Lecture 3- The Coronary Circulation 1.

Exit valves from ventricles - Pulmonary and aortic valve - Comprised of three semilunar cusps

Aortic sinus : a dilatation [orifice being dilated] between the aortic wall and each of the semilunar cusps of the aortic valve; from two of these sinuses the coronary arteries take origin.

 Aortic valve Superior to each valve is the aortic sinus There are generally three aortic sinuses : the left posterior ( which gives rise to left coronary artery), the anterior( give rise to right coronary artery), and the right posterior ( no vessels arise from the right posterior aortic sinus- also known as non-coronary sinus)

Right coronary artery From the right aortic sinus Sinuatrial node branch Site of the fastest depolarisation All hearts cells have the ability to generate the electrical impulses that trigger cardiac contraction, the SAN normally initiates it simply because it generates impulses slightly faster than other areas with pacemaker potential. Depolarisation becomes slower when it reaches AV and ventricle Right auricle and infundibulum Infundibulum- the conus arteriosus[ conical pouch formed from the upper and left angle of right ventricle in the chordate heart, from which the pulmonary trunk arises] is the outflow portion of the right ventricle, known as infundibulum of the heart[ is a funnel-shaped cavity or organ]

A-V groove Right coronary artery travel between right atrium and right ventricle Right marginal branch Right marginal branch of right coronary artery ( or also known as right marginal artery)is a large marginal branch which follows the acute margin of the heart and supplies branches to both surfaces of the right ventricle

AV nodal branch It electrically connects atrial and ventricular chambers Is an area of specialised tissue between the atria and the ventricles of the heart, in the posteroinferior region of interatrial septum near the opening of coronary sinus

## coronary sinus- opens into the right atrium between the inferior vena cava and the atrio-ventricular orifice Posterior interventricular artery (PIVA) Is an artery running in the posterior interventricular sulcus[groove that separate ventricles of the heart] to the apex of the heart where it meets with the anterior interventricular artery (AIVA) Septal branch Supply blood to posterior atrioventricular septum, Arteriolar anastomoses [ alternate pathways for blood]

Refers to connection between blood vessels or between other tubular structures such as loops of intestine. SUMMARY Right coronary artery supplies RA and most RV Diaphragmatic surface of LV Posterior 1/3 septum SAN[60%] ; AVN[80%] Left coronary artery Is an artery that arise from the aorta above the left cusp of the aortic valve and feeds blood to the left side of the heart. Left auricle and infundibulum It typically runs for 1 to 25 mm and then bifurcates into the anterior interventricular artery (AIVA) also called left anterior descending(LAD) artery and left circumflex artery(LCX) Left marginal artery is a branch of the circumflex artery Summary Left coronary artery supplies to : LA, most LV

 Anterior surface of RV Anterior 2/3 of IV septum SAN [40%]; AVN[20%]

2. Anastomoses Anteriolar anastomoses In septum In posterior wall of LV Occlusion [blockage]: Angina, AMI[Myocardial Infarction] Gives time for healthy arterioles to open - Surface ( Capillary) Anastomoses Apex AV groove With pericardial arteries

3. DOMINANCE: Depends on PIVA - 60%+ of patients the right coronary artery(RCA) is said to be dominant because it supplies circulation to the inferior portion of interventricular septum via the right posterior descending coronary artery - 15% of patients the RCA is said to be non-codominat because it does not supply circulation to the inferior portion of interventricular septum via the right posterior descending coronary artery - In 8% of patients- the left coronary artery(LCA) is dominant because it travels to the cross section of AV groove and the posterior interventricular http://www.youtube.com/watch?feature=endscreen&NR=1&v=eefHDKGWSR4 4. Myocardial Infarction: Complications - Possible within 20 minutes onset - Arrhythmias [disturbance or loss of regular rhythm]/ heart block - Cardiogenic shock/ CCF - Valve problems : acute mitral regurgitation[ a disorder of the heart in which the mitral valve does not close properly when the heart pumps out blood- abnormal leaking of blood from the left ventricle, through mitral valve, and the into left atrium, when left ventricle contracts- ie regurgitation of blood back into the left atrium] Papillary muscles may die off due to blockage in coronary artery

Can predict which coronary artery is blocked by injury pattern on the ECG 5. Veins of the Heart - The coronary sinus o Receives 60% venous blood opens at the lower end of the AV groove into the posterior wall of the right atrium

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Receives : Great cardiac vein(LAD/LCx) Middle cardiac vein(PIVA) Posterior vein of the LV Small cardiac vein(MA) Anterior cardiac veins Comprise three or four small vessels which collect blood from the front of the right ventricle and open into the right atrium Right marginal vein frequently opens into the right atrium and is therefore sometimes regarded as belonging to this group Cross anterior Surface RV Drain directly into RA ( unlike most cardiac veins which usually end in the coronary sinus Drain remaining 40% Venae cordis minimae Smallest cardiac vein: numerous small veins arising in the muscular walls and draining independently into the cavities of the heart, particularly the right atrium and ventricle Drains directly into all 4 chambers Valveless- forms AV shunts/ Collateral[ secondary or accessory] Circulation for parts of myocardium

6. Blood supply: Pericardium o Pericardiacophrenic arteries(internal thoracic)is a long slender branch of the internal thoracic artery. It accompanies the phrenic nerve, between pleura and pericardium, to the diaphragm, to which it is distributed.

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Coronary arteries Supply from nearby structures/ extra-cardiac anastomosis [ it anastomoses with musculophrenic and inferior phrenic arteries]