MODULE 4: Heart and Major Blood Vessels

Module Four - Laboratory

Anatomy & Physiology of the Heart

Everybody's got a (hungry) heart... (Bruce Springsteen)

In this module we examine the role of the heart in circulating blood around the body. Blood is the transport
medium, the blood vessels provide the conduits in which the blood circulates and the heart is the pump
that moves the blood throughout the body. The heart is actually a 'double pump' because it firstly pumps
blood to the lungs to allow gaseous exchange to occur and, when the blood returns to the heart, it is
pumped via the systemic circulation to the rest of the body. In this laboratory session you will:

1. Perform a heart dissection, and explore the anatomy of the atria, ventricles, and great vessels (aorta,
pulmonary arteries, superior and inferior vena cava): and
2. Learn how to record an electrocardiogram (ECG) to measure the electrical events of the cardiac cycle,
and relate the waveforms and intervals to events in the cardiac cycle.

Learning Outcomes

Upon completion of this module you should be able to:

1. Describe the structural and functional relationships of the heart.
2. Describe how the heart gets its own blood supply.
3. Describe the conducting system of the heart and explain the main features of an electrocardiogram
(ECG).
4. Describe the mechanical and electrical events of the cardiac cycle.
5. Discuss factors that influence cardiac output, stroke volume and heart rate.
6. Explain how the heart generates the pressure required to move the blood through the circulatory
system.

Use the Feedforward questions to guide you through the Learning Outcomes for the Module!

Readings

Van Putte, Regan & Russo (2017) Seeley’s Anatomy and Physiology (11th Ed) McGraw Hill, New York,
Chapter 20.

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 MODULE 4: Heart and Major Blood Vessels

Pre-Lab – The Heart

Heart anatomy
1. Label the following features of the heart on Figure 4.1 below:

1. Superior vena cava 9. Chordae tendineae

2. Aorta 10. Apex
3. Right atrium 11. Right ventricle
4. Left atrium 12. Left ventricle
5. Right atrioventricular valve 13. Pulmonary arteries
6. Left atrioventricular valve 14. Pulmonary veins
7. Rt Coronary artery 15. Pulmonary trunk
8. Interventricular septum 16. Inferior vena cava

Figure 4.1 –
Internal Anatomy
of the Heart
Adapted from Van
Putte et al, 11th
edition.

2. On Figure 4.1, use arrows to show the direction of blood flow through the heart. See numbers on diagram 4.1

The heart has its own circulation that supplies and drains the heart wall with blood, the coronary circulation. The
major vessels of coronary circulation lie in grooves (sulci) on the surface of the heart. In a fully intact heart the
grooves are covered in adipose tissue – once this is removed the individual vessels can be seen. The heart beats
day in day out, and cardiac muscle cells require a lot of oxygen and ATP to function – therefore coronary circulation
is vital for our survival. A person suffering from coronary heart disease may require a coronary stent - a tube-
shaped device placed in a coronary artery - to keep the coronary artery open and thus the heart functioning as
required.

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3. On Figure 4.2A label the following arteries that supply the heart muscle:
• left coronary artery
• anterior interventricular artery (sometimes known as left anterior descending)
• circumflex arteries
• right coronary artery
• posterior interventricular artery

4. Off which major artery do the left and right coronary arteries arise?
Ascending Aorta

5. On Figure 4.2B label the following major veins that drain the heart muscle:
• great cardiac vein
• middle cardiac vein
• small cardiac vein

6. Name the vessel the great, middle & small cardiac veins drain into to? Label this on Figure 4.2.
Coronary sinus

Fig 4.2A - The Coronary Arteries Fig 4.2B - The Coronary Veins
(Anterior View) (Anterior View)
Adapted from Van Putte et al, 11th edition.

