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Human Physiology 14Th Edition Fox Solutions Manual Full Chapter PDF
Human Physiology 14Th Edition Fox Solutions Manual Full Chapter PDF
Solutions Manual
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SECTION 7 - THE CARDIOVASCULAR SYSTEM
Anxiety and coffee can increase the heart rate by stimulating the central nervous system.
Atropine dilates the pupils and also increases the heart rate.
Digitalis stops atrial fibrillation. It inactivates the Na+/K+ pumps. This causes an increase in Ca2+ influx.
This increases muscle contraction thus increasing heart contraction strength.
2. Explain the mechanisms whereby atropine is used for eye exams for the treatment of gastritis.
Atropine blocks parasympathetic activity. This results in a decrease in gastric secretions by the stomach
and causes pupil dilation if the eyes.
The parasympathetic nerves cause pupil constriction and stomach acid secretion. Since atropine inhibits
parasympathetic activity, this results in pupil dilation and a decrease in gastric secretions.
3. Explain the mechanisms by which digitalis can help treat atrial fibrillation.
Digitalis affects the heart in this manner: It inhibits SA node activity. It also slows the conduction through
the bundle of His.
1
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Atrial contraction is represented by the impulse from the SA node to the AV node. During atrial fibrillation
this impulse is out of control. Therefore, digitalis can be given since it inhibits the SA node.
Answers to Questions
1. d 4. c
2. a 5. b
3. f 6. e
7. digitalis glycosides
8. atropine
9. abnormally high potassium levels in the blood
10. Hyperkalemia may cause the production of ectopic pacemakers and result in fibrillation. These effects are
produced because a rise in plasma potassium concentration promotes the entry of K+ into cardiac fibers
resulting in depolarization and myocardial hyperexcitability.
11. A sympathomimetic drug mimics or duplicates the actions of the sympathetic nervous system. In this way, a
sympathomimetic drug causes the heart to beat stronger (increased contractility) and faster (increased
cardiac rate) and promotes a net vasoconstriction of the blood vessels (raises blood pressure).
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
12. By deactivating the Na+/K+ pump, digitalis increases the force of contraction (increased Ca2+) and slows the
rate of impulse conduction from the atria to the ventricles. The latter effect reduces the excitability of the
ventricles that respond by beating more slowly. As a result of these actions, digitalis may be used in
congestive heart failure to increase the pumping strength of the heart and it may be used to treat atrial flutter
and fibrillation by decreasing the overall excitability of the heart.
13. Bathing the heart with Ca2+ increases the amplitude of the heart’s contraction recording. The heartbeat is
stronger yet the cardiac rate should slow. This occurs because unlike skeletal muscle contractions that are
all or none, an increase in intracellular Ca2+ in cardiac muscle promotes the formation of a greater number
of myosin cross bridges. The extra influx of Ca2+ lengthens the duration of the myocardial action potential
at the calcium plateau, and, consequently, the duration of each contraction-relaxation cycle. The added
intracellular calcium also increases the overall tension in the cardiac fibers even while relaxing between
beats.
14. Theophylline, like caffeine, is a mild central nervous system (CNS) stimulant that also acts directly on the
myocardium to increase both the strength of contraction and the cardiac rate. Theophylline inhibits the
activity of the enzyme phosphodiesterase, which breaks down cyclic AMP second messenger molecules.
As a result, rising cAMP concentration in heart cells mimics the action of epinephrine on the heart.
Similarly, epinephrine and rising levels of cycle AMP cause the smooth muscle fibers of the bronchioles to
relax and dilate. Theophylline, therefore, duplicates and enhances the effects of epinephrine by promoting
the rise in cyclic AMP levels in the bronchiolar smooth muscle, thereby relieving the stress of breathing in
asthmatics.
15. Anxiety and coffee can increase the heart rate by stimulating the central nervous system.
Atropine dilates the pupils and also increases the heart rate.
Digitalis stops atrial fibrillation. It inactivates the Na+/K+ pumps. This causes an increase in Ca2+ influx.
This increases muscle contraction thus increasing heart contraction strength.
16. Atropine blocks parasympathetic activity. This results in a decrease in gastric secretions by the stomach
and causes pupil dilation if the eyes.
The parasympathetic nerves cause pupil constriction and stomach acid secretion. Since atropine inhibits
parasympathetic activity, this results in pupil dilation and a decrease in gastric secretions.
17. Digitalis affects the heart in this manner: It inhibits SA node activity. It also slows the conduction through
the bundle of His.
Atrial contraction is represented by the impulse from the SA node to the AV node. During atrial fibrillation
this impulse is out of control. Therefore, digitalis can be given since it inhibits the SA node.
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
Materials
1. Electrocardiograph or other strip chart recorder, such as Physiograph (Narco), or Lafayette Instrument Co., Inc.
recorder with EKG module (Alternatively, the Biopac system may be used.)
2. Electrode plates, rubber straps, electrolyte gel or paste; disposable electrodes and electrode clips
3. Alternatively, simulated electrocardiograph exercises may be performed using the Physiology Interactive Lab
Simulations: Electrocardiogram and Heart Function (exercises 4 and 6).
Textbook Correlations: Chapter 13 – Electrical Activity of the Heart and the Electrocardiogram
Clinical Investigations
1. Explain the significance of her ECG pattern when she was first brought to the hospital.
The wavy baseline and an atrial beat of 600 indicate atrial fibrillation. An increase in atrial contractions
would result in a decrease in blood volume entering the ventricles and therefore decrease cardiac
output by about 15%. This decrease in cardiac output results in a decrease in oxygen being delivered
to the tissues of the body. This decrease in oxygen being delivered could cause a patient to ―pass out.‖
Plus, a decrease in cardiac output will result in a decrease in blood pressure thus resulting in a loss of
consciousness.
2. Explain the meaning of a normal sinus rhythm, a PR interval of 0.16 sec, and PVCs.
A normal sinus rhythm is when the sinus node generates a normal atrial impulse, which produces a normal
p wave. The normal interval is .12 to .20 seconds. Regarding this patient; the interval value was .16
seconds, which is within the normal range.
This patient had a run of PVCs (premature ventricular contractions). This is a situation where the heart
beat is initiated by the ventricles rather than the SA node. This is felt as a skipped beat.
Since the ventricles contract before the atria, the ventricles do not fill properly and therefore do not
eject an adequate volume of blood. A run of PVCs could result in ventricular tachycardia, which is
dangerous.
Answers to Questions
1. Sinoatrial (SA) node in the right atrium
2. atrioventricular bundle (bundle of His)
3. a. depolarization of the atria
b. depolarization of the ventricles
c. repolarization of the ventricles
4. gap junctions
5. tachycardia; bradycardia
6. first-degree AV block
7. standard limb
8. QRS
9. T wave [S-T segment]
10. The SA node fibers serve as the pacemaker of the heart because they open special ion channels and undergo
spontaneous depolarization faster than any other fibers in the heart. Consequently, the SA node sets the
pace, generating action potentials that are rapidly conducted to other myocardial cells via intercalated discs
(gap junctions). Although capable of spontaneous depolarization, other myocardial cells depolarize at a
slower rate and thus normally follow the SA node rhythm. The depolarized cells of the atria respond first by
contracting as a unit, followed shortly by the ventricles that similarly depolarize and contract. Furthermore,
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the SA node pace is influenced by autonomic neurotransmitters acetylcholine (slows) and norepinephrine
(speeds), and by epinephrine (speeds).
