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NBDE PART 1 BIOCHEM/PHYSIOLOGY > Heart > Flashcards

Flashcards in Heart Deck (264):
1

in cardiac muscle the action potential is caused by the opening of _ channels

2 types

2

the presence of the plateau in the action potential causes ventricular contraction to last as much as 15x longer in cardiac muscle as in

skeletal muscle

3

the cardiac muscle have __ action potentials and __

prolonged action potentials and plateau in cardiac muscles

4

the AP of skeletal muscles caused almost entirely by sudden opening of large numbers of __ channels

fast sodium

5

in cardiac muscle the AP is caused by the opening of 2 types of channels:

the same fast sodium channels as skeletal and the SLOW CALCIUM CHANNELS aka calcium-sodium channels

6

the slow calcium channels

remain open longer and are slower to open than the sodium channels

7

another difference in cardiac muscle membrane is that after the onset of the AP, the permeability of the cardiac muscle membrane for ___ decreases about 5 fold= which does not happen in skeletal muscle

potassium (K+)

8

the strength of the cardiac muscle contraction is directly proportional to

intracellular Ca concentration

9

the refractory period of atrial muscle is much __ than that of the ventricles

shorter = therefore the rhythmic rate of contraction of the atria can be much faster than that of the ventricles

10

skeletal muscle cells have a _ refractory period that allows them to be stimulated to contract a second time before they have relaxed from an initial concentration

short

11

the bicuspid is aka

mitral valve

12

the bicuspid is on the left/right

left

13

which valve is unique in having a different number of cusps than the others

mitral valve/bicuspid!

14

the valves bw the atria and ventricles prevent

blood from backflowing

15

1. Atrioventricular valves are anchored to the wall of the ventricle by ___, which prevent the valve from inverting.

1. chordae tendineae

16

1. The chordae tendineae are attached to __ that cause tension to better hold the valve.

papillary muscles
Together, the papillary muscles and the chordae tendineae are known as the subvalvular apparatus

17

the pulmonary semilunar valve is located

at the entrance to the pulmonary trunk

18

the pulmonary semilunar valve has how many cusps

3

19

the pulmonary semilunar valve prevents

backflow of blood from the artery into the right ventricle during ventricular relaxation

20

the aortic semilunar valve Is located at the entrance to the aorta and is composed of how many cusps

3

21

aortic semilunar valve prevents backflow during

left ventricular relaxation

22

the semilunar valves are open during

systole

23

when are all the valves in the heart open at the same time in the cardiac cycle

never

24

the first heart sound, S1 is the _

AV valves closing

25

the second heart sounds S2 is the

closure of the semilunar valves

26

the electrocardiogram is a graphic illustration of the

cardiac conduction system

27

the natural pacemaker of the heart is the

sinoatrial node

28

the signals that make the heart muscle fibers contract come from the

sinoatrial node = pacemaker of the heart

29

the _ wave is the electrical recording from the body surface of atrial depolarization and precedes atrial contraction

P wave= so right after the p wave the atria should contract.

30

the _ wave represents repolarization of the ventricles

T wave (relaxing of the ventricles)

31

the QRS complex represents

ventricular depolarization

32

the first heart sounds represent the closure of the _ valves on the onset of systole

AV

33

the second heart sound represents the closure of the _ valves on the onset of diastole

semilunar

34

both heart sounds are of _ of the valves

closing

35

why is there no distinct wave visible on ECG of the atrial repolarization?

bc it occurs during ventricular depolarization and so it is obscured

36

an ECG with extra P waves before each QRS indicates

partial heart block (second degree block)

37

if P wave and QRS complex are dissociated -

complete heart block

38

Cardiac output =

SV x HR

39

CO is expressed in

L/min

40

SV is the

stroke volume per beat

41

HR is

the number of beats per minute

42

average resting cardiac output is

5.6 L per minute for men and 10-20% less for women

43

stroke volume is determined by

preload, afterload and contractility

44

__ is the arterial pressure against which the muscle will contract

afterload

45

SV =

end diastolic volume - end systolic volume
SV = EDV - ESV
stroke volume (SV) is the volume of blood pumped from one ventricle of the heart with each beat

46

SV is average

70-80mL

47

is the cardiac output of the left and right side of the heart the same or different

same (equal)

