CORONARY VASCULATURE DR. NIVIN SHARAF MD LMCC. OBJECTIVES This lecture covers the ILO titled: Enlist the arteries, veins and nerves supplying the heart.

CORONARY VA

SCULATU

RE

DR

. NI V

I N S

HA

RA

F M

D

LM

CC

OBJECTIVES

This lecture covers the ILO titled: Enlist the arteries, veins and nerves supplying the heart.

By the end of this lecture we will be able to:

Define Right/ left or Coronary co dominance

Enlist areas of the heart supplied by the right andd left coronary arteries

Define the origins of coronary arteries

Recognize innervation of the heart

ORIGIN

ORIGIN CONT.

RIGHT CORONARY ARTERY (RCA)

Supplies:

Right atrium

Most of right ventricle

Diaphragmatic surface of left ventricle

Post 1/3 of iv septum

SA node 60% of people

AV node 80% of people

LEFT CORONARY ARTERY

LEFT CORONARY ARTERY (LCA)

Supplies

- Left atrium

- - Most of lt ventricle

- Part of right ventricle

- Most of the interventricular septum 2/3 rds

- SAN (40%)

- AVN( 20%)

VENOUS DRAINAGE

VENOUS DRAINAGE CONT.

The heart is drained by veins that empty in the coronary sinus, partly by small veins that empty in the right atrium

Coronary sinus:

Main vein of the heart

Runs left to right in the coronary groove

CORONARY SINUS

Tributaries:

Great Cardiac Vein= Anterior interventricular vein, runs with LAD

Drains most of the area supplied by the left coronary artery

Middle Cardiac Vein and small cardiac veins:

Drains most of the area supplied by the right coronary artery

Middle Cardiac vein runs in the posterior intervenricular groove

INNERVATION OF THE HEART

Autonomic nervous system from superficial and deep Cardiac plexuses

Nerve networks lie anterior to the bifurcation of the trachea, posterior to ascending aorta

Superior to bifurcation of Pulmonary trunk

INNERVATION OF THE HEART

Parasympathetic supply:

Presynaptic fibers of the vagus nerves

Post synaptic fibers also end in the SA,& AV nodes, and directly on the coronary arteries

Stimulation results in Saving energy between periods of increased demands)

Decreased heart rate

Reduce the force of heart beats

Constrics cornoray arteries

INNERVATION OF THE HEART CON.

Sympathetic stimulationIncreases heart rate, and the force of contraction, and inhibits contraction of the coronary arteries”Passively dilates “

Presynaptic fibers with cell bodies in the lateral horn of T1-6 segments of spinal cord

Postsynaptic: cervical, and superior thoracic prevertebral ganglia of the sympathetic trunk( end in SA, and AV nodal tissue)

LYMPHATIC TRAINAGE

Subepicardial lymphatic plexus

Pass to the coronary groove, and follow the coronary arterie

End in the inferior tracheobronchial lymphnodes, usually on the right side

REFERENCES

http://www.youtube.com/watch?v=Rcn3ZV-Iy6o

Myocardial blood supply

http://www.youtube.com/watch?v=tBQa8IBzP6I

Anatomy of the heart

http://www.youtube.com/watch?v=960_mAShiXQ

Part II

http://www.youtube.com/watch?v=Vr-DAhgq75w&feature=relmfu

CLINICALLY ORIENTED ANATOMY FOURTH EDITION/ KEITH L. MOORE

RECOMMENDED READING PAGES 132-139