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CVS > Coronary artery anatomy and circulation > Flashcards

Coronary artery anatomy and circulation Flashcards

1
Q

How many origins of the coronary artery are there?

A

2
Right and left coronary artery

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2
Q

Where do the coronary arteries arise from?

A

Ascending aorta just above aortic valve cusps

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3
Q

Why do people refer to 3 coronary arteries?

A

The three coronary artery branches:

Right Coronary Artery (RCA)
-Left Coronary Artery (LCA)

Left anterior descending artery (LAD)

Circumflex branch (Cx)

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4
Q

What surface of the heart do the coronary artery branches lie on?

A

Epicardial

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5
Q

They dive into the ______ and branch towards the _______ surface

A

They dive into the myocardium and branch towards the endocardial surface

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6
Q

Epicardial arteries lie in ______ that contain ___

A

Epicardial arteries lie in grooves that contain fat

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7
Q

What are the three different types of grooves?

A

Atrioventricular sulcus

Anterior intraventricular sulcus

Posterior intraventricular sulcus

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8
Q

Where are atrioventricular (coronary) sulus grooves found?

A

Between atria and ventricles

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9
Q

The anterior intraventricular sulcus grooves are found between ________ on ___________ surface

A

The anterior intraventricular sulcus grooves are found between ventricles on the anterior surface

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10
Q

Where are posterior intraventricular sulcus grooves found?

A

Between ventricles and posterior surface

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11
Q

The left coronary artery (LCA) is also named the LMS? What does that stand for?

A

Left Major Stem

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12
Q

Where does the LCA originate from?

A

Left coronary sinus of aorta

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13
Q

The LCA ranges from _ to _ mm in diameter and _ to _ mm in length

A

The left coronary artery ranges from 3 to 6 mm in diameter and 0 to 10 mm in length

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14
Q

The left coronary artery courses from the right ventricular outflow tract (RVOT) into two branches. What are the two branches?

A

Left anterior descending (LAD)
Circumflex (Cx)

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15
Q

The left anterior descending artery extends along the _______ aspect of the heart and passes _____ the ______ ______ in __ _______ towards ______

A

The left anterior descending artery extends along the anterior aspect of the heart and passes down the cardiac midline, in IV sulcus towards apex

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16
Q

What areas of the hearts muscle does the left anterior descending artery supply?

A

anterior lateral
apical walls of Left Ventricle
Bundle branches

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17
Q

The LAD has ______ branches which supplies most of the ______ and _______ branches

A

The LAD has septal branches which supplies most of the septum and diagonal branches

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18
Q

The left anterior descending branch (LAD) is also known as the (Dx) branch. What does this stand for?

A

The diagonal branch

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19
Q

The LAD or Dx runs ______ away from the AV sulcus towards the _________ aspect

A

The LAD or Dx runs diagonally away from the AV sulcus towards the anterolateral aspect

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20
Q

The LAD has a wide variability in the ______ and _____ of __________ branches

A

The LAD has a wide variability in the number and size of the diagonal branches

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21
Q

The first Dx branch marks the boundary between the ______ and __ ____-

A

The first Dx branch marks the boundary between the proximal and mid artery

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22
Q

Of the left anterior descending branch (LAD) are other branches that branch towards the _______________ (IVS) named __________ ___________ (SP) branches

A

Of the left anterior descending branch (LAD) are other branches that branch towards the intraventricular sulcus (IVS) named Septal perforator (SP) branches

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23
Q

SP branches vary widely in _____ and ______

A

SP branches vary widely in number and distribution

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24
Q

In 78% of patients, the LAD courses around the __ ____ and terminates along the _________ aspect of the __

A

In 78% of patients, the LAD courses around the LV apex and terminates along the diaphragmatic aspect of the LV

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25
Q

In 22% of patients, the LAD fails to reach the __________ surface and terminates either at or before the _______ ____

A

In 22% of patients, the LAD fails to reach the diaphragmatic surface and terminates either at or before the cardiac apex

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26
Q

The circumflex artery (Cx) flexes around the ____ side of the ‘________’ of the heart to the ______ surface.

A

The circumflex artery (Cx) flexes around the left side of the ‘circumference’ of the heart to the posterior surface

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27
Q

The circumflex artery supplies most of the _____ - ______ walls and the ____ ______.

A

The circumflex artery supplies most of the posterior-lateral walls and the left atrium

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28
Q

The circumflex artery (Cx) lies in the __ ______

A

The circumflex artery (Cx) lies in the AV sulcus

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29
Q

What are the two types of branches from the circumflex artery?

A

Obtuse marginal branch (OM)

Posterolateral branch (PL)

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30
Q

Proximal major branches are ____ ________

A

Proximal major branches are obtuse marginals

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31
Q

There may also be a third branch of the circumflex artery that supplies the ____ , _ _____ and _ ____

A

There may also be a third branch of the circumflex artery that supplies the atria, SA node and AV node

32
Q

Sometimes the LCA ________

A

Sometimes the LCA trifurcates

33
Q

In some (___ to ___ %), there may be a third branch between the ___ _____ ____ ____ and the ______ _____

A

In some (15-30%), there may be a third branch between the left anterior descending artery (LAD) and the circumflex artery (Cx).