7. Which heart chamber does the coronary sinus drain into? This is shown on the diagram by the small arrow.
The right atrium

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Practical Session
Part 1 - Dissection of the Heart
Students should work in groups of 5:
Dissection of a pig heart is valuable because the pig heart is similar in size and structure to the human heart. Also,
a dissection experience allows you to view structures in a way not possible with models and diagrams. There is no
better way to teach the structure to function relationship of the heart than to actually dissect it for yourself. Refer
to Figures 4.1 – 4.4 as you proceed with the dissection.

1. Obtain a pig heart, a dissection tray, and dissecting instruments. Rinse the pig heart in cold water to flush out
any trapped blood clots. Now you are ready to make your observations.
Observe the texture of the pericardium and fatty tissue.

i) Note the point of attachment of the pericardium to the heart. Where is it attached?
At the base where the great vessels enter and exit

2. Orientation of the heart.

Before proceeding with the dissection hold the heart in the correct anatomical position with the major
trunks (aorta and pulmonary trunk) in the anterior and superior position. See Figure 4.3. Check with your
tutor if you are unsure of anterior versus posterior.

i) Does the pulmonary trunk lie in front or behind the aorta when viewing the heart from the anterior aspect?
In front of

Figure 4.3 – Anterior View of the Heart

Adapted from Van Putte et al, 11th edition.

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3. External Surface features of the heart.

Now you have the heart correctly orientated identify the following features;
• right and left atrioventricular sulcus (sulci (sulcus) means a groove).
Follow each sulcus around the circumference to where they meet at the back of the heart.

i) These two grooves separate which chambers? (hint: its all in the name!).
The atria above from the ventricles below

• anterior and posterior interventricular sulci.

ii) Which chambers do they separate?

Separates the left and right ventricles

• the left and right atria and distinguish them from the left and right ventricles. The each atrium has an
associated auricle, earlike flaps of tissue, projecting from the atrial chamber.

• the left ventricle by compressing the ventricular chambers on each side of the interventricular sulci. The
side that feels thicker and more solid is the left ventricle. The right ventricle feels much thinner and
somewhat flabby upon compression. This difference reflects the greater demand placed on the left
ventricle, which must pump blood through the systemic circulation, a pathway with much higher
resistance than the pulmonary circulation (to the lungs and back), which is served by the right ventricle.

• the base and apex of the heart, the base is where the great vessels enter and exit the heart and where
the pericardium attaches.

iii) Which ventricle makes up the apex of the heart?

left ventricle

Take time at this point to identify the following vessels at the base of the heart;

- superior and inferior vena cava (these vessels will more than likely be collapsed, as they are thin wall veins)
- the pulmonary trunk (and if possible it dividing into right and left pulmonary arteries)
- the pulmonary veins (It may or may not be possible to locate all four pulmonary veins; it depends on how they
were cut as the heart was removed)
- the aorta.

4. Coronary circulation.
The grooves mentioned above contain epicardial fat which surrounds the main blood vessels of the coronary
circulation. Refer back to your prelab;
i) Which coronary artery lies in the right atrioventricular sulcus?
The Right coronary artery

ii) Which coronary artery lies in the left atrioventricular sulcus?

The circumflex artery, which is a branch of the left coronary artery.

iii) Which groove does the anterior interventricular coronary artery lie?

Anterior interventicular sulcus

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iv) Three cardiac veins drain the muscle of the heart wall. Examine the heart and identify
in which grooves you would find the;

Small cardiac vein: right artrioventricular sulcus

Middle cardiac vein: posterior interventricular sulcus

anterior interventricular and left

Great cardiac vein:
atrioventricular sulcus

The three veins meet at the coronary sinus located at the posterior aspect of the heart (find this on the
model and then on the real heart).

v) Which chamber of the heart does the coronary sinus drain into? (hint: its carrying deoxygenated blood)
The right atrium

vi) Why does the heart need a specific blood supply? Why can’t it get all its nutrients and oxygen from the
blood pumping through its chambers?
The blood moves too fast through the heart chambers to allow sufficient exchange of
nutrients. Also the heart wall is much too thick for diffusion of nutrients

vii) When someone has a “heart attack” it is a coronary vessel that becomes occluded (blocked); not the
aorta or pulmonary vessels. What do you think happens to the muscle of the heart if blood supply is
blocked?

