Cardiovascular System Anatomy and Physiology 1

Functions of the Heart

The functions of the heart are as follows:

1. Managing blood supply. Variations in the rate and force of heart contraction match blood flow to the
changing metabolic needs of the tissues during rest, exercise, and changes in body position.
2. Producing blood pressure. Contractions of the heart produce blood pressure, which is needed for blood
flow through the blood vessels.
3. Securing one-way blood flow. The valves of the heart secure a one-way blood flow through the heart
and blood vessels.
4. Transmitting blood. The heart separates the pulmonary and systemic circulations, which ensures the
flow of oxygenated blood to tissues.

Anatomy of the Heart

The cardiovascular system can be compared to a muscular pump equipped with one-way valves and a system of
large and small plumbing tubes within which the blood travels.

Heart Structure and Functions

The modest size and weight of the heart give few hints of its incredible strength.
 Cardiovascular System Anatomy and Physiology 2

 Weight. Approximately the size of a person’s fist, the hollow, cone-shaped heart weighs less than a
pound.
 Mediastinum. Snugly enclosed within the inferior mediastinum, the medial cavity of the thorax, the
heart is flanked on each side by the lungs.
 Apex. It’s more pointed apex is directed toward the left hip and rests on the diaphragm, approximately at
the level of the fifth intercostal space.
 Base. Its broad posterosuperior aspect, or base, from which the great vessels of the body emerge, points
toward the right shoulder and lies beneath the second rib.
 Pericardium. The heart is enclosed in a double-walled sac called the pericardium and is the outermost
layer of the heart.
 Cardiovascular System Anatomy and Physiology 3

 Fibrous pericardium. The loosely fitting superficial part of this sac is referred to as the fibrous
pericardium, which helps protect the heart and anchors it to surrounding structures such as
the diaphragm and sternum.
 Serous pericardium. Deep to the fibrous pericardium is the slippery, two-layer serous pericardium,
where its parietal layer lines the interior of the fibrous pericardium.

Layers of the Heart

The heart muscle has three layers and they are as follows:

 Epicardium. The epicardium or the visceral and outermost layer is actually a part of the heart wall.
 Myocardium. The myocardium consists of thick bundles of cardiac muscle twisted and whirled into
ringlike arrangements and it is the layer that actually contracts.
 Endocardium. The endocardium is the innermost layer of the heart and is a thin, glistening sheet of
endothelium hat lines the heart chambers.

Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two ventricles.

 Receiving chambers. The two superior atria are primarily the receiving chambers, they play a lighter
role in the pumping activity of the heart.
 Discharging chambers. The two inferior, thick-walled ventricles are the discharging chambers, or
actual pumps of the heart wherein when they contract, blood is propelled out of the heart and into the
circulation.
 Septum. The septum that divides the heart longitudinally is referred to as either
the interventricular septum or the interatrial septum, depending on which chamber it separates.

Associated Great Vessels

The great blood vessels provide a pathway for the entire cardiac circulation to proceed.

 Superior and inferior vena cava. The heart receives relatively oxygen-poor blood from the veins of
the body through the large superior and inferior vena cava and pumps it through the pulmonary trunk.
 Pulmonary arteries. The pulmonary trunk splits into the right and left pulmonary arteries, which carry
blood to the lungs, where oxygen is picked up and carbon dioxide is unloaded.
 Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned to the left side of the heart
through the four pulmonary veins.
 Aorta. Blood returned to the left side of the heart is pumped out of the heart into the aorta from which
the systemic arteries branch to supply essentially all body tissues.

Heart Valves

The heart is equipped with four valves, which allow blood to flow in only one direction through the heart
chambers.
 Cardiovascular System Anatomy and Physiology 4

 Atrioventricular valves. Atrioventricular or AV valves are located between the atrial and ventricular
chambers on each side, and they prevent backflow into the atria when the ventricles contract.
 Bicuspid valves. The left AV valve- the bicuspid or mitral valve, consists of two flaps, or cusps, of
endocardium.
 Tricuspid valve. The right AV valve, the tricuspid valve, has three flaps.
 Semilunar valve. The second set of valves, the semilunar valves, guards the bases of the two large
arteries leaving the ventricular chambers, thus they are known as the pulmonary and aortic semilunar
valves.

