1. Good morning

2. BLOOD SUPPLY of HEART Dr. Qudsia Sultana

3. 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 ???

4. 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 ?

5. CORONARY ARTERIES AND BRANCHES CORONARY SINUS AND TRIBUTARIES
Blood supply of heart
Arterial supply:
CORONARY ARTERIES AND BRANCHES
Venous drainage :
CORONARY SINUS AND TRIBUTARIES

6. What are coronary arteries ???

7. CORONARY(Crown) ARTERIES
There are 2 coronary arteries
right and left.
Both arise from ascending aorta.
Inner µm-endothelial surface gets nutrition directly from the blood in the chambers.
The rest of the heart receives blood from coronary arteries.

8. CORONARY ARTERIES Vasa-vasorum of the ascending aorta.
Anatomically not end arteries but functionally-end arteries.
Only arteries -blood flows in diastole

9. 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

10. Arises from anterior aortic sinus
Right coronary artery
Arises from anterior aortic sinus

11. 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 coronary artery.

12. Branches of right coronary artery…..
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.

13. 5) Post Interventricular artery.
Septal
Diaphragmatic
Nodal artery-AV node

14. Areas of distribution…..
Right atrium.
Greater part of right ventricular except Ant Interventricular Groove.
Small part of left ventricle adjoining the post interventricular groove.
Post 1/3rd of interventricular septum.
Entire conducting system except left br. AV bundle.

15. Left coronary artery…..
Arises from left posterior aortic sinus

16. 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

17. 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

18. Branches….. Left conus artery (annulus of Vieussens)
Ventricular branches
-Rt ventricle adjoining the ant Interventricular groove
-left diagonal artery.
Septal branches
ant 2/3rd of the septum

19. 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….
Left marginal artery
Ventricular branches.
3. Atrial branches-
Kugel’s artery
SA nodal artery(35%)

20. Areas of distribution….
left atrium
Greater part left ventricle except Post Interventricular Groove.
Small part right ventricle at Ant Interventricular Groove.
Ant 2/3rd of interventricular septum
Left branch of AV bundle.

22. Variations Left Coronary Artery- arise- Pulmonary trunk
cyanosis-ventricular failure
arise- anterior aortic sinus
longer course-compressed-sudden cardiac death

23. 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.

24. Venous drainage….
Venous blood from heart drains into right atrium through
Coronary sinus
Anterior cardiac veins
Venae cordis minimae (thebesian veins)

25. 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.

26. 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

27. 2.Anterior cardiac veins…
Drains anterior part of right ventricle….
Usually 2 or 3 in number- parallel to each other.
Opens to right atrium.

28. 3.Venae cordis minimae/Thebesian veins…
Opens into all chambers.
Numerous in right atrium & ventricle.

29. Applied anatomy

30. 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 ???

31. 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.

32. 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 ?

33. Clinical…….
Myocardial infarction Complete obstruction coronary artery due to thrombosis results in death of myocardium - heart attack.

34. INVESTIGATIONS: ECG CARDIAC ENZYMES e.g. CK, LDH, TROPONIN etc.
ECHOCARDIOGRAPHY
TREADMILL EXERCISE TEST
THALLIUM STRESS TEST
CORONARY ANGIOGRAPHY

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

36. 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

37. 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

38. An intracoronary stent.

40. CABG(Coronary artery bypass graft)

41. CORONARY ARTERY BYPASS SURGERY

42. Question
Blood supply of heart?
Arterial and venous drainage.

43. Thanks for listening..