Cardiovascular Physiology Questions for Self Assessment -

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Introduction

The questions in this little book are intended primarily as an accompaniment to the fifth edition of the
textbook, An Introduction to Cardiovascular Physiology ( JR Levick, Hodder Arnold, 2010) – though the
explanations and the numerous diagrams should help make this a useful ‘stand-alone’ volume if desired.
The companion volume has a small, ‘taster’ selection of the questions on its website.The aim of this
collection of over 230 questions is to offer students an element of self-assessment, as they progress
through the companion book or revise for examinations. Lecturers may find some of the questions
useful as a template when setting questions of their own, but should note that the questions are
primarily educational in intent; their discriminatory power has not been tested. The questions
are grouped under the same headings as the chapters of the companion textbook, so they become
progressively more advanced (see Contents). Occasional statements call for information from later
chapters. Medically relevant questions are introduced wherever they are appropriate. I have set at least
one question on each learning objective given at the start of the chapter in the companion volume, to
help you assess your achievement of the learning objectives. Some questions require you to integrate
information from other chapters too. The questions aim to test basic understanding, fundamental
principles and medical relevance. Hopefully they avoid excessive detail – always the examiner’s easy
option!
The questions. Most of the questions are multiple choice questions (MCQs), generally with five
true/false statements, but occasionally more or less than five. Although some ‘educationalists’ now
demand single correct answer questions (SAQs, one correct answer out of four or five options), these
test less knowledge, so the MCQ style has been retained here.To add variety, there is a sprinkling of
other styles of question, such as ‘extended matching questions’ (i.e. choose the best answer from a list),
data interpretation problems, and little numerical problems that test reasoning power and ability to do
simple calculations.
The answers. Each answer is accompanied by a brief explanation, and very often an illustrative
figure, which should help if you got the answer wrong. Most of the figures are from the accompanying
textbook, but there are also new, explanatory diagrams after some questions. It is sometimes difficult to
avoid ambiguity in MCQ questions; so use your common sense – choose the answer that will be right
most of the time, rather than a remote, rare possibility. Nevertheless, if you disagree with the ‘official’
answer, do let me know.
vi Introduction

Your score. What score represents a good performance? There are roughly equal numbers of
T and F answers.Therefore, if ⫹1 is allotted for each correct answer and none subtracted for a wrong
answer, a score of 50% could be achieved simply by responding True (or False) to every question.
Around 65% (two-thirds) correct answers would probably be a ‘pass’ under this marking scheme. Many
universities use a negative marking scheme, namely ⫺1 for an incorrect answer, 0 for no answer
and ⫹1 for a correct answer. On this scheme, guessing True (or False) for every answer would score
roughly zero, and the pass mark is therefore usually set at a little below 50%. Over 60% would be good,
and over 70% excellent. Good luck!

Rodney Levick
Physiology
St George’s Hospital Medical School,
University of London, UK
CHAPTER 1
Overview of the cardiovascular
system
T F
1.1 Concerning transport by the cardiovascular system,
a. the transport of glucose by the circulation is convective rather than diffusive. 䊐 䊐
b. diffusion depends on transport up a concentration gradient. 䊐 䊐
c. the time taken for O2 to diffuse a certain distance is directly proportional
to the distance. 䊐 䊐
d. O2 is carried from capillary blood to the tissue cells mainly by fluid filtration. 䊐 䊐
e. if coronary perfusion were halted, O2 would take about 15 hours to diffuse
from the cavity of the left ventricle to the subepicardial muscle fibres. 䊐 䊐
1.2 Regarding the distribution of cardiac output (CO) to the tissues of a resting
human,
a. about 20% goes to skeletal muscle, which accounts for ⬃20% of resting
O2 consumption. 䊐 䊐
b. about 20% goes to the kidneys, which account for ⬃6% of resting
O2 consumption. 䊐 䊐
c. about 10% goes to the myocardium, which accounts for ⬃10% of resting
O2 consumption. 䊐 䊐
d. the proportion of the CO going to a given organ is regulated mainly by the
conduit arteries feeding the organ. 䊐 䊐
e. about 50% goes to the lungs, due to their low vascular resistance. 䊐 䊐
1.3 Regarding the flow of blood,
a. flow is proportional to the pressure difference between the inlet and outlet
of the blood vessel. 䊐 䊐
b. Darcy’s law states that flow equals pressure times resistance. 䊐 䊐
c. the flow per unit pressure drop along a vessel is called the hydraulic
conductance of the vessel. 䊐 䊐
d. the units for hydraulic resistance are mmHg per unit flow or equivalent. 䊐 䊐
e. the flow resistance of the pulmonary circulation is about two-thirds that
of the systemic circulation. 䊐 䊐
1.4 As blood flows around the systemic circulation,
a. its mean pressure falls markedly from the aorta to small, named arteries,
such as the radial artery. 䊐 䊐
b. the systolic pressure is higher in the brachial artery than the aorta. 䊐 䊐
c. the biggest fall in pressure occurs in the resistance arteries. 䊐 䊐
d. the greatest net, cross-sectional vascular area is encountered in the capillaries. 䊐 䊐
e. its velocity decreases in microvessels, yet the total flow does not. 䊐 䊐
f. its pressure falls to ⬃30 mmHg in the antecubital vein at heart level. 䊐 䊐
2 Cardiovascular physiology Questions