Cardiac Circulation Vessels

 Cardiovascular System Anatomy and Physiology 5

Although the heart chambers are bathed with blood almost continuously, the blood contained in the heart does
not nourish the myocardium.

 Coronary arteries. The coronary arteries branch from the base of the aorta and encircle the heart in
the coronary sulcus (atrioventricular groove) at the junction of the atria and ventricles, and these
arteries are compressed when the ventricles are contracting and fill when the heart is relaxed.
 Cardiac veins. The myocardium is drained by several cardiac veins, which empty into an enlarged
vessel on the posterior of the heart called the coronary sinus.

Blood Vessels

Blood circulates inside the blood vessels, which form a closed transport system, the so-called vascular system.

 Arteries. As the heart beats, blood is propelled into large arteries leaving the heart.
 Arterioles. It then moves into successively smaller and smaller arteries and then into arterioles, which
feed the capillary beds in the tissues.
 Veins. Capillary beds are drained by venules, which in turn empty into veins that finally empty into the
great veins entering the heart.

Tunics

Except for the microscopic capillaries, the walls of the blood vessels have three coats or tunics.
 Cardiovascular System Anatomy and Physiology 6

 Tunica intima. The tunica intima, which lines the lumen, or interior, of the vessels, is a thin layer of
endothelium resting on a basement membrane and decreases friction as blood flows through the vessel
lumen.
 Tunica media. The tunica media is the bulky middle coat which mostly consists of smooth muscle and
elastic fibers that constrict or dilate, making the blood pressure increase or decrease.
 Tunica externa. The tunica externa is the outermost tunic composed largely of fibrous connective tissue,
and its function is basically to support and protect the vessels.

Major Arteries of the Systemic Circulation

The major branches of the aorta and the organs they serve are listed next in sequence from the heart.
Cardiovascular System Anatomy and Physiology 7
 Cardiovascular System Anatomy and Physiology 8

Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of heart as the ascending aorta.

 Coronary arteries. The only branches of the ascending aorta are the right and left coronary arteries,
which serve the heart.

Arterial Branches of the Aortic Arch

The aorta arches to the left as the aortic arch.

 Brachiocephalic trunk. The brachiocephalic trunk, the first branch off the aortic arch, splits into
the right common carotid artery and right subclavian artery.
 Left common carotid artery. The left common carotid artery is the second branch off the aortic arch
and it divides, forming the left internal carotid, which serves the brain, and the left external carotid,
which serves the skin and muscles of the head and neck.
 Left subclavian artery. The third branch of the aortic arch, the left subclavian artery, gives off an
important branch- the vertebral artery, which serves part of the brain.
 Axillary artery. In the axilla, the subclavian artery becomes the axillary artery.
 Brachial artery. the subclavian artery continues into the arm as the brachial artery, which supplies the
arm.
 Radial and ulnar arteries. At the elbow, the brachial artery splits to form the radial and ulnar arteries,
which serve the forearm.

Arterial Branches of the Thoracic Aorta

The aorta plunges downward through the thorax, following the spine as the thoracic aorta.

 Intercostal arteries. Ten pairs of intercostal arteries supply the muscles of the thorax wall.

Arterial Branches of the Abdominal Aorta

Finally, the aorta passes through the diaphragm into the abdominopelvic cavity, where it becomes the
abdominal aorta.

 Celiac trunk. The celiac trunk is the first branch of the abdominal aorta and has three branches: the left
gastric artery supplies the stomach; the splenic artery supplies the spleen, and the common hepatic
artery supplies the liver.
 Superior mesenteric artery. The unpaired superior mesenteric artery supplies most of the
small intestine and the first half of the large intestine or colon.
 Renal arteries. The renal arteries serve the kidneys.
 Gonadal arteries. The gonadal arteries supply the gonads, and they are called ovarian arteries in
females while in males they are testicular arteries.
 Cardiovascular System Anatomy and Physiology 9

 Lumbar arteries. The lumbar arteries are several pairs of arteries serving the heavy muscles of the
abdomen and trunk walls.
 Inferior mesenteric artery. The inferior mesenteric artery is a small, unpaired artery supplying the
second half of the large intestine.
 Common iliac arteries. The common iliac arteries are the final branches of the abdominal aorta.