The area of the heart muscle no longer receiving blood can be damaged or die due to lack

of oxygen.

5. Examination of the right atrium.

Now return to the superior and inferior vena cava, which drain blood from the body into the
right atrium.
i) The superior vena cava drains blood from which parts of the body?
The head, neck, upper limbs and thorax

ii) The inferior vena cava drains blood from which parts of the body?
The lower limbs and the abdominopelvic cavity

Gently insert a probe into the superior vena cava and down through into the inferior vena cava and use
scissors to make a longitudinal cut through the wall on the posterior aspect following the probe, you should
now be able to view into the interior of the right atrium. Notice that part of the inside wall of the right
atrium is smooth (near the openings of the vena cavae), while other areas within the right atria is rough with
ridges of muscle, particularly near the right auricle.

iii) Observe the comb-like ridges of the pectinate muscle, which are found throughout most of the right
atrium, what is their function?
help increase the surface area of the right atrium during times of dilation

helps overcome the constantly changing volume due to different amounts of blood coming

back to the heart (venous return – we cover this next week)

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iv) Just below the inferior vena cava opening, identify the opening of the coronary sinus. What is the role of
the coronary sinus?

It returns blood of the coronary circulation (from the cardiac veins) to the right atrium

v) Examine the opening into the right ventricle in the floor of the right atrium and observe the right
atrioventricular valve. Pour some water down through this valve into the right ventricle. Now gently squeeze
the ventricle and watch for the valve closing. How many flaps (cusps) does it have?
3

6. Examination of the right ventricle.

Now cut through the wall of the right atrium down to the right ventricle, you will cut through the right
atrioventricular valve that separates the two chambers. The cut should run parallel to the interventricular
septum (the thick muscular wall that separates the right ventricle and the left ventricle) heading down to the
bottom of the right ventricle. Be careful not to cut into the interventricular septum. As you cut through the
right ventricular wall comment on its thickness.
It is thin walled.

Reflect the cut edges to examine the features inside the right ventricle. Note the pitted and ridged
appearance of the inner ventricular wall.
i) These are columns of muscle called trabeculae carnae. What are is their function?
Promote mixing and prevent pooling of blood in the heart chambers.

Identify the papillary muscles in the right ventricle and follow their attached chordae
tendineae to the flaps of the right atrioventricular valve (tricuspid valve).
ii) What is the function of the papillary muscles and chordae tendineae?
The chordae tendineae help anchor the valves and stop the valves from inverting during

ventricular contraction. This stops the back-flow of blood through the heart.

Cut up the anterior wall of the right ventricle towards and into the pulmonary trunk. Blood leaves the right
ventricle via this opening on its way to the lungs. Continue the cut along the length of the pulmonary trunk.
Examine the point at which the right ventricle meets the pulmonary trunk and find the pulmonary semilunar
valve. Note the direction of the cusps of the valve and comment on how it can prevent blood flowing back
into the ventricle when the heart muscle is at rest.

7. Examination of the left atrium.

Turn the heart to view its posterior surface. The heart will appear as shown in Figure 4.4 below. Orientate
yourselves to this view of the heart before proceeding. Make sure you can still identify the four chambers of
the heart correctly.

Identify the pulmonary veins entering the left atrium.

i) Blood coming from which organ enters the left atrium? ______Lungs _________________
Cut open the posterior wall of the left atrium and reflect the cut edges to view the interior. Note how thin-
walled the atrium is along with the thin wall of the pulmonary veins (this is indicative of veins). The interior of
the left atrium is mostly smooth with some pectinate muscle located in the left auricle.

Examine the interatrial wall (the wall which separates the left and right atria) and locate a small oval
depression, this is called the fossa ovalis, (it may be easily felt, rather than seen). This marks the site of an

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opening, the foramen ovale that allowed blood to pass from the right to the left atrium in the foetal heart,
thus bypassing the foetal lungs. This hole is closed just after birth and remains as a small depression in the
interatrial wall.

