Physio cycle 3 part 2
Physiology Cycle Quiz: Mastering Heart Mechanics
Test your knowledge of cardiovascular physiology with our comprehensive quiz focusing on heart mechanics and fun
Key Features:
- 85 detailed questions
- Multiple answer options
- Designed for students and professionals in healthcare
In the phase of ventricular ejection?
Av valves open
Av valves close producing the second heart sound
Atrial pressure is maximal
Ventricular pressure is lower than pressure in pulmonary trunk and aorta
Ventricular pressure exceeds the pressure in pulmonary trunk and aorta
Heart sound S2
Splitting during inspiration
Best heard in 2th intercostals space, on both sides of the sternum
Duration longer than S1
Frequency higher than S1
Isovoluemtric relaxation
Pressure in ventricle decrease
Pressure in ventricle increase
AV and seminular valves are opened
AV and seminular valves are closed
Which statements are right?
Duration of the QRS complex ranges from 0.06 to 0.1 sec
Q waves results from depolarization of intraventricular septum
R waves results from ventricular repolarization
QRS complex in the aVR is mainly positive because an electrode of this lead is located closer to the apex of heart
Which statements are right?
The musculature of ventricles is connected to musculature of atria only through bundle of his
Cardiac cycle is the sequence of electrical and mechanical events that repeats every heartbeat
EDV is observed in ventricles during isovolumetric relaxation
EDV is the volume of blood left in ventricles after systole
In unipolar chest leads
Lead V1 is located in the 4th intercostal space on right side of the sternum
Lead V5 is located in the 5th intercostal space in left midaxillary line
Lead V2 is located in the 2nd intercostal space on left side of the sternum
Lead V4 is located in the 5th intercostal space in left midclavicular line
The P wave
Represents repolarization of ventricles
Represent depolarization of atria
Is a positive deflection in leads I, II.
Is a negative deflection in lead aVR
Is a positive deflection in lead aVR
Which statements concerning auscultation are right?
Closure of mitral valve is best heard in the fifth left intercostal space, in midclavicular line
Opening of the mitral valve is best heard in the second right intercostal space, in midclavicular line
Closure of the aortic valve is best heard in the second right intercostal space at the sternal border
Pulmonic valve is best heard at the forth right intercostal space at the sternal border
Which statements concerning the influence of the vagus nerve on hearth are right?
Right vagus nerve innervates SA node
Left vagus nerve innervates left ventricle
Left vagus nerve innervates SA node
Ventricles of heart are not innervated by parasympathetic branches
In unipolar chest leads
Lead V1 is located in 5th intercostal space in left midclavicular line
Lead V5 is located in 5th intercostal space in left anterior anterior axillary line
Lead V2 is located in 2nd intercostal space on left side of the sternum
Lead V4 is located in 5th intercostal space in left midclavicular line
Which statements are related to preload phenomenon?
It controls cardiac output in response to changes of the venous return
SV is the clinical representation of preload
Frank Starling mechanism maintains an exact matching between the stroke volume and the venous return
It is related to the sarcomere length and the end of systole
Stretching of the sarcomere maximises the number of actin-myosin bridges responsible for development of force.
Cardiac contractility depends on various factors. Indicate the correct statement
Contractility is increased by thyroid gland hormones and glucocorticoids
Contractility is increased by hypoclacemia of the extracellular fluid
Contractility is decreased by caffeine and teophilin that inhibits the phosphodiestereases
Contractility is decreased by blockers of the B1-adrenergic receptors as well as blockers of the Ca2+ channel
Contractility is decreased by catecholamines and glucagon
Which statements are right?
Secondary waves of arterial pressure reflect changes of pressure in chest due to ventilation phase
Normal MAP in aorta is 120 mmHg
MAP= BP systolic+1/3 (BpSystolic – BP diastolic)
Proper value of the arterial pressure in aorta is 160/95 mmHg
Primary waves of arterial pressure reflect phases of the cardiac cycle
Proper values of the arterial pressure (systolic and diastolic) should not be higher than
160 mmHg
140 mmHg
150 mmHg
170 mmHg
90 mmHg
95 mmHg
100 mmHg
97 mmHg
Which statements are right?