Major Veins of the Systemic Circulation

Major veins converge on the venae cavae, which enter the right atrium of the heart.
 Cardiovascular System Anatomy and Physiology 10

Veins Draining into the Superior Vena Cava

Veins draining into the superior vena cava are named in a distal-to-proximal direction; that is, in the same
direction the blood flows into the superior vena cava.
 Cardiovascular System Anatomy and Physiology 11

 Radial and ulnar veins. The radial and ulnar veins are deep veins draining the forearm; they unite to
form the deep brachial vein, which drains the arm and empties into the axillary vein in the axillary
region.
 Cephalic vein. The cephalic vein provides for the superficial drainage of the lateral aspect of the arm
and empties into the axillary vein.
 Basilic vein. The basilic vein is a superficial vein that drains the medial aspect of the arm and empties
into the brachial vein proximally.
 Median cubital vein. The basilic and cephalic veins are joined at the anterior aspect of the elbow by the
median cubital vein, often chosen as the site for blood removal for the purpose of blood testing.
 Subclavian vein. The subclavian vein receives venous blood from the arm through the axillary vein and
from the skin and muscles of the head through the external jugular vein.
 Vertebral vein. The vertebral vein drains the posterior part of the head.
 Internal jugular vein. The internal jugular vein drains the dural sinuses of the brain.
 Brachiocephalic veins. The right and left brachiocephalic veins are large veins that receive venous
drainage from the subclavian, vertebral, and internal jugular veins on their respective sides.
 Azygos vein. The azygos vein is a single vein that drains the thorax and enters the superior vena cava
just before it joins the heart.

Veins Draining into the Inferior Vena Cava

The inferior vena cava, which is much longer than the superior vena cava, returns blood to the heart from all
body regions below the diaphragm.

 Tibial veins. The anterior and posterior tibial veins and the fibular vein drain the leg; the posterior
tibial veins becomes the popliteal vein at the knee and then the femoral vein in the thigh; the femoral
vein becomes the external iliac vein as it enters the pelvis.
 Great saphenous veins. The great saphenous veins are the longest veins in the body; they begin at
the dorsal venous arch in the foot and travel up the medial aspect of the leg to empty into the femoral
vein in the thigh.
 Common iliac vein. Each common iliac vein is formed by the union of the external iliac vein and the
internal iliac vein which drains the pelvis.
 Gonadal vein. The right gonadal vein drains the right ovary in females and the right testicles in males;
the left gonadal veins empties into the left renal veins superiorly.
 Renal veins. The right and left renal veins drain the kidneys.
 Hepatic portal vein. The hepatic portal vein is a single vein that drains the digestive tract organs and
carries this blood through the liver before it enters the systemic circulation.
 Hepatic veins. The hepatic veins drain the liver.

Physiology of the Heart

As the heart beats or contracts, the blood makes continuous round trips- into and out of the heart, through the
rest of the body, and then back to the heart- only to be sent out again.

Intrinsic Conduction System of the Heart

The spontaneous contractions of the cardiac muscle cells occurs in a regular and continuous way, giving rhythm
to the heart.
 Cardiovascular System Anatomy and Physiology 12

 Cardiac muscle cells. Cardiac muscle cells can and do contract spontaneously and independently, even
if all nervous connections are severed.
 Rhythms. Although cardiac muscles can beat independently, the muscle cells in the different areas of the
heart have different rhythms.
 Intrinsic conduction system. The intrinsic conduction system, or the nodal system, that is built into the
heart tissue sets the basic rhythm.
 Composition. The intrinsic conduction system is composed of a special tissue found nowhere else in the
body; it is much like a cross between a muscle and nervous tissue.
 Function. This system causes heart muscle depolarization in only one direction- from the atria to the
ventricles; it enforces a contraction rate of approximately 75 beats per minute on the heart, thus the heart
beats as a coordinated unit.
 Cardiovascular System Anatomy and Physiology 13

 Sinoatrial (SA) node. The SA node has the highest rate of depolarization in the whole system, so it
can start the beat and set the pace for the whole heart; thus the term “pacemaker“.
 Atrial contraction. From the SA node, the impulse spread through the atria to the AV node, and then the
atria contract.
 Ventricular contraction. It then passes through the AV bundle, the bundle branches, and the Purkinje
fibers, resulting in a “wringing” contraction of the ventricles that begins at the heart apex and moves
toward the atria.
 Ejection. This contraction effectively ejects blood superiorly into the large arteries leaving the heart.

