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EducationalGame–CardiacCyclePuzzle

Authors:MarcondesFK,MouraMJCS,CardozoLT,LuchiKCG

1. Objectiveofthegame

Understanding how the special characteristics of the heart contribute to its

functioning,relatingitsmorphologytophysiology.

2. GameDescription

The Cardiac Cycle Puzzle is a simulation game, with no competitive goal. It is a

puzzle because it has pieces that fit together, each piece fits into only one place, the

strategiesusedby the solverswill help them to solveotherproblems in the futureand

provides entertainment tp solvers (Michalewicz andMichalewicz, 2008; Cardozo et al.,

2016). It isclassifiedasasimulationgamebecausethepiecesof thepuzzleconstitutea

simplifiedsimulationoftheeventsthatoccurintheheartduringbloodpumping.

This gamewas developed based on figures adapted from the textbook "Human

Physiology" (Moffett,Moffett & Schauf, 1993), and is composed of the pictures of the

cardiaccyclephases,atableandchips.Thepicturesillustratingthephasesofthecardiac

cycle, pathways of arterial and venous blood in the heart as well as contraction and

relaxationoftheatriaandventriclesfigures(Figure1).

Thetable(Figure2)containssixcolumnswiththefollowingindications:1-phase

of the cardiac cycle, 2 - figure, 3 - atrial state, 4 - ventricular state, 5 - atrioventricular

valvesand6-pulmonaryandaorticvalves,whichmustbecompleted.

Thechips (Figure3) indicate thephasesof thecardiaccycle (passive filling,atrial

contraction,ventricularisovolumetriccontraction,ejection,andventricularisovolumetric

relaxation)andtherespectivefigures,theconditionoftheatriumandventricles(relaxed;

contracting)thestateoftheheartvalves(openorclosed)andtheheartsounds.Thechips

thatcompletethefirstcolumn(phases)areinblue,toavoidconfusionwiththechipsthat

indicatethephase“Ventricularisovolumetriccontractionorrelaxation”andthechipsthat

completetheventricularstate"Isovolumetriccontractionorrelaxation”.

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Figure1.Figuresofthephasesofthecardiaccycle,presentedinfullsizeinAppendix1.

Figure2.Tableofthecardiaccyclepuzzle,presentedinfullsizeinAppendix2.

Phase 1: C

Phase 2: ____

Phase 3: ____

Phase 4: ____

Phase 5: ____

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Figure3.Chips for completing thecardiac cyclepuzzle table,presented in full size inAppendix3.

3. Descriptionofactivity

Beforetheactivitywiththegame,itissuggestedtoteacha30-40-minuteclasson

thebasisofcardiacphysiology,addressingthespecialcharacteristicsof thecardiaccells

(physiologyof thepacemaker cells and their control by the autonomic nervous system,

comparison between the action potential of skeletal muscle and the plateau action

potential of cardiacmuscle, cardiac conduction fibers and transmissionof the electrical

stimulusintheheart,withoutthedescriptionofthecardiaccycle).

In thisway the gamewill be used as an active teachingmethod for the cardiac

cycle theme. However, at the teacher's discretion, the activity can be used after

theoreticalclasseswiththecompletedescriptionofthesubject,becoming inthiscasea

strategytoreinforcelearning.

The activitywith the game canbe immediately after that first class or in a later

class. In thiscase, studentsare instructedtostudy thecontentcovered inclassandthe

cardiaccyclebeforetheactivitywiththegame.