T F
1.5 The conclusion that terminal arteries and arterioles offer more resistance to
blood flow than other vessels stems from the observation that
a. they have the thickest walls, relative to lumen width. 䊐 䊐
b. they have a rich sympathetic vasomotor innervation. 䊐 䊐
c. they have the smallest internal radius of all blood vessels. 䊐 䊐
d. they have the biggest pressure drop across them. 䊐 䊐
e. they are less numerous than venules. 䊐 䊐
1.6 Blood vessels classified as
a. elastic vessels expand to receive the stroke volume of the heart. 䊐 䊐
b. conduit vessels conduct venous blood back to the heart. 䊐 䊐
c. resistance vessels can actively regulate the blood flow through a tissue. 䊐 䊐
d. exchange vessels include some venules as well as capillaries. 䊐 䊐
e. capacitance vessels have the capacity to alter blood pressure directly. 䊐 䊐
1.7 The wall of a blood vessel
a. is lined internally by cells that secretes anti-thrombotic agents. 䊐 䊐
b. is divided into two layers (tunica) by a sheet of elastin. 䊐 䊐
c. always contains tension-resisting collagen. 䊐 䊐
d. has a higher proportion of elastin in the aorta than in distal arteries. 䊐 䊐
e. always contains contractile smooth muscle, except in capillaries. 䊐 䊐
f. has the lowest proportion of smooth muscle in the arterioles. 䊐 䊐
g. rarely contains efferent nerve fibres. 䊐 䊐
1.8 The proximal aorta gives off arteries to the brain; the abdominal aorta gives
off arteries to the intestine; and the distal aorta gives off arteries to the leg;
but the liver is supplied chiefly by venous blood from the intestine. Therefore,
a. the blood supply to the brain and intestine are in parallel. 䊐 䊐
b. the blood supply to the intestine and leg are in series. 䊐 䊐
c. the pressure of arterial blood supplying the leg is substantially lower than
that supplying the brain. 䊐 䊐
d. the blood supply to the liver is in series with the intestinal supply. 䊐 䊐
e. the blood supply to the liver is an example of a portal circulation. 䊐 䊐
1.9 Roles of different classes of systemic blood vessel
(Here is a different style of question, the extended matching question (EMQ). If you succeeded
with questions 1–8, you will find this one easy.)
Regarding the various systemic blood vessels, enter the code from the list below to answer
questions (i) to (vii).A code can be used more than once, or not at all.
a. proximal aorta
b. conduit arteries
c. arterioles
d. capillaries
e. venules
f. peripheral veins
g. central vein
(i) This vessel has the largest radius. 䊐
(ii) If all the vessels in parallel are added together, this class of vessel has the
greatest net cross-sectional area. 䊐
Overview of the cardiovascular system Questions 3

