Arterial supply of heart

Heart is supplied by the:

1) Left coronary artery
2) Right coronary artery
They are the branches of
ascending aorta.

Right coronary artery its

branches, distribution
1) Arises from anterior right aortic sinus of
ascending aorta.
2) Descends vertically downwards in the
anterior part of the coronary sulcus.
3) Winds round the inferior border and extend
into the posterior part of coronary sulcus.
4) It terminates by anastomosing with
circumflex branch of left coronary artery
just to the left of crux of the heart.

Branches and distribution

1) Right conus artery
In 64 percent cases it is the first branch
of right coronary artery supplies
infundibulum of right ventricle.
In 36 percent cases it arises separately
from the anterior aortic sinus as third
coronary artery.

3) artery of SA node supplies

part of right atrium.

SA node

4) right anterior ventricular rami runs

horizontally from right coronary artery
supply sternocostal surface of right
ventricle.
5) right marginal artery supply both
sternocostal and diaphramatic surfaces of
right ventricle.

6) right posterior ventricular rami supply the

diaphramatic surface of the right ventricle
7) posterior interventricular(posterior
descending) branch descends in the posterior
inter ventricular sulcus
with middle cardiac vein
anastomose with anterior interventricular
branch of left coronary artery close to the
apex
it supplies:
-Posterior 1\3 interventricular septum.
-Diaphramatic surfaces both ventricles.
-AV nodal artery arises from it,supply AV
node.

Area of distribution
1) Right atrium
2) Right ventricle
3) Posterior 1\3 of interventricular
septum
4) SA node
5) Av node
6) Right branch of av bundle(HIS)

Left coronary artery

1) It is a branch of left posterior aortic sinus
of ascending aorta
-It is shorter and larger in calibre
-Supply greater volume of myocardium than
right coronary artery.
2) Course
runs to the left between pulmonary trunk
and left auricle to reach coronary sulcus
where it bifurcates into:
-Anterior interventricular artery and
-circumflex artery.

Branches and distribution

1) anterior inter ventricular artery(anterior
desecending branch) accompanied by great
cardiac vein.
- large branch descends in the anterior inter
ventricular groove
-Winds round the acute margin
- for a short distance in the posterior
interventricular groove to anastomose with
posterior interventricular artery a branch
from right coronary artery.

Branches of anterior
interventricular artery
1) left conus artery suppling the infundibulum of
right ventricle and forms annulus vieussens
with right conus artery .
2) left anterior ventricular rami 2 to 9 in number
run obliquely downwards on the antero lateral
wall of left ventricle
the largest of these branches is known as
diagonal artery
supply sternocostal surface of left ventricle.

3) septal branches supply anterior

2\3 of interventricular septum
including the left branch of AV
bundle of His

Circumflex branch
1) Runs in the posterior part of the coronary sulcus
towards the crux of heart and ends by
anastomosing with termial part of right coronary
artery.
2) Branches:
- Anterior and posterior atrial rami supply
left atrium.
- Left marginal supply lateral wall of left
ventricle.
- Posterior ventricular rami suppling
diaphragmatic surface of left ventricle.
3)In 35 percent artery to SA node arises from
circumflex artery.

Area of distribution of left

coronary artery
1) Left ventricle.
2) Left atrium.
3) anterior 2\3 of interventricular septum.
4) Left branch of av bundle.

Venous drainage of heart

1) coronary sinus its tributaries.
2) anterior cardiac vein.
3) venae cordis minimae.

Coronary sinus
1) A venous channel 2 to 3 cm long.
2) Lying in the posterior part of the coronary
sulcus.
3) Draining most of the venous blood into right
atrium of heart.
4) The coronary sinus opens into the right
atrium between the inferior vena cava and
tricuspid valve.

5) Valve of coronary sinus which prevents

regurgitation of blood into the
coronary sinus during atrial systole.
6) coronary sinus develops from body and
left horn of sinus venosus.

Tributaries
1)
2)
3)
4)
5)

great cardic vein.

middle cardiac vein.
posterior vein of left ventricle.
small cardiac vein.
oblique vein of left atrium (vein of
marshall).
6) right marginal vein.

LCA

Ant. interVentricular

RCA
Conus
Atrial
SA nodal
Ventricular
Marginal

Circumflex
Conus
Atrial
Ventricular
Diagonal

Circumflex
Atrial
Ventricular
Marginal
SAnodal
Post.
interVentricul
ar

RCA
Ventricular
Post.
interVentricul
ar

Thank you

Nerve supply of heart

- Nerve of the heart are derived from

cardiac plexus,which is formed by the
sympathetic and parasympathetic
(vagal) fibres.

Parasympathetic motor fibres

Preganglionic parasympathetic
cardioinhibitory fibres arise from:
1) Nucleus ambiguus
2) Dorsal nucleus of vagus
3) Both the vagi gives
- two cervical cardiac branches
- thoracic cardiac branches
- recurrent laryngeal nerve also gives off
cardiac branches.

Sympathetic fibres

Preganglion fibres arise

1) from lateral horn cells of T1 toT 5 segments of

spinal cord.
2) they relay in the superior, middle, inferior cervical
sympathetic ganglia and upper five thoracic ganglia.
3)These ganglia give cardiac branches to the cardiac
plexuses
(Sympathetic fibres innervate ventricular
myocardium).

Superficial cardiac plexus

1) Lies in front of the bifurcation of
pulmonary trunk just to right of
ligamentum arteriosum.
2) Formed by
- superior cervical cardiac branch of
left sympathetic
-inferior cervical cardiac branch of left
vagus

Cardiac plexuses

Branches
1) A branch to deep part of cardiac plexus.
2) Branch to the right coronary plexus.
3) Branch to the left anterior pulmonary
plexus.

Deep cardiac plexus

1) Lies in front bifurcation of trachea.
2) It is formed by
-All sympathetic and Parasympathetic
cardiac branches except those
forming the superficial cardiac plexus.

DEEP CARDIAC PLEXUS

Branches consist of right and left halves.

Right half:
1) Anterior pulmonary plexus.
2) Right coronary plexus.
3) Atrial branch.
4) Left coronary plexus.

Left half:
1) Left anterior pulmonary plexus.
2) Left atrial branch.
3) Left coronary plexus.

Effect of sympathetic and

parasympathetic fibres
1) Sympathetic fibres supply the
atria,ventricles and conducting system of
heart.
-sympathetic stimulation lead to
(a) increase in heart rate.
(b) increase in cardiac output.
(c) vasodilation of coronary artery.
(d) convey painful sensation from heart.

2) Parasympathetic fibres supply only the

atria and conducting system of heart.
stimulation of vagus nerve lead to
(a) decrease in heart rate.
(b) decrease in coronary blood flow.
(c) visceral reflexes which depress
cardiac activity.

Conducting system of the heart

1) Sinuatrial node ( SA node)
2) Atrioventricular(AV )
3) Atrioventricular Bundle(AV Bundle of HIS)
4) Right and left branches

Applied aspects
pain sensation due to ischaemia is conveyed by
afferents which passes through cardiac fibers
and reach the T1 to T5 segments of left side.
first order neurons located in the T1-T5 dorsal
root ganglion.
So in Angina Pectoris due to myocardial ischaemia
the referred pain is felt in T1-T5 dermatomes.
Hence the referred pain of cardiac origin is felt
in the pre-cardial region. (left pectoral region),
also medial aspect of left forearm.