34
Q

When the LCA trifurcates, this is known as ____ _____ or ______ or ______ _______

A

When the LCA trifurcates, this is knows as ramus intermedium or intermediate or optional diagonal

35
Q

The right coronary artery (RCA) originates from the ____ _____ ___ of the _____

A

The right coronary artery (RCA) originates from the right coronary sinus of the aorta.

36
Q

The RCA passes along the ____ __ _____ (opposite direct to Cx) to the ______ surface of the heart.

A

The RCA passes along the right AV groove (opposite direction to the Cx) to the inferior surface of the heart.

37
Q

in __ to __% of individuals, the small ____ branch is the first RCA branch that runs to the ____ ______ _____ _____. In __ to __% of people, the ____ arises directly from the ____.

A

In 50-60% of individuals, the small conus branch is the first RCA branch that runs to the right ventricular outflow tract. In 20-30£ of people, the conus arises directly from the aorta.

38
Q

In __% of people, the _nd _____ branch of the RCA is the ___-_____ (__ ____) artery (__ - __%). In __% of people, it originates from the __.

A

In 60% of people, the 2nd proximal branch of the RCA is the Sino-atrial (SA node) artery (50-60%).In 40% of people, it originates from the Circumflex artery.

39
Q

The mid portion of the RCA gives rise to one or more ______ sized ___ _____ branches which, supply the _____ wall of the _____ _____.

A

The mid portion of the RCA gives rises to one or more medium sized acute marginal branches which, supply the anterior wall of the right ventricle.

40
Q

The first acute marginal branch, marks the division between the ____ and __ - _____ of the RCA

A

The first acute marginal branch marks the division between the proximal and mid-portions of the RCA

41
Q

A large acute marginal branch, comes of at an ____ angle and runs along the ____ of the ____ _____ above the ______.

A

A large acute marginal branch, comes off at an acute angle and runs along the margin of the right ventricle above the diaphragm.

42
Q

The RCA continues in the __ ____ _____ and gives off a branch to the __ ____.

A

The RCA continues in the AV groove posteriorly and gives off a branch to the AV node.

43
Q

In __% of cases, the ____ ____ ___ (PDA) is a branch of the RCA.

A

In 85% of cases, the posterior descending artery (PDA) is a branch of the (RCA)

44
Q

The posterior descending artery (PDA) supplies the ____ wall of the ____ ventricle and ____ part of the septum.

A

The posterior descending artery (PDA) supplies the inferior wall of the left ventricle and the inferior part of the septum.

45
Q

What is RIGHT coronary dominance?

A

RCA continues to supply the PDA with septal perforators and 1 or more posterolateral (PL) arteries

46
Q

What occurs when there is no RCA dominance?

A

Cx supplies PDA and 1 or more PL arteries

47
Q

What occurs when there is a mixed pattern/co-dominance?

A

RCA supplies PDA and Cx supplies PL

48
Q

When there is a right coronary dominance, the RCA also gives rise to an __ ___ artery as it leaves the __ ____.

A

When there is right coronary dominance, the RCA also gives rise to an AV node artery as it leaves the AV groove.

49
Q

What are the % of the supply from coronary arteries to the SA node?

A

60% RCA
40%LCA

RARELY BOTH

50
Q

What are the % of the supply from coronary arteries to the AV node?

A

85% RCA
15% LCA

RARELY BOTH

51
Q

Collateral vessels are s____, pr existing vascular _____ that interconnect the _______ arteries

A

Collateral vessels are small, pre existing vascular channels that interconnect the epicardial arteries

52
Q

Collateral vessels are generally not used however, they can open and become L_____ if a _____ _____ becomes severely narrowed or blocked. This helps _____ and ischemic myocardium

A

Collateral vessels are generally not used however, become larger is a coronary artery becomes severely narrowed or blocked. This helps perfusion and ischemic myocardium.

53
Q

Patients with diabetes and hyperlipidaemia have an impaired ability to develop collateral blood vessels in o______ c_____ a______ d_____

A

Patients with diabetes and hyperlipidaemia have an impaired ability to develop collateral blood vessels in obstructive coronary artery disease

54
Q

What is the benefit of collaterals in MI?

A

Increase blood flow

Reduce infarct size

Improve LV function

Reduce risk of LV aneurysm formation

Improve survival

55
Q

What are the role of cardiac veins?

A

Transport deoxygenated blood from myocardium to right side of heart in order for RV to pump blood to lungs

56
Q

Arteries - arterioles - capillaries- venules- veins

A

Arteries- arterioles - capillaries- venules- veins

57
Q

Major cardiac veins lie p______ to branches of main coronary arteries

A

Major cardiac veins lie parallel to branches of main coronary arteries

58
Q

The great cardiac vein receives tributaries from __ , __ , __. It curves around ____ __ sulcus and becomes c_____ sinus

A

The great cardiac vein receives tributaries from LA, RV,LV. It curves around left AV sulcus and becomes coronary sinus

59
Q

Most of the veins of the heart drain to the c___ S____

A

Most of the veins of the heart drain to the coronary sinus

60
Q

The coronary sinus is a w___ c____ abont _cm in length

A

The coronary sinus is a wide channel about 2cm in length

61
Q

The coronary sinus is situated in the p_____ part of the __ sulcus. Ending low in the r____ a_____.