(iii) This vessel has the slowest velocity of blood flow. 䊐

(iv) This vessel has the highest velocity of blood flow. 䊐
(v) This category of vessel has the greatest pressure drop across it. 䊐
(vi) These three types of vessel together contain around two-thirds of the
circulating blood volume. 䊐
(vii) This vessel actively regulates the blood flow through a tissue. 䊐
4 Cardiovascular physiology Answers

Answers
1.1 a. T – The circulation evolved because convective transport (wash-along) is faster than diffusion
over long distances.
b. F – Diffusion is a passive transport process down a concentration gradient (Figure 1.1).
c. F – Einstein showed that the time increases as the square of distance.This is why diffusion is
so slow over distances of over a millimetre (Table 1.1).
d. F – Transport from blood to tissue is by passive diffusion down the concentration gradient,
not fluid filtration down a pressure gradient (Figure 1.2).
e. T – This is why the coronary circulation evolved (Table 1.1).
1.2 a. T – Organ blood flow is, as a broad generalization, related to the organ’s O2 consumption
(Figure 1.3).
b. T – The high flow is ‘excessive’ relative to renal O2 demand, but is needed for adequate renal
excretion and urine production (Figure 1.3).
c. F – The myocardium receives only ⬃4% of the cardiac output, despite the fact that it
consumes 10% of the oxygen (Figure 1.3).
d. F – It is not the wide, low-resistance conduit arteries that primarily regulate blood flow. It is
the fine arterioles and terminal arterial twigs – the resistance vessels. Dilatation of conduit
arteries prevents their resistance becoming a flow-limiting factor during exercise.
e. F – What a silly question! The lungs of course receive the entire cardiac output of the right
ventricle (Figure 1.4).
1.3 a. T – The difference in pressure, ΔP, provides the energy gradient driving the flow.
b. F – Darcy’s law states the flow Q· equals pressure difference, divided by resistance; Q· ⫽ ΔP/R,
or equivalently Q· ⫽ ΔP ⫻ conductance K (Figure 1.5).
c. T – From Darcy’s law, conductance K is Q· /ΔP (Figure 1.5).
d. T – From Darcy’s law, resistance R is ΔP/Q· ; so the units of resistance are pressure difference
required to drive unit flow.
e. F – The pulmonary circulation has a much lower resistance, namely ⬃15% of systemic
resistance.This is proved by the low pulmonary artery pressure required to drive the
cardiac output through the lungs.
1.4 a. F – Mean pressure falls by only a few mmHg in the named arteries, because they are wide
and offer little resistance to flow.This is evident from the pressure profile of the
circulation (Figure 1.6).
b. T – Although the mean brachial arterial pressure is slightly lower than mean aortic pressure,
brachial artery systolic pressure is actually higher than aortic systolic pressure, because the
shape of the pressure wave changes as it travels distally (Figure 1.6).
c. T – Darcy’s law tell us that resistance is pressure drop per unit flow.The resistance vessels are
the terminal arteries and arterioles, as is evident from the large pressure drop across them
(Figure 1.6).
d. T – Though narrow individually, there are millions of capillaries in parallel.This creates a very
large total cross-sectional area, much bigger than that of the aorta (Figure 1.6).
e. T – The entire cardiac output (cm3/min) flows through the microcirculation, but its velocity
(cm/min) is slowed by the very large, net cross-sectional area (cm2) of the microvessels
(Figure 1.6). Note that velocity (cm/min) ⫽ flow (cm3/min) / area cm2.
f. F – Peripheral venous pressure at heart level is much lower, namely ⬃8–10 mmHg
(Figure 1.6).
Overview of the cardiovascular system Answers 5

