Which of the following hormones is a positive inotropic agent?

A. The atria and ventricles are in diastole, and the atrioventricular valves are open: At the beginning of the cardiac cycle, both the atria and ventricles are relaxed (diastole). The atrioventricular (tricuspid and mitral) valves are open due to higher atrial pressure compared to ventricular pressure, allowing passive ventricular filling. This phase establishes the end-diastolic volume and prepares the ventricles for subsequent contraction.

B. The atria are in systole, the ventricles are in diastole, and the semilunar valves are open: During atrial systole, the atria contract to complete ventricular filling, but the semilunar valves remain closed because ventricular pressure has not yet exceeded the pressure in the aorta or pulmonary trunk.

C. The atria and ventricles are in systole, and all valves are open: Both chambers are never in systole simultaneously. If both contracted at once, it would impair filling and ejection, and physiologically, the valves are not all open at the same time.

D. The atria and ventricles are in diastole, and the semilunar valves are open: Semilunar valves (aortic and pulmonary) open only when ventricular pressure exceeds arterial pressure during ventricular systole. At the start of the cycle, ventricles are relaxed, so the semilunar valves remain closed.

A. The semilunar valves close, preventing backflow into the heart: During ventricular diastole, the ventricles relax and ventricular pressure falls below the pressure in the aorta and pulmonary trunk. This pressure gradient causes the aortic and pulmonary semilunar valves to close, preventing blood from flowing backward into the ventricles.

B. The electrical impulse initiates ventricular depolarization: Ventricular depolarization occurs during the onset of systole, not diastole. It is triggered by the action potential conducted through the bundle branches and Purkinje fibers, leading to contraction. Depolarization does not directly cause semilunar valve closure.

C. The atrioventricular valves close, preventing backflow into the atria: The atrioventricular (tricuspid and mitral) valves close at the beginning of ventricular systole when ventricular pressure exceeds atrial pressure. This prevents regurgitation into the atria and generates the first heart sound (S1), distinct from the semilunar valve closure occurring later in diastole.

D. The ventricles contract, forcing blood into the great arteries: Ventricular contraction occurs during systole when ventricular pressure rises above aortic and pulmonary pressures to open the semilunar valves. Closure of these valves happens during diastole when the ventricles relax, not during active ejection.