ECGs Made Easy, 4th Edition 
Instructor Questions Chapter 1 - Anatomy & Physiology

TRUE/FALSE

1.	Stimulation of beta-adrenergic receptor sites will result in peripheral vasoconstriction.

ANS:	F
Beta receptor sites are divided into beta1 and beta2. Beta1 receptors are found in the heart and kidneys. Stimulation of beta1 receptor sites in the heart results in increased heart rate, contractility, and, ultimately, irritability of cardiac cells. Stimulation of beta1 receptor sites in the kidneys results in the release of renin into the blood. Renin promotes the production of angiotensin, a powerful vasoconstrictor. Beta2 receptor sites are found in the arterioles of the heart, lungs, and skeletal muscle. Stimulation results in dilation. Stimulation of beta2 receptor sites in the smooth muscle of the bronchi results in dilation.

OBJ:	Describe the effects of stimulation of alpha-receptors, beta-1-receptors, 
beta-2- receptors, and dopaminergic receptors. 

2.	Blood pressure is the result of cardiac output and peripheral vascular resistance.

ANS:	T
Blood pressure is equal to cardiac output multiplied by peripheral vascular resistance. Blood pressure is the force exerted by the circulating blood volume on the walls of the arteries. Peripheral vascular resistance is the resistance to the flow of blood determined by blood vessel diameter and the tone of the vascular musculature.

OBJ:	Identify and define the components of cardiac output.

MULTIPLE CHOICE

3.	The apex of the heart is formed by the
a.	tip of the left ventricle.	
b.	tip of the right atrium.	
c.	right atrium and right ventricle.	
d.	left atrium and left ventricle.	

ANS:	A
The heart’s apex, or lower portion, is formed by the tip of the left ventricle. The apex lies just above the diaphragm, between the fifth and sixth ribs, in the midclavicular line.

OBJ:	Distinguish between the apex and base of the heart.
4.	The base of the heart is found at approximately the level of the
a.	first rib.	
b.	second rib.	
c.	fourth rib.	
d.	fifth and sixth ribs.	

ANS:	B
The base of the heart is its upper portion and is formed mainly by the left atrium, with a small amount of right atrium. It lies at approximately the level of the second rib, immediately in front of the esophagus and descending aorta.

OBJ:	Distinguish between the apex and base of the heart.

5.	The anterior surface of the heart consists primarily of the
a.	left atrium.	
b.	right atrium.	
c.	left ventricle.	
d.	right ventricle.	

ANS:	D
The front (anterior) surface of the heart lies behind the sternum and costal cartilages. It is formed by portions of the right atrium and the left and right ventricles. However, because the heart is tilted slightly toward the left in the chest, the right ventricle is the area of the heart that lies most directly behind the sternum.

OBJ:	N/A

6.	The inferior surface of the heart is formed by the
a.	right and left atria.	
b.	right and left ventricles.	
c.	left atrium and left ventricle.	
d.	right atrium and right ventricle.	

ANS:	B
The heart’s bottom (inferior) surface is formed by both the right and left ventricles, but mostly the left. The inferior surface of the heart is also called the diaphragmatic surface.

OBJ:	N/A

7.	Blood pressure is determined by
a.	stroke volume multiplied by heart rate.	
b.	heart rate multiplied by cardiac output.	
c.	cardiac output multiplied by peripheral vascular resistance.	
d.	stroke volume multiplied by peripheral vascular resistance.	

ANS:	C
Blood pressure is equal to cardiac output multiplied by peripheral vascular resistance.

OBJ:	Identify and define the components of cardiac output.

8.	The heart is divided into _____ chambers but functions as a _____-sided pump. 
a.	2; 4	
b.	3; 2	
c.	4; 2	
d.	4; 3	

ANS:	C
The heart has four chambers—two atria and two ventricles. The right and left sides of the heart are separated by an internal wall of connective tissue called a septum. The interatrial septum separates the right and left atria. The interventricular septum separates the right and left ventricles. The septa separate the heart into two functional pumps. The right atrium and right ventricle make up one pump. The left atrium and left ventricle make up the other.

OBJ:	Identify and describe the chambers of the heart and the vessels that enter or leave each.

9.	Which side of the heart is a low-pressure system that pumps venous blood to the lungs? 
a.	Left	
b.	Right	

ANS:	B
The job of the right side of the heart is to pump unoxygenated blood to and through the lungs to the left side of the heart. This is called the pulmonary circulation. The right side of the heart is a low-pressure system.

OBJ:	Identify and describe the chambers of the heart and the vessels that enter or leave each.

