SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 18.1 Using Figure 18.1, match the following: 1) Purkinje fibers.

1)

Answer: E
Diff: 1

Page Ref: 677; Fig. 18.14

2) SA node. Answer: A
Diff: 1 Page Ref: 677; Fig. 18.14

2)

3) AV bundle. Answer: C
Diff: 1 Page Ref: 677; Fig. 18.14

3)

4) AV node. Answer: B
Diff: 1 Page Ref: 677; Fig. 18.14

4)

5) Bundle branches. Answer: D

Diff: 1 Page Ref: 677; Fig. 18.14

5)

Figure 18.2 Using Figure 18.2, match the following: 6) Atrial depolarization.

6)

Answer: A
Diff: 1

Page Ref: 679; Fig. 18.16

7) Point after which pressure begins to rise in the aorta. Answer: D

Diff: 2 Page Ref: 679; Fig. 18.16

7)

8) Ventricular repolarization. Answer: E

Diff: 2 Page Ref: 679; Fig. 18.16

8)

9) Point that represents the "dup" sound made by the heart. Answer: E
Diff: 3 Page Ref: 679; Fig. 18.16

9)

Figure 18.3 Using Figure 18.3, match the following: 10) Ventricular fibrillation.

10)

Answer: D
Diff: 2

Page Ref: 681; Fig. 18.18

11) Second-degree heart block. Answer: C

Diff: 3 Page Ref: 681; Fig. 18.18

11)

12) Junctional rhythm. Answer: B

Diff: 3 Page Ref: 681; Fig. 18.18

12)

13) Normal sinus rhythm. Answer: A

Diff: 3 Page Ref: 681; Fig. 18.18

13)

MATCHING. Choose the item in column 2 that best matches each item in column 1. Match the following: 14) The inner lining of the heart. Answer: C
Diff: 1 Page Ref: 664

A) Epicardium B) Myocardium C) Endocardium D) Parietal layer

14)

15) Heart muscle. Answer: B

Diff: 1 Page Ref: 663

15)

16) Serous layer covering the heart muscle. Answer: A

Diff: 1 Page Ref: 663

16)

17) The outermost layer of the serous pericardium. Answer: D

Diff: 2 Page Ref: 663

17)

Match the following: 18) The pacemaker of the heart. Answer: A

Diff: 1 Page Ref: 677; Fig. 18.14

A) SA node B) AV node C) AV bundle D) Purkinje fibers

18)

19) Found in the interventricular septum. Answer: C

Diff: 1 Page Ref: 677

19)

20) Network found in the ventricular myocardium. Answer: D

Diff: 2 Page Ref: 677

20)

21) The point in the conduction system of the heart where the impulse is temporarily delayed. Answer: B
Diff: 2 Page Ref: 677

21)

Match the following: 22) Prevents backflow into the left ventricle. Answer: D
Diff: 1 Page Ref: 670

A) Tricuspid valve B) Mitral valve C) Pulmonary valves D) Aortic valve

22)

23) Prevents backflow into the right atrium. Answer: A

Diff: 1 Page Ref: 670

23)

24) Prevents backflow into the left atrium. Answer: B

Diff: 1 Page Ref: 670

24)

25) Prevents backflow into the right ventricle. Answer: C

Diff: 1 Page Ref: 670

25)

26) AV valve with two flaps. Answer: B

Diff: 1 Page Ref: 670

26)

27) AV valve with three flaps. Answer: A

Diff: 1 Page Ref: 670

27)

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 18.4 Using Figure 18.4, match the following: 28) Tricuspid valve.

28)

Answer: B
Diff: 1

Page Ref: 667; Fig. 18.4e

29) Mitral valve. Answer: D

Diff: 1 Page Ref: 667; Fig. 18.4e

29)

30) Right atrium. Answer: A

Diff: 1 Page Ref: 667; Fig. 18.4e

30)

31) Left ventricle. Answer: E

Diff: 1 Page Ref: 667; Fig. 18.4e

31)

32) Pulmonary veins. Answer: C

Diff: 1 Page Ref: 667; Fig. 18.4e

32)

MATCHING. Choose the item in column 2 that best matches each item in column 1. Match the following: 33) Heart muscle is deprived of oxygen. Answer: A
Diff: 1 Page Ref: 675

A) Ischemia B) Fibrillation C) Infarction D) Ectopic focus E) Quiescent period

33)

34) Death of heart muscle cells. Answer: C

Diff: 1 Page Ref: 670

34)