11. Depolarization spreads through the atria producing the P wave. After a delay at the AV node, the
depolarization then spreads down the bundle of His to the Purkinje fibers and the ventricular myocardium.
This produces the QRS wave. Repolarization of the ventricles in the reverse direction produces the T wave.
In third-degree, or complete AV node block the ventricles are not depolarized by impulses from the atria.
The atria continue to beat according to the pace set by the SA node (supraventricular) while the ventricles
beat according to the pace set by an ectopic pacemaker within the ventricles, responsible for the slower rate
and the lack of response to the demands of exercise that raise the atrial pacing only.
12. Supraventricular tachycardia is characterized by an abrupt rapid atrial beat that drives a rapid ventricular
beat for short intervals for periods of time. The ECG is normal in appearance and the ventricles are able to
pump blood during this brief condition. In ventricular tachycardia however, the ventricles are not paced by
the atria but rather by excitable ectopic foci in the ventricles that cause the ECG to have widened and
distorted QRS complexes that can mask normal P waves. Ventricular tachycardia is more serious because it
can degenerate into ventricular fibrillation and because the ventricular pumping is very erratic.
13. In third-degree AV node block none of the impulses from the atria reach the ventricles. No longer
subservient to the SA node rhythm, the ventricle fibers beat at a much slower rate (20-45 beats per minute)
and do not respond to any demands from the cardiovascular control center in the medulla oblongata. The
atria however, are still responding to the medulla and will continue to beat at a normal pace (sinus rhythm).
14. At the time of the initial examination a P-R interval of 0.24 seconds defines a first-degree AV node block.
A year later the AV conduction block has progressed with the patient now in third-degree AV node block as
demonstrated by the appearance of ectopic pacemakers in the ventricles, the very slow rate of beat, and the
lack of response to the demands of exercise. An artificial pacemaker may be installed to compensate for the
complete conduction block.
15. Paroxysmal atrial tachycardia is also known as supraventricular tachycardia in which an ectopic focus
above the ventricles results in spontaneous rapid running of the heart (150-250 beats per minute) that begins
and ends abruptly. The ectopic focus extrasystoles often produce a subjective feeling in the chest, called
palpitations. This condition is often treated successfully with digitalis. Digitalis decreases the excitability
of the AV node and thus maintains the ventricular rate within the normal range, despite the excitability that
may be occurring in the atria.
17. The cardiac rate in this ECG is approximately 62 beats per minute (BPM).
18. The wavy baseline and an atrial beat of 600 indicate atrial fibrillation. An increase in atrial contractions
would result in a decrease in blood volume entering the ventricles and therefore decrease cardiac output by
about 15%. This decrease in cardiac output results in a decrease in oxygen being delivered to the tissues of
the body. This decrease in oxygen being delivered could cause a patient to ―pass out.‖ Plus, a decrease in
cardiac output will result in a decrease in blood pressure thus resulting in a loss of consciousness.
19. A normal sinus rhythm is when the sinus node generates a normal atrial impulse, which produces a normal
p wave. The normal interval is .12 to .20 seconds. Regarding this patient; the interval value was .16
seconds, which is within the normal range.
This patient had a run of PVCs (premature ventricular contractions). This is a situation where the heart beat
is initiated by the ventricles rather than the SA node. This is felt as a skipped beat.
Since the ventricles contract before the atria, the ventricles do not fill properly and therefore do not eject an
adequate volume of blood. A run of PVCs could result in ventricular tachycardia, which is dangerous.
5
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EXERCISE 7.3 EFFECTS OF EXERCISE ON THE ELECTROCARDIOGRAM
Approximate Time for Completion: 15 minutes
Introduction
This exercise shows the effects of exercise on the electrocardiogram. Since the setup is the same, this exercise should be
performed while recordings for exercise 7.2 are being made.
Materials
1. Electrocardiograph or multichannel recorder (e.g., Physiograph) with appropriate ECG module
2. ECG plates, straps, gel
3. Alternatively, the Biopac system may be used with the pulse transducer and electrodes for Student Lab Lesson
7.
4. Simulated electrocardiograph exercises may be performed using the Physiology Interactive Lab Simulations:
Electrocardiogram and Heart Function (exercises 4 and 6).
Textbook Correlations: Chapter 13 – Pressure Changes During the Cardiac Cycle, The Electrocardiogram;
Chapter 14 – Regulation of Cardiac Rate
Clinical Investigations
1. Explain how regular exercise can increase cardiac output and aerobic capacity, and how this
influences a stress ECG test.
In well-trained athletes, the stroke volume is increased, which allows them to reach cardiac outputs that are
6 or 7 times greater than their resting values. This higher cardiac output results in a greater amount of
oxygen being delivered to the tissues of the body (in this case, the muscles).
The activity of the stress test would have to be higher than that of a non-exerciser because at rest, the
cardiac output of an elite athlete would provide adequate oxygen even if there is a defect in a blood vessel.
In a non-athlete, this vessel defect could be detected without the stress test.
2. Explain why the patient experienced ST segment depression only at the highest cardiac rate
achieved, and how that might relate to his possible angina pectoris episode.
A depressed ST wave could mean myocardial ischemia due to coronary blockage or a constricted coronary
vessel thus leading to a decrease in oxygenated blood going to myocardial tissues. Athletic individuals can
achieve a cardiac output that is 6-7 times higher than a nonathletic person. Therefore, only at the high
cardiac rate did any abnormalities appear. With the high strenuous activity, the cardiac output has to be
higher and it was affected either a coronary blockage or a narrowing of the diameter of the coronary
vessels. This was evidenced by the depressed ST. This could result in angina pectoris because while
exercising, the myocardial tissues are not getting adequate oxygen due to problems with the coronary
vessels.
Answers to Questions
1. QRS
2. T
3. P
6
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4. sympathetic (cardiac)
5. parasympathetic (vagus)
6. ischemia
7. At the beginning of the exercise, there is a decrease in the activity of the parasympathetic (vagus)
innervation of the heart. This causes an increase in cardiac rate that is further raised during greater levels of
exercise by increased sympathetic nerve (cardiac) activity. As a result of the faster rate, the period of
diastole is shortened so that the time between the T wave of one ECG tracing and the P wave of the next
tracing is significantly reduced. At higher heart rates the increased conduction velocity shortens the period
of systole as shown by a decrease in the QRS-T interval.
8. During the P wave depolarization of the atria, pressure in the ventricles changes little. During the Q to R
the septum is depolarizing and starting to contract with only slight changes in the ventricular pressure. The
R to S interval completes depolarization of the lateral walls of the ventricles and produces the sharp rise in
ventricular pressure. The S to T segment represents the peak depolarization and contraction resulting in
maximum pressure developed by the ventricular fibers. During the peak of the T wave the ventricle fibers
are undergoing repolarization and beginning diastole. The pressure in the ventricles during the T wave falls
sharply, returning to the near zero value.
