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Coronary circulation

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731: 719: 523:), the subendocardial coronary vessels (the vessels that enter the myocardium) are compressed due to the high ventricular pressures. This compression results in momentary retrograde blood flow (i.e., blood flows backward toward the aorta) which further inhibits perfusion of myocardium during systole. However, the epicardial coronary vessels (the vessels that run along the outer surface of the heart) remain open. Because of this, blood flow in the subendocardium stops during ventricular contraction. As a result, most myocardial perfusion occurs during heart relaxation ( 743: 40: 365: 160: 171: 376:, which lack function, as opposed to true anastomoses like that in the palm of the hand. This is because blockage of one coronary artery generally results in death of the heart tissue due to lack of sufficient blood supply from the other branch. When two arteries or their branches join, the area of the myocardium receives dual blood supply. These junctions are called anastomoses. If one coronary artery is obstructed by an 384:
interventricular sulcus (groove). More superiorly, there is an anastomosis between the circumflex artery (a branch of the left coronary artery) and the right coronary artery in the atrioventricular groove. There is also an anastomosis between the septal branches of the two coronary arteries in the interventricular septum. The photograph shows area of heart supplied by the right and the left coronary arteries.
269: 476:) to the wall of the heart. If the papillary muscles are not functioning properly, the mitral valve may leak during contraction of the left ventricle. This causes some of the blood to travel "in reverse", from the left ventricle to the left atrium, instead of forward to the aorta and the rest of the body. This leaking of blood to the left atrium is known as 539:
or vasoconstriction of the coronary arteries based upon the oxygen requirements of the heart. This contributes to the filling difficulties of the coronary arteries. Compression remains the same. Failure of oxygen delivery caused by a decrease in blood flow in front of increased oxygen demand of the
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arise from the right coronary artery inferior to the right atrium. The marginal arteries supply blood to the superficial portions of the right ventricle. On the posterior surface of the heart, the right coronary artery gives rise to the posterior interventricular artery, also known as the posterior
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The left and right coronary arteries occasionally arise by a common trunk, or their number may be increased to three; the additional branch being the posterior coronary artery (which is smaller in size). In rare cases, a person will have the third coronary artery run around the root of the aorta.
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Under the most common configuration of coronary arteries, there are three areas of anastomoses. Small branches of the LAD (left anterior descending/anterior interventricular) branch of the left coronary join with branches of the posterior interventricular branch of the right coronary in the
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Approximately 70% of the general population are right-dominant, 20% are co-dominant, and 10% are left-dominant. A precise anatomic definition of dominance would be the artery which gives off supply to the AV node i.e. the AV nodal artery. Most of the time this is the right coronary artery.
236:. An anastomosis is an area where vessels unite to form interconnections that normally allow blood to circulate to a region even if there may be partial blockage in another branch. The anastomoses in the heart are very small. Therefore, this ability is somewhat restricted in the heart so a 122:, needs a steady supply of oxygenated blood that is free of all but the slightest interruptions, the heart is required to function continuously. Therefore its circulation is of major importance not only to its own tissues but to the entire body and even the 228:(LAD), is the second major branch arising from the left coronary artery. It follows the anterior interventricular sulcus around the pulmonary trunk. Along the way it gives rise to numerous smaller branches that interconnect with the branches of the 707:. The coronary arteries are classified as "terminal circulation", since they represent the only source of blood supply to the myocardium; there is very little redundant blood supply, that is why blockage of these vessels can be so critical. 527:) when the subendocardial coronary vessels are open and under lower pressure. Flow never comes to zero in the right coronary artery, since the right ventricular pressure is less than the diastolic blood pressure. 260:
descending artery. It runs along the posterior portion of the interventricular sulcus toward the apex of the heart, giving rise to branches that supply the interventricular septum and portions of both ventricles.