The Pathway of the Conduction System

The conduction system occurs systematically through:

 SA node. The depolarization wave is initiated by the sinoatrial node.

 Atrial myocardium. The wave then successively passes through the atrial myocardium.
 Atrioventricular node. The depolarization wave then spreads to the AV node, and then the atria
contract.
 AV bundle. It then passes rapidly through the AV bundle.
 Bundle branches and Purkinje fibers. The wave then continues on through the right and left bundle
branches, and then to the Purkinje fibers in the ventricular walls, resulting in a contraction that ejects
blood, leaving the heart.

Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to relax, contraction of the ventricles
begin.

 Systole. Systole means heart contraction.

 Diastole. Diastole means heart relaxation.
 Cardiac cycle. The term cardiac cycle refers to the events of one complete heart beat, during which both
atria and ventricles contract and then relax.
 Length. The average heart beats approximately 75 times per minute, so the length of the cardiac cycle is
normally about 0.8 second.
 Mid-to-late diastole. The cycle starts with the heart in complete relaxation; the pressure in the heart is
low, and blood is flowing passively into and through the atria into the ventricles from the pulmonary and
systemic circulations; the semilunar valves are closed, and the AV valves are open; then the atria
contract and force the blood remaining in their chambers into the ventricles.
 Ventricular systole. Shortly after, the ventricular contraction begins, and the pressure within the
ventricles increases rapidly, closing the AV valves; when the intraventricular pressure is higher than
the pressure in the large arteries leaving the heart, the semilunar valves are forced open, and blood rushes
through them out of the ventricles; the atria are relaxed, and their chambers are again filling with blood.
 Early diastole. At the end of systole, the ventricles relax, the semilunar valves snap shut, and for a
moment the ventricles are completely closed chambers; the intraventricular pressure drops and the AV
valves are forced open; the ventricles again begin refilling rapidly with blood, completing the cycle.
 First heart sound. The first heart sound, “lub”, is caused by the closing of the AV valves.
 Second heart sound. The second heart sound, “dub”, occurs when the semilunar valves close at the end
of systole.
 Cardiovascular System Anatomy and Physiology 14

Cardiac Output

Cardiac output is the amount of blood pumped out by each side of the heart in one minute. It is the product of
the heart rate and the stroke volume.

 Stroke volume. Stroke volume is the volume of blood pumped out by a ventricle with each heartbeat.
 Regulation of stroke volume. According to Starling’s law of the heart, the critical factor
controlling stroke volume is how much the cardiac muscle cells are stretched just before they contract;
the more they are stretched, the stronger the contraction will be; and anything that increases the volume
or speed of venous return also increases stroke volume and force of contraction.
 Factors modifying basic heart rate.The most important external influence on heart rate is the activity
of the autonomic nervous system, as well as physical factors (age, gender, exercise, and body
temperature).

Physiology of Circulation

A fairly good indication of the efficiency of a person’s circulatory system can be obtained by taking arterial
blood and blood pressure measurements.

Cardiovascular Vital Signs

Arterial pulse pressure and blood pressure measurements, along with those of respiratory rate and body
temperature, are referred to collectively as vital signs in clinical settings.