9. At rest, the delivery of blood to the heart may be adequate for the needs of the myocardium despite the
possibility that there may be some occlusion affecting coronary blood flow. After moderate exercise, the
myocardial demand for oxygen is raised so that the myocardium may become ischemic as a result of the
coronary occlusion. This myocardial ischemia may thus be revealed in the ECG taken during exercise
primarily as an abnormally elevated or depressed S-T segment (ventricular repolarization) that was not
present during the resting ECG. Variable answer, yet regular treadmill ECG tests are highly recommended
in persons over 40 years of age, or sooner if heart disease runs in the family.
10. Electrical excitation of the cardiac fibers (ECG tracing) results in their mechanical contraction (pulse).
More rapid discharge of the SA node, more rapid conduction of impulses, and a faster rate of contraction all
result in an increased cardiac rate with exercise. The reverse occurs while resting. Increased cardiac rates
are mainly due to shortening of the ventricular diastole and only secondarily due to a shortening of
ventricular systole.
11. In well-trained athletes, the stroke volume is increased, which allows them to reach cardiac outputs that are
6 or 7 times greater than their resting values. This higher cardiac output results in a greater amount of
oxygen being delivered to the tissues of the body (in this case, the muscles).
The activity of the stress test would have to be higher than that of a non-exerciser because at rest, the
cardiac output of an elite athlete would provide adequate oxygen even if there is a defect in a blood vessel.
In a non-athlete, this vessel defect could be detected without the stress test.
12. A depressed ST wave could mean myocardial ischemia due to coronary blockage or a constricted coronary
vessel thus leading to a decrease in oxygenated blood going to myocardial tissues. Athletic individuals can
achieve a cardiac output that is 6-7 times higher than a nonathletic person. Therefore, only at the high
cardiac rate did any abnormalities appear. With the high strenuous activity, the cardiac output has to be
higher and it was affected either a coronary blockage or a narrowing of the diameter of the coronary
vessels. This was evidenced by the depressed ST. This could result in angina pectoris because while
exercising, the myocardial tissues are not getting adequate oxygen due to problems with the coronary
vessels.
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
Approximate Time for Completion: 15 minutes
Introduction
This exercise is designed to emphasize the use of the ECG to monitor the electrical activity of the heart and to showcase
the versatility of the ECG in the determination of the mean electrical axis of the ventricles. This exercise also lends itself
to further discussion of leads I and III, which should help the students better visualize Einthoven’s hypothesis and
triangle. This exercise could be combined with exercise 7.2 and 7.3 for a laboratory period about the electrical activity of
the heart or could be assigned as a take-home exercise using data from exercise 7.2.
Materials
1. Electrocardiograph or multichannel recorder (e.g., Physiograph) with appropriate ECG module
2. ECG plates, straps, gel
3. Alternatively, simulated electrocardiograph exercises may be performed using the Physiology Interactive Lab
Simulations: Electrocardiogram and Heart Function (exercises 4 and 6).
2. Explain the significance of the patient’s measurements and how this might relate to his medical
history.
A normal mean electrical axis of the heart is 0-900. The patient’s mean electrical axis was 1200. This
represents a right axis deviation.
Right axis deviation could be due to: right ventricular hypertrophy or septal defect. The right ventricular
hypertrophy could be due to pulmonary hypertension, which could be due to a defect in the pulmonic valve.
Since this patient now has pulmonary hypertension, this is most likely the cause of the right axis deviation.
Answers to Questions
1. P
2. Q to the R
8
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3. Leads I and III
4. left
5. His; right
6. When one ventricle is hypertrophied, a longer time will be required to depolarize the thicker muscle of that
ventricle relative to the other, normal ventricle. In this way, hypertrophy changes the orientation (axis) of
the heart in the chest and will change the QRS portion of the ECG. These changes in the ECG recorded at
leads I (horizontal) and III (about 120 degrees) are used to note the change in the mean electrical axis of the
ventricles. Whenever a longer time than normal is needed to depolarize one ventricle, the mean electrical
axis will deviate in the direction of the affected ventricle. Hypertrophy of the left ventricle may occur as a
result of hypertension or narrowing of the aortic semilunar valve. Right ventricular hypertrophy may be
secondary to narrowing of the pulmonary semilunar valve or to such congenital conditions as a septal defect
or the tetralogy of Fallot.
7. If there is a block in one branch of the atrioventricular bundle of His, it will take longer for action potentials
to travel into the region of the ventricles served by that branch A block in the left branch, for example, will
cause the left ventricle to be depolarized more slowly than the right resulting in a shift in the mean electrical
axis to the left. Bundle branch blocks are the result of the interruption of conduction along one branch of
the bundle of His, such as the progression from first- to third-degree AV conduction block.
8. The spread of action potentials into the ventricles from the AV node produces the QRS wave. As the
impulses spread down the interventricular septum into the myocardium one region of the ventricles is
depolarized (septum) while other regions (lateral walls) are not, creating a potential difference in the
ventricles. This potential difference is seen by an upward deflection of the ECG from the baseline (Q to R).
When the entire mass of the ventricles is depolarized and all regions have the same polarity, there is no
potential difference in the ventricles and the ECG pattern returns to the baseline (R to S).
9. Both obesity and pregnancy present strains on the cardiovascular system that could result in hypertrophy of
cardiac fibers. In both cases, the heart has to work harder to circulate blood through excess adipose tissue
and to circulate extra blood volume to a growing fetus. The extra load on the left ventricle could cause left
heart hypertrophy and shift the mean electrical axis to the left.
10. A normal mean electrical axis of the heart is 0-900. The patient’s mean electrical axis was 1200. This
represents a right axis deviation.
11. Right axis deviation could be due to: right ventricular hypertrophy or septal defect. The right ventricular
hypertrophy could be due to pulmonary hypertension, which could be due to a defect in the pulmonic valve.
Since this patient now has pulmonary hypertension, this is most likely the cause of the right axis deviation.
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
Materials
1. Stethoscopes
2. Physiograph, high-gain couplers, microphone for heart sounds (Narco), ultrasonic flowmeter (such as Doppler)
3. Alternatively, the Biopac system may be used per Student Lab Lesson 17, employing the Biopac electrode lead
set and the amplified stethoscope.
4. Simulated electrocardiograph exercises may be performed using the Physiology Interactive Lab Simulations:
Electrocardiogram and Heart Function (exercise 5).
Textbook Correlations: Chapter 13 – Cardiac Cycle; Heart Sounds; The Electrocardiogram
Clinical Investigations
1. Explain how blood would flow, in a fetus and in an adult, if there were an opening in the septum
between the atria.
In the fetus: Blood would flow from the right atrium through the foramen ovale into the left atrium.
In the adult: Blood would flow from the left atrium through the opening into the right atrium. This flow is
due to the strength of the left side of the heart.
The flow of blood through an opening such as an opening in the atrial septum, could cause a sound that is
heard as a murmur. This would be much the same as the flow of blood through a partially closed AV valve.
A murmur is heard in this situation as well.
