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Coronary Vasculature. Dr. Nivin Sharaf MD LMCC. Objectives. This lecture covers the ILO titled: Enlist the arteries, veins and nerves supplying the heart. By the end of this lecture we will be able to: Define Right/ left or Coronary co dominance
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Coronary Vasculature Dr. Nivin Sharaf MD LMCC
Objectives • This lecture covers the ILO titled: Enlist the arteries, veins and nerves supplying the heart. • By the end of this lecture we will be able to: • Define Right/ left or Coronary co dominance • Enlist areas of the heart supplied by the right andd left coronary arteries • Define the origins of coronary artery • Recognize innervation of the heart
Venous drainage Cont. • The heart is drained by veins that empty in the coronary sinus, partly by small veins that empty in the right atrium • Coronary sinus: • Main vein of the heart • Runs left to right in the coronary groove
Coronary Sinus • Tributaries: • Great Cardiac Vein= Anterior interventricular vein, runs with LAD • Drains most of the area supplied by the left coronary artery • Middle Cardiac Vein and small cardiac veins: • Drains most of the area supplied by the right coronary artery • Middle Cardiac vein runs in the posterior intervenricular groove
Innervation of the heart • Autonomic nervous system from superficial and deep Cardiac plexuses • Nerve networks lie anterior to the bifurcation of the trachea, posterior to ascending aorta • Superior to bifurcation of Pulmonary trunk
Innervation of the Heart • Parasympathetic supply: Presynaptic fibers of the vagus nerves Post synaptic fibers also end in the SA,& AV nodes, and directly on the coronary arteries Stimulation results in Saving energy between periods of increased demands) Decreased heart rate Reduce the force of heart beats Constricscornoray arteries
Innervation of the Heart Con. • Sympathetic stimulationIncreases heart rate, and the force of contraction, and inhibits contraction of the coronary arteries”Passively dilates “ • Presynaptic fibers with cell bodies in the lateral horn of T1-6 segments of spinal cord • Postsynaptic: cervical, and superior thoracic prevertebral ganglia of the sympathetic trunk( end in SA, and AV nodal tissue)
Lymphatic trainage • Subepicardial lymphatic plexus • Pass to the coronary groove, and follow the coronary arterie • End in the inferior tracheobronchial lymphnodes, usually on the right side
References • http://www.youtube.com/watch?v=Rcn3ZV-Iy6o • Myocardial blood supply • http://www.youtube.com/watch?v=tBQa8IBzP6I • Anatomy of the heart • http://www.youtube.com/watch?v=960_mAShiXQ • Part II • http://www.youtube.com/watch?v=Vr-DAhgq75w&feature=relmfu • CLINICALLY ORIENTED ANATOMY FOURTH EDITION/ KEITH L. MOORE • RECOMMENDED READING PAGES 132-139