For the activity, students are divided in groups of four to five participants and

received the puzzle containing pictures of the cardiac cycle phases (Figure 1), they are

Passive filling

Atrial contraction

Ventricular isovolumetriccontraction

Ejection

Ventricular isovolumetric

relaxation

Relaxed

RelaxedRelaxed Relaxed

Contracting

Isovolumetricrelaxation

Contraction: ejection

Isovolumetriccontraction

Relaxed: filling

Relaxed: filling

Open Open

Closed

Closed Closed

Closed

Closed

Closed

Open

Closed

1st heart sound

2st heart sound

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askedtoanalyzethefiguresrepresentingthephasesofthecardiaccycleandto identify

thecorrectsequence inwhichtheyshouldbeplaced.Thechips“ firstandsecondheart

sound”shouldbeplacedamongtheotherchipsinordertoindicatewhendothesounds

aregenerated(appendix4).Thefirstphaseisindicatedinordertoavoiddifferentcorrect

answersandtofacilitatethediscussionwithallthegroupstogetherattheendofactivity,

mainlyifthereisnomonitorstohelptheteacher.

Ifthesequenceiscorrect,theymoveontothenextstep.Otherwise,theteacher

shouldinformthatthesequenceisnotcorrect,withoutindicatingwheretheerroris,and

thegroupmustdiscussandredefinethecorrectsequence.

In thenext step, theyareasked to complete the table (Figure2)using thechips

(Figure3),relatingeachphasetoafigure.

Whilethegroupsassemblethepuzzle,theteacheraskseachgrouptochoosethe

chips,withoutmaking the corrections directly. In thisway, students are encouraged to

discussandreviewtheirchoices,helpingeachotherthroughgroupwork.Aftercompleting

thecorrecttable,thefollowingquestionsarepresentedforgroupdiscussion:

ü Howistheelectricalstimulustransmittedintheheartduringacardiaccycle?

ü Whyistheelectricalstimulusdelayintheatrioventricularnodeimportantforcardiac

function?

ü Whenandhowdotheheartvalvescloseandopen?

ü Whatareandwhenareheartsounds?

ü Howdogapjunctionsofcardiacmusclecellsparticipateintheconductionofelectrical

stimulationandcontractionoftheheartmuscle?

Atthisstageofdiscussionofthequestions,itisuptotheteachertoallowstudents

toconsulttheirclassnotesandtextbooks.

This activity has variable duration according to the development of each class,

amountofteachersandmonitorsfortheclass.

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At the end of the activity with the game or in a next class, the teacher should

conductageneraldiscussionwiththestudents inordertosummarizetheeventsofthe

cardiaccycle,theimportanceofthespecialcharacteristicsoftheheartforitsfunctioning

andclarifydoubtsthatremainafterthegametoensurethattheessentialaspectshave

beenlearnedbyallgroups.

4.References

CardozoLT,MirandaAS,MouraMJCS,MarcondesFK.Effectofapuzzleontheprocessofstudents’learningaboutcardiacphysiology.AdvPhysiolEduc40:425–431,2016.Marcondes FK, Amaral ME. Understanding the physiology of heart with a puzzle. In:PráticasPedagógicasnoEnsinoSuperior,editedbySignoriniCE,RaymundoOJr,RipaR.Araras,p.93–111,2014[portuguese].MarcondesFK,MouraMJ,SanchesA,CostaR,deLimaPO,GroppoFC,AmaralME,ZeniP,GaviaoKC,MontrezorLH.Apuzzleusedtoteachthecardiaccycle.AdvPhysiolEduc39:27–31,2015.MarcondesFK,MouraMJ.Understanding thePhysiologyofHeartand theCardiacCycleWith a Puzzle. Piracicaba, SP, Brazil: Workshop of Active Methodologies in PhysiologyTeaching,2013,p.2013[Portuguese].http://www.sbfis.org.br/undergratuate-committee/Michalewicz Z, Michalewicz M. Puzzle-based Learning: Introduction to critical thinking,mathematics,andproblemsolving.1sted.CredibilityCorporationPtyLtd,2008.MoffettDF,Moffett SB, Schauf CL.HumanPhysiology, editedbyMosby-Year Book Inc.,1993.

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Appendix1

Partofthegame-Imagesofthecardiaccycle

Phase 1: C

Phase 2: ____

Phase 3: ____

Phase 4: ____

Phase 5: ____

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Appendix2

Partofthegame–Table

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Appendix3

Partofthegame-Chips

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Appendix4

Filledtable