2. Describe the cause of mitral valve prolapse and how that would affect blood flow and heart sounds.
The most common cause of MVP is the formation of extra material on one of the leaflets of the valves. The
sound that is heard is due to the regurgitation of blood flowing backwards through the valve into the
atrium. This regurgitation is heard as a murmur sound.
In this case, since blood is flowing from the left ventricle back into the left atrium, oxygenated blood is
not flowing to the body’s tissues adequately. In this case, oxygenated blood is going back into the left
atrium. It is supposed to leave the left ventricle and go through the aortic valve and around the aortic
arch, etc.
Answers to Questions
1. auscultation
2. the closing of the AV valves
3. systole
4. the closing of the semilunar valves
5. end of systole
6. murmurs
7. end of the QRS
8. peak of the T wave
9. The QRS wave represents ventricular depolarization. When the ventricles depolarize they are stimulated to
contract, causing pressure to rise in the ventricles and the AV valves to close, with vibrations that produce
the first heart sound. The T wave represents ventricular repolarization. When the ventricles repolarize
electrically they begin to relax mechanically, causing the aortic and pulmonary semilunar valves to close,
with vibrations that produce the second heart sound.
10. As explained above heart sounds are normally produced by pressure changes causing two valves of the
heart to close simultaneously, producing vibrations that can be heard with a stethoscope. The first heart
sound, ―lub,‖ is caused by the closure of the right and left atrioventricular valves. The second heart sound,
10
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―dub,‖ is caused by the closure of the aortic and pulmonary semilunar valves (pulmonic valves). Heart
murmurs are caused by structural defects in the valves that affect the pattern of blood flow through the
heart. Abnormal patterns of blood flow produced by defective valves can cause abnormal vibrations and
thus abnormal heart sounds that can be heard by auscultation. Heart murmurs may be caused by an
irregularity in a valve, a septal defect, or the persistent fetal opening (foramen ovale) between the right and
left atria after birth.
11. Splitting of the heart sounds refers to hearing two separate components to the lub (first sound) and/or the
dub (second sound). This is caused by deep inspiration promoting an increase in venous return and the
separate closure of the two AV valves or separate closure of the aortic and pulmonary valves to handle the
increased volume.
12. A defective valve produces abnormal flow patterns that can be detected only by auscultation.
Electrocardiography does not detect valve defects and palpation with the finger is too qualitative to permit
accurate detection of any changes in the peripheral pulse at the radial artery.
13. The P wave signifies the depolarization of the atria. This is detected by the ECG. Auscultation and
palpation of the radial artery are not sensitive enough to detect the small pressure changes generated by the
atrial contraction.
140/110 is high blood pressure and with a diastolic of 110, this would put the patient in the category of
stage 2 hypertension. The diastolic value is the pressure in the arteries at all times, even at rest. This would
represent a situation where the pressure in the arteries is constantly high.
2. Explain the mechanisms by which the drug lowers the patient’s blood pressure.
The antihypertension drugs reduce vasoconstriction so the pressure required to ―push‖ the blood into
smaller arteries is reduced. This action reduces peripheral pressure. Vasodilation reduces peripheral
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
resistance. Many antihypertension drugs also reduce cardiac output. A decrease in cardiac output and a
decrease in peripheral resistance will decrease blood pressure.
Answers to Questions
1. systolic
2. diastolic
3. vibrations due to the turbulent flow of blood in a partially compressed artery
4. a. 168
b. 112
5. Hypertension
6. cardiac output; total peripheral resistance
7. sphygmomanometer
8. Laminar or ―layered‖ flow of blood through the arteries occurs when all parts of the fluid move smoothly in
the same direction, parallel to the axis of the vessel. Blood in the central axial stream moves the fastest, and
blood closer to the artery wall moves more slowly. By contrast, turbulent flow occurs when some parts of
the fluid move in radial and circumferential directions, churning and mixing the blood, which may cause
vibrations and sounds. Blood flow in the brachial artery before the cuff is inflated is mostly laminar, and so
is smooth and silent.
9. Vibrations heard through a stethoscope due to the turbulent flow of blood through a partially compressed
brachial artery cause Korotkoff sounds. The narrowing of the lumen creates turbulent blood flow and the
vibrations produced are characterized as Korotkoff sounds. The first Korotkoff sound is heard when the
pressure in the sphygmomanometer cuff is lowered so that the brachial artery is only partially compressed
(the cuff pressure is equal to the systolic pressure) thereby permitting the initial turbulent flow out the distal
portion of the cuff. The last Korotkoff sound is heard as the flow of blood through the cuff is no longer
compressed by the cuff and laminar flow is restored (diastolic pressure) and no more sounds are detected .
10. The pulse pressure is systolic minus diastolic pressure. As the blood pressure rises from diastolic to
systolic values within an artery, the rise in hydrostatic pressure against the artery wall causes the artery to
expand somewhat. This is the ―pulse‖ you feel when you press your fingers against the outside of an artery.
In this way, the pulse pressure causes the pulse. The mean arterial pressure is equal to the diastolic pressure
plus one-third of the pulse pressure. The mean arterial pressure represents the combined systolic and
diastolic pressure that drives the blood from the arterial tree into the blood capillaries.
11. The position of the arm directly affects the measurement of diastolic pressure partially due to the effect of
gravity. When the arm is below the heart level the diastolic pressure measured by the cuff is raised. When
the arm is positioned above the heart level, the diastolic pressure is lowered. This helps to explain why the
cuff should be placed at the heart level on the arm of the subject during blood pressure measurements. The
greatest drop in diastolic pressure should occur immediately upon standing. Theoretically, the highest
diastolic pressures should be read when the subject is lying down or immediately upon standing with
activation of the baroreceptors reflex response. However, there are many factors that can vary results from
the expected — such as anxiety, sympathetic drive, respiratory movements (laughter), and others.
12. During exercise the increase in heart rate and stroke volume (cardiac output) raises the systolic pressure
more than it raises the diastolic pressure. However, both pressures can rise to as high as 200/100 mmHg.
The pulse pressure (systolic minus diastolic) in this case would increase to 100 mmHg while the mean
arterial pressure (1/3 pulse pressure plus diastolic pressure) would rise accordingly. The exercise-induced
vasodilation causes the diastolic pressure to raise the least.
Of special note: after exercise, the diastolic value changes very little; perhaps + or – 5 units of the resting
12
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diastolic value. This is because the diastolic value is the pressure in the arteries at all times (basically it’s
the minimum amount of pressure all the time). If this value rises very much, the arteries would be under a
lot of pressure all the time.
13. The pulse pressure is the difference between systolic and diastolic pressures, or 142 – 92 = 50 mmHg.
14. The mean arterial pressure is = 1/3 pulse pressure + diastolic pressure, or 1/3(50) + 92 = 108.7 mmHg.
15. 140/110 is high blood pressure and with a diastolic of 110, this would put the patient in the category of
stage 2 hypertension. The diastolic value is the pressure in the arteries at all times, even at rest. This would
represent a situation where the pressure in the arteries is constantly high.