35) A condition of rapid and irregular or out-of-phase contraction of heart muscle cells. Answer: B
Diff: 1 Page Ref: 678

35)

36) An abnormal pacemaker. Answer: D

Diff: 1 Page Ref: 679

36)

37) Total heart relaxation. Answer: E

Diff: 1 Page Ref: 682

37)

TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false. 38) The myocardium receives its blood supply from the coronary arteries. Answer:
Diff: 1 Page Ref: 670

38)

True

False

39) Cardiac muscle has more mitochondria and depends less on a continual supply of oxygen than does skeletal muscle. Answer:
Diff: 1 Page Ref: 673

39)

True

False

40) Anastomoses among coronary arterial branches provide collateral routes for blood delivery to the heart muscle. Answer:
Diff: 2 Page Ref: 669

40)

True

False

41) Congestive heart failure means that the pumping efficiency of the heart is depressed so that there is inadequate delivery of blood to body tissues. Answer:
Diff: 1 Page Ref: 687

41)

True

False

42) Tissues damaged by myocardial infarction are replaced by connective tissue. Answer:
Diff: 1 Page Ref: 670, 687

42)

True

False

43) The left side of the heart pumps the same volume of blood as the right. Answer:
Diff: 1 Page Ref: 668

43)

True

False

44) Chronic release of excess thyroxine can cause a sustained increase in heart rate and a weakened heart. Answer:
Diff: 1 Page Ref: 686

44)

True

False

45) Arterial blood supply to heart muscle is continuous whether the heart is in systole or diastole. Answer:
Diff: 2 Page Ref: 669-670

45)

True

False

46) Trabeculae carneae are found in the ventricles and never the atria. Answer:
Diff: 1 Page Ref: 668

46)

True

False

47) The "lub" sounds of the heart are valuable in diagnosis because they provide information about the function of the heart's pulmonary and aortic valves. Answer:
Diff: 2 Page Ref: 681

47)

True

False

48) Autonomic regulation of heart rate is via two reflex centers found in the pons. Answer:
Diff: 2 Page Ref: 685

48)

True

False

49) The papillary muscles contract after the other ventricular muscles so that they can take up the slack on the chordae tendineae before the full force of ventricular contractions sends blood against the AV valve flaps. Answer:
Diff: 2 Page Ref: 670

49)

True

False

50) An ECG provides direct information about valve function. Answer:

Diff: 3 Page Ref: 679

50)

True

False

51) As pressure in the aorta rises due to atherosclerosis, more ventricular pressure is required to open the aortic valve. Answer:
Diff: 3 Page Ref: 687

51)

True

False

52) Proxysmal atrial tachycardia is characterized by bursts of atrial contractions with little pause between them. Answer:
Diff: 2 Page Ref: 690

52)

True

False

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 53) Normal heart sounds are caused by which of the following events? A) excitation of the SA node B) opening and closing of the heart valves C) closure of the heart valves D) friction of blood against the chamber walls Answer: C
Diff: 1 Page Ref: 681

53)

54) Which of the events below does not occur when the semilunar valves are open? A) AV valves are closed. B) Blood enters pulmonary arteries and the aorta. C) Ventricles are in diastole. D) Ventricles are in systole. Answer: C
Diff: 2 Page Ref: 670

54)

55) Hemorrhage with a large loss of blood causes ________. A) no change in blood pressure but a slower heart rate B) a lowering of blood pressure due to change in cardiac output C) no change in blood pressure but a change in respiration D) a rise in blood pressure due to change in cardiac output Answer: B
Diff: 1 Page Ref: 682-684

55)

56) The left ventricular wall of the heart is thicker than the right wall in order to ________. A) pump blood through a smaller valve B) pump blood with greater pressure C) expand the thoracic cage during diastole D) accommodate a greater volume of blood Answer: B
Diff: 2 Page Ref: 668

56)

57) Damage to the ________ is referred to as heart block. A) AV node B) SA node C) AV bundle Answer: A
Diff: 1 Page Ref: 679

D) AV valves

57)

58) The P wave of a normal electrocardiogram indicates ________. A) atrial repolarization B) ventricular repolarization C) ventricular depolarization D) atrial depolarization Answer: D
Diff: 1 Page Ref: 679

58)

59) Blood within the pulmonary veins returns to the ________. A) right ventricle B) left ventricle C) right atrium Answer: D
Diff: 1 Page Ref: 668

D) left atrium

59)

