3. Introduction:
ï§ Coronary arteries -
VASAVASORUM arising
from aortic sinuses of
Valsalva of Ascending
aorta
ï§ Rt CA - from Rt aortic
sinus (ant)
ï§ Lt CA from Lt aortic
sinus(left post)
ï§ Post Aortic sinus - non
coronary
ï§ Max filling of sinuses - in
diastole
3
4. Basic considerations
âą A-V groove
âą I-V groove
âą Crux of Heart
âą SA node & its location
âą A-V node & its location
4
10. Rt Coronary Artery
ï± Passes to rt & forwards
b/w infundibulum of rt
ven & rt auricle
ï± Runs downwards in ant
AV groove
ï± Reaches inf margin of
heart; winds around it to
the diaph surface; runs in
post AV groove
ï± Ends by anastomosing
with circumflex br of LCA
-60%
Conus brs
Ventricular brs
AV nodal br
10
11. Branches of Rt coronary Artery
ï± Rt conus artery-
Annulus of Vieussens
ï± SA Nodal br â 60%
ï± Ant atrial branches
ï± Ant ventr branches
ï± Rt Marginal artery:
(Largest br)
ï± Post ventr branches
ï± Post IV br arises near
CRUX â 70% br of RCA
ï± Post atrial branches
ï± AV Nodal artery â 80%
Conus brs
Ventricular brs
AV nodal br
11
13. Lt Coronary Artery
ï± Origin: Lt Aortic
sinus
ï± Passes behind
infundibulum of Rt
ventricle
ï± Length: 0 to 10mm
ï± Bifurcates into Ant
IV branch (LAD) &
Circumflex artery
Conus brs
Ventricular brs
AV nodal br
13
14. LAD (Ant IV) artery
ï± Continuation of
LCA
ï± Extends beyond the
apex, ends by
anastamosing with
post IV artery (br of
RCA)
Branches:
ï Ant ventr brs:
i. Diagonal arteries
ii. Lt Conus artery
ï Septal branches
Conus brs
Ventricular brs
AV nodal br
14
15. Circumflex artery
ï± Runs in Ant AV groove and post AV groove
ï± 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. Kugelâs artery
vii.AV nodal br
(10-20%)
15
17. Coronary dominance
ï± CA that gives post IV branch is supposed to be
dominant
ï± Misleading term as LCA supplies greater part of
myocardium, but in 70% cases post IV is a br of RCA (Rt
coronary dominance)
ï± 3 types â 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
17
18. Summary:
RCA:
âą Rt atrium
âą Lt atrium (ant part)
âą Rt ventr except a small strip along the Ant IV groove
âą Diaphragmatic surface of Rt ventricle
âą Post 1/3 of IV septum
âą SA Node and AV Node in majority
âą Most conducting system of heart except Lt branch of
Bundle of His
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19. LCA:
âą Post part of Lt Atrium
âą Ant and Lat walls of Lt ventricle
âą Ant 2/3 of IV septum
âą Lt br of Bundle of His
âą SA & AV Nodes in 30% cases
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21. Coronary Anastomosis
-Anatomically CA are not end arteries but functionally
they behave like end arteries.
-Anastomosis occur at:
âą superficial
âą subepicardial
âą Myocardial
âą 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
21
22. 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
22
23. Post IV A arising from Circumflex br of LCA
Post IV Artery
23
25. Coronary Sinus
ï¶ Heart is drained by CS - empties into Rt Atrium.
ï¶ Two set of veins empty directly into Rt Atrium
ï¶ Venae cordis minimi
ï¶ Ant cardiac vein,
ï¶ s/t Rt marginal vein also
ï¶ CS - dilatation of Great Cardiac Vein located in post part of AV
groove
ï¶ Opens into Rt atrium b/w IVC and Tricuspid opening guarded
by incomplete semicircular âThebasian valveâ
ï¶ Tributaries- all have valves except oblique V of lt atrium
25
26. Tributaries of Coronary sinus:
1. Great Cardiac vein
âą Begins near apex of
heart; acc. Ant IV A &
more proximally cx
artery
âą Terminates at lt end of
coronary sinus
2. Middle cardiac vein
âą Accompanies Post IV
artery and opens at
termination of coronary
sinus
26
27. 3. Small Cardiac vein
âą Accompanies rt marginal artery
âą Runs in AV groove to end into rt end of CS
âą May open directly into rt atrium
4. Oblique Vein of Lt Atrium (of Marshall)
âą Runs in the post surface of Lt Atrium and drains into Lt end of Coronary sinus
5. Post Vein of Lt Ventricle
âą Runs on diaphragmatic surface of Lt ventricle and ends in middle of coronary
sinus
6. Rt Marginal vein
âą Accompanies Rt Marginal artery and drains into Small Cardiac vein or directly
into the Rt Atrium 27
29. Veins directly emptying into Rt Atrium
1. Ant Cardiac Veins:
âą 3-4 in no .drains the infundibulum of Rt ventricle
âą opens into Rt Atrium through its Ant wall
2. Venae Cordis Minimi/ Thebasian veins
âą Numerous small veins opening into the Post wall of
Rt Atrium
3. Small cardiac vein â may open directly into Rt atrium
29