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Y2S1 ANATOMY > Blood Supply To The Heart > Flashcards

Blood Supply To The Heart Flashcards

1
Q

Describe the general blood supply of the heart

A

1) Coronary Arteries

2) Coronary Veins

3) Embedded in fat deep into the epicardium

4) The endocardium and the subendocardial tissue receive oxygen & nutrients by diffusion directly from the chambers of the heart

5) It is a functional end artery (their anastomoses work in case of narrowing or obstruction), but not in sudden obstruction

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2
Q

What are the branches of the right coronary arteries?

A

1) Branch to the right atrium

2) Branch to the right ventricle

3) Right marginal branch

4) Posterior-interventricular artery

5) Right conus artery (supplies the infundibulum)

6) Artery to the SA, AV node, and bundle

7) Twigs to the ascending aorta and pulmonary trunk

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3
Q

Describe the course of the right coronary artery

A

1) Anterior Aortic Sinus

2) Comes out between the right auricle and the pulmonary trunk

3) Runs in the right coronary sulcus/groove to the back of the heart

4) Gives the right marginal artery, supplies the lower margin of the heart

5) It then curves on the lower border of the heart to reach the PIVG giving the Posterior interventricular artery

6) SA artery

7) Right conus artery for the infundibulum

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4
Q

Describe the course of the left coronary artery

A

1) Comes out of the posterior left sinus

2) Runs between the left auricle and the pulmonary trunk

3) Branches to anterior interventricular (left anterior descending) and left circumflex artery (its continuation)

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5
Q

What are the areas of anastomoses of the coronary arteries?

A

1) The right coronary artery will anastomose with the left circumflex artery at the back of the heart in the coronary sulcus

2) The anterior interventricular artery will anastomose with the posterior interventricular artery around the apex of the heart

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6
Q

What are the branches of the left coronary artery?

A

1) Anterior interventricular artery

2) Left circumflex artery (continuation of left coronary and anastomose with the right coronary artery)

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7
Q

Which coronary artery is commonly injured?

A

1) The anterior interventricular artery 40% (“widow maker” due to the high mortality rate if obstructed)

2) Right coronary artery 30%

3) Left circumflex artery 15%

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8
Q

Which heart structures are innervated by the right coronary artery?

A

1) Right Atrium

2) Most of the right ventricle

3) The diaphragmatic surface of the left ventricle

4) posterior 1/3 of the interventricular septum

5) innervates the SA node in 60% of the population

6) Innervates the AV node in 80% of the population

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9
Q

What are the branches of the left coronary artery?

A

1) Twigs to the ascending aorta & pulmonary trunk

2) Left anterior descending artery (anterior interventricular artery) which gives a left conus branch to the vestibule

3) Left circumflex branch

4) Left atrium and ventricle

5) Left marginal arteries

6) SA & AV node

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10
Q

Which heart structures are supplied by the left coronary artery?

A

1) Left atrium

2) Left ventricle

3) Part of right ventricle

4) Interventricular septum

5) SA node in 40% of population

6) AV node in 20% of the population

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11
Q

What are the different types of coronary artery dominance?

A

1) Right dominance

2) Left dominance

3) Codominance

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12
Q

What is meant by left dominance?

A

It is when the posterior interventricular artery originates from the left circumflex artery of the left coronary artery and this is found in 8% of the population

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12
Q

What is meant by right dominance?

A

It is when the posterior descending artery originates from the right coronary artery and this is found in 85% of the population

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13
Q

What is meant by codominance?

A

It is when the posterior interventricular artery originates from both the left circumflex artery and the right coronary artery

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14
Q

When is the blood flow in the coronary arteries at its peak?

A

During early diastole

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15
Q

Is the anastomosis sufficient in case of a sudden block of a large branch?

A

No, this will usually lead to myocardial infarction, but when the lumen gradually narrows the patient starts to complain of pain “angina”

16
Q

Describe the compensatory mechanism of the coronary arteries during atherosclerosis

A

The collateral channels connecting one coronary artery with the other expand which initially will permit adequate perfusion of the heart during relative inactivity

17
Q

What are the different surgical approaches to treat an atherosclerotic coronary artery?

A

1) Percutaneous Transluminal Coronary Angioplasty

  • Inserting a catheter with an inflatable balloon, inflating the balloon to flatten the plaque and increase the size of the lumen
  • Thrombokinases can be injected through the catheter to dissolve the blood clot

2) CABG, coronary artery bypass graft

  • Indicated for patients with obstructed coronary circulation and severe angina, where a segment of an artery is attached to the aorta and the other segment is attached to part distal to the obstruction
  • Complete revascularization of the heart
18
Q

What is the most vessel used for CABG?

A

Saphenous vein (it has a good diameter, no valves, and easily directed)

  • Vascular pathologies of the leg must be absent
19
Q

What vein drains into the coronary sinus?

A
  • It is a large vein that is formed by the drainage of:

1) Great cardiac vein

2) Midlle cardiac vein

3) Small cardiac vein (moves with the right marginal artery)

4) Posterior vein of the left ventricle

5) Oblique vein of the left atrium

  • Basically, all veins except the Anterior cardiac vein and vena cordis minimi open directly into the right atrium
20
Q

Which veins do not drain into the coronary sinus?

A

1) Anterior cardiac vein (drains into the RA)

2) Venae cordis minimi (drains in all chambers)

21
Q

Describe the coronary sinus

A
  • It is a wide and short venous channel
  • Lies at the posterior part of the coronary sulcus (AV groove) between the LA & LV
  • It terminates in the RA between the IVC and tricuspid orifice and has a valve that guards it
22
Q

Describe the course of the great cardiac vein

A
  • Begins near the apex of the heart
  • Runs in the anterior interventricular groove accompanying the anterior interventricular artery
  • It then curves to the left accompanying the left circumflex artery
23
Q

What are the tributaries of the great cardiac vein?

A

1) Both ventricles

2) Left atrium

3) Left marginal vein

24
Q

Describe the course of the middle cardiac vein

A
  • Runs in the posterior interventricular groove
  • It terminates by joining the coronary sinus near the right end
25
Q

What are the tributaries of the middle cardiac vein?

A

Both ventricles

26
Q

Describe the course of the small cardiac vein

A
  • Runs in the right part of the posterior AV groove along the right coronary artery
  • It terminates by joining the right end of the coronary sinus
27
Q

What are the tributaries of the small cardiac vein?

A

1) Right ventricle

2) Right atrium

3) Right marginal vein

28
Q

Which coronary veins receive blood from the right marginal artery?

A

Small cardiac vein

29
Q

Describe the course of the oblique vein of the left atrium

A
  • Descends obliquely on the back of the left atrium
  • Terminates at the left end of the coronary sinus
30
Q

What are the tributaries of the oblique vein of left atrium?

A

Left atrium

31
Q

Describe the course of the posterior vein of left ventricle

A
  • Runs on the diaphragmatic surface of the left ventricle
  • Terminates at the middle of the coronary sinus
32
Q

What are the tributaries of the poster vein of the left ventricle?

A

Left ventricle

33
Q

Describe the anterior cardiac veins

A

They are 3-4 veins that lie on the sternocostal surface of the right ventricle

  • They terminate directly into the right atrium
34
Q

What is the vena cordis minimi

A
  • They are small veins on the wall of the heart that opens directly into the four chambers of the heart
  • They have the capability to bring blood from the heart chambers into the capillary beds of the myocardium, providing little collateral circulation that might be helpful in MI
35
Q

what is meant by coronary angiogram?

A

It is the visualization of the coronary arteries using coronary arteriograms

Y2S1 ANATOMY (15 decks)

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