Figure 4.4 – Posterior View of the Heart

Adapted from Van Putte et al, 11th edition.

8. Examination of the left ventricle.

Continue your incision from the left atrium into the left ventricle through the left atrioventicular valve, down
towards the apex,

i) As you cut into the left ventricle, comment on its thickness.

It is very thick walled, especially when you compare it to the right ventricle.

ii) Are the papillary muscles and chordae tendineae observed in the right ventricle, also present in the left
ventricle?
Yes

iii) Count the number of cusps in the left atrioventricular valve. How does this compare with the number
seen in the right atrioventricular valve?
Left = 2, right = 3

Now make a cut from the anterior left ventricle wall heading superiorly towards the aorta. Cut along the
aortic wall. Examine the junction between the left ventricle and the aorta to find the aortic semilunar valve.
This valve operates in the same fashion to the pulmonary semilunar valve in that is prevents backflow of
blood into the ventricle when the heart is at rest.

Look for small two openings, just above the valve. Insert a wooden probe into these openings to help identify
the two (left and right) coronary arteries. As these are the first branches to arise from the aorta means the
heart supplies itself with blood before any other organ.

10. Cleaning up: When finished make sure you place the heart into the medical waste container and wash your
tray and instruments.

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11. Review Questions on Blood Flow and Blood Pressure Changes in the Heart.
A. Place the following into their correct order to show how blood flows through the heart and its associated
vessels. The first and last events are already indicated as a guide.

1 Right Atrium 11 Aortic Semilunar Valve

7 Pulmonary Veins 5 Pulmonary Trunk

4 Pulmonary Semilunar Valve 9 Left AV (bicuspid) Valve

8 Left Atrium 3 Right Ventricle

2 Right AV (tricuspid) Valve 6 Pulmonary Arteries

10 Left Ventricle 12 Aorta (systemic circulation)

Blood is moved through the heart primarily through contraction of the cardiac muscle in the chamber walls,
which increases the pressure on the blood in the respective chamber. Changes in pressure also causes the
valves to open and close, which ensures that unidirectional blood flow between the chambers is achieved

B. Using the answer key below, match up the correct action, (a) to (f), with the cardiac event it is responsible
for. Some answers may be used more than once.

(a) Increase in pressure (contraction) of the right atrium

(b) Increase in pressure (contraction) of the left atrium
(c) Increase in pressure (contraction) of the right ventricle
(d) Decrease in pressure (relaxation) of the right ventricle
(e) Increase in pressure (contraction) of the left ventricle
(f) Decrease in pressure (relaxation) of the left ventricle

1. ___(a)___ Pushes remaining blood into the right ventricle

2. ___(e)___ Opens the aortic semilunar valve

3. ___(e)___ Closes the left AV (bicuspid) valve

4. ___(d)___ Opens the right AV (tricuspid) valve

5. ___(f)___ Closes the aortic semilunar valve

6. ___(b)___ Pushes remaining blood into the left ventricle

7. ___(f)___ Opens the left AV (bicuspid) valve

8. ___(c)___ Opens the pulmonary semilunar valve

9. ___(d)___ Closes the pulmonary semilunar valve

10. ___(c)___ Closes the right AV (tricuspid) valve

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Part 2 – Listening to Heart Sounds

Normal heart sounds are caused by the closure of the valves of the heart. These may be heard by applying the ear
to the chest wall of the subject or by listening through a stethoscope.

The sounds heard can be likened to the following: LUB-DUP pause LUB-DUP pause. The first heart sound (LUB) is
caused by the closure of the left atrioventricular (bicuspid/mitral) and right atrioventricular (tricuspid) valves at
the onset of ventricular systole (contraction). This sound may be augmented by the impact of the heart on the
chest wall, which can be felt in the 5th intercostal space (between the 5th and 6th ribs). This is known as the apex
beat.

