Coronary Arteries
Right Coronary Artery
- Origin: Right aortic sinus
↳ anterior
- Course: Runs between the pulmonary trunk and right auricle and descends vertically
to the right anterior atrioventricular groove/coronary sulcus up to the junction of the
right and inferior border of the heart. At the inferior border of the heart, it turns
posteriorly and runs into the posterior atrioventricular groove up to the posterior
interventricular groove. It terminates by anastomosing with the left coronary artery.
- Branches
1) Right conus artery – supplies the anterior surface of pulmonary conus
2) Anterior ventricular branches – supplies the anterior surface of right ventricle
obtuse ● Marginal branch is the largest and runs along the lower margin of the
sternocostal surface to reach the apex.
3) Atrial branches
● Artery of sinoatrial node (60% of cases)
4) Posterior ventricular branches – supplies the diaphragmatic surface of the right
and left ventricles
5) Posterior descending artery (posterior interventricular artery) – runs in the
posterior interventricular groove up to the apex and supplies the posterior part
of the IVS, AV node (60% of cases), and right and left ventricles.
Left Coronary Artery
- Origin: Left posterior aortic sinus of the ascending aorta above the aortic valve.
- Course: Runs between the pulmonary trunk and left auricle and divides into the
*
anterior descending artery (anterior interventricular artery) and descends vertically to
the left anterior interventricular groove up to the apex of the heart, where it turns
EHBsKoAiµgqÉ
posteriorly to enter the posterior interventricular groove. It terminates by
anastomosing with the posterior interventricular artery (branch of the right coronary
artery). The*circumflex artery winds around the left margin of the heart and continues
into the left posterior coronary sulcus up to the posterior interventricular groove. It
terminates by anastomosing with the right coronary artery.
-
- Branches
, 1) Left anterior descending artery (anterior interventricular artery) – supplies the
anterior part of the IVS, greater part of the MAMA
right ventricle and part of the Wyant
left
ventricle, and part of the left AV bundle (bundle of Hiss).
2) Circumflex artery – gives a left marginal artery that supplies the left margin of
the left ventricle up to the apex of the heart. b
acute
3) Diagonal artery
4) Conus artery – supplies the pulmonary conus.
5) Atrial branches – supply the left atrium.
Clinical Correlation
- Angina Pectoris: If the coronary arteries are narrowed, the blood supply to the cardiac
k
muscle is reduced. As a result, on exertion, the patient feels severe pain in the region
of the left precordium for ~20 minutes. The pain is often referred to the left shoulder
and medial side of the arm and forearm. Pain occurs on exertion and is relieved by
rest.
- Myocardial Infarction: A sudden block of one the largest branches of the coronary
- -
artery usually leads to myocardial ischemia followed by myocardial necrosis. The part
of the heart suffering from MI stops functioning and often causes death– heart attack
or coronary attack. MI mostly occurs at rest.
● Clinical features
1. Sensation of pressure/sinking and pain in the chest that last more than 30
minutes.
2. Nausea or vomiting, sweating, shortness of breath and tachycardia.
.
3. Pain radiates to the medial side of the arm, forearm and hand. Sometimes
it may be referred to the jaw or neck.
4. If PDA is damaged – low blood pressure; tachycardia.
- AP – plaque not ruptured, vessels are not totally occluded.
- MI – plaque ruptured, thrombocytes are clotted, vessels are totally occluded.
- Common sites of coronary artery occlusion
1. Left anterior descending artery (anterior interventricular artery) – 40-50%
2. Right coronary artery – 30-40%
3. Circumflex branch of the left coronary artery – 15-20%
Right Coronary Artery
- Origin: Right aortic sinus
↳ anterior
- Course: Runs between the pulmonary trunk and right auricle and descends vertically
to the right anterior atrioventricular groove/coronary sulcus up to the junction of the
right and inferior border of the heart. At the inferior border of the heart, it turns
posteriorly and runs into the posterior atrioventricular groove up to the posterior
interventricular groove. It terminates by anastomosing with the left coronary artery.
- Branches
1) Right conus artery – supplies the anterior surface of pulmonary conus
2) Anterior ventricular branches – supplies the anterior surface of right ventricle
obtuse ● Marginal branch is the largest and runs along the lower margin of the
sternocostal surface to reach the apex.
3) Atrial branches
● Artery of sinoatrial node (60% of cases)
4) Posterior ventricular branches – supplies the diaphragmatic surface of the right
and left ventricles
5) Posterior descending artery (posterior interventricular artery) – runs in the
posterior interventricular groove up to the apex and supplies the posterior part
of the IVS, AV node (60% of cases), and right and left ventricles.
Left Coronary Artery
- Origin: Left posterior aortic sinus of the ascending aorta above the aortic valve.
- Course: Runs between the pulmonary trunk and left auricle and divides into the
*
anterior descending artery (anterior interventricular artery) and descends vertically to
the left anterior interventricular groove up to the apex of the heart, where it turns
EHBsKoAiµgqÉ
posteriorly to enter the posterior interventricular groove. It terminates by
anastomosing with the posterior interventricular artery (branch of the right coronary
artery). The*circumflex artery winds around the left margin of the heart and continues
into the left posterior coronary sulcus up to the posterior interventricular groove. It
terminates by anastomosing with the right coronary artery.
-
- Branches
, 1) Left anterior descending artery (anterior interventricular artery) – supplies the
anterior part of the IVS, greater part of the MAMA
right ventricle and part of the Wyant
left
ventricle, and part of the left AV bundle (bundle of Hiss).
2) Circumflex artery – gives a left marginal artery that supplies the left margin of
the left ventricle up to the apex of the heart. b
acute
3) Diagonal artery
4) Conus artery – supplies the pulmonary conus.
5) Atrial branches – supply the left atrium.
Clinical Correlation
- Angina Pectoris: If the coronary arteries are narrowed, the blood supply to the cardiac
k
muscle is reduced. As a result, on exertion, the patient feels severe pain in the region
of the left precordium for ~20 minutes. The pain is often referred to the left shoulder
and medial side of the arm and forearm. Pain occurs on exertion and is relieved by
rest.
- Myocardial Infarction: A sudden block of one the largest branches of the coronary
- -
artery usually leads to myocardial ischemia followed by myocardial necrosis. The part
of the heart suffering from MI stops functioning and often causes death– heart attack
or coronary attack. MI mostly occurs at rest.
● Clinical features
1. Sensation of pressure/sinking and pain in the chest that last more than 30
minutes.
2. Nausea or vomiting, sweating, shortness of breath and tachycardia.
.
3. Pain radiates to the medial side of the arm, forearm and hand. Sometimes
it may be referred to the jaw or neck.
4. If PDA is damaged – low blood pressure; tachycardia.
- AP – plaque not ruptured, vessels are not totally occluded.
- MI – plaque ruptured, thrombocytes are clotted, vessels are totally occluded.
- Common sites of coronary artery occlusion
1. Left anterior descending artery (anterior interventricular artery) – 40-50%
2. Right coronary artery – 30-40%
3. Circumflex branch of the left coronary artery – 15-20%