16. The antihypertension drugs reduce vasoconstriction so the pressure required to ―push‖ the blood into
smaller arteries is reduced. This action reduces peripheral pressure. Vasodilation reduces peripheral
resistance. Many antihypertension drugs also reduce cardiac output. A decrease in cardiac output and a
decrease in peripheral resistance will decrease blood pressure.
Clinical Investigations
1. Explain the significance of his resting cardiac rate and calculate what percentage 170 represents of
his probable maximum cardiac rate.
The resting cardiac value for this patient is 50 bpm. Athletes have a higher stroke volume. The equation
pertaining to this question is: cardiac output equals the rate value times stroke volume. If the stroke
volume value goes up, the cardiac output value goes down. Therefore, the athlete having a high stroke
volume will have a lower cardiac rate.
The equation pertaining to this question is: 220 minus age. Divide this value into the maximum cardiac
rate the patient obtained.
13
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
The value of 89% represents that this athlete has reached 89% of his maximum value. A value higher than
80% represents a positive change in respiratory enzymes with the trained muscles.
2. Explain how the ST segment change could appear only when his cardiac rate reached 170 beats per
minute and the medical significance of this observation.
An elevated ST segment may mean myocardial ischemia. Athletes typically do not reach their maximum
rate until it is much higher than normal. Until this rate is reached, the heart is not ―working very hard.‖
Answers to Questions
1. decreases
2. lower
3. endurance training – Results from higher levels of inhibitory activity by the vagus nerve.
4. Aerobic capacity is the maximum oxygen uptake or the maximum rate of oxygen consumption by the body.
5. Lactate threshold is that percent of one’s aerobic capacity when the muscle’s anaerobic respiration
production of lactic acid (lactate) rises significantly (normally at about 50–70% of one’s aerobic capacity).
6. a higher maximum cardiac output, and thus higher rates of oxygen delivery to the muscles in endurance
athletes.
7. Endurance training increases the cardiac output through a higher blood volume and a stronger contraction
of the ventricles, which thus ejects more blood per beat. The increase in oxygen demand also stimulates an
increase in blood volume. The higher stroke volume and larger blood volume allow the same cardiac
output to be achieved at a slower heart rate and thus endurance improves with training and training
improves performance.
8. Persons who are physically fit may have a higher stroke volume and, therefore, a greater cardiac output than
those who are unfit. Higher cardiac output increases the rate of blood flow and the delivery of oxygen to
the exercising muscles. Conditioned muscles also have an increased ability to extract oxygen from the
blood because of biochemical and metabolic changes within the muscle cells. At a given level of physical
exercise, therefore, the physically fit have a slower rate of increase in the cardiac rate and a faster rate of
return to the resting cardiac rate after exercise. Since mean arterial blood pressure is directly related to
cardiac rate and to cardiac output, the fit person will have a slower rise in blood pressure and a
correspondingly faster return to resting pressures after exercise.
9. Maximal oxygen uptake, or aerobic capacity, measures the maximum rate of oxygen consumption by the
body. The intensity of exercise can be rated by the percent of the aerobic capacity attained. In most
healthy people, blood levels of lactic acid (lactate) rise significantly when exercise is performed at about
50–70% of their aerobic capacity. This is the lactate (or anaerobic) threshold. Endurance trained athletes
have a higher aerobic capacity and may not reach their lactate threshold until exercising at about 80% of
their maximal oxygen uptake. The primary cause of this higher aerobic capacity is their higher maximum
cardiac outputs, and thus their higher rates of oxygen delivery to the muscles. In turn, this rise in cardiac
output is brought about by a stronger contraction of the ventricles (thus ejecting more blood per beat) and
an increase in blood volume.
10. Both aerobic capacity and lactate threshold decline with age beyond about age 29. This results in part from
the decrease in the maximum cardiac rate with age, accompanied by a decrease in cardiac output and thus in
the maximal rate of oxygen delivery to the tissues. Also, ageing alters the biochemical and metabolic
processes in muscle tissue such that the anaerobic metabolism and lactic acid production occur sooner at
14
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
lower levels of activity, thus lowering the lactate threshold.
11. Myocardial ischemia is inadequate blood flow to the heart muscle via the coronary circulation. The heart
requires a continuous supply of oxygen and has only a limited ability to respire anaerobically. If oxygen
delivery is inadequate for an extended period, myocardial ischemia may occur that is often accompanied by
pain, angina pectoris. Severe ischemia may result in a myocardial infarction (heart attack). Since physical
activity raises the myocardial demand for oxygen, the presence of myocardial ischemia with consequent
changes in the S-T segment of the ECG, may be evident during a medically supervised treadmill test that
was not observed at rest. Regular exercise in a healthy person helps the heart maintain a higher cardiac
output and greater blood volume at a lower workload than that seen in the sedentary person. Regular
exercise, therefore, along with physical checkups, healthy eating habits, avoidance of smoke, and healthy
blood lipid levels would all contribute to promoting the adequate flow of blood through the coronary blood
vessels and to minimizing the risk of myocardial ischemia.
12. The resting cardiac value for this patient is 50 bpm. Athletes have a higher stroke volume. The equation
pertaining to this question is: cardiac output equals the rate value times stroke volume. If the stroke
volume value goes up, the cardiac output value goes down. Therefore, the athlete having a high stroke
volume will have a lower cardiac rate.
13. The equation pertaining to this question is: 220 minus age. Divide this value into the maximum cardiac
rate the patient obtained.
15
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
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Non conviene che tu vada sola, specialmente dopo quella tua
bambinata che diede da discorrere oltre al bisogno. T’accompagnerò
io al primo momento di libertà. — Ed ella replicò con inusata
mansuetudine: — Come vuoi. — Per disgrazia il conte era
occupatissimo a cercare una nuova pariglia pel suo landau e non
aveva in quei giorni un minuto disponibile. Anche la contessa era
tanto tanto occupata.... a riposarsi dalle fatiche del carnovale e a
prepararsi alle penitenze della quaresima.... Però ell’aveva dato
ordine espresso a uno dei servi di passare ogni mattina dal
professore, e, quel che più importa, quando il servo tornava dalla
sua spedizione, ell’aveva l’abitudine non troppo comune di star a
sentire ciò ch’egli le riferiva. Anzi un paio di volte ella esclamò: —
Povero Teofoli! Quanto mi dispiace!
Il bello si è che pel solo dubbio d’incontrar la Serlati non si recava da
Teofoli nemmeno la Ermansi, la quale avrebbe pur voluto portare il
suo perdono in extremis all’amico che l’aveva offesa, ferita nel suo
amor proprio, posposta ad una civetta. Le due donne erano ormai
nemiche mortali, e la Ermansi parlando della Giorgina, diceva: — In
società devo subirla; se la trovassi in casa del professore temo che
mi dimenticherei d’essere una dama. — Ora, a essere una dama la
contessa ci teneva troppo per non sfuggir tutte le occasioni che
potevano farla discendere al grado di pedina. Rinunciò quindi al suo
magnanimo proposito affidando al conte marito l’ufficio di sostituirla.