48

total peripheral resistance =

BP = CO x TPR

49

The _ reflex is a positive feedback mechanism in which there is a compensatory increase in heart rate due to a rise in right atrial pressure

Bainbridge reflex

50

Bainbridge Reflex is commonly referred to as an

Atrial reflex

51

Bainbridge Reflex is a _ feedback mechanism (Positive or negative)

positive

52

in Bainbridge Reflex what increases due to what

increase in heart rate due to rise in the right atrial pressure

53

the stretch receptors in the atria transmit their __ signal thru the __ nerves to the medulla of the brain

afferent
vagus nerves

54

then efferent signals are transmitted back thru vagal and sympathetic nerves to increase heart rate and strength of contraction. this helps prevent?

damming of the blood in the veins atria and pulmonary circulation

55

each cardiac cycle lasts how long

0.8 seconds = from the end of one heart contraction to the end of the subsequent heart contraction

56

two phases of the cardiac cycle

diastole = ventricles are relaxed and heart fills with blood.
systole = ventricles contract and pump blood into the arteries

57

during the _ phase the atria and the ventricle are both relaxed (the whole heart)

diastole

58

blood flow to the coronary arteries would be greatest during ___ in a resting individual

ventricular relaxation

59

ventricular volume is greatest when

following atrial systole

60

ventricular pressure is greatest during ___

ventricular ejection

61

increased ventricular volume ___ end diastolic fiber length

increases

62

how many beats per minute?

75 bpm

63

each beat takes __ sec

0.8sec

64

when we say the heart is in diastole, relaxed and filling what does that mean

it is not consuming a lot of oxygen or ATP

65

the heart spends 2/3 of its time in

diastole
1/3 of the time the heart is in systole

66

stroke volume is the amount of blood pumped out from

ventricles

67

at rest stroke volume is about

70mL per beat

68

you have a greater capacity to change your heartbeat or stroke volume?

heartbeat. can go up into 200s

69

cardiac output is

the amount of blood pumped out per min

70

your average blood volume is

5L

71

CO is about

5L/min = so our body pumps all of our blood

72

venous return is?

if heart is pumping at 5L/min then the venous return should be the same. venous return should equal the cardiac output

73

EDV

the amount of blood in the ventricle at the end of diastole

74

do we pump all the EDV out?

no. some remains. ESV. the amount of blood left after systole is the ESV

75

Ejection volume is =

SV/EDV x100

76

ejection volume in a healthy person should be

at least 50%

77

3 phases of diastole:

1st rapid inflow = rapid passive filling, volume changing the most
2nd phase: diastasis: slow passive filling passive, less volume change because getting full
3rd phase: atrial systole

78

ECG shows atrial depolarization as

P wave. = right before it will contract

79

most of the filling occurs in which phase?

in PASSIVE FILLING: Rapid inflow is the most and second is diastasis. 80-90% of filling occurs passively: which is good bc we need our energy to pump blood. also ok because if you don't have a P wave it is ok because your heart is still filling, you just don't have the little bit from atrial systole

80

if you hear a 3rd heart sound what is it?

it is at the end of rapid passive phase of diastole = you hear the blood rushing into the ventricle

81

P wave occurs just before

atrial systole

82

when does the heart use the most energy and oxygen?

isovolumic/isoventricular contraction

83

T wave

is ventricular repolarization = relaxing ventricles

84

which is longer and louder = the lub or the dub

the lub (1st heart sound) is the louder and longer one

85

___ starts with the first heart sound (LUB)

ventricular systole

86

___ ends with the first heart sound

ventricular diastole

87

___ begins with the second heart sound

diastole

88

which valve closes before the other semilunar valve?

the aortic valve closes before the pulmonary valve = causes splitting of the second heart sound

89

the ventricles are COMPLETELY DEPOLARIZED DURING which isoelectric portion of the ECG

S-T segment

90

This portion of the ECG represents the segment bw depolarization of the atria and depolarization of the ventricle

PR

91

2 isoelectric segments of ECG

ST segment
and bw T and P waves

92

__ interval represents the period bw ventricular depolarization and ventricular repolarization

QT

93

isoelectric means

ventricle is at resting membrane potential

94

cardiac muscle is very similar to __

skeletal muscle
bc actin, myosin, etc

95

the heart lies behind the

sternum

96

the heart lies between the

lungs

97

2/3 of the heart mass is on the

left side. it is in the middle of your chest but most mass is on the left

98

the apex of the heart is at the top or bottom?

