stroke volume?

Answer 77

SV = EDV - ESV

Question 78

Anything that alters either EDV or ESV will alter stroke volume and therefore alter cardiac output. Name each of the three factors that regulate stroke volume and ensure that the left and right ventricles pump equal volumes of blood.

Answer 78

Preload
contractility
afterload

Question 79

preload

Answer 79

Preload is the stretch on the heart muscle before it

contracts.

Question 80

contractility

Answer 80

Contractility is the forcefulness of contraction of

individual cardiac muscle cells

Question 81

Afterload

Answer 81

Afterload is the pressure that must be exceeded by the

ventricle before blood can be ejected from the ventricle into the artery.

Question 82

Define and describe preload and its effects on stroke volume and cardiac output.

Answer 82

Preload –a greater stretching on cardiac muscle cells just
before they contract increases their force of contraction (remember that the same is true of skeletal muscle fibers)

Within physiological limits, the more the heart is filled during diastole, the greater the force of contraction. This is known as the Frank-Starling law of the heart.

The preload depends on the volume of blood that fills the ventricles at the end of diastole (EDV) and is determined by two factors: (1) length of diastole and (2) venous pressure.

When heart rate increases, the duration of ventricular diastole is shortened. Less filling time means a smaller EDV and the ventricles may contract before they are adequately filled.

On the other hand, when venous pressure increases, a greater volume of blood is forced into the atria and therefore into the ventricles, so that EDV is increased.

The Frank-Starling law equalizes the output of the two ventricles and keeps the same volume of blood flowing to both the systemic and pulmonary circuits.

Ex: at the beginning of exercise, the left ventricles pumps more than the right, causing the volume of blood returning to the right atrium to increase. This increases right side EDV and the right ventricle contracts more forcefully with the next beat.

Question 83

What is contractility?

Answer 83

Myocardial contractility is the strength of contraction at any given preload.

Question 84

positive inotropic agent

Answer 84

A positive inotropic agent
increases contractility. Positive inotropic agents include stimulation by the sympathetic nervous system, the hormones glucagon and epinephrine, increased calcium ions in the extracellular fluid an the drug digitalis.

Question 85

negative inotropic agent

Answer 85

A negative inotropic agent
decreases contractility. Negative inotropic agents include inhibition of the sympathetic nervous system, anoxia and acidosis, some anesthetics and increased potassium ions in the extracellular fluid.

Question 86

How do inotropic agents work?

Answer 86

Inotropic agents are believed to affect cardiac contractility by altering the flow of calcium ions during impulse conduction through the cardiac muscle fibers and thus altering the strength of contraction.

Question 87

What is afterload?

Answer 87

the arterial pressure that must be exceeded before ventricular ejection can occur. Right ventricular pressure must exceed arterial pressure in the pulmonary trunk and left ventricular pressure must exceed arterial pressure in the aorta.

Question 88

What would happen to stroke volume if afterload was increased? (i.e. – hypertension)

Answer 88

With an increased afterload (hypertension or high blood pressure), stroke volume decreases and more blood remains in the ventricle at the end of systole (increased ESV). As blood pools in the ventricle there is increased contractility and the ventricle has to work harder to pump.

Question 89

The second major controller of cardiac output is heart rate. Describe the autonomic mechanisms by which heart rate is managed and their effects on cardiac output.

Answer 89

Regulation of heart rate – Cardiac output depends upon
heart rate as well as stroke volume; therefore, anything that affects heart rate ultimately affects cardiac output.

Because SV may be adversely affected by a number of pathological situations, several homeostatic mechanisms work to maintain adequate cardiac output by increasing heart rate and strength of contraction.

Although the SA node initiates heart contractions, other factors regulate the SA node and contribute to the control of heart rate. The most important of these is the autonomic nervous system and the hormones norepinephrine and epinephrine.

Nervous system control of HR stems from the cardiovascular center of the medulla. It receives input from the cerebral cortex, the hypothalamus, and various receptors in blood vessels related to blood pressure and blood oxygen content.

As a result of this input, the cardiovascular system directs autonomic impulses to the SA node that regulate heart rate.

Sympathetic fibers, called cardiac acceleratory nerves, synapses in the SA node, AV node, and most of the myo-cardium, releasing norepinephrine and causing increased HR and force of contraction. As a result, CO increases.

Parasympathetic fibers reach the heart via cranial nerve X (right and left vagus), synapse in the SA node and AV node, release acetylcholine, and slow the heart rate. As a result CO decreases. This is the dominant control of the heart at rest.

Question 90

Describe the effects of hormones on heart rate.

Answer 90

The hormones epinephrine, norepinephrine, and thyroxine increase HR and force of contraction while glucagon increases HR only.

Question 91

Describe the effects of ions on the heart rate.

Answer 91

Ions, in particular the relative concentrations of Na+, K+, and Ca++ in the extracellular fluids have a large impact on heart rate.

Increased K+ blocks impulse formation by the SA and AV nodes, increased Na+ causes decreased force of contraction, and moderate increase in Ca++ speeds and strengthens the heart.