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Understanding Coronary Arteries and Circulation

Explore the intricate network of coronary arteries supplying blood to the heart, variations in anatomy, and implications of reduced blood flow on myocardial health. Learn about coronary flow dynamics, ischemia consequences, and treatment options.

ernestpatrick
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Understanding Coronary Arteries and Circulation

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  1. Coronary Circulation

  2. The Coronary Arteries • Blood is supplied to the heart by its own vascular system called the coronary arteries. • Off the left ventricle, the aorta branches off into two main coronary blood vessels (arteries). • There are epicardial coronary arteries and those that run deeper into the myocardium and are called subendocardial coronary arteries.

  3. The Coronary Arteries • The right coronary artery supplies blood mainly to the right side of the heart. • The left coronary artery supplies blood to the left side of the heart and branches into the left anterior descending artery and the circumflex artery. • The exact anatomy of the myocardial blood supply varies from person to person.

  4. More About the Coronary Arteries • The right coronary artery splits into the marginal branch which supplies blood to the right ventricle and the posterior interventricular branch which supplies the left ventricle.

  5. More About the Coronary Arteries • The left coronary artery is larger than the right coronary artery because it feeds the left heart. It splits into the anterior interventricular branch (ventricles and ventricular septum) and the circumflex branch (follows the groove between the left atrium and left ventricle supplying blood to both chambers).

  6. More Coronary Artery Info • The circumflex joins the coronary artery in the posterior heart. • Blood passing through the chambers does not supply blood to the myocardium.

  7. The Layout of the Coronary Arteries

  8. Layout of the Coronary Arteries

  9. Coronary Flow • During contraction of the ventricular myocardium (systole), the subendocardial coronary vessels are compressed due to high intraventricular pressures. • However, the epicardial coronary vessels remain patent. • At this point blood flow to the subendocardium stops.

  10. Coronary Flow • Most myocardial perfusion occurs during relaxation (diastole) when the subendocardial arteries are patent and under low pressure. • Failure of oxygen delivery from decreased blood flow with increased oxygen demand results in tissue ischemia. • Brief ischemia is associated with chest pain (angina).

  11. Just a Little More • Severe ischemia can result in myocardial cell death. • The majority of the coronary vessels dilate with norepinephrine due to predominance of beta-adrenergic receptors in coronary circulation.

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