New PDF release: 2008 Kaplan USMLE Step 1 Home Study Program-Brand New Volume

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Additional info for 2008 Kaplan USMLE Step 1 Home Study Program-Brand New Volume III: Organ Systems Book 1

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3. S, may also be a sign of diastolic volume overload without significant abnormalities of systolic ventricular function. S, can, therefore, be present in mitral regurgitation, severe aneTrar or jhyrotoxicosis. D. Fourth heart sound (Sn) 1. 54,or the atrial gallop sound, is synchronouswith atrial systole. Sinceatrial contraction is requiied to generateSn,it is never heard in atrial fibrillation. 2. Sufrequently occurs in conditions associatedwith decreasedleft ventricular compliance, or i4-c1e_ased stiffness,such as systemichlryertension,aortic stenosis,idiopathic hypertrophic subaortic stenosis,acut6myocardialischemiaor infarction.

Z -- t Figure l-4-9. Rapid ventricular ejection. a. Left ventricular pressure rises above the aortic pressure,opening the aortic valve; in fact, aortic valve opening defines the beginning of ventricular ejection. Left ventricular pressurecontinuesto rise at a slower rate until maximum left ventricular pressure(= 120 mm Hg) is reached. Note that aortic valve opening occurs after pulmonic valveopening; thus, isovolumetric contraction is longer in the left ventricle. r-P b. t€ft ventricular pressure decreasesrapidly, then more slowly.

MYOCARDIAL CONTRACTION Note T tubules facilitate action potential transmission intotheinterior ofthefiber. Theyarewelldeveloped intheventricles. 58 A. Mechanism of excitation-contraction coupling. As in skeletal muscle, Ca2+ions mediate myocardial excitation-contraction coupling. 1. During phase 2 of the action potential, Ca2nions enter the cell through voltage-gated L-type Ca2*channels (slow inward Ca2*current). At the Z line of each sarcomere,the sarcolemma invaginates to form the system of T tubules, thus ensuring that the action potential spreadsinto the interior of the myocardial fiber.

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2008 Kaplan USMLE Step 1 Home Study Program-Brand New Volume III: Organ Systems Book 1 by Kaplan


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