1.5 a. F – The high wall/lumen ratio is true, but this does not prove that resistance is high.
Resistance is pressure drop required to produce unit flow.
b. F – Again, the fact is true but it does not prove that resistance is high.
c. F – Capillaries are even narrower, ⬃5 μm wide.
d. T – Resistance is by definition the pressure drop required to produce unit flow (Darcy’s law).
The biggest pressure drop is across the terminal arteries and arterioles (Figure 1.6).
e. F – Again the fact is true, but it does not prove their high resistance.
1.6 a. T – The aorta and major branches are elastin rich and expand to accommodate the stroke
volume (Figure 1.7).
b. F – Conduit vessels are arteries with abundant smooth muscle that conduct blood to the
tissues. Examples include the coronary arteries, cerebral arteries and popliteal artery.
c. T – Dilatation reduces their resistance and thus increases local perfusion (blood flow).
Contraction increases resistance and thus reduces local blood flow.
d. T – Post-capillary venules, as well as capillaries, are permeable to water and respiratory gases.
e. F – Capacitance vessels are veins.They serve as contractile, adjustable blood reservoirs.Any
effect on blood pressure is mediated indirectly, by changing the volume of blood in the
heart (Starling’s law of the heart).
1.7 a. T – The endothelium secretes the anti-thrombotic agents nitric oxide and prostaglandins.
b. F – There are three layers (tunica intima, tunica media, tunica adventitia), as defined by two
elastin sheets, the internal and external elastic laminae (Figure 1.8).
c. T – Even the capillary has collagen (type IV) in its basal lamina; all other vessels also have
type I-III collagen fibrils throughout the wall.
d. T – See Table 1.2. Elastin allows the aorta to stretch readily to accommodate the stroke
volume of the left ventricle.
e. T – Smooth muscle makes up most of the tunica media in most vessels (Figure 1.8).
f. F – Arterioles have the highest proportion of smooth muscle (Table 1.2).This enables them
to act as contractile ‘taps’ that regulate local blood flow and blood pressure.
g. F – Most blood vessels, except capillaries, are innervated by sympathetic vasoconstrictor fibres
(Figure 1.8). Some also have afferent fibres, e.g. nociceptor (pain) fibres.
1.8 a. T – The plumbing is ‘in parallel’, by analogy with electrical circuits (Figure 1.4).
b. F – These two circulations are again in parallel, as are most circulations (Figure 1.4).
c. F – The arterial pressure is virtually identical in all parallel arteries, so the tissues are all
perfused by the same pressure head and receive blood with the same O2 content.This is
the big advantage of parallel plumbing.
d. T – Almost three-quarters of the liver’s blood supply comes from the portal vein, which
drains the intestine (Figure 1.4).
e. T – A portal circulation delivers material directly from one organ to another without mixing
in the general circulation.
1.9 (i) g (ii) d (iii) d (iv) a (v) c (vi) e, f, g. (vii) c
 CHAPTER 2
The cardiac cycle
T F
2.1 During cardiac development in the fetus,
a. the ductus arteriosus shunts blood from the aorta into pulmonary trunk. 䊐 䊐
b. the foramen ovale remains open until birth. 䊐 䊐
c. the coronary sinus does not open until birth. 䊐 䊐
d. failure of the atrial or ventricular septum to close causes cyanosis after birth. 䊐 䊐
e. transposition of the major vessels occurs in Fallot’s tetralogy. 䊐 䊐
2.2 During the cardiac cycle of a human adult,
a. pressure is higher in the left atrium than right atrium. 䊐 䊐
b. ventricular filling depends mainly on atrial contraction. 䊐 䊐
c. the ventricle fills fastest during early diastole. 䊐 䊐
d. the atria and ventricles contract simultaneously during systole. 䊐 䊐
e. systole is initiated in the left atrium. 䊐 䊐
2.3 With reference to the cardiac cycle,
a. right atrial pressure is typically 3–5 mmHg. 䊐 䊐
b. the work of the right ventricle is greater than the work of the left ventricle. 䊐 䊐
c. the first heart sound occurs at the end of the isovolumetric contraction phase. 䊐 䊐
d. two-thirds of the blood in the ventricle is ejected during systole in a resting
human. 䊐 䊐
e. the QRS complex of the ECG immediately precedes the isovolumetric
contraction phase. 䊐 䊐
2.4 Ventricular filling
a. begins as soon as the aortic valve closes. 䊐 䊐
b. is increasingly dependent on atrial contraction during exercise. 䊐 䊐
c. can cause a third heart sound in some healthy people. 䊐 䊐
d. is boosted initially by the elastic recoil of the ventricle wall. 䊐 䊐
e. influences the force of the next heart beat. 䊐 䊐
2.5 The right ventricle
a. receives blood through the mitral valve. 䊐 䊐
b. ejects less blood than the left ventricle because its wall is thinner. 䊐 䊐
c. blood has an O2 content which is approximately three-quarters that
of aortic blood in a resting human. 䊐 䊐
d. raises pulmonary blood pressure to ⬃100 mmHg during ejection. 䊐 䊐
e. is connected to the left atrium by the ductus arteriosus before birth. 䊐 䊐
2.6. Isovolumetric contraction is closely associated with
a. the first heart sound. 䊐 䊐
b. the P wave of the ECG. 䊐 䊐
 The cardiac cycle Questions 7