60) Small muscle masses attached to the chordae tendineae are the ________. A) trabeculae carneae B) papillary muscles C) venae cavae D) pectinate muscles Answer: B
Diff: 1 Page Ref: 670

60)

61) The term for pain associated with deficient blood delivery to the heart that may be caused by the transient spasm of coronary arteries is ________. A) angina pectoris B) myocardial infarct C) pericarditis D) ischemia Answer: A
Diff: 1 Page Ref: 670

61)

62) To auscultate the aortic semilunar valve, you would place your stethoscope in the ________. A) second intercostal space to the left of the sternum B) fifth intercostal space inferior to the left nipple C) second intercostal space to the right of the sternum D) fifth right intercostal space Answer: C
Diff: 1 Page Ref: 681; Fig. 18.19

62)

63) The source of blood carried to capillaries in the myocardium would be the ________. A) fossa ovalis B) coronary veins C) coronary arteries D) coronary sinus Answer: C
Diff: 1 Page Ref: 669

63)

64) The fact that the left ventricle of the heart is thicker than the right ventricle reveals that it ________. A) expands the thoracic cage B) pumps a greater volume of blood C) sends blood through a smaller valve D) pumps blood against a greater resistance Answer: D
Diff: 1 Page Ref: 668

64)

65) Which of the following factors does not influence heart rate? A) skin color B) body temperature C) gender D) age Answer: A
Diff: 1 Page Ref: 685-687

65)

66) Which of the following is not an age-related change affecting the heart? A) fibrosis of cardiac muscle B) decline in cardiac reserve C) thinning of the valve flaps D) atherosclerosis Answer: C
Diff: 2 Page Ref: 686-687

66)

10

67) If cardiac muscle is deprived of its normal blood supply, damage would primarily result from ________. A) an inadequate supply of lactic acid B) a decrease in the number of available mitochondria for energy production C) decreased delivery of oxygen D) a lack of nutrients to feed into metabolic pathways Answer: C
Diff: 1 Page Ref: 675

67)

68) If the length of the absolute refractory period in cardiac muscle cells was the same as it is for skeletal muscle cells ________. A) tetanic contractions might occur, which would stop the heart's pumping action B) contractions would last as long as the refractory period C) it would be much longer before cardiac cells could respond to a second stimulation D) it would be less than 1 2 ms Answer: A
Diff: 2 Page Ref: 673

68)

69) Norepinephrine acts on the heart by ________. A) decreasing heart contractility B) causing a decrease in stroke volume C) causing threshold to be reached more quickly D) blocking the action of calcium Answer: C
Diff: 2 Page Ref: 685-686

69)

70) If the vagal nerves to the heart were cut, the result would be that ________. A) the AV node would become the pacemaker of the heart B) the heart rate would increase by about 25 beats per minute C) the heart would stop, since the vagal nerves trigger the heart to contract D) parasympathetic stimulation would increase, causing a decrease in heart rate Answer: B
Diff: 2 Page Ref: 686

70)

71) Foramen ovale ________. A) is a connection between the pulmonary trunk and the aorta in the fetus B) is a shallow depression in the interventricular septum C) connects the two atria in the fetal heart D) is a condition in which the heart valves do not completely close Answer: C
Diff: 1 Page Ref: 688

71)

72) Which vessel of the heart receives blood during right ventricular systole? A) aorta B) pulmonary veins C) pulmonary trunk D) venae cavae Answer: C
Diff: 1 Page Ref: 668, 682

72)

11

73) Which of these vessels receives blood during ventricular systole? A) aorta only B) both the aorta and pulmonary trunk C) pulmonary veins only D) pulmonary arteries only Answer: B
Diff: 1 Page Ref: 682

73)

74) Which of the following is not part of the conduction system of the heart? A) bundle of His B) AV node C) AV valve Answer: C
Diff: 1 Page Ref: 677; Fig. 18.14

D) SA node

74)

75) The tricuspid valve is closed ________. A) while the atrium is contracting B) by the movement of blood from atrium to ventricle C) when the ventricle is in systole D) while the ventricle is in diastole Answer: C
Diff: 2 Page Ref: 682; Fig. 18.20

75)

76) When viewing a dissected heart, it is easy to visually discern the right and left ventricles by ________. A) noticing the thickness of the ventricle walls B) tracing out where the auricles connect C) finding the papillary muscles D) locating the apex Answer: A
Diff: 1 Page Ref: 668

76)

