Good morning

BLOOD SUPPLY
of HEART

Dr. Qudsia Sultana

• A known hypertensive patient comes to a physician
with a history of chest pain which subsides at rest….
• What diagnosis can you make from this history ???
• A known hypertensive patient comes to a
physician with a history of acute severe chest
pain associated with sweating, radiating to left
hand side or both, short breath…….
• What diagnosis can you make from this history ?
Blood supply of heart
Arterial supply:
CORONARY ARTERIES AND
BRANCHES
Venous drainage :
CORONARY SINUS AND
TRIBUTARIES
• What are coronary arteries ???
 CORONARY(Crown) ARTERIES
There are 2 coronary
arteries
right and left.
Both arise from ascending
aorta.
Inner 75-100µm-endothelial
surface gets nutrition directly
from the blood in the
chambers.
The rest of the heart receives
blood from coronary arteries.
 CORONARY ARTERIES
Vasa-vasorum of the ascending
aorta.
Anatomically not end arteries
but functionally-end arteries.
Only arteries -blood flows in
diastole
Right coronary artery…..
 Caliber is less than the left
coronary

 65% of the cases supplies

the SA node

 80% of the cases supplies

the AV node

 80% of the cases has right

dominance
Right coronary artery
Arises from anterior aortic sinus
Course of right coronary artery…….
• Appears b/w right auricle
& pulmonary trunk---
right ant. Coronary
sulcus.
• Descends—junction of
the right and inf border of
the heart—right post.
Coronary sulcus on the
diaphragmatic surface
• Reaches crux & ends little
left to crux & terminates
by anastomosing –
circumflex branch of left
Branches of right coronary artery…..
1) Right conus artery
annulus of Vieussens.
third coronary artery.
2) Anterior Atrial
branches
• Nodal artery-SA node
3) Anterior Ventricular
branches
• Right marginal artery
4) Posterior Atrial and
Ventricular branches.
5) Post Interventricular
artery.
• Septal
• Diaphragmatic
• Nodal artery-AV node
 Areas of distribution…..
1. Right atrium.
2. Greater part of right
ventricular except Ant
Interventricular Groove.
3. Small part of left
ventricle adjoining the
post interventricular
groove.
4. Post 1/3rd of
interventricular septum.
5. Entire conducting system
except left br. AV bundle.
 Left coronary artery…..
Arises from left posterior aortic sinus
Course of left coronary artery……………

• Larger
• Passes behind the
pulmonary trunk
• b/w pulmonary trunk &
left auricle.
• divides into 2 branches
• Ant interventricular
artery
• Circumflex artery
 1. Anterior interventricular artery……
Left anterior descending
(LAD) artery…..
Descends in anterior
interventricular
groove….
Terminates on inferior
surface- by
anastomosing –post
interventricular br of
right coronary artery
in the post
interventricular
groove
 Branches…..
1. Left conus artery
(annulus of Vieussens)
2. Ventricular branches
-Rt ventricle adjoining
the ant Interventricular
groove
-left diagonal artery.
4. Septal branches
ant 2/3rd of the septum
 2. Circumflex artery……..
Traverses left ant coronary sulcus – curves left border ;
left post. coronary sulcus. Finally ends left of crux to
establish anastomosis with right coronary artery.
Branches….
1. Left marginal artery
2. Ventricular branches.
3. Atrial branches-
• Kugel’s artery
4. SA nodal artery(35%)
 Areas of distribution….
1. left atrium
2. Greater part left ventricle except Post Interventricular
Groove.
3. Small part right ventricle at Ant Interventricular Groove.
4. Ant 2/3rd of interventricular septum
5. Left branch of AV bundle.
 Variations

Left Coronary Artery-

• arise- Pulmonary trunk
cyanosis-ventricular failure
• arise- anterior aortic sinus
longer course-compressed-sudden
cardiac death
 Cardiac dominance…
• Right coronary artery-post interventricular
branch- Right cardiac dominance.(majority)
• Left coronary artery- post interventricular
branch- left cardiac dominance (10%) -
commonly affected by coronary diseases-
entire left ventricle and ventricular septum-
under its control.
• Rarely-post interventricular artery-from both
–coronaries-least affected by coronary
diseases-Balanced type.
 Venous drainage….

Venous blood from heart drains into right atrium

through

a. Coronary sinus
b. Anterior cardiac veins
c. Venae cordis minimae (thebesian veins)
 1.Coronary sinus…..
• 2 to 3cm long
• Situated – left posterior coronary sulcus
• Opens – right atrium.
• Valve- Thebasian valve
Tributaries are…..
1.Great cardiac vein
begins apex, ascends – AIG,
traverses – coronary sulcus.
It receives left marginal vein.
2.Small cardiac vein
passes along right posterior coronary
sulcus.
3.Middle cardiac vein
Begins – apex, traverses – PIG, ends – middle of
coronary sinus.
4.Posterior vein of left ventricle
Present on diaphragmatic surface of left ventricle.
5.Obligue vein of left atrium(vein of Marshall)
Descends obliquely – back of left atrium
 2.Anterior cardiac veins…

Drains anterior part of

right ventricle….

Usually 2 or 3 in
number- parallel to
each other.

Opens to right atrium.

 3.Venae cordis minimae/Thebesian veins…
• Opens into all chambers.
• Numerous in right atrium & ventricle.
• Applied anatomy
• A known hypertensive patient comes to a physician
with a history of chest pain which subsides at rest….
• What diagnosis can you make from this history ???
 Clinical…….
Angina pectoris
Incomplete obstruction of coronary artery due to
atherosclerotic plaque results decrease blood supply
to heart –insufficient oxygen-severe pain in chest
region & also in left arm.
• A known hypertensive patient comes to a
physician with a history of acute severe chest
pain associated with sweating, radiating to left
hand side or both, short breath…….
• What diagnosis can you make from this history ?
 Clinical…….
Myocardial infarction
Complete obstruction coronary artery due to
thrombosis results in death of myocardium - heart
attack.
INVESTIGATIONS:
 ECG
 CARDIAC ENZYMES e.g. CK, LDH, TROPONIN etc.
 ECHOCARDIOGRAPHY
 TREADMILL EXERCISE TEST
 THALLIUM STRESS TEST
 CORONARY ANGIOGRAPHY

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TREATMENT:
– CORONARY DILATORS E.g. NITRATES
– BETA-BLOCKERS
– ANGIOPLASTY (DILATE AREA OF CONSTRICTION)
– STENT
– BYPASS SURGERY

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• Coronary Angiography
• Radiological proceedure-arteries are visualised
after injecting dye into them.
• Useful-localization of block.
• Proceedure-special catheter is passed -femoral
artery-base of ascending aorta-contrast media
injected and photographs are taken
PTCA (Percutaneous transluminal coronary angioplasty)

Used to increase the diameter of narrowed lumen of coronary artery

Percutaneous transluminal coronary angioplasty (PTCA). (a) Coronary

angiography demonstrates a severe stenosis in the proximal left anterior
descending artery. (b) During PTCA a soft guidewire is passed across the
stenosis and then a balloon is expanded that dilates the stenosis. (c) Post-
PTC
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An intracoronary stent.
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CABG(Coronary artery bypass graft)
CORONARY ARTERY BYPASS
SURGERY

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 Question
• Blood supply of heart?
• Arterial and venous drainage.
Thanks for listening..