bottom = formed by the tip of the left ventricle

99

the top of the heart is called the

base

100

the base of the heart (top of the heart) is near which rib?

the 2nd costal cartilages = to remember think your hear is split bw two people

101

the vessels of the heart emenate from the base/apex

base

102

the anterior surface consists primarily of

the right ventricle

103

___ is the arterial pressure against which the ventricle ejects the blood

afterload

104

what nerve stimulates the diaphragm

phrenic

105

___ is stretch of the fibers by blood during ventricular filling.

preload

106

preload is related to __ atrial pressure

right

107

the most important determining factor for preload is

venous return

108

the heart is a ___ pump.

dual

109

afterload for the left ventricle is determined by __

aortic pressure

110

afterload for the right ventricle is determined by

pulmonary artery pressure

111

increase in heart rate will also increase cardiac output EXCEPT at

very high heart rates where there will be less time for filling

112

the atria/ventricles are thinner

atria bc less muscle tissue there. therefore they are not as powerful as pumping as the ventricles

113

the atria are separated by the ___in adults

interatrial septum

114

as a fetus the atria are connected by a hole called the

foramen ovale

115

before birth the foramen ovale will fuse to form

foramen ovalis = depression in interatrial septum = remnants of foramen ovale. it should fuse after birth but if it doesn't surgery needed

116

failure of the foramen ovale to close over time in infants results in

patent foramen ovale

117

the __ activation of the heart will increase heart rate, conduction velocity and contractility

sympathetic

118

atrial septal defect is the term used to describe

an interatrial septum that fails to develop properly = anytime a defect in this wall = usually means there is a hole there

119

what is the problem with patent foramen ovale

less oxygenated blood will mix with the oxygenated blood (venous blood mixes)

120

why is it ok that the two bloods mix in the baby?

bc they are not using their lungs, mom is breathing for the baby

121

the myocardium functions only __ aerobically/anaerobically

aerobically

122

intraventricular septum

separates the ventricles

123

___ septal defects are the most common congenital abnormalities

ventricular septal defects = they are found in 30-60% of all newborns with a congenital heart defect

124

ventricular septal defects can also be acquired by forming within a few days after a

myocardial infarction due to macrophage remodeling of dead heart tissue before scar tissue forms

125

the larger the vessel, the _ the resistance

less

126

resistance =

resistance = ((viscosity (of blood) x length (vessel)) /(radius)^4

127

each ventricle holds about _ mL of blood = called

150mL = end diastolic volume

128

if the radius is double the resistance will decrease by a factor of

16

129

the major physiological regulation of blood flow is via the activation of

vascular smooth muscle (vasoconstriction)
resistance = ((viscosity (of blood) x length (vessel)) /(radius)^4

130

do you pump out the entire 150mL of the end diastolic volume?

no, you pump out a little more than half = called the stroke volume. you don't pump out all because you need pressure in the ventricles from the blood to keep the chambers from collapsing

131

ejection fraction is

SV/EDV ie. 75mL/150mL x 100% = 50%

132

the circulating pressure is about

100mmHg

133

if ejection fraction is lower than the 50% you get

congestive heart failure because the heart is overfilling and not pumping it out

134

endocardium is the inner layer of the heart. it is serous and thin. the myocardium is the _ layer

middle and thickest = all muscle = responsible for pumping.

135

can the myocardium regenerate?

no. therefore no hyperplasia (= cell division)

136

can the myocardium undergo hypertrophy or hyperplasia?

hypertrophy = means no extra cells but instead they get bigger. heart can do that.

137

why is pathological hypertrophy bad?

muscle gets too thick = so the ventricles can't fill up with enough blood so you cant pump a lot of wall. Also the walls become too rigid.

138

what metabolites cause local vasodilation?

CO2, NO2, H+, K+, lactate, and adenosine

139

cardiac muscles have:
1. shape
2. # nucleus
3. branched/unbranched

1. cylindrical branching cells
with a single nucleus

140

intercalated disks are ONLY found in what muscle

cardiac muscle only!