10.	Which side of the heart is a high-pressure system that pumps arterial blood to the systemic circulation?
a.	Left	
b.	Right	

ANS:	A
The left side of the heart is a high-pressure pump. The job of the left heart is to receive oxygenated blood and pump it out to the rest of the body. This is called the systemic circulation. The left ventricle is a high-pressure chamber. Its wall is much thicker than the right ventricle (the right ventricle is about 3 to 5 mm thick; the left ventricle is about 13 to 15 mm). This is because the left ventricle must overcome a lot of pressure and resistance from the arteries and contract forcefully in order to pump blood out to the body.

OBJ:	Identify and describe the chambers of the heart and the vessels that enter or leave each.

11.	The right atrium receives venous blood from the head, neck, and thorax 
via the _____, from the remainder of the body via the _____, and from the 
heart via the _____.
a.	coronary sinus; superior vena cava; inferior vena cava	
b.	superior vena cava; coronary sinus; inferior vena cava	
c.	inferior vena cava; superior vena cava; coronary sinus	
d.	superior vena cava; inferior vena cava; coronary sinus	

ANS:	D
The right atrium receives blood low in oxygen from:
·	The superior vena cava, which carries blood from the head and upper extremities
·	The inferior vena cava, which carries blood from the lower body
·	The coronary sinus, which is the largest vein that drains the heart

OBJ:	Identify and describe the chambers of the heart and the vessels that enter or leave each.

12.	The left atrium receives blood from the
a.	pulmonary veins.	
b.	aorta.	
c.	pulmonary arteries.	
d.	inferior vena cava.	

ANS:	A
The left atrium receives freshly oxygenated blood from the lungs via the right and left pulmonary veins.

OBJ:	Identify and describe the chambers of the heart and the vessels that enter or leave each.
13.	The _____ is the largest vein that drains the heart.
a.	inferior vena cava	
b.	coronary sinus	
c.	anterior cardiac vein	
d.	great cardiac vein	

ANS:	B
The coronary sinus is the largest vein that drains the heart.

OBJ:	N/A

14.	Movement of blood from the left ventricle through the body is called the
a.	systemic circulation.	
b.	pulmonary circulation.	

ANS:	A
The left side of the heart is a high-pressure pump. The job of the left heart is to receive oxygenated blood and pump it out to the rest of the body. This is called the systemic circulation.

OBJ:	N/A

15.	The thick, muscular middle layer of the heart wall that contains the atrial and ventricular muscle fibers necessary for contraction is the
a.	epicardium.	
b.	pericardium.	
c.	myocardium.	
d.	endocardium.	

ANS:	C
The myocardium (middle layer) is a thick, muscular layer that consists of cardiac muscle fibers (cells) responsible for the pumping action of the heart.

OBJ:	Describe the structure and location of the pericardium, epicardium, myocardium, and endocardium.

16.	Which of the following are semilunar valves?
a.	Aortic and pulmonic	
b.	Aortic and tricuspid	
c.	Pulmonic and mitral	
d.	Tricuspid and mitral	

ANS:	A
The pulmonic and aortic valves are semilunar (SL) valves. The semilunar valves prevent backflow of blood from the aorta and pulmonary arteries into the ventricles.

OBJ:	Name and identify the location of the atrioventricular (AV) and semilunar (SL) valves.
17.	Thin strands of fibrous connective tissue extend from the AV valves to the papillary muscles and prevent the AV valves from bulging back into the atria during ventricular systole. These strands are called:
a.	cardiac cilia.	
b.	Purkinje fibers.	
c.	papillary muscles.	
d.	chordae tendineae.	

ANS:	D
Chordae tendineae are thin strands of connective tissue. On one end, they are attached to the underside of the AV valves. On the other end, they are attached to small mounds of myocardium called papillary muscles. Papillary muscles project inward from the lower portion of the ventricular walls. When the ventricles contract and relax, so do the papillary muscles. The papillary muscles adjust their tension on the chordae tendineae, preventing them from bulging too far into the atria.

OBJ:	Discuss the function of the chordae tendineae and papillary muscles.

18.	Blood leaves the left ventricle through the _____ valve to the aorta and its branches and is distributed throughout the body. 
a.	mitral	
b.	aortic	
c.	pulmonic	
d.	tricuspid	

ANS:	B
When the left ventricle contracts, freshly oxygenated blood flows through the aortic valve into the aorta and out to the body.

OBJ:	Beginning with the right atrium, describe blood flow through the normal heart and lungs to the systemic circulation.