EDV is observed in ventricles during isovolumetric contraction
EDV is obsverved in ventricles during isovolumetric relaxation
EDV is the volume of blood left in ventricles after systole.
ESV is the volume of blood left in ventricles after ventricular ejection
Phenomenon of the air-chamber
Equals MAP
Represent elasticity of the arterial system
Closes AV valves
Maintains continuous blood flow in arterial system, even during diastole of the heart
According to Poisseuille-Hagen formula
Resistance of the blood flow is inversely proportionate to the fourth power of the radius
Resistance of the blood flow is proportiante to the length of the vessel
Resistance of the blood flow is inversely proportionate to viscosity
All answers are improper
An increase of the vessel radius from 1mm to 2mm causes the resistance to
Increase 4 times
Decrease 8 times
Increase 8 times
Decrease 16 times
Factors that stimulate arterial Baroreceptors of carotid sinus of arch of aorta are
Hypoxia (low pCO2)
MAP higher than 50 mmHg
Phasic changes of arterial pressure
Decompression of baroreceptors
Cyon-Ludwig reflex:
Begins in baroreceptors of arch of aorta
Afferent fibers are located in aortic nerve (branch of the vagus nerve)
Begins in subendothelial region of the right ventricles
Produces reflective elevation of systolic pressure after changing of the body pressure
Which statements express decompression
Decompression of baroreceptors leads to deactivation of the depressor zone(CVLM)
Decompression of baroreceptors is produces by reduction of the arterial pressure
Decompression of baroreceptors leads to deactivation of the pressor zone (RVLM)
Decompression of baroreceptors leads to bradycardia
S2 sound
S1 has higher frequency
Duration is longer
Is due to closure of AV valves
Due to opening of AV valves
Splitted in inspiration
Ejection (stroke volume)
Pressure in ventricles is higher than pressure in aorta
Pressure in ventricles is lower than the pressure in aorta
Opening of SL valves
Opening of AV valves
PQ interval
Depolarization of atria
Finishes with depolarization of Purkinje fibers
Atrial contraction
Finishes with depolarization of AV node
Mark the right order of electrodes
V1–4th right intercostal (RICS) space
V2–2nd left intercostal space (LICS)
V4– Midclavicular line (MCL), 5ft left intercostal space (LICS)
V5– Midaxillary line (MAL), 5ft left intercostal
Preload
Frank’s Sterlings law – “the length of the sacromere is proportionate to the strength of contraction”
Normal value is: 160/95
Contractility is decreased by
Blockage of catecholamines through B1 receptor
Blockage of Ca2+ channels
Right axis deviation
Both I and III leads are negative
I is negative, III is positive
Normal axis deviation ranges from 0-90 degrees
True is
Q is absent in V1 and V2
R wave is highest in V2
Duration of QRS complex is 0,06-0,1 sec
V1 and V2 are more positive in QRS complex
Radius increases from 1mm to 2mm. What happens with R(resistance)?