T F

c. a falling pressure in the aorta. 䊐 䊐

d. a ‘c’ wave in the right atrium 䊐 䊐
e. a closed tricuspid, mitral, pulmonary and aortic valve. 䊐 䊐
2.7 During the ventricular ejection phase of the normal human cardiac cycle,
a. ejection takes less time than filling, in a resting human. 䊐 䊐
b. the left ventricle diameter decreases and the ventricle shortens from base to apex. 䊐 䊐
c. papillary muscles close the atrioventricular valves. 䊐 䊐
d. the apex beat is best felt in the anterior axillary line, fifth intercostal space. 䊐 䊐
e. the chordae tendineae are tensed. 䊐 䊐
2.8. Regarding cardiac ejection,
a. the opening of the aortic and pulmonary valves causes the first heart sound. 䊐 䊐
b. ventricular pressure rises more quickly during early ejection than during
isovolumetric contraction. 䊐 䊐
c. the aortic valve stays open for some time after ventricular pressure has fallen
below aortic pressure. 䊐 䊐
d. aortic valve incompetence creates a mid-systolic murmur. 䊐 䊐
2.9 During the human cardiac cycle,
a. the ‘a’ wave of atrial pressure coincides with the arterial pulse. 䊐 䊐
b. the ‘v’ wave of the jugular pulse coincides with the P wave of the ECG. 䊐 䊐
c. ejection reduces ventricular blood volume by more than 90% at rest. 䊐 䊐
d. ventricular pressure falls soon after the T wave of the ECG. 䊐 䊐
e. the first heart sound follows immediately after the arterial pulse. 䊐 䊐
2.10 In the human neck the jugular venous
a. pressure increases on standing up. 䊐 䊐
b. pulse is exaggerated if tricuspid incompetence develops. 䊐 䊐
c. pressure is raised in right ventricular failure. 䊐 䊐
d. ‘a’ wave is exaggerated in atrial fibrillation. 䊐 䊐
e. pulse is exaggerated in patients with complete heart block when a P wave
occurs between the QRS and T wave. 䊐 䊐
2.11 In the classic pressure–volume loop of the left ventricle,
a. the right-hand vertical line represents isovolumetric relaxation. 䊐 䊐
b. the top left corner represents aortic valve closure. 䊐 䊐
c. the bottom right corner represents tricuspid valve closure. 䊐 䊐
d. the width of the loop represents stroke work. 䊐 䊐
e. the area of the loop represents cardiac output. 䊐 䊐
2.12 With respect to the cardiac valves,
a. the mitral valve closes at the end of isovolumetric contraction. 䊐 䊐
b. mitral valve incompetence produces a pansystolic murmur. 䊐 䊐
c. the aortic valve closes at the onset of isovolumetric relaxation. 䊐 䊐
d. the aortic valve usually has two cusps. 䊐 䊐
e. the tricuspid valve opens during the rapid filling phase of the cycle. 䊐 䊐
8 Cardiovascular physiology Questions