141

the visceral pericardium is aka

epicardium = external layer of the heart with nerve fibers, lymph vessels, bv's, and fat, thin layer

142

bradykinin and histamine causes arteriolar __- and venous__

arteriolar dilation and venous constriction

143

serotonin causes

arteriolar constriction

144

the parietal pericardium is the

heart sac

145

the space bw the heart and the sac is the

pericardial space = pericardial fluid = 10mL of fluid = lubricant to prevent friction as heart beats

146

valves of heart have ONE JOB what is it

to ensure blood is flowing in one direction only

147

the contraction of _ increases venous return to the heart:

skeletal/cardiac/smooth muscle

skeletal

148

increase/decrease in intrathoracic pressure will increase venous return to the heart:

decrease

149

which valve is thicker the mitral/bicuspid or the tricuspid

mitral bicuspid

150

the presence of venous valves/peristalsis increases venous return to the heart:

valves

151

the heart strands are called

chordae tendinae

152

chordae tendinae attach to

bottom of AV valve and endocardium's papillary muscle

153

do the chordae tendinae cause opening or closing of the AV valves?

NO. they help continue to keep it open or closed once they have done so. keeps them from inverting into the atria like an inverted umbrella. help keep valves open or valves closed

154

an increase/decrease in venous compliance increases venous return to the heart:

decrease

155

venous return is influenced by several factors: muscle contraction of the limbs muscle as in moving, walking swimming promotes

venous return by the muscle pump mechanism

156

__ activation of veins decreases venous compliance, increases central venous pressure and promotes venous return indirectly by augmenting cardiac output

sympathetic

157

during respiratory inspiration the venous return will increase/decrease

increase because of a decrease in right atrial pressure

158

First heart sound is called

S1 = lub
Second sound is called S2 = dub

159

the right atrium receives blood from the

superior vena cava, inferior vena cava, and carotid sinus

160

trace flow of blood into the heart

superior vena cava, inferior vena cava, and carotid sinus ==> right atrium ==> tricuspid ==> r ventricle ==> pulmonic valve ==> PULMONARY TRUNK ==> splits into the two pulmonary arteries ==> lungs ==> pulmonary vein ==> left atrium ==> mitral valve ==> left ventricle ==> aortic valve ==> aorta ==> systemic circulation

161

the carotid SINUS received _ blood from

deoxygenated blood from the cardiac wall muscles

162

vena cava compression = an increase in the resistance of the vena cava will _ venous return

decrease

163

Starling's law of the heart states that the rate of ___ is the major factor that determines cardiac output

venous return

164

the veins have a great degree of compliance that can be regulated by the

sympathetic nervous system

165

an increase in sympathetic nervous system activation will __ compliance and __ venous return

decrease compliance and increase venous return

166

an increase in intrathoracic pressure will decrease/increase venous return

decrease

167

during exercise the total peripheral resistance decreases due to

the accumulation of vasodilator metabolites (lactate, K+, adenosine). these accumulate bc increase metabolic rate. the arterial vasodilation = decrease in TPR

168

3 major effects essential for circulatory system supplying body with blood flow during exercise

mass discharge of SNS throughout the body
increase CO
increase arterial pressure

169

during exercise:
1. BV in active skeletal muscle __
2. elsewhere in the body sympathetic __ occurs to compensate for this
3. there is an increase in the activity of the sympathetic nerves to the heart and a __ of PNS nerves activity

1. dilate = increase blood to muscles
2.vasoconstriction
3.decrease

170

during exercise venous return

is enhanced bc pumping effects of the contracting skeletal muscles and sympathetic vasoconstrictor effects

171

during exercise the increase in CO is greater than the decrease in TPR so the _ rises

mean arterial pressure

172

an anxious dental patient may have a higher systolic blood pressure than normal due to a _ arterial compliance

decreased

173

Parasympathetic fibers innervate the heart by way of the _ nerves

vagus

174

HR is controlled primarily by the ANS. Sympathetic (norepinephrine) stimulation causes an increase in

heart rate

175

parasympathetic (AcH) stimulation of the heart causes _ HR

decrease in heart rate

176

the main centers for autonomic cardiac control are located in the

medulla oblongata of the brain stem

177

Sympathetic cardiac effects:
1. increase in rate of discharge of the _
2. increase in rate at which _ spreads through the heart.
3. increase in ICF __ which increases the _

1. sinoatrial node (SA)
2. depolarization spreading = heart contracts more uniformly = which increases its pumping effectiveness
3. calcium which increases the FORCE of the ventricular contractions