77) Select the correct statement about the heart valves. A) The AV valves are supported by chordae tendineae so that regurgitation of blood into the atria during ventricular contraction does not occur. B) The tricuspid valve divides the left atrium from the left ventricle. C) The mitral valve separates the right atrium from the right ventricle. D) Aortic and pulmonary valves control the flow of blood into the heart. Answer: A
Diff: 2 Page Ref: 670

77)

78) Select the correct statement about the function of myocardial cells. A) The refractory period in skeletal muscle is much longer than that in cardiac muscle. B) Each cardiac muscle cell is innervated by a sympathetic nerve ending so that the nervous system can increase heart rate. C) The influx of potassium ions from extracellular sources is the initiating event in cardiac muscle contraction. D) The entire heart contracts as a unit or it does not contract at all. Answer: D
Diff: 3 Page Ref: 673-675

78)

12

79) Select the correct statement about the structure of the heart wall. A) The fibrous skeleton forms the bulk of the heart. B) The myocardium is the layer of the heart that actually contracts. C) The heart chambers are lined by the endomysium. D) Connective tissue in the heart wall aids in the conduction of the action potential. Answer: B
Diff: 2 Page Ref: 663-664

79)

80) Compared to skeletal muscle, cardiac muscle ________. A) has gap junctions that allow it to act as a functional syncytium B) lacks striations C) cells are larger than skeletal muscle cells D) has more nuclei per cell Answer: A
Diff: 2 Page Ref: 672-673

80)

81) During the period of ventricular filling ________. A) it is represented by the P wave on the ECG B) pressure in the heart is at its peak C) the atria remain in diastole D) blood flows passively through the atria and the open AV valves into the ventricles Answer: D
Diff: 2 Page Ref: 682

81)

82) The second heart sound is heard during which phase of the cardiac cycle? A) isovolumetric relaxation B) isovolumetric contraction C) ventricular filling D) ventricular ejection Answer: A
Diff: 3 Page Ref: 682; Fig. 18.20

82)

83) The time of day most hazardous for heart attacks is ________. A) morning B) noontime C) evening Answer: A
Diff: 3 Page Ref: 685-686

D) during sleep

83)

84) If we were able to artificially alter the membrane permeability of pacemaker cells so that sodium influx is more rapid, ________. A) heart rate would decrease, but blood pressure would rise due to the excess sodium present B) threshold is reached more quickly and heart rate would increase C) potassium channels compensate and no change in heart rate would occur D) tetanic contraction would occur due to the short absolute refractory period of cardiac muscle Answer: B
Diff: 3 Page Ref: 676-677

84)

13

85) Select the correct statement about cardiac output. A) A slow heart rate increases end diastolic volume, stroke volume, and force of contraction. B) If a semilunar valve were partially obstructed, the end systolic volume in the affected ventricle would be decreased. C) Decreased venous return will result in increased end diastolic volume. D) Stroke volume increases if end diastolic volume decreases. Answer: A
Diff: 3 Page Ref: 682-684

85)

86) During contraction of heart muscle cells ________. A) the action potential is prevented from spreading from cell to cell by gap junctions B) the action potential is initiated by voltage-gated slow calcium channels C) calcium is prevented from entering cardiac fibers that have been stimulated D) some calcium enters the cell from the extracellular space and triggers the release of larger amounts of calcium from intracellular stores Answer: D
Diff: 2 Page Ref: 673-675

86)

87) Isovolumetric contraction ________. A) occurs only in people with heart valve defects B) occurs immediately after the aortic and pulmonary valves close C) refers to the short period during ventricular systole when the ventricles are completely closed chambers D) occurs while the AV valves are open Answer: C
Diff: 3 Page Ref: 682; Fig. 18.20

87)

88) Commotio cordis is heart failure due to a ________. A) severe electrical shock to the body B) loss of blood from an artery C) relatively mild blow to the chest that occurs during a vulnerable interval (2 ms) when the heart is repolarizing D) mild electrical shock to the heart itself Answer: C
Diff: 3 Page Ref: 690

88)

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question. 89) The enlarged coronary vessel outside the heart that empties blood into the right atrium is the ________. Answer: coronary sinus
Diff: 1 Page Ref: 669

89)

90) What structure in the fetal heart allows blood to flow from the right atrium directly to the left atrium? Answer: foramen ovale
Diff: 1 Page Ref: 688

90)

14

91) The ECG T wave interval represents ________. Answer: ventricular repolarization
Diff: 1 Page Ref: 679; Fig. 18.16

