CORONARY VA

SCULATURE

DR . N

I V I N S H A R A F MD

L MC C

OBJECTIVESThis 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 arteriesDefine the origins of coronary arteriesRecognize innervation of the heart

ORIGIN

ORIGIN CONT.

RIGHT CORONARY ARTERY (RCA)Supplies:Right atriumMost of right ventricleDiaphragmatic surface of left ventriclePost 1/3 of iv septumSA node 60% of peopleAV 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 heartRuns left to right in the coronary groove

CORONARY SINUSTributaries:Great Cardiac Vein= Anterior interventricular vein, runs with

LADDrains most of the area supplied by the left coronary arteryMiddle Cardiac Vein and small cardiac veins:Drains most of the area supplied by the right coronary arteryMiddle Cardiac vein runs in the posterior intervenricular groove

INNERVATION OF THE HEARTAutonomic nervous system from superficial and deep Cardiac

plexusesNerve networks lie anterior to the bifurcation of the trachea,

posterior to ascending aortaSuperior to bifurcation of Pulmonary trunk

INNERVATION OF THE HEARTParasympathetic supply:Presynaptic fibers of the vagus nervesPost 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 rateReduce the force of heart beatsConstrics 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 TRAINAGESubepicardial lymphatic plexusPass to the coronary groove, and follow the coronary arterieEnd in the inferior tracheobronchial lymphnodes, usually on the

right side

REFERENCEShttp://www.youtube.com/watch?v=Rcn3ZV-Iy6oMyocardial blood supplyhttp://www.youtube.com/watch?v=tBQa8IBzP6I

Anatomy of the hearthttp://www.youtube.com/watch?v=960_mAShiXQPart IIhttp://www.youtube.com/watch?v=Vr-DAhgq75w&feature=relmfu

CLINICALLY ORIENTED ANATOMY FOURTH EDITION/ KEITH L. MOORE RECOMMENDED READING PAGES 132-139