 Arterial pulse. The alternating expansion and recoil of an artery that occurs with each beat of the left
ventricle creates a pressure wave-a pulse- that travels through the entire arterial system.
 Normal pulse rate. Normally, the pulse rate (pressure surges per minute) equals the heart rate, so the
pulse averages 70 to 76 beats per minute in a normal resting person.
 Pressure points. There are several clinically important arterial pulse points, and these are the same
points that are compressed to stop blood flow into distal tissues during hemorrhage, referred to as
pressure points.
 Blood pressure. Blood pressure is the pressure the blood exerts against the inner walls of the blood
vessels, and it is the force that keeps blood circulating continuously even between heartbeats.
 Blood pressure gradient. The pressure is highest in the large arteries and continues to drop throughout
the systemic and pulmonary pathways, reaching either zero or negative pressure at the venae cavae.
 Measuring blood pressure. Because the heart alternately contracts and relaxes, the off-and-on flow of
the blood into the arteries causes the blood pressure to rise and fall during each beat, thus, two arterial
blood pressure measurements are usually made: systolic pressure (the pressure in the arteries at the peak
of ventricular contraction) and diastolic pressure (the pressure when the ventricles are relaxing).
 Peripheral resistance. Peripheral resistance is the amount of friction the blood encounters as it flows
through the blood vessels.
 Neural factors. The parasympathetic division of the autonomic nervous system has little or no effect on
blood pressure, but the sympathetic division has the major action of causing vasoconstriction or
narrowing of the blood vessels, which increases blood pressure.
 Renal factors. The kidneys play a major role in regulating arterial blood pressure by altering blood
volume, so when blood pressure increases beyond normal, the kidneys allow more water to leave the
body in the urine, then blood volume decreases which in turn decreases blood pressure.
 Cardiovascular System Anatomy and Physiology 15

 Temperature. In general, cold has a vasoconstricting effect, while heat has a vasodilating effect.
 Chemicals. Epinephrine increases both heart rate and blood pressure; nicotine increases blood pressure
by causing vasoconstriction; alcohol and histamine cause vasodilation and decreased blood pressure.
 Diet. Although medical opinions tend to change and are at odds from time to time, it is generally
believed that a diet low in salt, saturated fats, and cholesterol help to prevent hypertension, or high
blood pressure.

Blood Circulation Through the Heart

The right and left sides of the heart work together in achieving a smooth flowing blood circulation.
 Cardiovascular System Anatomy and Physiology 16

 Entrance to the heart. Blood enters the heart through two large veins, the inferior and superior vena
cava, emptying oxygen-poor blood from the body into the right atrium of the heart.
 Atrial contraction. As the atrium contracts, blood flows from the right atrium to the right ventricle
through the open tricuspid valve.
 Closure of the tricuspid valve. When the ventricle is full, the tricuspid valve shuts to prevent blood
from flowing backward into the atria while the ventricle contracts.
 Ventricle contraction. As the ventricle contracts, blood leaves the heart through the pulmonic valve,
into the pulmonary artery and to the lungs where it is oxygenated.
 Oxygen-rich blood circulates. The pulmonary vein empties oxygen-rich blood from the lungs into
the left atrium of the heart.
 Opening of the mitral valve. As the atrium contracts, blood flows from your left atrium into your left
ventricle through the open mitral valve.
 Prevention of backflow. When the ventricle is full, the mitral valve shuts. This prevents blood from
flowing backward into the atrium while the ventricle contracts.
 Blood flow to systemic circulation. As the ventricle contracts, blood leaves the heart through the aortic
valve, into the aorta and to the body.

Capillary Exchange of Gases and Nutrients

Substances tend to move to and from the body cells according to their concentration gradients.

 Capillary network. Capillaries form an intricate network among the body’s cells such that no substance
has to diffuse very far to enter or leave a cell.
 Routes. Basically, substances leaving or entering the blood may take one of four routes across the
plasma membranes of the single layer of endothelial cells forming the capillary wall.
 Lipid-soluble substances. As with all cells, substances can diffuse directly through their plasma
membranes if the substances are lipid-soluble.
 Lipid-insoluble substances. Certain lipid-insoluble substances may enter or leave the blood and/or pass
through the plasma membranes within vesicles, that is, by endocytosis or exocytosis.
 Intercellular clefts. Limited passage of fluid and small solutes is allowed by intercellular clefts (gaps or
areas of plasma membrane not joined by tight junctions), so most of our capillaries have intercellular
clefts.
 Fenestrated capillaries. Very free passage of small solutes and fluid is allowed by fenestrated
capillaries, and these unique capillaries are found where absorption is a priority or
where filtration occurs.
 Cardiovascular System Anatomy and Physiology 17