499:(insufficiency of oxygen-rich blood). On the other hand, the posteromedial papillary muscle is usually supplied only by the PDA. This makes the posteromedial papillary muscle significantly more susceptible to 380:, the second artery is still able to supply oxygenated blood to the myocardium. However, this can only occur if the atheroma progresses slowly, giving the anastomoses a chance to proliferate. 372:
There are some anastomoses between branches of the two coronary arteries. However the coronary arteries are functionally end arteries and so these meetings are referred to as potential
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If the posterior descending artery is supplied by both the right coronary artery and the circumflex artery, then the coronary circulation can be classified as "co-dominant."
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In addition to metabolism, the coronary circulation possesses unique pharmacologic characteristics. Prominent among these is its reactivity to adrenergic stimulation.
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Occasionally, a coronary artery will exist as a double structure (i.e. there are two arteries, parallel to each other, where ordinarily there would be one).
480:. Similarly, the leaking of blood from the right ventricle through the tricuspid valve and into the right atrium can also occur, and this is described as 209:, typically does not give rise to a vessel. Coronary vessel branches that remain on the surface of the heart and follow the sulci of the heart are called 181:
supply blood to the myocardium and other components of the heart. Two coronary arteries originate from the left side of the heart at the beginning (root)
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Voci P, Bilotta F, Caretta Q, Mercanti C, Marino B (1995). "Papillary muscle perfusion pattern. A hypothesis for ischemic papillary muscle dysfunction".
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of the veins of the heart is very variable, but generally it is formed by the following veins: heart veins that go into the coronary sinus: the
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The left coronary artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum. The
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The right coronary artery proceeds along the coronary sulcus and distributes blood to the right atrium, portions of both ventricles, and the
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are healthy, they are capable of autoregulating themselves to maintain the coronary blood flow at levels appropriate to the needs of the
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then drain away the blood after it has been deoxygenated. Because the rest of the body, and most especially the
626: 111: 1491: 1268: 1021: 806: 636: 552:. Chronic moderate ischemia causes contraction of the heart to weaken, known as myocardial hibernation. 409: 91: 224:
to the left. Eventually, it will fuse with the small branches of the right coronary artery. The larger
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of the brain from moment to moment. Interruptions of coronary circulation quickly cause heart attacks (
955: 427:(CX), a branch of the left artery, then the coronary circulation can be classified as "left-dominant." 1292: 189:(dilations) in the wall of the aorta just superior to the aortic semilunar valve. Two of these, the 1561: 827: 544:, a condition of oxygen deficiency. Brief ischemia is associated with intense chest pain, known as 488: 237: 58: 1272: 1185: 1153: 1141: 481: 405: 252: 202: 139: 1510: 1288: 1260: 1252: 1014: 590: 584: 578: 492: 353: 309: 305: 123: 70: 1433: 1338: 1306: 1180: 1099: 789: 704: 631: 620: 549: 504: 417: 241: 127: 563:
The following are the named branches of the coronary circulation in a right-dominant heart:
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of the coronary circulation of the human heart viewed from the front and from behind
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The anterolateral papillary muscle more frequently receives two blood supplies:
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Circulation of blood in the blood vessels of the heart muscle (myocardium)
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OpenStax College, Anatomy & Physiology. OpenStax CNX. 30 July 2014.
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Base and diaphragmatic surface of heart showing some cardiac veins
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from other causes like obstruction in blood flow through vessels.
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The relatively narrow coronary arteries are commonly affected by
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Algranati, Dotan; Kassab, Ghassan S; Lanir, Yoram (March 2010).
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involving the PDA is more likely to cause mitral regurgitation.