178

the right vagus nerve goes to the

SA node

179

left vagus nerve goes to the

AV node

180

Parasympathetic innervation will decrease what two things

heart rate and spread of depolarization from the atria to the ventricles

181

SA node initiates impulse which is propagated from the

SA node to the atria and ultimately reaches the AV node. after a delay in the AV node, the cardiac impulse is propagated thru the ventricles

182

velocity of conduction is highest in

Purkinje system

183

velocity of conduction is lowest in the

AV node

184

automaticity

heart can generate its own beat

185

rhythmicity

regularity of pacemaker activity

186

rhythmicity and automaticity allow for the heart to __

beat even when removed from body

187

automaticity is greater in the SA or AV node or Purkinje

SA > AV > Purkinje

188

skeletal muscle: a muscle fiber is aka

muscle cell.

189

a myofibril is within a

muscle fiber

190

anytime you see "sarco" or "myo" it means

muscle

191

the sarcolemma is the

membrane of the muscle fiber (cells) since they are cells they have membranes

192

t tubules penetrate deep into muscle cell. function

carry the electrical signal (action potential) deep into muscle where the myofibrils are since the myosin etc are on the myofibrils

193

ER of muscle

Sarcoplasmic reticulum

194

the terminal cisternae are the ends of the __ where we store

ends of SR store calcium

195

cylinders within the muscle fiber/cell is

muscle myofibril

196

a unit of myofibril is called a

sarcomere

197

the thin/thick filament has three proteins

thin

198

the __ filament has one protein

thick

199

Myosin bound to ADP and Pi will release ___ and bind the actin

Pi

200

upon __ being released power stroke is done

ADP

201

cardiac muscle have thick and thin filaments? sarcomeres

yes

202

in skeletal muscle, AP comes down T-tubules, and releases calcium only from

terminal cisternae in Sarcoplasmic reticulum

203

cardiac muscle cells have lots of _ channels along the surface of the sarcolemma

calcium

204

when the AP spreads along the sarcolemma and t tubules in cardiac muscle, calcium will

enter into the cardiac muscle cells when the calcium channels open they go down their gradient

205

cardiac cells have dependency of __ calcium

extracellular (vs skeletal muscle cells that get it from SR)

206

cardiac are different from skeletal muscles bc they get their calcium from

2 sources (not 1): SR and ECF

207

once calcium enters the cardiac cell from ECF, that triggers

the release of calcium from the SR

208

in both cardiac and skeletal muscle Ca2+ binds to

troponin

209

troponin has 3 subunits called

I, C, T

210

Troponin C binds

calcium

211

when calcium binds to troponin, __ moves

tropomyosin moves and reveals binding sites of actin for myosin

212

the force of contraction and extent of contraction heavily depends on

how much calcium there is in the cell.

213

cardiac muscle MUST have a period of relaxation so that

the heart can fill

214

if you shorten the relaxation phase of the cardiac muscle

will effect how much blood you pump

215

big difference of skeletal and cardiac muscle is that cardiac muscle is ALWAYS

involuntary

216

1. skeletal muscle is for the most part __
2. when can skeletal muscle be involuntary?

1. voluntary
2. deep tendon reflexes and diaphragm

217

skeletal muscle/cardiac has more mitochondria

cardiac has wayyyy more bc it is always beating! skeletal is not always moving. so cardiac muscle makes way more ATP

218

skeletal muscle/cardiac has more sarcoplasmic reticulum

skeletal has more. but that is ok because bc cardiac has 2 sources of calcium

219

intercalated discs = wavy lines under microscope that stains darker under microscope. there are 2 parts to the disc. what are they

2 parts = desmosome and gap junctions

220

desmosomes purpose in cardiac muscle

glue cells together so the muscle cells don't separate during contraction

221

gap junctions in cardiac muscle allow

ions to pass freely from cell to cell directly transmitting the stimulus

222

angina vs myocardial infarction
1. both due to
2.

1. both are due to ischemia, usually bc of lack of blood flow to the tissue
2.