91)

92) CO = ________ SV. Answer: HR or heart rate

Diff: 1 Page Ref: 683

92)

93) The ________ membrane covers the heart. Answer: visceral layer of the serous pericardium
Diff: 1 Page Ref: 663

93)

94) The ________ valve of the heart has three valves with chordae tendineae. Answer: tricuspid
Diff: 1 Page Ref: 670

94)

95) The ________ and ________ valves of the heart have no chordae tendineae attached. Answer: aortic; pulmonary
Diff: 1 Page Ref: 670; Fig. 18.9

95)

96) Define systole and diastole. Which heart chambers are usually referenced when these terms are used? Answer: Systole is contraction of the muscle. Diastole is relaxation of the muscle. The contraction and relaxation of the ventricles are normally described with the terms systole and diastole.
Diff: 1 Page Ref: 682

96)

97) Define the terms end diastolic volume (EDV) and end systolic volume (ESV) and relate them to the calculation of stroke volume. Answer: EDV is the amount of blood that collects in a ventricle during diastole. ESV is the volume of blood remaining in a ventricle after it has contracted. Stroke volume (ml/beat) equals EDV - ESV.
Diff: 1 Page Ref: 684

97)

98) What is the difference between the auricles and the atria? Answer: Auricles are the flaplike appendages attached to the atria that increase the atrial volume. The atria are receiving chambers for blood returning to the heart from the pulmonary and systemic circulation.
Diff: 1 Page Ref: 664

98)

99) The heart is called a "double pump" because there are two functionally separate circulations. Trace the pathway of each of these circulations and include the following information: heart chambers involved, major blood vessels involved, and general areas through which the blood flows. Begin with the right atrium. Answer: Right atrium to right ventricle to pulmonary arteries to lungs (pulmonary circuit pump); pulmonary veins to left atrium to left ventricle to aorta to body tissues to venae cavae (systemic circuit pump).
Diff: 2 Page Ref: 668-670

99)

15

100) What two important functions does the cardiac conduction system perform? Answer: The important functions of the cardiac conduction system are to initiate impulses (pacemaker) and to distribute impulses throughout the heart so that it depolarizes and contracts in an orderly, sequential manner.
Diff: 2 Page Ref: 676

100)

101) Explain autorhythmicity in cardiac muscle cells. Answer: Autorhythmic cells do not maintain a stable resting membrane potential. Instead, they have an unstable resting potential that continuously depolarizes, drifting toward threshold for firing. These spontaneously changing membrane potentials, called pacemaker potentials, initiate the action potentials that trigger the hearts rhythmic contractions.
Diff: 3 Page Ref: 676

101)

102) Why is oxygen so much more critical to the heart muscle than to skeletal muscles? Answer: Cardiac muscle cells are highly dependent on oxygen and rely almost exclusively on aerobic respiration. Thus, they cannot incur much oxygen debt. When there is a forced switch to anaerobic respiration, lactic acid and rising H + levels impair heart
Diff: 3

102)

function.

Page Ref: 675

103) What is the functional importance of the intercalated discs of cardiac muscle? What is the functional importance of the fibrous skeleton of the heart? Answer: Intercalated discs contain anchoring desmosomes that prevent cell separation, and gap junctions that allow ions to travel from cell to cell, transmitting current across the entire heart. The fibrous skeleton acts both as a tendon and an insertion, giving the cardiac cells something to pull or exert their force on.
Diff: 2 Page Ref: 673

103)

104) What is bradycardia? Answer: Bradycardia is a heart rate slower than 60 beats per minute.
Diff: 1 Page Ref: 687

104)

105) Why is fibrosis of the cardiac muscle serious? Answer: With fibrosis the heart muscle stiffens and is unable to fill the atria as it once did; therefore, less blood is pumped. Further, as the muscle stiffens it takes more energy to expel the bolus of blood from the heart, which will eventually weaken the heart.
Diff: 2 Page Ref: 689

105)

ESSAY. Write your answer in the space provided or on a separate sheet of paper. 106) A 14-year-old girl undergoing a physical examination prior to being admitted to summer camp was found to have a loud heart diastolic murmur at the second intercostal space to the left side of the sternum. Explain the reason for the loud heart murmur associated with this girl's condition. Answer: The heart murmur is due to incomplete closing of the pulmonary valve.
Diff: 2 Page Ref: 681