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If the posterior descending artery is supplied by the
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If the posterior descending artery is supplied by the
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Cast of coronary arteries (right = yellow, left = red)
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arises from the left coronary artery and follows the
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The artery that supplies the posterior third of the
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labeled in red text and other landmarks in blue text
312:. Cardiac veins carry blood with a poor level of 1553: 503:. The clinical significance of this is that a 443: 1022: 891:Fuster, V; Alexander RW; O'Rourke RA (2001). 760:Anomalous aortic origin of a coronary artery 399: 530: 134:. Such interruptions are usually caused by 130:), in which the heart muscle is damaged by 1029: 1015: 895:(10th ed.). McGraw-Hill. p. 53. 979: 821: 819: 817: 412:(PDA) determines the coronary dominance. 1036: 801:This article incorporates text from the 659: 363: 267: 169: 158: 886: 884: 14: 1554: 1289:moderator band/septomarginal trabecula 914: 912: 814: 736:Posterior view of coronary circulation 510: 1010: 825: 724:Anterior view of coronary circulation 205:, respectively. The third sinus, the 881: 710: 154: 909: 575:/ Left main coronary artery (LMCA) 248:supplied by the particular vessel. 24: 535:The heart regulates the amount of 115: 25: 1583: 748:Illustration of coronary arteries 230:posterior interventricular artery 741: 729: 717: 699:and can become blocked, causing 263: 38: 960:Am J Physiol Heart Circ Physiol 599:Left anterior descending artery 226:left anterior descending artery 947: 864: 853: 359: 13: 1: 795: 627:Atrioventricular nodal branch 280:that remove the deoxygenated 484:or tricuspid regurgitation. 387: 344:, the posterior vein of the 207:right posterior aortic sinus 149: 7: 1492:sternopericardial ligaments 1269:valve of inferior vena cava 972:10.1152/ajpheart.00925.2009 753: 637:Posterior descending artery 558: 444:Supply to papillary muscles 438: 410:posterior descending artery 191:left posterior aortic sinus 174:Schematic view of the heart 114:blood to the heart muscle. 10: 1588: 1090:posterior interventricular 515:During contraction of the 1523: 1504:epicardium/visceral layer 1477: 1459: 1404: 1386: 1379: 1317: 1293:crista supraventricularis 1227: 1220: 1194: 1122: 1115: 1085:anterior interventricular 1052: 1045: 826:Betts, J. Gordon (2013). 400:Coronary artery dominance 69: 57: 52: 37: 32: 18:Coronary artery dominance 933:10.1161/01.cir.91.6.1714 829:Anatomy & physiology 540:heart results in tissue 531:Changes in oxygen demand 489:left anterior descending 350:oblique vein of Marshall 255:. Normally, one or more 238:coronary artery blockage 1273:valve of coronary sinus 1186:atrioventricular septum 1154:interventricular septum 482:tricuspid insufficiency 468:(the valve between the 456:(the valve between the 406:interventricular septum 288:muscle are the cardiac 253:heart conduction system 203:right coronary arteries 140:coronary artery disease 1511:fold of left vena cava 1261:limbus of fossa ovalis 649:Posteriolateral artery 643:Posteriolateral artery 591:Obtuse marginal artery 585:Obtuse marginal artery 579:Left circumflex artery 493:left circumflex artery 369: 354:smallest cardiac veins 310:anterior cardiac veins 306:smallest cardiac veins 273: 175: 167: 128:myocardial infarctions 124:level of consciousness 71:Anatomical terminology 1307:pulmonary circulation 790:Right coronary artery 660:Clinical significance 632:Right marginal artery 621:Right coronary artery 550:myocardial infarction 505:myocardial infarction 491:(LAD) artery and the 418:right coronary artery 367: 271: 242:myocardial infarction 195:anterior aortic sinus 173: 162: 1536:Coronary circulation 1365:systemic circulation 1204:intervenous tubercle 860:www.radiopaedia.org/ 832:. pp. 787–846. 