T F
2.13 The aortic valve
a. cusps comprise vascular myocytes covered by endothelium. 䊐 䊐
b. is just superior to the openings of the coronary arteries. 䊐 䊐
c. is prevented from collapsing by chordae tendineae. 䊐 䊐
d. provides the first component of a split second heart sound. 䊐 䊐
e. when stenosed creates a systolic crescendo–decrescendo murmur. 䊐 䊐
2.14 During cardiac auscultation,
a. the second heart sound marks closure of the tricuspid and mitral valve. 䊐 䊐
b. the first heart sound is associated with the opening of the aortic and
pulmonary valves. 䊐 䊐
c. tricuspid murmurs are heard best at the lower left sternal border. 䊐 䊐
d. the aortic area is the second right intercostal space adjacent to the sternum. 䊐 䊐
e. murmurs heard best at the cardiac apex typically arise from the
pulmonary valve. 䊐 䊐
2.15 The second heart sound
a. is caused in part by the mitral valve opening. 䊐 䊐
b. occurs at the end of atrial systole. 䊐 䊐
c. is closely followed by a fall in ventricular pressure. 䊐 䊐
d. shows splitting that is increased by inspiration. 䊐 䊐
e. immediately precedes the T wave of the ECG. 䊐 䊐
2.16 In the clinical assessment of the cardiovascular system
a. radial artery palpation during sphygmomanometry provides an initial
estimate of diastolic pressure. 䊐 䊐
b. a highly irregular radial pulse may indicate atrial fibrillation. 䊐 䊐
c. a pulse rate of 40 beats/min may indicate complete heart block. 䊐 䊐
d. the jugular venous pulse is normally visible in the neck of a human
sitting upright. 䊐 䊐
e. an early diastolic murmur may indicate mitral valve incompetence. 䊐 䊐
For a change, here is a simple numerical problem.
2.17 The pressure–volume loop of a human left ventricle had end-systolic and end-diastolic
volumes of 42 and 120 ml, respectively, the mean diastolic and mean systolic pressures
were 8 and 88 mmHg, respectively, and aortic pressure was 119/79 mmHg.
a. What was the subject’s stroke volume?
b. How much did systole raise the mean left ventricular pressure?
c. What, approximately, was the subject’s stroke work?
d. What was the arterial pulse pressure?
The cardiac cycle Answers 9

Answers
2.1 a. F – The ductus arteriosus shunts blood from the pulmonary trunk into the aorta, to bypass
the lungs.
b. T – The foramen ovale in the interatrial wall shunts blood from the right to left atrium, thus
bypassing the unused fetal lungs.
c. F – The coronary sinus (Figure 2.1) is the main drainage vessel for coronary blood; it
develops very early in the embryo.
d. F – A septal defect alone does not cause cyanosis. Pressures are higher on the left side than
the right (Table 2.1). Consequently, blood flow through the defect is from left
(oxygenated) to right.
e. T – Fallot’s tetralogy comprise the aortic orifice overlying the ventricular septum, a
ventricular septal defect, a narrow pulmonary trunk and a hypertrophied right ventricle.
2.2 a. T – The left atrium has to fill the thick-walled, relatively stiff left ventricle, so it has to exert a
higher pressure than the right atrium (Table 2.1).
b. F – Most filling is passive and occurs before atrial contraction (Figures 2.2 and 2.3).
c. T – Rapid filling occurs in early diastole (Figures 2.2).This is important because, as heart
rate increases (exercise), diastolic interval shortens (Figure 2.4).
d. F – The atria contract first to boost the filling of the still-relaxed ventricles (Figure 2.2).
e. F – The pacemaker (SA node) is in the right atrium.
2.3 a. T – Since the right ventricle has a thin, compliant wall, the right atrium only needs to exert
a low pressure to fill it (Table 2.1).
b. F – Work ⫽ increase in pressure ⫻ volume displaced.The right side pumps to a lower
pressure than the left, so it does less work.
c. F – The first heart sound is made by the closure of the mitral and tricuspid valves as pressure
begins to rise in the ventricles.This happens at the start of the isovolumetric contraction
phase (Figure 2.2).
d. T – The ejection fraction in a healthy human is 67% at rest and more during exercise.
e. T – The QRS complex, created by the action potential upstroke in the excited ventricles,
must precede contraction (Figure 2.2).
2.4 a. F – Filling does not start until the atrioventricular valves open at the end of the next phase,
the isovolumetric relaxation phase (Figure 2.2).
b. T – As heart rate increases, diastole shortens (Figure 2.4). Consequently, the atrial ‘boost’ to
filling becomes increasingly important.
c. T – The initial rapid filling phase in diastole can cause a low third sound, especially in young
people.
d. T – The recoil has a sucking effect during early diastole.
e. T – Increased filling stretches the ventricular myocytes, which raises their contractile energy.
This is Starling’s law of the heart.
2.5 a. F – The tricuspid valve connects the right atrium to the right ventricle (Figure 2.1).
b. F – Each ventricle ejects the same stroke volume on average.
c. T – Mixed venous blood is about three-quarters saturated with O2 in a resting human.
d. F – Systolic pressure in the low-resistance pulmonary circulation is only ⬃25 mmHg in a
resting human (Figure 1.6).
e. F – The ductus arteriosus connects the pulmonary trunk to the aorta before birth, diverting
the right ventricular output away from the unused lungs.
10 Cardiovascular physiology Answers

