Blood supply and nerve supply of heart

• Arterial supply:
• Heart is supplied by right and left coronary arteries
• These surround the heart like an inverted crown
• Modified muscular arteries with poorly developed internal
elastic lamina
• The blood vessels of the heart, normally embedded in fat,
located just deep to the epicardium
• Originate from the ascending aorta
• Commonly two in number (right and left) but could be up to
four in number.
• The left artery usually has a larger diameter but shorter than
the right one
 Heart (sternocostal surface)

Ascending aorta

Right auricle
Left coronary artery

Right
coronary
artery Circumflex artery

Anterior
interventricular
artery

Right marginal Great cardiac

artery vein
Pulmonary trunk
 Heart (base and diaphragmatic surface)
Left atrium

Right atrium
Circumflex
artery

Right coronary
artery

Posterior
Left ventricle interventricular artery
Right ventricle
• Right coronary artery:
• Origin:
• Branch of ascending aorta
• Begins from the anterior aortic (right coronary) sinus
• Course:
• Runs between the right auricle and pulmonary trunk,
enters the anterior part of coronary sulcus
• Runs to the right in the anterior part of coronary
sulcus
• Curves around the right margin of heart
• Then runs to the left in the posterior part of coronary
sulcus
• Termination:
• Terminal branches anastomose with terminal
branches of circumflex branch of left coronary artery
at the left of the crux
 Branches of right coronary artery
• Right conus
artery
• Artery to SA node
• Atrial branches
• Ventricular
branches
• Right marginal
artery
Atrial • Posterior
branch
interventricular
artery
Right
marginal Right • Artery to AV node
artery conus Ventricular
artery branch
 Branches of right coronary artery
• Right conus branch
– usually the first branch of the right coronary
artery but could arise directly from the right
aortic sinus (36%).
– supplies lower part of pulmonary trunk and
upper part of right ventricle
• Artery to the sinuatrial (SA) node
– branch of the right coronary artery in 60% of the
population. This branch also supplies the right
atrium, which accommodates the node
• Atrial branches supply right atrium,
• Ventricular branches supply right ventricle
 Branches of right coronary artery
• Right marginal artery – is one of the ventricular
branch, runs along the inferior margin of heart
• Posterior inter-ventricular branch (posterior
descending) runs in the posterior inter-
ventricular groove, terminates by anastomosing
with anterior inter-ventricular artery, supplies
posterior part of inter-ventricular septum and
adjoining part of right and left ventricles
• The artery to the atrioventricular (AV)node - This
artery arises in the region of the crux from the
right coronary artery in 80% of the population.
• Area of distribution of right coronary
artery:
• Right atrium
• Right ventricle (except a part on the
sternocostal surface near the anterior inter-
ventricular groove)
• Part of the left ventricle (on the inferior
surface near the posterior inter-ventricular
groove)
• Posterior part of inter-ventricular septum
• Most of the conducting system of heart (SA
node, AV node, right AV bundle) except left
AV bundle
• Left coronary artery:
• Origin:
• Branch of ascending aorta
• Arises from the left posterior
aortic sinus
• Course:
• Runs between the left auricle
and pulmonary trunk
• Reaches the anterior part of
coronary sulcus
• As it enters the coronary
sulcus it terminates by dividing
to 2 branches
• Termination:
• Divides into anterior inter-
ventricular and circumflex
branches
• Anterior interventricular artery (left anterior
descending):
• Larger terminal branch of left coronary artery
• Runs on the sternocostal surface in the anterior
inter-ventricular groove with the great cardiac vein
• Terminates by anastomosing with posterior inter-
ventricular artery
• Branches:
• Left conus artery – supplies upper part of right
ventricle and lower part of pulmonary trunk
• Ventricular branches – supply the left ventricle and
part of right ventricle near the anterior inter-
ventricular groove. One of the ventricular branch is
large and is known as left (lateral) diagonal artery
• Septal branches – supply anterior part of inter-
ventricular septum
• Circumflex artery:
• Branch of left coronary artery
• Curves around the left margin of heart in the coronary
sulcus
• Enters the posterior part of coronary sulcus
• Terminates by anastomosing with right coronary artery
• Branches:
– Atrial branches – supply left atrium
– Ventricular branches – supply left ventricle
– Left marginal artery – runs along the left margin of
heart, supplies left ventricle
• The artery to the sinuatrial node: This artery arises from
the left coronary artery in 40% of the population.
• The artery to the atrioventricular node. This artery arises
from the left coronary artery in 20% of the population.
• Area of distribution of left coronary
artery:
• Left atrium
• Left ventricle except a part on the
diaphragmatic surface near the posterior
interventricular groove
• Part right ventricle on the anterior surface
near the anterior interventricular groove
• Anterior part of interventricular septum
• Left AV bundle
 CORONARY ARTERIAL DOMINANCE
• Coronary arterial dominance is concerned with the
pattern of distribution of the two coronary arteries
• Determined by the artery, which gives rise to the
posterior interventricular artery of the posterior
interventricular groove
• In 67% of the population, the right coronary artery is the
dominant artery
• In 15% of the population, the left coronary artery is the
dominant artery
• In 18% of the population, the distribution is shared
equally
 Coronary arterial anastomoses
• Branches of the coronary arteries are referred to as
‘Functional end arteries’
• Some degree of anastomosis occurs between branches of
the coronary arteries at various levels as follows:
– Sub-endocardial – In all the cavities.
– Myocardial - In the tunica media of the walls and the
interventricular septum.
– Subepicardial – In the coronary grooves
– Extracardial - Involving the pericardiophrenic, bronchial
and mediastinnal branches of the internal thoracic and
the descending thoracic aorta.
• These anastomoses occur between branches of individual
coronary arteries (Intracoronary) and between branches of
the left and the right coronary arteries (Intercoronary).
• Venous drainage of heart:
• Coronary sinus and its tributaries
• Anterior cardiac veins
• Thebesian veins
• Coronary sinus:
• Largest vein of heart, about 3 cm long
• Situated in the posterior part of coronary sulcus
between the left atrium and left ventricle
• Terminates by opening into the smooth part of right
atrium
• Opening is guarded by valve of coronary sinus
(Thebasian valve)
• Receives most of the veins of heart
 Coronary sinus and its tributaries
Left atrium