223

the coronary vessels

feed the heart with oxygenated blood

224

both angina and myocardial ischemia is due to myocardial ischemia which is commonly the result of

atherosclerosis

225

both MI and angina result in

chest pain

226

in general, __ pain is often related to exertion emotion eating, cold, it is usually short lived and relieved by NG

angina

227

the pain associated with MI often occurs ___ and is more long lasting compared to angina pain and not relieved by NG

spontaneously

228

the key difference bw angina and MI is that there is no __ in angina

cell death in angina. in angina cells don't die.

229

Creatine kinase is an enzyme in all muscle cells. T/F

True

230

Tropinin I (cTnI) is good for MI detection bc

only cardiac cells have Troponin I

231

which can stay elevated longer the troponin I or troponin T

T
cTnT

232

in the plateau phase of cardiac actin potential what is happening

calcium channels open and calcium enters the cell from the ECF

233

the sinoatrial node (SA) = pacemaker is located

in the right atrium. right next to where the superior vena cava drains into the atria

234

SA node spreads electrical impulse to the right side via the __ tracts and to the left side of the heart via the_ tracts

right = internodal tracts
left - interatrial tracts
(simultaneously)

235

on the left side the electrical activity dies (dissipates out). on the right side the internodal tract leads to the

AV node ==> AV bundle (bundle of His) which enter the interventricular septum, then splits into the Rand L bundle branches that runp parallel to the apes. the bundle branches spread to the outer wall. little pieces of tissue from bundle brances are the purkinje fibers

236

purkinje fibers stimulate the _

ventricles to contract

237

you first stimulate the apex of the ventricles and then it spreads

up

238

two types of cardiac action potentials:
1. non pacemaker AP aka fast response AP
happen in what cells.
2. pacemaker aka slow response AP occur in __

1. atria, ventricles and purkinje = undergo fast depolarization
2. occur in SA and AV node - undergo slow depolarization

239

phases of fast response AP?

phase 0 ==> 1 --> 2 ==> 3 ==> 4
0 is influx of Na, 1 Na close, 2 calcium channels open (long lasting channels) = plateau phase = 3 and 4 K+

240

CICR calcium induced calcium release is

when calcium influx from AP triggers release of ca from SR. via ryanodine receptors RyR2

241

NT that alter calcium conductance. NE will

increase calcium conductance

242

NT AcH

will decrease calcium conductance

243

in slow response (pacemaker AP) the phases are

4 ==> 0 ==> 3

244

in which phase in slow response (pacemaker AP) does calcium rush in

phase 0

245

in slow response (pacemaker AP) phase 4

slowly depolarizes. sodium channels open and sodium flows in. called If

246

steps in in slow response (pacemaker AP) vs fast?

0 ==> 1 ==> 2==> 3 ==> 4 (fast)
4 ==> 0 ==> 3

247

conduction velocities: spreads fastest in the

purkinje

248

conduction velocities slowest in

AV node - which allows ventricles to fill before the atria contract

249

chronotropic effect

means a change in the heart rate

250

if someone is enduring a negative chronotropic effect means

decrease heart rate = decreasing rate of SA node firing

251

if someone is enduring a positive chronotropic effect means

increase heart rate = decreasing rate of SA node firing

252

SA node cannot change its rate of firing. something has to force it to change. T/F

true
ANS tells it. SNS cranks it up, PNS cranks it down

253

dromotropic effect means

when you change the conductance velocity. how fast it goes from SA node to purkinje. usually we change the conduction velocity in the AV nodes

254

the SA node, atria, and AV node have __ innervation but the ventricles do not.

parasympathetic innervation

255

negative dromotropic effect means

decreased velocity of conductance

256

the NT for PNS is __ which acts at

ACh = muscarinic receptors

257

The SA node, AV node, atria AND VENTRICLES have __ innervation

sympathetic.

258

The NT for SNS is _ acts on _ receptors

NE Beta 1

259

the ventricles are only innervated by

sympathetic

260

sympathetic fibers will cause _ dromotropic and chromotropic effects

positive = increase heart rate and increase conduction

261

PNS slows down which part of slow acting AP to make negative chronotropic effect

phase 4 the slow depolarization

262

1. negative dromotropic effect decreases conduction velocity thru the
2. increase the __interval

1. AV node
2. PR interval

263

mechanism of negative dromotropic effect is

decreased inward calcium current and increased outward K+ current

264

the _ lung is shorter, wider and heavier.

right lung. it is shorter, heavier, and wider and has three lobes. to remember think of him as the fat one, and thRee is the Right lung