The second heart sound, DUP, is caused by the closure of the aortic and pulmonary valves at the beginning of
ventricular diastole. It is shorter and sharper than the first. Since systole is shorter than diastole (relaxation)
there will be a pause between “DUP” and the following “LUB”. Sometimes a third heart sound may be heard
shortly after the second. It is due to blood rushing into the ventricles during diastole.

Figure 4.5 Positions for Heart Sounds

Adapted from Van Putte et al, 11th edition.

1. Seat the subject and place the diaphragm of the stethoscope at the fifth intercostal space, approximately 9
cm from the midline on the left (Figure 4.5). Listen for the first heart sound.

2. Listen for the second sound at the second intercostal space, just to the left of the sternum.

3. See if you can identify the mitral (M) and tricuspid (T) components of the first sound, and pulmonary (P) and
aortic (A) components of the second sound, by placing the stethoscope at the locations shown in Figure 4.5.

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Part 3 – The Electrocardiogram (ECG/EKG)

Cardiac muscle has the fundamental physiological property of automatic rhythmicity. This feature is responsible
for the uniformly paced alternating periods of depolarisation and repolarisation of the heart that must precede
the mechanical events of contraction and relaxation of the heart muscle. In humans, the heartbeat is regulated
by the sinoatrial (SA) node or “pacemaker”, which is located in the wall of the right atrium.

Figure 4.6 Conduction System of the Heart

Adapted from Van Putte et al, 11th edition.

Action potentials (AP) start in the SA node (labelled 1 in Fig 4.6 above) and travel across the wall of the right
atrium to the AV node (labelled 2). The AP then passes through the AV node and along the AV bundle, which
extends from the AV node into the interventricular septum. The AV bundle divides into left and right bundle
branches and action potentials extend to the apex of each ventricle (labelled 3). APs are then carried by the
Purkinje fibres to the ventricular walls and papillary muscles (labelled 4).

In this activity we will be recording the electrical events of the heart during the cardiac cycle with a view to linking
them to their associated mechanical events. Records of the electrical activity, or bioelectrical potentials, are made
using an electrocardiograph. Electrocardiographs are important tools in the diagnosis of many cardiac disorders.

Electrocardiographs amplify the electrical currents generated by the heart so that they are strong enough to
activate a recording device. The currents are conducted to the surface of the body where they are picked up by
recording electrodes attached to the electrocardiograph. The
amplified impulses can be recorded digitally or by use of a chart recorder.
The record produced by the electrocardiograph is called an electrocardiogram (ECG/EKG), which represents the
sum of all the electrical events occurring in the heart at that time. An ECG recording is shown in Figure 4.7 and a
description of the features and the major events is in Table 4.1.

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Figure 4.7 – A Normal Electrocardiogram

Adapted from Van Putte et al, 11th edition.

1. Complete the table below to relate the ECG feature to the electrical and mechanical events of the cardiac
cycle. Indicate whether the respective valves are OPEN or CLOSED. Your tutor will work through the table with
you.
Table 4.1 - The major features of an ECG and associated events

ECG
Electrical Event Mechanical Event AV Valves SL Valves
Feature

P wave Atrial depolarisation Atrial systole (contraction) OPEN CLOSED

QRS Start ventricular

Ventricular systole (contraction) CLOSED OPEN
complex depolarisation

T wave Ventricular repolarisation Ventricular diastole (relaxation) OPEN CLOSED

T wave – Atrial and ventricular diastole

No Events OPEN CLOSED
P wave (relaxation)

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When ECG recordings are made, electrodes are placed in quite specific positions on the body surface, such that
the electrical events of the heart can be "viewed" from different vantage points. The particular arrangement of
any two electrodes is called a lead.
Generally, 12 standard leads are used:
• 3 are bipolar limb leads (Leads I, II and III). Bipolar means the lead is reading from two electrodes
• 6 are unipolar chest leads (V1-6)
• 3 are augmented unipolar limb leads (aVR, aVL and aVF).