19.	Blood flows from the right atrium through the _____ valve into the right ventricle.
a.	mitral	
b.	aortic	
c.	pulmonic	
d.	tricuspid	

ANS:	D
Blood flows from the right atrium through the tricuspid valve into the right ventricle.

OBJ:	Beginning with the right atrium, describe blood flow through the normal heart and lungs to the systemic circulation.

20.	Blood flows from the left atrium through the _____ valve into the left ventricle.
a.	mitral	
b.	aortic	
c.	pulmonic	
d.	tricuspid	

ANS:	A
Blood flows from the left atrium through the mitral (bicuspid) valve into the left ventricle.

OBJ:	Beginning with the right atrium, describe blood flow through the normal heart and lungs to the systemic circulation.

21.	The right ventricle expels blood through the _____ valve into the pulmonary trunk. 
a.	mitral	
b.	aortic	
c.	pulmonic	
d.	tricuspid	

ANS:	C
The right ventricle expels the blood through the pulmonic valve into the pulmonary trunk. The pulmonary trunk divides into a right and left pulmonary artery, each of which carries blood to one lung (pulmonary circuit).

OBJ:	Beginning with the right atrium, describe blood flow through the normal heart and lungs to the systemic circulation.

22.	The coronary arteries originate at the base of the
a.	aorta, immediately above the leaflets of the aortic valve.	
b.	superior vena cava, immediately above the sinoatrial node.	
c.	pulmonary artery, immediately above the leaflets of the tricuspid valve.	
d.	pulmonary artery, immediately above the leaflets of the pulmonic valve.	

ANS:	A
The right and left coronary arteries are the very first branches off the proximal aorta. The openings to these vessels lie just beyond the cusps of the aortic semilunar valve.

OBJ:	Name the primary branches and areas of the heart supplied by the right and left coronary arteries.

23.	Complete occlusion of the _____ coronary artery, also referred to as the “widow maker,” usually results in sudden death.
a.	right	
b.	left main	
c.	left circumflex	
d.	left anterior descending	

ANS:	B
Complete occlusion of the left main coronary artery, also referred to as the “widow maker,” usually results in sudden death.

OBJ:	Name the primary branches and areas of the heart supplied by the right and left coronary arteries.

24.	Stimulation of alpha-adrenergic receptors results in
a.	increased heart rate.	
b.	peripheral vasoconstriction.	
c.	constriction of bronchial smooth muscle.	
d.	increased force of myocardial contraction.	

ANS:	B
Alpha1 receptors are found in the eyes, blood vessels, bladder, and male reproductive organs. Stimulation of alpha1 receptor sites results in constriction.

OBJ:	Describe the effects of stimulation of alpha-receptors, beta-1-receptors, 
beta-2- receptors, and dopaminergic receptors. 

25.	Stimulation of beta-2 receptors sites results in
a.	increased heart rate.	
b.	peripheral vasoconstriction.	
c.	constriction of renal blood vessels.	
d.	relaxation of bronchial smooth muscle.	

ANS:	D
Beta2 receptor sites are found in the arterioles of the heart, lungs, and skeletal muscle. Stimulation results in dilation. Stimulation of beta2 receptor sites in the smooth muscle of the bronchi results in dilation.

OBJ:	Describe the effects of stimulation of alpha-receptors, beta-1-receptors, 
beta-2- receptors, and dopaminergic receptors. 

26.	“Chronotropy” refers to an effect on
a.	heart rate.	
b.	force of contraction.	
c.	bronchial smooth muscle.	
d.	speed of conduction through the AV node.	

ANS:	A
“Chrono” refers to rate. A chronotropic effect refers to a change in heart rate. A positive chronotropic effect refers to an increase in heart rate. A negative chronotropic effect refers to a decrease in heart rate.

OBJ:	Define the terms acute coronary syndrome, chronotropy, inotropy, and dromotropy.

27.	Rapid ejection of blood from the ventricular chambers of the heart occurs because the _____ and _____ valves open.
a.	pulmonic and aortic	
b.	tricuspid and mitral	
c.	pulmonic and mitral	
d.	tricuspid and aortic	

ANS:	A
When the ventricles contract, the pulmonic and aortic valves open, allowing blood to flow out of the ventricles.

OBJ:	Name and identify the location of the atrioventricular (AV) and semilunar (SL) valves.