16

107) A man enters the hospital complaining of chest pain. His history includes smoking, a stressful job, a diet heavy in saturated fats, lack of exercise, and high blood pressure. Although he is not suffering from a heart attack, his doctor explains to him that a heart attack is quite possible. What did the chest pain indicate? Why is this man a prime candidate for a heart attack? Answer: His symptoms indicate angina pectoris, possibly due to either atherosclerosis or stress-induced spasms of the coronary arteries. If the arteries are occluded (atherosclerosis), the heart muscle could be deprived of blood, and therefore oxygen. A heart attack could occur if the coronary vessels experience further (or progressive) occlusion.
Diff: 3 Page Ref: 670

108) An older woman complains of shortness of breath and intermittent fainting spells. Her doctor runs various tests and finds that the AV node is not functioning properly. What is the suggested treatment? Answer: The suggested treatment is surgery to implant an artificial pacemaker.
Diff: 2 Page Ref: 678-679

109) An angiocardiogram was performed on an infant who had symptoms of breathlessness and it was found that he had a patent ductus arteriosus. Discuss the location and function of the ductus arteriosus in the fetus and relate it to the reason for the infant's breathlessness. Answer: The ductus arteriosus is a shunt between the pulmonary trunk and the aorta in the fetus, which normally closes at birth. Breathlessness is due to the mixing of oxygenated and deoxygenated blood because the connection between the aorta and the pulmonary trunk remains slightly open.
Diff: 2 Page Ref: 689

110) A patient takes a nitroglycerin tablet sublingually for chest pain. Nitroglycerin acts directly on smooth muscle, producing relaxation and vessel dilation. How would this relieve chest pain? Answer: Angina pectoris is thoracic pain caused by a fleeting deficiency in blood delivery to the myocardium, with resulting decreased oxygen being delivered to the cells. Because nitroglycerin acts as a vasodilator, blood flow is increased, promoting the delivery of oxygen to the cells.
Diff: 3 Page Ref: 670

111) A patient was admitted to the hospital with chest pains. On admission, his pulse was 110 and blood pressure was 96/64. According to his history, his normal pulse rate is usually between 80 and 88 and his blood pressure runs from 120/70 to 130/80. Explain why these changes in BP and HR occur. Answer: Increased heart rate (measured by taking his pulse) without maintaining his normal blood pressure is suggestive of reduced stroke volume. Both a drop in blood volume and a weakened heart could cause this, but the chest pains suggest heart damage. Failure of compensating mechanisms to maintain blood pressure suggest a serious decline in cardiac output.
Diff: 3 Page Ref: 682, 684

17

112) A 55-year-old male was admitted to the hospital with heart failure. He complains of increasing shortness of breath on exertion and needing to sleep on three pillows at night. On physical assessment, the nurse determines that his ankles and feet are very swollen. Which of these symptoms reflect left-sided heart failure and which reflect right-sided heart failure? Answer: Because the heart is a double pump, each side can initially fail independently of the other. If the left side fails, pulmonary congestion occurs. The right side of the heart continues to propel blood to the lungs, but the left side does not adequately eject the returning blood into the systemic circulation. Thus, blood vessels in the lungs become engorged with blood, pressure within them increases, and fluid leaks from the circulation into the lung tissue, causing pulmonary edema. Shortness of breath and difficulty breathing in a prone position may occur.
If the right side of the heart fails, peripheral congestion occurs. Blood stagnates within body organs, and pooled fluids in the tissue spaces impair the ability of body cells to obtain adequate nutrients and oxygen and to rid themselves of wastes. Edema is most noticeable in the extremities (feet, ankles, and fingers).
Page Ref: 687

Diff: 3

113) Asystole is the total absence of ventricular electrical activity. Explain why defibrillation would not be effective in this situation. Answer: Defibrillation is accomplished by electrically shocking the heart, which interrupts its chaotic twitching by depolarizing the entire myocardium. In this case, the ventricles are at a total standstill and defibrillation would not be effective.
Diff: 3 Page Ref: 678-679

114) A patient is prescribed a calcium channel blocker to prevent angina (chest pain), by decreasing the demand for oxygen. Explain why. Answer: By preventing the influx of calcium ions into myocardial and vascular smooth muscle cells, calcium channel blockers inhibit the intracellular release of additional stores of calcium ions. A drug that inhibits the release of intracellular calcium ions decreases the force of myocardial contractility, thereby decreasing the oxygen demand.
Diff: 3 Page Ref: 676, 687

18