785:Left coronary artery 573:Left coronary artery 478:mitral regurgitation 292:. These include the 92:circulation of blood 88:Coronary circulation 33:Coronary circulation 1487:fibrous pericardium 511:Changes in diastole 356:(Thebesian veins). 338:middle cardiac vein 298:middle cardiac vein 213:coronary arteries. 197:, give rise to the 142:, and sometimes to 1531:Circulatory system 1499:serous pericardium 1461:Pericardial cavity 1159:trabeculae carneae 1132:interatrial septum 370: 342:small cardiac vein 334:great cardiac vein 302:small cardiac vein 294:great cardiac vein 274: 246:death of the cells 185:. There are three 176: 168: 1549: 1548: 1541:Coronary arteries 1519: 1518: 1469:pericardial sinus 1429:Bachmann's bundle 1419:cardiac pacemaker 1414:Conduction system 1375: 1374: 1265:crista terminalis 1216: 1215: 1212: 1211: 1164:chordae tendineae 1137:pectinate muscles 893:Hurst's The Heart 711:Additional images 682:coronary arteries 497:coronary ischemia 450:papillary muscles 425:circumflex artery 257:marginal arteries 240:often results in 218:circumflex artery 179:Coronary arteries 164:Coronary arteries 155:Coronary arteries 136:coronary ischemia 132:oxygen starvation 108:Coronary arteries 85: 84: 80: 16:(Redirected from 1579: 1384: 1383: 1339:atrial appendage 1303:pulmonary artery 1253:atrial appendage 1225: 1224: 1199:cardiac skeleton 1169:papillary muscle 1120: 1119: 1050: 1049: 1031: 1024: 1017: 1008: 1007: 1001: 1000: 998: 996: 983: 951: 945: 944: 927:(6): 1714–1718. 916: 907: 906: 888: 879: 868: 862: 857: 851: 850: 848: 846: 823: 765:Cardiac skeleton 745: 733: 721: 102:that supply the 77:edit on Wikidata 74: 42: 30: 29: 21: 1587: 1586: 1582: 1581: 1580: 1578: 1577: 1576: 1562:Cardiac anatomy 1552: 1551: 1550: 1545: 1515: 1473: 1455: 1449:Purkinje fibers 1444:bundle branches 1400: 1371: 1329:pulmonary veins 1313: 1297:pulmonary valve 1281:right ventricle 1277:tricuspid valve 1208: 1190: 1142:terminal sulcus 1111: 1041: 1037:Anatomy of the 1035: 1005: 1004: 994: 992: 966:(3): H861–873. 952: 948: 917: 910: 903: 889: 882: 869: 865: 858: 854: 844: 842: 840: 824: 815: 798: 756: 749: 746: 737: 734: 725: 722: 713: 697:atherosclerosis 662: 611:Diagonal artery 605:Diagonal artery 561: 533: 513: 474:right ventricle 466:tricuspid valve 446: 441: 402: 390: 362: 266: 222:coronary sulcus 157: 152: 81: 48: 28: 23: 22: 15: 12: 11: 5: 1585: 1575: 1574: 1569: 1564: 1547: 1546: 1544: 1543: 1538: 1533: 1527: 1525: 1521: 1520: 1517: 1516: 1514: 1513: 1508: 1507: 1506: 1496: 1495: 1494: 1483: 1481: 1475: 1474: 1472: 1471: 1465: 1463: 1457: 1456: 1454: 1453: 1452: 1451: 1446: 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346:left ventricle 326:coronary sinus 265: 262: 187:aortic sinuses 183:left ventricle 156: 153: 151: 148: 106:(myocardium). 