The position of the electrodes on the body and the manner in which they are activated, determine the amplitude
and direction of the recorded waveforms. In this practical the 3 bipolar limb leads ONLY will be used.
Your tutor will demonstrate the principles, calibration, and correct use of the electrocardiograph system.

THE PROCEDURE
1. The recording speed is fixed at 25 mm/sec (0.04 sec/mm).
2. A volunteer from the group acts as subject and removes anything that could interfere with taking a recording,
e.g., metal wristwatches, bracelets or bling! Roll up your sleeves and roll down your socks.
3. Have your subject lie supine on the couch in a relaxed position and apply the small “button electrodes" to the
4 limbs as directed by your tutor. Once you have removed the backing plastic from the "electrode pad", apply
a very small amout of EKG gel to the centre of the "electrode". The reason for this is that electrodes have a
limited shelf life, which can lead to the pad gel drying out and not providing a good electrical connection
between the "electrode" and your skin; the liquid gel helps overcome this problem.
Attach the respective recording leads to the buttons on the LEFT ARM, RIGHT ARM and LEFT LEG as directed
by your tutor. The earth lead is attached to the RIGHT LEG button.
The three standard limb leads are used in this exercise:
• Lead I - electrodes attached to right and left wrists are active.
• Lead II - electrodes attached to the right wrist and left ankle are active.
• Lead III - electrodes attached to the left wrist and left ankle are active.
4. Once the subject is connected to the ECG machine you are going to collect ECG records from two different
exercises:
A. Firstly to look at the Similarities and Differences between the three leads and to calculate heart rate,
and
B. Secondly, to look at the Effect of Changing Body Position on the ECG trace.

A. SIMILARITIES AND DIFFERENCES BETWEEN THE 3 LEADS:

5. Obtain sample recordings from the three leads while the subject is at rest, lying on the couch. The subject
should keep quite still during the procedure. Usually 10-12 ECG complexes (10-12 complete cycles of P wave,
QRS and T wave) for each lead will be sufficient. Note the difference in recording patterns from each lead.
Mark the record with the subject's name.
6. Whilst your subject is still connected to the ECG, take their pulse from the radial artery in the normal
manner and see if your heart rate calculations below compare with their pulse heart rate.

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B. THE EFFECT OF CHANGING BODY POSITION ON THE ECG:

7. For this exercise you need to record continuously from the subject using Lead II. After obtaining some
“control” trace (about 10 seconds) with the subject in the supine position, ask him/her to sit up slowly on the
couch. The subject needs to move slowly, not spring upright like a jack-in-the-box, and remain in the sitting
position.
After sitting upright for 30 seconds, direct the subject to slowly return to the supine position. Indicate where
these movements have occurred on the respective ECG trace. You may have noticed that while the subject
was moving there was a lot of "noise" (instability) on the trace.

ANALYSIS OF THE RESULTS:

A. SIMILARITIES AND DIFFERENCES BETWEEN THE 3 LEADS:
8. Why do you think the ECG components look different (size and shape) in each trace?
Because they are looking at the beating heart from different perspectives (views).

9. By convention, Lead II usually provides the best signal for most individuals. Calculate the subject's heart rate
from this section of trace. It is much better practice, and more accurate, to calculate the subject's heart rate
manually; this can be done very easily because the trace moves at a fixed speed (25 mm/sec), which gives an
accurate indication of the time.

To calculate HR at the chart speed of 25 mm/sec

IN ALL OF THESE METHODS YOU NEED TO COUNT A REPRESENTATIVE NUMBER OF BEATS (6-8) FROM THE ECG
TRACE TO ACCURATELY DETERMINE THE HEART RATE. AVERAGING THE TIME OVER ONE OR TWO BEATS WILL
NOT PROVIDE A TRUE RECORD OF HEART RATE; THE MORE BEATS YOU INCLUDE IN YOUR CALCULATIONS, THE
MORE ACCURATE YOUR HEART RATE DETERMINATION WILL BE.