In luogo della Serlati e della Ermansi, all’ultimo momento e quando
l’infermo aveva già perduto i sensi e non ravvisava nessuno, giunse
la sorella Teofoli da Roma. Era una signora magra, stecchita, dalla
fisonomia impassibile, d’un’età che non si sarebbe potuta
determinare a prima vista. In realtà aveva dieci o dodici anni meno
del fratello che studiava all’estero mentr’ella era fanciulla, che, per le
necessità della sua carriera, era rimasto lontano anche dopo, e col
quale ella non aveva nè analogia di gusti, nè consuetudine di vita, nè
frequenza di relazioni epistolari. L’imminente catastrofe la lasciava
fredda; mostrava appena quel tanto di dolore ch’era voluto dalle
convenienze; aveva piuttosto l’aria dell’erede che volgendo in giro lo
sguardo valuta, così a un dipresso, gli oggetti destinati a divenire in
breve sua proprietà. In fondo, di tutte le persone che in quell’ora
suprema s’affollavano nella casa, ell’era la meno afflitta, la meno
commossa; e verso quelle persone ella provava un sentimento
difficile a definirsi, un misto di stizza e di soggezione; le parevano
intrusi, e nel medesimo tempo una voce le diceva che l’intrusa era
lei, lei che del fratello non aveva curato la gloria, lei che ne ignorava i
trionfi e le debolezze. Pure, intrusa o no, poichè la parentela le dava
una larva di padronanza, ella si affrettò a far prevalere la sua volontà
in un soggetto delicatissimo. Tepida credente, ma ligia alle forme,
ma convinta della santità d’una massima che il suo consorte,
impiegato superiore al Demanio, amava spesso ripetere: bisogna far
sempre quello che fa la maggioranza; ella si scandalizzò altamente
che Teofoli si fosse ridotto a quel punto senz’adempiere alle pratiche
di buon cattolico. Che poi egli fosse vissuto sempre fuori d’ogni
religione positiva, che avesse ne’ suoi scritti e ne’ suoi discorsi
sostenuto dottrine razionaliste erano piccolezze che alla brava
signora non importavano affatto; le importava soltanto ch’egli
uscisse dal mondo, per dir così, con le sue carte in regola. Mandò
quindi lì per lì a chiamare un prete. Costui, un po’ per sincero zelo
religioso, un po’ per il vanto di ricondurre in grembo alla Chiesa
l’illustre professore Teofoli, accorse subito, e non fu colpa sua se
mentr’egli saliva le scale l’illustre professore Teofoli esalava
l’estremo sospiro. Però la Curia fu di manica larga, tenne conto al
morto del buon volere manifestato da chi rappresentava la famiglia e
si mostrò ben lieta di accompagnarlo con le sue preghiere e di
avvolgerlo nello sue pompe. Alcuni arricciavano il naso,
protestavano contro questa specie di violenza postuma usata ad un
uomo di cui erano notissime le opinioni, e Dalla Volpe in particolare
schizzava veleno pensando che la cosa avrebbe fatto piacere a sua
moglie. Ma già conveniva piegare il capo, perchè in mancanza di
qualsiasi disposizione del defunto non c’era chi avesse diritto di
opporsi all’autorità della sorella. Del resto, anche molti indifferenti,
molti scettici davano ragione a lei; dicevano ch’ell’aveva fatto
benissimo, che non c’è il prezzo dell’opera a singolarizzarsi per
questioni di forma, e che i funerali religiosi sono più belli dei funerali
civili.
XVIII.
I.
Non sono che dieci anni. Ero nel banco Prosperi da qualche tempo,
addetto alla corrispondenza in lingue straniere.
Quantunque il più giovine e l’ultimo arrivato dei commessi, ero
trattato con distinzione speciale; forse conferiva al mio credito la
conoscenza delle lingue, forse s’era scoperta in me qualche
attitudine per gli affari, forse il mio carattere inspirava fiducia. Fatto si
è che non mi si nascondeva nulla, e che nelle operazioni importanti il
principale chiedeva spesso il mio parere. Ero stato anche due o tre
volte a pranzo su in casa, e la signora Agnese s’era mostrata
gentilissima meco. Ma la sua era una gentilezza fredda, un po’
altera, ben diversa da quella del marito. I miei colleghi non
l’amavano; dicevano ch’ella non era donna adatta pel signor
Roberto, ch’ella aveva gusti troppo raffinati, troppo aristocratici, e
che a lui sarebbe convenuto di prender per moglie una figliuola di
negozianti con mezzo milione di dote, invece di questa che gli aveva
portato pochissimo e che senza esser nobile aveva tutti i fumi della
nobiltà. Però quelli che si ricordavano del matrimonio (e non ci
voleva molto a ricordarsene perchè il matrimonio datava solo da sei
anni) dovevano riconoscere che il signor Roberto e la signora
Agnese s’erano sposati per inclinazione e che difficilmente si poteva
vedere una coppia più bella e più innamorata. Adesso l’amore
durava in uno solo dei coniugi, nel signor Roberto, ed era un amore
ardente, appassionato, un amore a cui non sarebbe parso grave
alcun sacrifizio pur di riconquistare quel cuore che gli sfuggiva. Del
resto, nessun’altra accusa seria, tranne quella di ricambiare con un
riserbo gelato tanta tenerezza, si faceva alla signora Agnese. Non
era nè vana, nè civetta, nè esigente; se non trovava la felicità nella
sua casa non la cercava di fuori. — Ah se avesse avuto figliuoli! —
esclamava qualcheduno. E l’esclamazione coglieva nel segno.
Ho detto che non era esigente. Guai se fosse stata! Ogni desiderio
di lei era una legge pel marito; e non soltanto i desideri espressi
palesemente, ma anche quelli appena adombrati, ma anche quelli
supposti. Uomo savio com’era, il signor Roberto, per compiacerla,
avrebbe dato fondo al suo patrimonio.
Fu appunto per soddisfare uno di questi desideri sfuggitole dal
labbro ch’egli mi consegnò una mattina una lunga nota tutta di suo
pugno pregandomi di tradurla in inglese e d’inserirla nella lettera
ch’io dovevo scrivere il giorno stesso ai nostri corrispondenti di
Hiogo nel Giappone, i signori James Holiday e C.º. Noi avevamo in
corso coi signori Holiday un grossissimo affare; un’importazione di
60 mila sacchi di riso da loro acquistati per nostro conto e ch’essi
dovevano caricare appena arrivasse a Hiogo il vapore inglese King
Arthur, capitano George Atkinson, che in quel momento si trovava a
Venezia e che avevamo noleggiato apposta. Ma la nota
consegnatami dal principale si riferiva a cosa affatto diversa. Essa
conteneva la preghiera, rivolta in particolare a M.r James Holiday,
che i Prosperi avevano conosciuto due anni addietro in un suo
viaggio in Europa, di comperare e spedire per mezzo del King Arthur
tutto l’occorrente per arredare alla giapponese un salottino di cui
s’indicavano le dimensioni e si univa la pianta. Si fidava nel buon
gusto di M.r Holiday lasciandogli mano libera per la scelta degli
oggetti, e dandogli per la spesa il limite approssimativo di mille a
milleduecento sterline. Questo importo doveva essere aggiunto a
quello del riso e compreso nelle tratte con cui i signori Holiday si
sarebbero rimborsati del loro avere sui banchieri di Londra Eliot,
Green e Cº.