28.	When the left ventricle contracts, freshly oxygenated blood flows through the _____ valve into the _____. 
a.	aortic; aorta	
b.	mitral; right atrium	
c.	tricuspid; right ventricle	
d.	pulmonic; pulmonary arteries	

ANS:	A
When the ventricles contract, the SL valves open, allowing blood to flow out of the ventricles. When the right ventricle contracts, blood low in oxygen flows through the pulmonic valve into the right and left pulmonary arteries. When the left ventricle contracts, freshly oxygenated blood flows through the aortic valve into the aorta and out to the body.

OBJ:	Name and identify the location of the atrioventricular (AV) and semilunar (SL) valves.

29.	The left main coronary artery divides into the
a.	marginal and circumflex branches.	
b.	marginal and anterior descending branches.	
c.	anterior and posterior descending branches.	
d.	anterior descending and circumflex branches.	

ANS:	D
The left main coronary artery supplies oxygenated blood to its two primary branches: the left anterior descending (LAD) (also called the anterior interventricular) artery and the left circumflex artery (LCX).

OBJ:	Name the primary branches and areas of the heart supplied by the right and left coronary arteries.

30.	The primary chemical mediator of the parasympathetic division of the autonomic nervous system is
a.	dopamine.	
b.	muscarine.	
c.	acetylcholine.	
d.	norepinephrine.	

ANS:	C
Acetylcholine (Ach) is a chemical messenger (neurotransmitter) released when parasympathetic nerves are stimulated. Acetylcholine binds to parasympathetic receptors.

OBJ:	Name the primary neurotransmitter of the sympathetic and parasympathetic divisions of the autonomic nervous system.

COMPLETION

31.	The right atrium receives deoxygenated blood from the __________ __________ __________ (which carries blood from the head and upper extremities), the __________ __________ __________ (which carries blood from the lower body), and the __________ __________ (which receives blood from the intracardiac circulation).

ANS:	The right atrium receives deoxygenated blood from the superior vena cava (which carries blood from the head and upper extremities), the inferior vena cava (which carries blood from the lower body), and the coronary sinus (which receives blood from the intracardiac circulation).

OBJ:	Identify and describe the chambers of the heart and the vessels that enter or leave each.

32.	__________ is the period during which a heart chamber is contracting and blood is being ejected.

ANS:	Systole is the period during which a heart chamber is contracting and blood is being ejected.

OBJ:	Identify the phases of the cardiac cycle.	

33.	__________ is the period of relaxation during which a heart chamber is filling.

ANS:	Diastole is the period of relaxation during which a heart chamber is filling.

OBJ:	Identify the phases of the cardiac cycle.	

SHORT ANSWER

34.	List two (2) factors that may affect the heart's efficiency as a pump.

1.
2.

ANS:	
The efficiency of the heart as a pump may be affected by abnormalities of cardiac muscle, the valves, or the conduction system.

OBJ:	Identify and define the components of cardiac output.

35.	Name the valve that separates the right ventricle from the right atrium.

ANS:	
Tricuspid valve

OBJ:	Name and identify the location of the atrioventricular (AV) and semilunar (SL) valves.

36.	Define “systole.”

ANS:	
Contraction or the ejection of blood from a chamber of the heart

OBJ:	Identify the phases of the cardiac cycle.	

37.	What is meant by the term, “ejection fraction?”

ANS:	
Ejection fraction is the percentage of blood pumped out of a heart chamber with each contraction. Each ventricle holds about 150 mL when it is full. They normally eject only about half this volume (70 to 80 mL) with each contraction.

OBJ:	Explain stroke volume and ejection fraction.	

38.	Explain the Frank-Starling law of the heart.

ANS:	
According to the Frank-Starling law of the heart, to a point, the greater the volume of blood in the heart during diastole, the more forceful the cardiac contraction, and the more blood the ventricle will pump (stroke volume). This is important so that the heart can adjust its pumping capacity in response to changes in venous return, such as during exercise. If, however, the ventricle is stretched beyond its physiological limit, cardiac output may fall due to volume overload and overstretching of the muscle fibers.

OBJ:	Identify and define the components of cardiac output.

39.	List the four major electrolytes that influence cardiac function. 

1.
2.
3.
4.

ANS:	
The four major electrolytes that influence cardiac function are sodium, potassium, calcium, and chloride.

OBJ:	N/A

40.	A patient has a heart rate of 80 beats/minute. His stroke volume is 70 mL/beat. Is his cardiac output normal, decreased, or increased?

ANS:	
Stroke volume = 70 mL/beat
Heart rate = 80 beats/minute
SV x HR = CO 
70 mL/beat x 80 beats/min = 5600 mL/min = 5.6 L/min 
Cardiac output = normal (normal is between 4 and 8 L/min)

OBJ:	Identify and define the components of cardiac output.