Blood supply of

heart

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Learning objectives
 Coronary Arteries – Origin, Course & Branches

 Coronary dominance

 Coronary anastomosis

 Variations

 Applied anatomy

 Venous return

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 Introduction:
 Coronary arteries -
VASAVASORUM arising
from aortic sinuses of
Valsalva of Ascending
aorta

 Rt CA - from Rt aortic
sinus (ant)
 Lt CA from Lt aortic
sinus(left post)

 Post Aortic sinus - non

coronary

 Max filling of sinuses - in

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diastole
 Basic considerations
• A-V groove

• I-V groove

• Crux of Heart

• SA node & its location

• A-V node & its location

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Rt Atrioventricular Groove,
Ant Interventricular groove

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Atrioventricular groove (CS) &
Post Interventricular groove

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 Crux
Meeting point of
•IA groove
• Post AV groove
•Post IV groove

Posteroinferior view 7
SA Node & AV Node location

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 Rt Coronary Artery
 Passes to rt & forwards
Conus brs
b/w infundibulum of rt
ven & rt auricle
 Runs downwards in ant
AV groove
 Reaches inf margin of
heart; winds around it to
the diaph surface; runs in
post AV groove
 Ends by anastomosing Ventricular brs
with circumflex br of LCA AV nodal br
-60%

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 Branches of Rt coronary Artery
 Rt conus artery-
Annulus of Vieussens
Conus brs
 SA Nodal br – 60%
 Ant atrial branches
 Ant ventr branches
 Rt Marginal artery:
(Largest br)
 Post ventr branches
 Post IV br arises near
CRUX – 70% br of RCA
 Post atrial branches
Ventricular brs
 AV Nodal artery – 80%
AV nodal br

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 Conus brs

Ventricular brs
AV nodal br

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 Lt Coronary Artery
 Origin: Lt Aortic
sinus
Conus brs

 Passes behind
infundibulum of Rt
ventricle

 Length: 0 to 10mm

 Bifurcates into Ant

Ventricular brs
IV branch (LAD) &
AV nodal br
Circumflex artery

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LAD (Ant IV) artery
 Continuation of
LCA
Conus brs
 Extends beyond the
apex, ends by
anastamosing with
post IV artery (br of
RCA)

Branches:
 Ant ventr brs:
i. Diagonal arteries
ii. Lt Conus artery
Ventricular brs
 Septal branches AV nodal br

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Circumflex artery
 Runs in Ant AV groove and post AV groove
 Terminates by anastamosing with RCA near crux

Branches:
i. Atrial brs
ii. Ventr branches
iii. SA nodal
(40% cases)
iv. Lt Marginal
v. Post IV br
(only 10% cases)
vi. Kugel’s artery
vii.AV nodal br
(10-20%)
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 Branches of
Coronary arteries

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 Coronary dominance
 CA that gives post IV branch is supposed to be
dominant

 Misleading term as LCA supplies greater part of

myocardium, but in 70% cases post IV is a br of RCA (Rt
coronary dominance)

 3 types – Rt (70%), Lt (20%) & Balanced (10%)

Clinical importance:
In Lt dominance a block in LCA affect entire Lt ventricle and IV
septum, while in Rt or balanced dominance a block in RCA at
least spares part (2/3) of septum and lt ventricle
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 Summary:
RCA:
• Rt atrium
• Lt atrium (ant part)
• Rt ventr except a small strip along the Ant IV groove
• Diaphragmatic surface of Rt ventricle
• Post 1/3 of IV septum
• SA Node and AV Node in majority
• Most conducting system of heart except Lt branch of
Bundle of His

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 LCA:
• Post part of Lt Atrium

• Ant and Lat walls of Lt ventricle

• Ant 2/3 of IV septum

• Lt br of Bundle of His

• SA & AV Nodes in 30% cases

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 Coronary Anastomosis
-Anatomically CA are not end arteries but functionally
they behave like end arteries.
-Anastomosis occur at:
• superficial
• subepicardial
• Myocardial
• subendocardial levels

Important sites:
i) b/w terminations of RCA & LCA near crux of heart
ii) b/w their IV brs (in septum)
iii) b/w conus As
iv) apex
Prognosis better in slow occlusion
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 Variations
Congenital anomalies

- LCA arising from Pul trunk; cyanosis occurs

- LCA arises from right aortic sinus; may get compressed b/w
Pul trunk & aorta in strenuous exercise; may cause sudden
cardiac death

- Post IV A arising from Cx A (left dominance)

- SA nodal A in 40% from Cx A; AV nodal A in 20% from Cx A

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 Post IV Artery

Post IV A arising from Circumflex br of LCA

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Venous Drainage

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Coronary Sinus

 Heart is drained by CS - empties into Rt Atrium.

 Two set of veins empty directly into Rt Atrium

 Venae cordis minimi
 Ant cardiac vein,
 s/t Rt marginal vein also

 CS - dilatation of Great Cardiac Vein located in post part of AV

groove

 Opens into Rt atrium b/w IVC and Tricuspid opening guarded

by incomplete semicircular “Thebasian valve”

 Tributaries- all have valves except oblique V of lt atrium

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 Tributaries of Coronary sinus:

1. Great Cardiac vein

• Begins near apex of
heart; acc. Ant IV A &
more proximally cx
artery
• Terminates at lt end of
coronary sinus

2. Middle cardiac vein

• Accompanies Post IV
artery and opens at
termination of coronary
sinus
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3. Small Cardiac vein
• Accompanies rt marginal artery
• Runs in AV groove to end into rt end of CS
• May open directly into rt atrium

4. Oblique Vein of Lt Atrium (of Marshall)

• Runs in the post surface of Lt Atrium and drains into Lt end of Coronary sinus

5. Post Vein of Lt Ventricle

• Runs on diaphragmatic surface of Lt ventricle and ends in middle of coronary
sinus

6. Rt Marginal vein
• Accompanies Rt Marginal artery and drains into Small Cardiac vein or directly
into the Rt Atrium 27
Oblique Vein of Lt Atrium (of Marshall)

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 Veins directly emptying into Rt Atrium
1. Ant Cardiac Veins:
• 3-4 in no .drains the infundibulum of Rt ventricle
• opens into Rt Atrium through its Ant wall

2. Venae Cordis Minimi/ Thebasian veins

• Numerous small veins opening into the Post wall of
Rt Atrium

3. Small cardiac vein – may open directly into Rt atrium

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 Applied Anatomy:
• Coronary Artery Disease (CAD)

• Coronary Angiography

• PTCA (Percutaneus Transluminal

Coronary Angioplasty)

• CABG ( Coronary Artery Bypass Graft)

• Cardiac catheterisation
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Coronary Artery Disease (CAD) & Ischaemic Heart
Diseases (IHD) – due to atherosclerosis

- Angina Pectoris – transient myocardial ischemia

- Myocardial Infarction – occlusive thrombus

Investigations for CAD & IHD

a) ECG
b) Coronary Angiography

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Treatment of CAD

1. Medical T/t for angina

2. Stents- simple or drug-eluting (vasodilators)

3. Coronary Angioplasty (PTCA) - single vessel disease

4. Coronary Artery Bypass Graft (CABG) – triple vessel disease

-median sternotomy
-thymus incised
-pericardium incised
-SVC & IVC cannulated, venous blood goes to bypass
machine
-graft used: reversed Gr Saph V or Int Th A

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M. I.

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STENTING
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CABG

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CABG

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 CORONARY
CATHETRISATION

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Thank
you

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