PRACTICE QUIZ

1. Specialized cell membrane structures that decrease electrical resistance between the cells
allowing action potentials to pass efficiently from one cell to adjacent cells are the:

A. Extensive capillary network

B. Intercalated disks
C. Mitochondria
D. Gap junctions

1. Answer: D. Gap junctions

D: Gap junctions are a specialized intercellular connection between a multitude of animal cell-types.
They directly connect the cytoplasm of two cells, which allows various molecules, ions and electrical
impulses to directly pass through a regulated gate between cells.
A: Extensive capillary networks allows abundant supply of oxygen and nutrients on tissues such as
skeletal muscle, liver, and kidney.
B: Intercalated disks support synchronized contraction of cardiac tissue. They occur at the Z-line of the
sarcomere and can be visualized easily when observing a longitudinal section of the tissue.
C: Mitochondrion is an organelle found in large numbers in most cells, in which the biochemical
processes of respiration and energy production occur.

2. Complete the diagram so that it will show the correct route of blood in the heart.
 Cardiovascular System Anatomy and Physiology 18

A. (1) Tricuspid Valve, (2) Aortic Valve, (3) Pulmonary Circulation, (4) Mitral Valve, (5) Pulmonic
Valve
B. (1) Mitral Valve, (2) Pulmonic Valve, (3) Pulmonary Circulation, (4) Tricuspid Valve, (5) Aortic
Valve
C. (1) Mitral Valve, (2) Aortic Valve, (3) Pulmonary Circulation, (4) Tricuspid Valve, (5) Pulmonic
Valve
D. (1) Tricuspid Valve, (2) Pulmonic Valve, (3) Pulmonary Circulation, (4) Mitral Valve, (5) Aortic
Valve

2. Answer: D. (1) Tricuspid Valve, (2) Pulmonic Valve, (3) Pulmonary Circulation, (4) Mitral
Valve, (5) Aortic Valve

Blood enters the heart through two large veins, the inferior and superior vena cava, emptying oxygen-
poor blood from the body into the right atrium. As the atrium contracts, blood flows from your right
atrium into your right ventricle through the open tricuspid valve. When the ventricle is full, the tricuspid
valve shuts. This prevents blood from flowing backward into the right atrium while the ventricle
contracts. As the ventricle contracts, blood leaves the heart through the pulmonic valve, into the
pulmonary artery and to the lungs, where it is oxygenated. The oxygenated blood then returns to the
heart through the pulmonary veins. The pulmonary veins empty oxygen-rich blood from the lungs into
the left atrium. As the atrium contracts, blood flows from your left atrium into your left ventricle
through the open mitral valve. When the ventricle is full, the mitral valve shuts. This prevents blood
from flowing backward into the atrium while the ventricle contracts. As the ventricle contracts, blood
leaves the heart through the aortic valve, into the aorta, and to the body.

3. It is considered as the bluntly rounded portion of the heart

A. Aorta
B. Apex
C. Base
D. Pericardium

3. Answer: B. Apex

B: The blunt, rounded point of the heart is the apex.

A: The aorta is the largest artery that carries blood from the left ventricle to the body.
C: The larger, flat portion at the opposite is the base.
D. The pericardium is also called the pericardial sac. It has a fibrous outer layer and a thin inner layer
that surrounds the heart.

4. Which event will NOT occur during depolarization phase?

A. Na+ channels open

B. Ca+ channels open
 Cardiovascular System Anatomy and Physiology 19

C. K+ channels open
D. None of the above

4. Answer: C. K+ channels open

Na+ channels open, increasing the permeability of the cell membrane to Na+. Sodium ions then diffuse
into the cell, causing depolarization. This causes K+ channels to close quickly, decreasing the
permeability of the cell membrane to K+. The decreased diffusion of K+ out of the cell also causes
depolarization. Ca2+ channels slowly open, increasing the permeability of cell membrane to
Ca2+. Calcium ions then diffuse into the cell and cause depolarization.