Method 1:
The quick way if the chart is running at 25 mm/sec.
HR = 1500
Average R-R interval in mm*
Where: 0.04 and 60 are constants and 60/0.04 = 1500
*Average R-R interval is calculated by measuring up to 6 R-R intervals and take the average
Example:
1500/23 = 65 bpm

Method 2:
a) Measure the average R –R interval in mm over 6 - 8 beats.
b) Multiply the mm by 0.04 (that is, at a chart speed of 25 mm/sec, each mm = 0.04 sec)
This gives your R-R interval in seconds
c) Divide 60 by your answer to b) (as there is 60 secs in 1 minute)
This gives your heart rate in beats per minute (bpm).
Example:
a) average R-R = 23 mm
b) R-R = 23 x 0.04 = 0.92 (this means the heart is beating every 0.92 seconds)
c) 60/0.92 = 65.2 (that is, the heart rate is 65 bpm).

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10. Using Lead II, calculate your subject's heart rate by each of these three methods.
Table 4.2 - The calculation of Heart Rate (HR).

Method 1 Calculation Method 2 Calculation

ECG HR Pulse HR
(show working) (show working)

N/A

B. THE EFFECT OF CHANGING BODY POSITION ON THE ECG:

After allowing the trace to stabilise, compare Lead II supine with Lead II sitting. Do you notice any differences
between the two traces (Hint: compare heart rate before and after sitting)?

11. Complete the following table with the results from changing position.

During sitting or standing

Activity Before Sitting After Sitting
@ 10 secs @ 20 secs @ 30 secs

Average
HR (bpm)

12. Are there also any changes in waveform amplitude and/or duration of intervals and segments visible on the
trace between the two body positions?
You should notice that the distance (mm) between the R waves get shorter when the subject

initially sits up.

13. You probably saw a lot of electrical ‘noise’ when the subject started to sit up; whilst they were sitting and
when they laid back down again; what are the reasons for this?
Increased electrical activity in the body other than from the heart. This would be caused by

the activation of skeletal muscles used for changing body position.

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14. Why does HR change when moving from supine to sitting? Your tutor will provide you with a physiological
explanation of this phenomenon? This is a topic we will revisit in the next module.

This is a demonstration of the BARORECEPTOR REFLEX. When the subject sits up, blood

pressure to the head falls. Baroreceptors in the carotid artery detect this change and relay

this info to the cardiac centres in the medulla, which responds by bringing about a reflex

increase in heart rate to restore blood pressure.

Heart rate
An increased or decreased heart rate at rest is often the first diagnosis that all is not well with the cardiovascular
system. A normal heart rate is between 60–100 bpm; tachycardia (fast HR) is >100 bpm and bradycardia (slow
HR) is <60 bpm)

Using these traces below, calculate the HR of Patients 1, 2 and 3 (Fig. 4.8 below) using the methods described on
page 12 (the chart speed for these examples is 25 mm/sec, as it was for your ECGs).

Patient 1:

Patient 2:

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Patient 3:

Figure 4.8 - Heart Rate

https://www.memorangapp.com/flashcards/137713/EMS+Dysrhythmia+Reference/

Patient 1. HR 78 bpm Patient 2. HR 30 bpm Patient 3. HR 130 bpm

Diagnosis: normal heart rat Diagnosis: bradycardia Diagnosis: tachycardia

Follow Up Activities
To complete this Module here are some suggestions for relevant follow-up activities to help you
consolidate the material at the end of the week.

1. Follow-up on any concepts or words that you still are having trouble understanding. You can do
this on your own, in a small study group, at a UniPASS session or with your tutor.
2. Complete the Revision activities for FEEDBACK on how you are coping with the work in this
module. These can be found on Blackboard or on McGraw Hill Connect website.
3. Make sure you read all the relevant pages in your textbook.
4. Complete the FeedForward questions.

ISAP 17 Sem 2, 2018