Oblique vein
of left atrium
Right atrium

Great cardiac vein

Coronary sinus

Small cardiac vein

Posterior vein of
left ventricle

Left ventricle Right ventricle Middle cardiac vein

• Tributaries of coronary sinus:
• Great cardiac vein
• Small cardiac vein
• Middle cardiac vein
• Posterior vein of left ventricle
• Oblique vein of left atrium
• Great cardiac vein:
• Situated in the anterior
interventricular groove and anterior
part of coronary sulcus
• Small cardiac vein:
• Situated in the posterior part of
coronary sulcus between right
atrium and right ventricle
• Middle cardiac vein:
• Situated in the posterior inter-
ventricular groove
• Posterior vein of left ventricle:
• Situated on the diaphragmatic surface of left
ventricle
• Oblique vein of left atrium (of Marshall):
• Situated on the posterior surface of left atrium
• Anterior cardiac veins:
• 3 to 4 veins situated on the sternocostal
surface of right ventricle
• Terminate by opening into the right atrium
• Thebasian veins (venae cordis minimae):
• Small veins situated in the myocardium of all
the chambers
• Terminate by opening into all chambers
• Blood could flow in the reverse direction in
these veins thus they could supply the
myocardium with blood as and when
necessary, e.g. in MI.
Anterior cardiac vein
• Nerve supply of heart:
• Supplied by nerves arising from superficial and
deep cardiac plexus
• Nerves arising from these plexuses run along the
coronary arteries and supply the heart
• These contain sympathetic and parasympathetic
nerves
• Sympathetic nerves are cardio-acceleratory, on
stimulation increase heart rate and dilate coronary
arteries
• Sympathetic nerves are derived from upper 4 or 5
thoracic segments of spinal cord
• Parasympathetic nerves run via vagus. These
begin at the dorsal nucleus of vagus (medulla
oblongata). These are cardio-inhibitory, and on
stimulation slow down the heart rate
• Superficial cardiac plexus:
• Situated below the arch of aorta
• Deep cardiac plexus:
• Situated in front of bifurcation of trachea and
behind the arch of aorta
Right superior
cervical sympathetic
ganglion
Left vagus nerve
Right sympathetic chain

Cardiac branch

Middle cervical
sympathetic ganglion

Inferior cervical
sympathetic ganglion

Cardiac plexus
of nerves