Resistance increase 4 times
Resistance decreases 4 times
Resistance decreases 8 times
Resistance increases 16 times
All answers are improper
Viscosity increases when
Decreased temperature
Decreased Hematocrit
Extremely decreased blood flow rate
Sinus rhytmh
QRS is always preceded by a P wave
P waves are positive in AVF, I and II and V3-V6
P waves are positive in AVR
PQ interval is shorter than 0,12 sec
PQ interval lasts 0,1-0,2 sec
Vaso Vagal Reflex – symptoms:
Bradycardia
Tachycardia
Vomiting and Nausea
Consciousness
Increased parasympathetic system
Vagus nerve
Right innervates SA node
Left innervates SA node
Left innervates left ventricle
Gives no parasympathetic innervation
Critical closing pressure
Equals motive pressure
Collapse small vessels
Is the pressure at which flow ceases
Pressure is zero
The Q wave of the electrocardiogram
Results from depolarization of interventricular septum
Is immediately followed by repolatization of ventricles
Is the positive deflection in most ECG leads
Should not be observed in chest leads located over the right ventricles
Should occurs 0,04 to 0,11 sec after the end of the P wave
Identify right statement concerning regulation of the cardiac performance
According to heterometric regulation ventricular ejection is inversely proportionate to the afterload
Strength of ventricular ejeaction is proportionate to the end-diastolic volume
Antagonists of the ßa-adrenergic receptor produce positive inotropic effect to heart
Strength of ventricular ejection is proportionate to the cardiac rate (treppe phenomenon)
The PQ interval
Represents passage of the impule from the SA node to the Purkinje system of the cardiac conductive system
Should last 0,04-0,11 sec
Includes P wave and PQ segment
Should last 0,1-0,2 sec
Is a part of the isoelectic line ranging from the end of the P wave to the beginning of the QRS complex
What is true about the Q wave
Results from the depolarization of the intraventricular septum, from right ventricle to the left.
Represent depolarization of the atria
Should normally not be heard over the right ventricle
Starts about 0,15 sec after finish of the P wave
Is the cardiac cycle put in the correct order? (Read this out loud)
1. Closure of semilunar valve
2.Rapid ventricular filling
3.First heart sound (mitral valve)
4.Open of mitral valve
No, it is not
Q wave:
Results from depolarization of atria
Represents contraction of the cardiac ventricles
Is the negative deflection of the ECG recording
Occurs usually 0.12-0.20sec after the beginning of the PQ interval
Is always present in normal electrocardiogram
Which of following statements concerning PQ (PR) segment are right?
It includes P wave + PQ interval
Atrial depolarization occurs in time of the PQ segment
Fragment of isoelectric line (flat line) following negative P wave in aVR
It is an isoelectric line separating P wave from ventricular complex
Duration of the PQ segment ranges 0,04 – 0,10
PQ segment ranges 0.1-0.2 sec. It is inversely proportional to heart rate
Duration ranges 0,16 - 0,20s and its proportionate to heart rate
PQ interval
Duration of PQ interval ranges from 0.1 to 0.2 sec (0.12-0.2)
Includes P wave and PQ segment
Depolarization of ventricle via bundle of his
Is an isoelectric line
Which of the following statements concerning ECG are true
Depth of Q wave should not exceed 25% of amplitude of R wave of chest lead recorded over left ventricle
Amplitude of R wave can be higher than 12mm in chest lead V5
Q wave should not be longer than 22mm at paper speed of 50 mm/sec
QT interval reflects action potential of entire ventricular musculature. Measure of time between start of Q wave + end of ST segment
Find right concerning cardiac cycle
Isovolumetric relaxation begins after generation of cardiac sounds S2
Volume of ventricle decreases right after opening of AV valve
Semilunar valves open at end of isovolumetric ventricular relaxation
Pressure recorded at end of isovolumetric ventricular contraction equal diastolic pressure in aorta
In mechanical cardiac cycle
In isovolumetric contraction of right ventricle pressure rises from 2mmHg to 80 mmHg
During ejection pressure in both cardiac ventricles does not change
Closure of semilunar valves (protodiastole) is followed immediately by diastasis
Formation of the EDV finishes after isovolumetric contraction of ventricles
Opening of atrioventricular follows isovolumetric relaxation
Which statements concerning the orthostatic test are NOT true?