83: 82: 73: 67: 66: 61: 55: 54: 50: 49: 43: 35: 34: 26: 9: 6: 4: 3: 2: 1584: 1573: 1570: 1568: 1565: 1563: 1560: 1559: 1557: 1542: 1539: 1537: 1534: 1532: 1529: 1528: 1526: 1522: 1512: 1509: 1505: 1502: 1501: 1500: 1497: 1493: 1490: 1489: 1488: 1485: 1484: 1482: 1480: 1476: 1470: 1467: 1466: 1464: 1462: 1458: 1450: 1447: 1445: 1442: 1440: 1439:bundle of His 1437: 1435: 1432: 1430: 1427: 1425: 1422: 1420: 1417: 1416: 1415: 1412: 1411: 1409: 1407: 1403: 1397: 1394: 1393: 1391: 1389: 1385: 1382: 1378: 1368: 1366: 1362: 1356: 1352: 1348: 1344: 1340: 1336: 1332: 1330: 1325: 1324: 1322: 1320: 1316: 1310: 1308: 1304: 1298: 1294: 1290: 1286: 1282: 1278: 1274: 1270: 1266: 1262: 1258: 1254: 1250: 1246: 1244: 1240: 1235: 1234: 1232: 1230: 1226: 1223: 1219: 1205: 1202: 1200: 1197: 1196: 1193: 1187: 1184: 1182: 1179: 1177: 1174: 1170: 1167: 1165: 1162: 1160: 1157: 1155: 1152: 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Retrieved 963: 959: 949: 924: 920: 892: 870: 866: 855: 843:. Retrieved 828: 800: 799: 705:heart attack 694: 690:heart muscle 663: 562: 554: 537:vasodilation 534: 519:myocardium ( 514: 486: 470:right atrium 454:mitral valve 447: 433: 403: 395: 391: 382: 371: 322:right atrium 275: 250: 215: 210: 177: 104:heart muscle 87: 86: 1479:Pericardium 1388:Endocardium 1335:left atrium 1239:venae cavae 1229:Right heart 1080:interatrial 921:Circulation 684:. When the 517:ventricular 458:left atrium 452:attach the 374:anastomoses 360:Anastomoses 316:, from the 234:anastomoses 53:Identifiers 1567:Cardiology 1556:Categories 1406:Myocardium 1319:Left heart 1149:ventricles 796:References 780:Cardiology 678:myocardium 464:) and the 348:, and the 318:myocardium 308:, and the 232:, forming 211:epicardial 138:linked to 112:oxygenated 845:11 August 651:#2 (PL#2) 645:#1 (PL#1) 388:Variation 284:from the 150:Structure 1572:Arteries 1221:Chambers 1116:Internal 1096:borders 1075:coronary 990:19966048 754:See also 686:arteries 680:are the 593:#2 (OM2) 587:#1 (OM1) 559:Branches 542:ischemia 525:diastole 501:ischemia 472:and the 460:and the 439:Function 378:atheroma 244:causing 144:embolism 96:arteries 1434:AV node 1424:SA node 1053:Surface 1046:General 981:2838558 941:7882478 676:to the 666:vessels 521:systole 330:anatomy 320:to the 278:vessels 110:supply 94:in the 90:is the 64:D003326 1380:Layers 1295:), → 1176:valves 995:26 May 988:  978:  939:  899:  877:CHORUS 836:  805:book: 701:angina 672:-rich 670:oxygen 623:(RCA) 601:(LAD) 581:(LCX) 546:angina 408:– the 340:, the 336:, the 328:. The 314:oxygen 304:, the 300:, the 296:, the 1361:aorta 1341:) → 1181:cusps 1127:atria 1100:right 1070:sulci 1039:heart 872:00460 803:CC BY 703:or a 674:blood 639:(PDA) 568:Aorta 290:veins 286:heart 282:blood 120:brain 100:veins 75:[ 1363:and 1357:) → 1305:and 1275:) → 1105:left 1065:apex 1060:base 997:2021 986:PMID 937:PMID 897:ISBN 847:2014 834:ISBN 664:The 448:The 276:The 201:and 199:left 193:and 98:and 59:MeSH 976:PMC 968:doi 964:298 929:doi 875:at 692:. 1558:: 1349:→ 1345:→ 1333:→ 1299:→ 1291:, 1287:, 1279:→ 1271:, 1267:, 1263:, 1259:, 1255:, 1247:→ 1241:, 984:. 974:. 962:. 958:. 935:. 925:91 923:. 911:^ 883:^ 816:^ 613:#2 607:#1 1367:) 1359:( 1353:( 1337:( 1331:) 1327:( 1309:) 1301:( 1283:( 1251:( 1245:) 1237:( 1030:e 1023:t 1016:v 999:. 970:: 943:. 931:: 905:. 849:. 79:] 20:)

Index

Coronary artery dominance

Blood vessels
MeSH
D003326
Anatomical terminology
edit on Wikidata
circulation of blood
arteries
veins
heart muscle
Coronary arteries
oxygenated
Cardiac veins
brain
level of consciousness
myocardial infarctions
oxygen starvation
coronary ischemia
coronary artery disease
embolism

Coronary arteries

Coronary arteries
left ventricle
aortic sinuses
left posterior aortic sinus
anterior aortic sinus
left

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