Naturalmente, io dissi che mi sarei accinto subito al lavoro.
— Procuri di aver spicciato la posta per le due — ripigliò il signor
Roberto. — Vorrei che mi accompagnasse a bordo del King Arthur.
Devo parlare col capitano, ed ella sa che l’inglese non è il mio forte e
che mi è sempre utile di avere un interprete.... A proposito, — egli
soggiunse dopo una breve pausa, — verrà con noi anche mia moglie
che non ha mai visitato un gran vapore mercantile.
Alle due in punto la signora Agnese era in banco in cappellino e
mantiglia, col ventaglio appeso alla cintura e con un ombrellino di
seta rossa in mano.
Il principale mi chiamò: — Ha scritto quella lettera a Hiogo?
Io feci col capo un segno affermativo.
— Abbia la cortesia di portarla qui — seguitò Prosperi — e di
leggere a mia moglie la parte che concerne il salottino giapponese.
Andai a prendere il foglio e cominciai la mia lettura traducendo
dall’inglese in italiano.
La signora Agnese sorrise. — Legga pure nell’originale. Capisco
abbastanza.
Dovetti compiacerla, benchè mi seccasse questa specie di esame di
pronuncia. Ella mi porse un’attenzione benevola, e quand’ebbi finito
mi indirizzò qualche frase gentile circa alla mia facilità di scrivere e
parlare le lingue straniere. Però (e si rivolse a suo marito) aveva
delle obbiezioni di massima. È vero, ell’aveva detto, che rimettendo
a nuovo alcune stanze del palazzo si sarebbe potuto fornire di
ninnoli giapponesi il salottino d’angolo, ma l’aveva detto così di volo,
non sognandosi nemmeno che si trattasse d’una spesa grave.
Venticinquemila lire e più per un salottino!... Era una pazzia.... No,
no, ella ne avrebbe rimorso per tutta la vita.
Il signor Roberto che s’era levato da sedere le mise una mano sulla
bocca pregandola di non insistere. La pazzia, s’era tale, la faceva lui;
ella non aveva fatto che dar forma a un’idea ch’egli ruminava già da
due anni, da quando M.r Holiday era stato a Venezia. Non si
sgomentasse della spesa; l’ultimo bilancio s’era chiuso con un utile
di oltre mezzo milione, e permetteva di levarsi qualche capriccio.
Come conclusione di questo discorso il signor Roberto mi tolse di
mano la lettera, la firmò, e mi ordinò di portarla nella stanza vicina
perchè la copiassero e la mandassero immediatamente alla posta.
— Cosa fatta, capo ha, — egli disse. — E adesso non perdiamo
tempo. Ceriani, è pronto?
Di lì a poco scendevamo tutti e tre la scaletta che dal banco metteva
nell’entratura, una lunga entratura di palazzo veneziano, con la riva
da una parte e un ampio cortile dall’altra.
Io guardavo con maggior attenzione dell’usato la giovine coppia che
mi stava dinanzi; due belle persone, ma due tipi affatto diversi. Egli
alto, largo di spalle e di torace, ben piantato sulle gambe nervose,
bruno d’occhi, di capelli e di barba, di carnagione rosea che si
coloriva forse un po’ troppo intensamente dopo il pasto, dopo una
passeggiata, nel calore d’una discussione; insomma un
temperamento sanguigno esuberante di forza e di vitalità. Ella,
pallida, bionda, magra: un profilo di cammeo sopra un corpo di
silfide; capelli lisci e finissimi spartiti regolarmente sulle tempie e
avvolti in treccia dietro alla nuca, grandi occhi azzurri dalla
guardatura un po’ incerta e fantastica, piedi e mani che uno scultore
avrebbe preso volentieri a modello; nel complesso un impasto di
correttezza classica e d’idealità romantica.
Si montò in gondola. Quantunque non fossimo che alla metà di
marzo era una temperatura da primavera inoltrata, e la gondola
aveva, anzichè il felze nero e opprimente, una elegante tenda di
raso a frangie. Arrivammo in dieci minuti nel Canale della Giudecca,
forse meno gaio, meno artistico di quello di San Marco, senza lo
sfondo superbo del Palazzo dei Dogi e della Piazzetta; non meno
bello però nè meno pittoresco nella doppia linea delle Zattere e della
Giudecca, quelle rivolte al mezzogiorno, questa un po’ in ombra, un
po’ severa, un po’ triste, se non fossero i rii che la traversano e che
lasciano vedere da lontano sotto gli archi dei ponti i muricciuoli degli
orti incoronati d’allegra verdura, e di là dall’Isola un altro e più ampio
tratto di laguna anch’esso riscintillante ai raggi del sole. E in questo
Canale, più assai che nel bacino di San Marco, s’agita e ferve,
piccolo o grande che sia, il commercio marittimo di Venezia, e a tutte
l’ore si vedono bastimenti a vela e piroscafi andare, venire, o cullarsi
indolentemente sull’onda come se posassero dalle fatiche del
viaggio.
Il giorno della nostra visita al King Arthur c’era un insolito
movimento. Mi ricordo che passò a poca distanza da noi, mandando
un urlo rauco e prolungato come un gemito di belva ferita, un vapore
inglese, vuoto, enorme e mostruoso, con quasi tutto lo scafo fuori
dell’acqua; intorno a un altro della Navigazione italiana arrivato
appena s’affollava uno sciame di barche e battelli; da un terzo,
ancorato in mezzo al Canale, si scaricava il carbone facendolo
scendere nelle peate per un piano inclinato e sollevando un nembo
di polvere scura o densa; uno dei grossi navigli della Peninsulare, di
quelli che si spingono direttamente a Bombay e Calcutta, pronto a
salpare prima di notte, levava già le ancore e fumava dalla
caminiera. E quanto più ci avvicinavamo alla Giudecca, ov’era
ormeggiato il King Arthur, tanto più spesseggiavano i legni e tanto
più cauta doveva proceder la gondola per non urtar nelle catene e
nei gavitelli.
Durante il tragitto il signor Roberto parlò quasi solo. Parlò di
quest’importazione di riso giapponese, la prima che si facesse in
Italia, e del profitto e dell’onore ch’egli sperava trarne. Disse dei gran
passi che s’eran fatti a Venezia, dopo il 1866, a dispetto dei
pessimisti e dei denigratori di professione, e rammentò i tempi
quando, per ogni prodotto di regioni lontane, si doveva ricorrere al
mercato di Londra. Se ci fossero altri dieci negozianti che avessero il
suo spirito d’iniziativa, — egli soggiunse con legittimo orgoglio, —
Venezia sarebbe la prima piazza d’Italia.
Nelle pause del suo discorso lo sguardo del signor Roberto cercava
quello di sua moglie, e più d’una volta la sua mano si posò sulla
mano di lei. Io notai a due riprese ch’ella, quand’era possibile,
sfuggiva il contatto, e questa mal celata ripugnanza per un uomo di
cui ell’era l’idolo offendeva in me il sentimento della giustizia e
dell’equità. Andavo persuadendomi che la scarsa simpatia dei miei
colleghi per la signora Agnese non era infondata.