Orthostatic test states cardiovascular adaptations produced by change of the body position from upright into recumbent
In result of orthostatic test, vascular peripheral resistance should rise
In result of orthostatic test, cardiac chronotropism should be up-regulated
In result of orthostatic test, both systolic + diastolic arterial pressure should be elevated
In result of orthostatic test, pulse pressure should be reduced
Factors that do NOT stimulatearterial baroreceptors of carotid sinus + arch of aorta are
Hypoxia (low pO2)
MAP higher than 50 mmHg
Phasic changes of arterial pressure
Decompression of baroreceptors
Absolute refractory period
Is long and lasts 0,2-0,3 sec in ventricular cardiomyocytes
Prevents contraction of the heart and its fibrillation
Results from prolonged inactivation of Ca2+ channel
Duration is proportional to duration of plateau phase of action potential
Lasts 5 ms
In ECG, lead 1 is positive, lead 3 is negative:
LAD
RAD
Following is mitral stenosis
Leading to hypertrophy of right ventricle
In cardiac cycle:
Protodiastolic phase follow atrial contraction
Atrial contraction finally regulates EDV of ventricle contraction
S2 created by closure of atrioventricular valves
Atrial contraction occurs when semilunar valves are close
Biggest pressure difference in ventricular ejection
Left ventricle
Aorta
Right atrium
Left atrium
Pulmonary artery
Choose FALSE sentences
Dromotropism affects conductance through CCS (AV)
Chronotropism affects strength of cardiac contraction
Cardiac output = ESV × HRmax
Batmotropism affects excitability of the heart
QRS complex in lead I positive, in lead III negative
Left axis deviation (LAD)
Right axis deviation
Something about right ventricle
Identify right statements concerning gap junction
Form cytoplasmic communication bridges to transmit electrical stimuli
Forms of electrical synapses located between atrial + ventricular cardiomyocytes
Maintain communication between Purkinje system + contractile ventricular cardiomyocytes
Maintain intercellular communication in the neuromuscular junction
Composed of phospholipase C and G proteins
Can be found in multi-unit smooth muscle cells
The Q wave of the electrocardiogram
Results from depolarization of atria
Represents contraction of the cardiac ventricles
Is the negative deflection of the ECG recording
Occurs usually 0.12-0.20sec. After the beginning of the PQ interval
Is always present in normal electrocardiogram
Identify right phenomena developed in cardiovascular systemic response to decompression of baroreceptors:
Neurogenic tension increases in small and large systemic veins
Contractility of cardiac ventricles is up-regulated
MAP decreases
Venous return decreases
Identify right statements concerning JVP (Jugular Venous Pressure)
It equals approximately 30mmH
JVP is the highest during the maximal ejection of blood
Wave 'a' of JVP results from bulging of mitral valve during ventricular action
It depends in respiratory phases and intrathoracic pressure
Identify proper definition concerning cardiac action:
Batmotropismo is the action that affects strength of the cardiac contraction
Dromotropism is the action that affects conductance through CCS (mainly AVN)
Isometric relaxation phase ventricular pressure increases
Cardiac output = SV x HR
Action potential of the conctractile cardiomyocyte is composed of phases 0-3. At which phase the membrane potential is dependant on potassium permeability
Depolarization (phase 0)
Prepotential
Plateau (phase2)
Repolarization
Identify right statements concerning recording of the aVR lead
Duration of the PQ interval ranges 0.06 - 0.12 sec in aVR
Waves P and R should be negative in aVR
AVR is a unipolar limb lead attached to the right arm
The amplitude of the P wave should NOT be greater than 3 mm in chest leads
Identify right statements concerning regulation of the cardiac performance
According to heterometric regulation ventricular ejection is inversely proportionate to afterload
Strength of ventricular contraction is proportionate to end diastolic volume (EDV)
Strength of ventricular contraction is proportionate to the heart rate (ranging 0 - 150 bpm)
Antagonists of the calcium pump produce positive inotropic effect to heart
Identify right statements concerning P waves of ECG
It is produced by the atrial depolarization.
It is generated along with a sound of closure of the atrioventricular valves
Duration of the normal P Wave ranges 0.04 -0.11 sec
It is a positive deflection of I, II and AVF leads
It is usually generated by the atrioventricular node of the intrinsic conduction system of heat
Identify right statements concerning the ventricular (QRS) complex of waves of the normal electrocardiogram
Q wave reflects depolarization distributing from the left to the right side of the interventricular septum
Duration of the QRS complex ranges 0.06 -0.1 sec
Duration of the Q wave ranges 0.06 - 0.1 sec
Q wave should NOT be recorded (should be absent) in chest leads V1 and V2 of the normal ECG.