2.6 a. T – The sharp rise in ventricular pressure closes the mitral and tricuspid valves (Figure 2.2).
b. F – The P wave marks atrial depolarization, which long precedes ventricular contraction.
(Figure 2.2).
c. T – At this point in the cycle, blood is leaving the aorta for the periphery and not entering it
from the ventricle, so aortic pressure is falling (Figure 2.2).
d. T – The atrial ‘c’ wave is created by the bulging of the tricuspid valve back into the right
atrium as right ventricle pressure rises (Figure 2.2).
e. T – This is why each ventricle is isovolumetric – both the inlet and outlet valves are closed.
2.7 a. T – Systole occupies only a third of the cycle at rest (Figure 2.4).
b. T – The ventricle contracts in all three dimensions.
c. F – Pressure closes the valves; the papillary contraction tenses the chordae tendineae to
prevent valve inversion (Figure 2.1).
d. F – The apex beat is normally best felt in the mid-clavicular line, fifth interspace
(Figure 2.5).
e. T – Tension in the chordae prevents valve eversion during systolic shortening (Figure 2.1).
2.8 a. F – The opening of healthy valves is silent.The first heart sound is caused by mitral and
tricuspid valve closure (Figure 2.2).
b. F – Pressure rises fastest when no blood can escape, i.e. during isovolumetric contraction.
dP/dtmax serves as a cardiological index of contractility (Figure 2.2).
c. T – This is because the escaping blood has to be decelerated to zero velocity by a reversed
pressure gradient before the valve leaflets can close (Figure 2.2).
d. F – The murmur of aortic regurgitation occurs in early diastole (Figure 2.6, bottom).
2.9 a. F – The ‘a’ is for atrial contraction, which long precedes the arterial pulse (Figure 2.2).
b. F – The ‘v’ is for ventricular contraction, which coincides with the ST segment of the ECG
(Figure 2.2).The P wave denotes atrial contraction and is closely followed by the ‘a’
wave.
c. F – About two-thirds (67%) is ejected at rest.The ejection fraction only reaches 90% during
heavy exercise.
d. T – The T wave marks ventricular repolarization, hence relaxation and a fall in ventricular
pressure (Figure 2.2).
e. F – The first heart sound, i.e. mitral and tricuspid closure, immediately precedes the arterial
pulse (Figure 2.2).
2.10 a. F – Jugular venous pressure falls on standing, due to the effect of gravity.
b. T – Regurgitation from the right ventricle into the right atrium and central veins creates
a pathological ‘v’ wave that is visible in the neck.
c. T – This is key diagnostic sign.The raised jugular venous pressure is brought about by
reduced pumping out of venous blood by the ventricle, coupled with peripheral
venoconstriction and fluid retention by the kidneys.
d. F – The ‘a’ stands for atrial systole.There is no longer a co-ordinated, discrete atrial systole
during atrial fibrillation, so the ‘a’ wave disappears.
e. T – The P wave marks the onset of atrial contraction. If the atria contract, yet the
atrioventricular valves remain closed (as during the ST period when the ventricle is
contracting), a wave of raised pressure shoots up the jugular veins.
2.11 a. F – The right, vertical side denotes isovolumetric contraction (Figure 2.7).
b. T – The top left corner marks the end of ejection as the aortic valve closes (Figure 2.7).