5. Which of these statements regarding the conduction system of the heart is TRUE?

A. The sinoatrial (SA) node of the heart acts as the pacemaker.

B. The SA node is located on the upper wall of the left atrium.
C. The AV node conducts action potentials rapidly through it.
D. Action potentials are carried slowly through the atrioventricular bundle.

5. Answer: A. The sinoatrial (SA) node of the heart acts as the pacemaker.

A: The SA node is the heart’s natural pacemaker.

B: The SA node consists of a cluster of cells that are situated in the upper part of the wall of the right
atrium (the right upper chamber of the heart).
C: When action potentials reach the AV node, they spread slowly through it.
D: Action potentials pass slowly through the atrioventricular node.

6. In a normal electrocardiogram (ECG or EKG),

A. The P wave results from repolarization of the atria.

B. The QRS complex results from depolarization of the ventricles.
C. The T wave represents repolarization of the auricles.
D. During the P-R interval, the ventricle contract.

6. Answer: B. The QRS complex results from depolarization of the ventricles.

B: The QRS complex consists of three individual waves: the Q, R, and S waves. The QRS complex
results from depolarization of the ventricles, and the beginning of the QRS complex precedes ventricular
contraction.
A: The P wave results from depolarization of the atrial myocardium, and the beginning of the P wave
precedes the onset of atrial contraction.
C: The T wave represents the repolarization of the ventricles, and the beginning of the T wave precedes
 Cardiovascular System Anatomy and Physiology 20

ventricular relaxation.
D: During the P-R interval, the atria contract and begin to relax.

7. During the Ventricular Systole, atrioventricular valves open, semilunar valves close. The
statement is:

A. True
B. False
C. Partially true
D. Partially false

7. Answer: B. False

During ventricular systole, contraction of the ventricles causes pressure in the ventricle to increase.
Almost immediately the AV valves close (the first heart sound). The pressure in the ventricle continues
to increase. Continued ventricular contraction causes the pressure in the ventricle to exceed in the
pulmonary trunk and aorta. As a result, the semilunar are forced open and blood is ejected into the
pulmonary trunk and aorta.

8. This sound is produced during the closure of the semilunar valves.

A. lubb
B. dupp
C. lubb dupp
D. lubb duppshhh

8. Answer: B. dupp

B: The second heart sound can be represented by dupp. It occurs at the beginning of ventricular diastole
and results from closure of the semilunar valves.
A: The first heart sound can be represented by the syllable lubb. It occurs at the beginning of ventricular
systole and results from closure of the AV valves.

9. Which of these statements correctly applies to intrinsic regulation of the heart?

A. Starling’s law of the heart has a major influence on cardiac output.

B. As venous return increases, cardiac output decreases.
C. In response to stretch, cardiac muscle fibers contract with less force.
D. In response to stretch, there is a slight decrease in heart rate.

9. Answer: A. Starling’s law of the heart has a major influence on cardiac output.
 Cardiovascular System Anatomy and Physiology 21

A: The relationship between preload and stroke volume is called Starling’s law of the heart.
B: As venous return increased, resulting in an increased preload, cardiac output increases.
C: In response to increased preload, cardiac muscle fibers contract with greater force.
D: In response to stretch, there is a slight increase in heart rate.

10. Repolarization of the ventricles is shown as the __________ on an ECG or EKG.

A. P wave
B. P-Q or P-R interval
C. QRS complex
D. Q-T interval
E. T wave

10. Answer: E. T wave

E: The T wave represents the repolarization of the ventricles, and the beginning of the T wave precedes
ventricular relaxation.
A: The P wave results from depolarization of the atrial myocardium, and the beginning of the P wave
precedes the onset of atrial contraction.
B: The time between the beginning of the P wave and the beginning of the QRS complex is the PQ
interval, commonly called the PR interval because the Q wave is very small. During the PR interval, the
atria contract and begin to relax.
C: The QRS complex consists of three individual waves: the Q, R, and S waves. The QRS complex
results from depolarization of the ventricles, and the beginning of the QRS complex precedes ventricular
contraction.
D: The QT interval extends from the beginning of the QRS complex to the end of the T wave and
represents the length of time required for ventricular depolarization and repolarization.