A

The coronary sinus is situated in the posterior part of the AV sulcus. Ending low in the right atrium

62
Q

The posterior intraventricular vein - middle lies close to PDA, begins at a___ of heart and a_____ (upwards) in the posterior intraventricular s____

A

The posterior intraventricular vein- middle lies close to PDA, begins at the apex of the heart and ascends in the posterior intraventricular sulcus

63
Q

Th posterior intraventricular vein drains from the I____ s____ and a______ parts of the v_____. And empties into c_____ s____.

A

The posterior intraventricular vein drains from the intraventricular sulcus and adjacent part of the ventricles. And empties into coronary sinus.

64
Q

The posterior vein of l__ V____ drains c_____ territory either, directly into c____ s_____ or via g____ c____ v_____.

A

The posterior vein of the left ventricle drains circumflex territory either, directly into coronary sinus or vial the great cardiac vein

65
Q

The small cardiac vein lies p_____ to r___ c____ a____ and branches. Runs in r____ __ s____.

A

The small cardiac vein lies parallel to right coronary artery and branches. Runs in the right AV sulcus

66
Q

The small cardiac vein receives blood from p____ r____ a_____ and r______ v____. Empties into r_____ extremity of c_____ s____.

A

The small cardiac vein receives blood from posterior right atrium and right ventricle. Empties into right extremity of coronary sinus

67
Q

The anterior cardiac veins collect blood from a_____ r_____ v_____. Drains directly into r____ a_____.

A

The anterior cardiac veins collect blood from anterior right ventricle. Drains directly into right atrium

68
Q

The oblique vein of left atrium is a s____ v____. Drains the l____ a____ into the c____ s_____ near its extremity.

A

The oblique vein of left atrium is a small vessel. Drains the left atrium into the coronary sinus near its extremity.

69
Q

The smallest cardiac veins are also known a……

A

veins of thebesius

70
Q

Veins of the thebesius are m____ veins which arise in m____ w____ of the heart. The majority open into a____. Few end in v____.

A

Veins of the thebesius are minute veins which arise in muscular wall of the heart. The majority open into atria. Few end in ventricle.

71
Q

The heart relies on a_____ m______

A

The heart relies on aerobic metabolism

72
Q

Coronary arteries supplies o____ and n_____ to cardiac m______ in order that they can function effectively - c_____ and c______

A

Coronary arteries supplies oxygen and nutrients to cardiac monocytes in order that they can function effectively - contraction and conduction

73
Q

Coronary artery stems and their principle branches are c________ v______ that have little r_____ to flow. Smaller branches are a_____ (resistance vessels) which have v______ reserve capacity. Enables high b____ f_____ and l_____ resistance in response to i_____ demand for example e____.

A

Coronary stems and their principle branches are conductance vessels that have little resistance to flow. Smaller branches are arterioles (resistance vessels) which habe vasodilatory reserve capacity. Enables high blood flow and low resistance in response to increased demand dor example exercise.

74
Q

How vasodilation is triggered:

-coronary e_______ continually produces n_____ o_____ (NO) to maintain high flow. If this production is blocked, flow is reduced by __%

-Increased m_____ o_____ demand causes production of a______ which dilates a______

  • During exercise, a______ activates b___ - 2 receptors causing vasodilation

S_____ and p______ nervous system also causes vasodilation

A

How vasodilation is triggered:

  • coronary endothelium continually produces nitric oxide (NO) to maintain high flow. If this production is blocked, flow is reduced by 60%
  • Increased myocardial oxygen demand causes production of adenosine which dilates arterioles

-During exercise, adrenaline activates beta-2 receptors causing vasodilation

-Sympathetic and parasympathetic nervous system also causes vasodilation

75
Q

Arterioles branch into a dense network of capillaries up to _____ in mm2

A

Arterioles branch into a dense network of capillaries up to 40000 in mm2

76
Q

Each capillary is next to a m_____ but only __ to __% are normally open and functioning. The number of open capillaries i____ when a____ o_____ levels d_____. This ensures efficient o_____ and n____ delivery.

A

Each capillary is next to a monocyte but only 60 to 80% are normally open and functioning. The number of open capillaries increases when an arterial oxygen levels decrease. This ensures efficient oxygen and nutrient delivery..

77
Q

Systole r____ coronary blood flow. When m_____ contracts, small c_____ b_____ within it are compressed. This is due to high pressure within v_____ w_____.

A

Systole reduces coronary blood flow. When myocardium contracts, small coronary branches within it are compressed, This is due to high pressure within the ventricle wall.

CVS (10 decks)

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