La scala si fermò ai piedi della scaletta del King Arthur, in cima alla
quale il capitano Atkinson stava ad aspettarci. Era un uomo di
mezza età, di tinta olivastra, di statura giusta e lineamenti regolari,
con un’espressione di malinconia nei grandi occhi grigi. Tutto
sommato, un bell’uomo, dall’aria distinta e signorile, ma uno di quelli
che a guardarli non mettono di buon umore. Del rimanente, la sua
tristezza si spiegava col fatto che gli era morta alcuni mesi addietro a
Londra, mentr’egli viaggiava nei mari dell’India, una moglie giovine e
adorata. Egli ne portava il lutto e ne’ suoi abiti neri pareva un
policeman, o un impiegato delle pompe funebri.
Taciturno per indole e ancor più taciturno dopo la disgrazia che
l’aveva colpito, quel giorno però il capitano Atkinson si sforzava di
esser loquace e faceva con perfetta cortesia gli onori del suo
bastimento, conducendoci a visitarne tutte le parti, dal ponte del
comando alla stiva, dalla cucina alle macchine, prendendo per mano
la signora Agnese nei punti difficili e rispondendo con molta
chiarezza alle sue domande sul meccanismo dell’elica, sull’orario di
bordo, sui segnali, sul carico e lo scarico delle merci. M’accorsi ben
presto che la signora Prosperi non solo capiva l’inglese, ma lo
parlava speditamente, con un fraseggiare elegante, con una
pronuncia corretta. Ell’avrebbe potuto quanto me e meglio di me
servire d’interprete a suo marito. Compiuto il giro del naviglio, il
capitano Atkinson ci fece entrare in un salottino addobbato con
molto decoro ch’era attiguo alla sua cabina e ove erano preparati
abbondanti rinfreschi. Io approfittai di questo momento per
comunicare al capitano certi desideri del mio principale circa a
qualche piccola modificazione da introdursi nei ventilatori, e stavo
scrivendo una noterella in proposito da lasciare a bordo, quando
s’intese un lieve rumore nella cabina. Master Atkinson si alzò,
aperse adagio l’uscio e diede un’occhiata attraverso lo spiraglio. Poi
tornò indietro con un sorriso sul labbro, un sorriso che faceva uno
strano effetto in quel viso triste, e disse: — C’è la mia bimba di là....
Dorme come un angelo e Tom la veglia.... il mio cane di Terranuova.
Era lui che aveva urtato un mobile.... Quando c’è lui è come se ci
fossi io.
— Ha una bimba con sè? — esclamò la signora Agnese. E nel far
questa semplice interrogazione un vivo incarnato le si diffuse sulle
guancie.
Egli chinò il capo affermativamente. — La mia unica figliuola.... L’ho
presa a bordo poche settimane fa, quando partii da Londra.... È
orfana di madre.... Con chi starebbe?... Di qui a qualche tempo forse
la metterò in un collegio.... Adesso è troppo piccina.... Ha cinque
anni.
Il capitano Atkinson, commosso, levò gli occhi verso la parete da cui
pendevano due fotografie; quella del King Artur, e un’altra più
piccola, difesa da un vetro e inquadrata in una cornice di legno,
d’una donna giovine, bionda, dall’aria gracile, una di quelle fisonomie
dolci che si raccomandano.
— Oh me la faccia conoscere la sua bambina, — supplicò la signora
Agnese.
— Anche subito, se si contenta di vederla addormentata.
— Si figuri.... Pur di non svegliarla.
— Oh per questo non si dia pensiero.... Finchè non abbia dormito le
sue due ore di fila, non la sveglierebbero le cannonate.
— In tal caso.... — replicò la signora.
— E se invece pregassimo il capitano di condurcela domattina,
quando deve venire in banco alle undici? — propose il signor
Roberto. — Farebbe colazione con noi.
— Magari! — soggiunse la signora Agnese. E non si quetò fin che
Master Atkinson non ebbe accettato l’invito. Ma questa non le parve
una buona ragione per non veder subito la piccina.... Le bastava
vederla di lontano.... per un momento.
Il capitano volle compiacerla. — Mi lasci passare avanti allora, —
egli disse. — Tom non le permetterebbe neppure di affacciarsi alla
soglia se non ci fossi io.
In fatti, quando il capitano aperse l’uscio della cabina, la prima cosa
che si vide fu il cane di Terranuova che seduto sulle due zampe
posteriori custodiva l’ingresso. A un cenno imperioso del padrone
egli si tirò in un angolo manifestando con un lieve brontolìo la sua
disapprovazione.
Per una curiosità forse indiscreta m’ero avvicinato anch’io e stavo
dietro alla signora Agnese. Il signor Roberto era rimasto seduto e
sfogliava un atlante.
La bimba dormiva profondamente nella sua cuccetta, posata su un
fianco, con la faccia rivolta verso l’uscio, tantochè la si vedeva
benissimo senza entrare nella cabina. Somigliava alla fotografia
appesa al salotto, ma era molto più bella, un vero angioletto dalla
capigliatura bionda che formava una specie d’aureola intorno al
visino di latte e di rosa.
— Oh che amore! — disse la signora Agnese smorzando la voce e
giungendo le palme in atto di adorazione. — E che nome ha?
— Ofelia, — rispose Master Atkinson.
— Strano nome! — pensai, evocando la dolce figura della
infelicissima innamorata di Amleto.
— Venga, venga avanti, — riprese il capitano lusingato nel suo
orgoglio di padre.
La signora Agnese non se lo fece dire due volte, e accostatasi in
punta di piedi alla cuccetta si chinò sulla bimba e le sfiorò con un
bacio la bocca.
Tom inquieto si mosse dal suo angolo, interrogando con gli occhi il
capitano. — Che novità sono queste? Perchè la disturbate?
No, non la disturbavano, ed ella seguitava a dormire sorridendo nel
sonno.
Resistendo alla tentazione di baciarla una seconda volta, la signora
Agnese s’avviò per uscire. Il cane, ormai rassicurato, le si fregò
amorevolmente intorno alle vesti; ella gli fece una carezza e rientrò
nel salottino ove suo marito l’aspettava. A me disse passando: —
Com’è bella, non è vero? — E subito dopo si rivolse al signor
Roberto con un mite rimprovero: — Perchè non hai voluto vederla?
Egli chiuse l’atlante. — La vedrò domani.
— È così bella! — ella ripetè.
Il signor Roberto abbozzò un triste sorriso; uno di quei sorrisi che
sono tanto vicini alle lacrime.
Ricordata al capitano Atkinson la promessa di venir a colazione la
mattina dopo con l’Ofelia, lasciammo il bastimento. Nel ritorno le
parti erano invertite. Prosperi taceva, la signora Agnese, trasfigurata
d’aspetto, spiegava un’insolita facondia. Ma non parlava che d’una
cosa, la sola che le fosse rimasta impressa tra le molte vedute;
parlava di quell’orfanella vegliata amorosamente da quel cane di
Terranuova.
Nello smontar dalla gondola ella mi disse: — Badi che aspetto anche
lei domattina a colazione.
II.