Blood supply of the Heart Dr. Sama ul Haque

Objectives Enlist the arteries and veins supplying heart.   Enlist the arteries and veins supplying heart. Describe the origin and branches of the right and left coronary arteries. Define coronary artery anastomosis. Describe the arterial supply of the conducting system of heart. Discuss the venous drainage and nerve supply of the heart.

Arterial supply of Heart   Right coronary artery Left coronary artery

Right Coronary Artery   Arises from anterior aortic sinus of the Ascending Aorta. It descends in the right atrioventricular groove. Near inferior border continuous posteriorly along the atrioventricular groove. Anastomose with left coronary artery in the posterior interventricular groove.

Right Coronary Artery

Branches of Right Coronary Artery   Right conus artery: Supplies infundibulum and anterior wall (upper part) of right ventricle. Anterior ventricular (2-3) branches: Supply anterior surface of right ventricle. Marginal branch is the largest and reaches up to the Apex.

Branches of Right Coronary Artery   3. Posterior ventricular (2) branches: Supply diaphragmatic surface of the right ventricle. Atrial branches: Supply anterior and lateral surface of the right atrium. One branch supply posterior surface of both right and left atria. Artery of Sinuatrial Node (60%)

Branches of Right Coronary Artery   5. Posterior interventricular (descending) artery Runs towards apex in the posterior interventricular groove. Supply right & left ventricles, including its inferior wall. Supply posterior part of the ventricular septum (Excluding Apex). Large septal branch Supply Atrioventricular Node.

Right Coronary Artery

Right Coronary Artery

Left Coronary Artery Larger then Right coronary artery.   Larger then Right coronary artery. Arises from posterior aortic sinus of the Ascending Aorta. Passes between pulmonary trunk and left auricle. It enters in the atrioventricular groove and divides into an anterior interventricular branch and a circumflex branch. Supply greater part of the left Atrium, left ventricle and ventricular septum.

Branches of Left Coronary Artery   Anterior interventricular (descending) artery: Runs in the anterior interventricular groove to the Apex. Passes around the Apex to enter the posterior interventricular groove & anastomoses with the terminal branches of Right coronary artery. Supply right and left ventricles & anterior part of ventricular septum. Left diagonal branch and left conus artery are its branches.

Left Coronary Artery

Branches of Left Coronary Artery   2. Circumflex artery: Winds around the left margin of the heart in the atrioventricular groove. Left marginal branch: Supply left ventricular margin up to Apex. Anterior and posterior ventricular branches: Supply left ventricle. Atrial branches: Supply left atrium. 3. Artery of Sinuatrial Node (40%)

Left Coronary Artery

Conducting system of Heart S-A Node: Right coronary artery (60%) Left coronary artery (40%)   A-V Node and A-V Bundle: Right coronary artery Right Bundle branch: Left coronary artery Left Bundle branch: Right & Left coronary arteries

Venous Drainage of Heart   1. Coronary Sinus: Runs in the coronary sulcus (posterior atrioventricular groove). Continuation of great cardiac vein. Opens in the right atrium. Tributaries: Great cardiac vein Middle cardiac vein Small cardiac vein

Venous Drainage of Heart   2. Anterior cardiac veins: Opens directly in the right atrium.

Contents of Heart grooves  1. Right atrioventricular groove: Right coronary artery Small cardiac vein 2. Left anterior atrioventricular groove: Left coronary artery 3. Left posterior atrioventricular groove: Coronary sinus 4. Anterior interventricular groove: Anterior interventricular artery Great cardiac vein 5. Posterior interventricular groove: Posterior interventricular artery Middle cardiac vein

Cardiac Veins (Sternocostal Surface) Anterior cardiac veins

Cardiac Veins (Diaphragmatic Surface)

Nerve supply of the Heart   Cardiac plexus lies below the arch of Aorta. 1. Sympathetic Supply: Cervical and upper thoracic spinal nerves  2. Parasympathetic Supply: Vagus nerve

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