Depolarization of the interventricular septum is initiated by the right bundle branch, distributing impulses directly to the right-upper part of the septum
Tonus of precapillary sphincters decreases (sphincters relax) in case of
(deficit of O2) hypoxia
Acidosis
Excess of glucose (hyperglycemia)
Deficit of CO2
Find WRONG expressions concerning phase 2 (plateau phase) of action potential of contractile cardiomyocytes
Cardiomyocytes develop the relative refractory period by the end of that phase
Sodium channel stays inactive in this phase
Muscarinic receptor of contractile cardiomyocytes is opened in this phase
Influx of calcium and outflow of potassium is observed during this phase
Plateau phase is the most characteristic feature of the pacemaker potential (prepotential)
Bainbridge reflex
Mechanical stretch of SA node
Increased something with B-receptor
Increased venous return
Excessive stretch of right ventricle
Identify cardiovascular phenomena observed in effect of deep inspiration of air
CVP falls
MAP decreases
Heart rate decreases
MAP increases
Venous return increases
Heart rate increases
Baroreceptor reflex induces compensation for the mild haemorrhage will cause which of following values to be higher?
Venous capacitance
Total peripheral resistance
Heart rate
Effective filtration pressure
Venous compliance
Increased venous return
Identify right phenomena developed in the cardiovascular system in response to decompression of baroreceptors
Neurogenic tension increases within small and large systemic veins
MAP decreases
Contractility of cardiac ventricles is up regulated
Venous return decreases
Starling forces
Hydrostatic pressure in arteriolar end of capillary is 32 mm Hg
Colloid osmotic pressure of intestinal fluid surrounding capillary of 33 mmHg
Colloid osmotic pressure in lumen of capillary of 25 mmHg
EFP in arteriolar end of capillary of 25 mmHg
Which of following statements properly concerning orthostatic response
In effect of orthostatic test, diastolic pressure should rise by ca. 10%
Orthostatic response is the range of adaptations of the cardiovascular system to standing position
In effect of standing up, venous return increase
In effect of orthostatic test, systolic pressure should rise by ca. 20%
Choose true about ECG
T-wave is repolarization of ventricles – duration of 0.12-0.16 sec
R-wave can be 26 mV in chest lead V6
S-wave represent lateral depolarization
Q-wave should NOT be recorded in V1 and V2
Cardiac sounds
The 2nd heart sound is normally splitted during inspiration due to increased tone of the vagus nerve
The 2nd heart sound is splitted during inspiration due to various gradients of pressure across semilunar valves
Apical impulse (apex beat) is palpable in 5th left intercostal space, in midclavicular line
Diastasis phase of the ventricular diastole is followed by atrial systole (contraction)
Resonance sound is heard over the cardiac area when percussion of the chest is performed
Identify right statements that can concern jugular venous pulse
Waves of jugular venous pulse spread retrogradely in relation to the venous blood flow.
Narrowing (stenosis) of the tricuspid valve will rise an amplitude of the "a" wave of jugular venous pulse.
Wave "c" of the jugular venous pulse develops due temporary bulging of the mitral valve
Venous pulse can be easily observed over large central veins such as superior and inferior vena cava
What's FALSE about electrocardiogram
The angle of the cardiac vector rapidly shifting to the right (right axis deviation—RAD) might suggest increased cardiac performance (cardiac work) of the right ventricle generated, for instance, in response to the pulmonary embolism
S wave is positive in chest leads located over the left ventricle (V5, V6)
Standard QRS complex recorded by chests leads VI, V2 characterize with small positive R waves and deep S waves
Amplitude of the R wave can reach 2,6 mV (26mm; 10mm—1mV) in V1 chest lead
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