10 marks

A 60 year old man presented with acute retro sternal chest pain radiating to the inner aspect of left arm. The ECG showed ST
segment elevation in some of the leads.
What is the most probable diagnosis?
What are the other ECG changes that may occur in this condition?
Explain the leads used in recording ECG
With the help of a diagram describe the waves, intervals and segments of normal ECG recording in Lead 1
(1+1+2+6=10)

Short essays - 5 marks

Effect of sympathetic stimulation on Cardiac muscle.
Explain the mechanisms of increase in force of contraction
Explain the waves, intervals & segments of ECG.
Define an ECG lead. Classify the leads.
Phasic coronary blood flow.
Compensatory mechanisms in left subendocardium of left ventricle to prevent Myocardial ischemia.
List the methods of study of Coronary blood flow. Add a note on Kety method.
List the factors regulating Coronary blood flow.
Add a note on Autoregulation of Coronary blood flow.
Explain the factors affecting Stroke volume.
Factors influencing venous return.
Differences in sarcotubular system of Cardiac & Skeletal muscles.
Differences between Smooth, Cardiac & Skeletal muscles.
Explain the five differences between smooth muscle and cardiac muscle.
All or none law of Cardiac muscle.
Refractory period of Cardiac muscle.
List the properties of Cardiac muscle (Mechanical & Electrical properties). Explain any one.
With the help of a neat labelled diagram, explain the action potential of Cardiac muscle
OR
With the help of a neat labelled diagram, explain the cardiac muscle action potential (Phases & ionic basis of each phase).
Pacemaker potential (Definition, Ionic basis)
OR
With the help of a neat labelled diagram, explain the Pacemaker potential
(Nodal tissue RMP & AP – Phases & ionic basis of each phase)
Effect of ANS stimulation on pacemaker potential & on Action Potential of Nodal tissue
Origin and spread of cardiac impulse OR Explain the conducting system of heart
Explain A-V nodal delay (Definition, Duration, Causes for the delay, Significance of the delay, & Regulation of A-V conduction
by Vagal & Sympathetic stimulation).
Or
Give reasons for the cause and significance of Atrio-ventricular nodal delay. What is the normal duration of the delay?
Add a note on force of contraction in Cardiac muscle.
Explain excitation – contraction coupling in Cardiac muscle (definition & steps in E-C coupling)
Draw a neat labelled diagram of ECG. Give the cause for the different waves in ECG.
Korotkoffs sounds
Describe the different phases of Cardiac cycle with the help of Lt. Ventricular pressure & Aortic pressure curves.
Mention the waves and causes for the waves in Jugular venous pulse tracing.
Explain the arterial pulse tracing (Diagram, Cause fr the different Waves).
Expalin the left Ventricular pressure volume loop with a neat labelled diagram.
Mention the methods of measurement of cardiac output & the merits & demerits of each method.
Define Fick’s principle. Give details of estimation of cardiac output based on it.

Answer briefly (3)

Autorhythmicity in Cardiac muscle
Frank – Starling’s Law of heart
Einthoven’s triangle
Sick sinus syndrome.
Wenkebach phenomenon
Genesis of Cardiac murmurs (3 or Physiological basis)
Methods of study of Cardiac cycle
Dicrotic pulse
Add a note on Ejection fraction.
Add a note on cardiac reserve
List the pacemaker & conduction tissues in Heart.
List the Phsiological characteristics of Cardiac muscle.
List the properties of Cardiac muscle.
Add a note on Stannius ligatures in amphibian heart.
List the Cardiac ion channels.
List the steps in spread of electrical activity in heart
Factors influencing Stroke volume
Heart sounds
End – diastolic ventricular volume
Volume changes during cardiac cycle
Arterial pulse tracing
 Draw & label (2.5)
Pacemaker potential.
2Normal E C G in Lead II
Cardiac muscle action potential
ECG of lead II
Left ventricular pressure changes recorded during normal cardiac cycle
Cardiac cycle
Conducting system of heart.
Left Ventricular pressure volume loop

Explain the physiological basis of the following: (2marks)

1. Prolonged action Potential in Cardiac muscle.
2. Cardiac muscle cannot be tetanized.
3. excitation – Contraction coupling.
4. Heart can beat even after denervation
5. Coronary arteries are perfused during diastole
6. Q wave in an ECG
7. Korotkoff’s sounds
8. Prolonged standing results in fainting attacks
9. Prolonged action potential in cardiac muscle
10. Change of posture from supine to standing causes tachycardia

NOTE: FOR INTERNAL ASSEMENT extra questions other than these may also be asked. So the students should come
prepared for the portion covered till the last class.

Key:
Give reasons for the cause and significance of Atrio-ventricular nodal delay. What is the normal duration
of the delay?
A-V nodal delay- Duration – 0.1 secs.
Cause for the delay – i. Small size of the nodal cells. ii. Slower conduction rate of AV nodal fibers, especially ‘AN’
& ‘N’ region (0.02 – 0.05 m / second). iii. Few gap junctions connecting the zones of AV node. iv. Slow voltage-
gated Ca++ channels.
Significance of the delay – Due to the delay, atrial depolarization is complete before ventricular depolarization
begins. Therefore when atrial systole occurs, ventricle is in diastole. This helps in ventricular filling.

Mention the waves and causes for the waves in Jugular venous pulse tracing.
a wave – a stands for Atrial systole. During atrial systole, a sharp rise in intra-atrial pressure (by 4-6 mmHg in Rt.
Atrium & by 7-8 mmHg in Lt. Atrium) occurs. This causes a pressure wave – ‘a’ wave.
c wave – ‘c’ sands for V contraction. It coincides with the onset of V systole & results from bulging of Tricuspid
valve ring into Rt. A as Rt. A pr. rises during IVC phase.
v wave – ‘v’ stands for venous filling. Passive rise in Rt. A pr. as venous return continues with Tricuspid valve
closed. It occurs during IVR (Isovolumic relaxation) phase.