<< Chapter < Page Chapter >> Page >

Coronary arteries

Coronary arteries supply blood to the myocardium and other components of the heart. The first portion of the aorta after it arises from the left ventricle gives rise to the coronary arteries. There are three dilations in the wall of the aorta just superior to the aortic semilunar valve. Two of these, the left posterior aortic sinus and anterior aortic sinus, give rise to the left and right coronary arteries, respectively. The third sinus, the right posterior aortic sinus, typically does not give rise to a vessel. Coronary vessel branches that remain on the surface of the artery and follow the sulci are called epicardial coronary arteries    .

The left coronary artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum. The circumflex artery    arises from the left coronary artery and follows the coronary sulcus to the left. Eventually, it will fuse with the small branches of the right coronary artery. The larger anterior interventricular artery    , also known as the left anterior descending artery (LAD), is the second major branch arising from the left coronary artery. It follows the anterior interventricular sulcus around the pulmonary trunk. Along the way it gives rise to numerous smaller branches that interconnect with the branches of the posterior interventricular artery, forming anastomoses. An anastomosis    is an area where vessels unite to form interconnections that normally allow blood to circulate to a region even if there may be partial blockage in another branch. The anastomoses in the heart are very small. Therefore, this ability is somewhat restricted in the heart so a coronary artery blockage often results in death of the cells (myocardial infarction) supplied by the particular vessel.

The right coronary artery proceeds along the coronary sulcus and distributes blood to the right atrium, portions of both ventricles, and the heart conduction system. Normally, one or more marginal arteries arise from the right coronary artery inferior to the right atrium. The marginal arteries    supply blood to the superficial portions of the right ventricle. On the posterior surface of the heart, the right coronary artery gives rise to the posterior interventricular artery    , also known as the posterior descending artery. It runs along the posterior portion of the interventricular sulcus toward the apex of the heart, giving rise to branches that supply the interventricular septum and portions of both ventricles. [link] presents views of the coronary circulation from both the anterior and posterior views.

Coronary circulation

The top panel of this figure shows the anterior view of the heart while the bottom panel shows the posterior view of the heart. The different blood vessels are labeled.
The anterior view of the heart shows the prominent coronary surface vessels. The posterior view of the heart shows the prominent coronary surface vessels.

Diseases of the…

Heart: myocardial infarction

Myocardial infarction (MI) is the formal term for what is commonly referred to as a heart attack. It normally results from a lack of blood flow (ischemia) and oxygen (hypoxia) to a region of the heart, resulting in death of the cardiac muscle cells. An MI often occurs when a coronary artery is blocked by the buildup of atherosclerotic plaque consisting of lipids, cholesterol and fatty acids, and white blood cells, primarily macrophages. It can also occur when a portion of an unstable atherosclerotic plaque travels through the coronary arterial system and lodges in one of the smaller vessels. The resulting blockage restricts the flow of blood and oxygen to the myocardium and causes death of the tissue. MIs may be triggered by excessive exercise, in which the partially occluded artery is no longer able to pump sufficient quantities of blood, or severe stress, which may induce spasm of the smooth muscle in the walls of the vessel.

In the case of acute MI, there is often sudden pain beneath the sternum (retrosternal pain) called angina pectoris, often radiating down the left arm in males but not in female patients. Until this anomaly between the sexes was discovered, many female patients suffering MIs were misdiagnosed and sent home. In addition, patients typically present with difficulty breathing and shortness of breath (dyspnea), irregular heartbeat (palpations), nausea and vomiting, sweating (diaphoresis), anxiety, and fainting (syncope), although not all of these symptoms may be present. Many of the symptoms are shared with other medical conditions, including anxiety attacks and simple indigestion, so differential diagnosis is critical. It is estimated that between 22 and 64 percent of MIs present without any symptoms.

An MI can be confirmed by examining the patient’s ECG, which frequently reveals alterations in the ST and Q components. Some classification schemes of MI are referred to as ST-elevated MI (STEMI) and non-elevated MI (non-STEMI). In addition, echocardiography or cardiac magnetic resonance imaging may be employed. Common blood tests indicating an MI include elevated levels of creatine kinase MB (an enzyme that catalyzes the conversion of creatine to phosphocreatine, consuming ATP) and cardiac troponin (the regulatory protein for muscle contraction), both of which are released by damaged cardiac muscle cells.

Immediate treatments for MI are essential and include administering supplemental oxygen, aspirin that helps to break up clots, and nitroglycerine administered sublingually (under the tongue) to facilitate its absorption. Despite its unquestioned success in treatments and use since the 1880s, the mechanism of nitroglycerine is still incompletely understood but is believed to involve the release of nitric oxide, a known vasodilator, and endothelium-derived releasing factor, which also relaxes the smooth muscle in the tunica media of coronary vessels. Longer-term treatments include injections of thrombolytic agents such as streptokinase that dissolve the clot, the anticoagulant heparin, balloon angioplasty and stents to open blocked vessels, and bypass surgery to allow blood to pass around the site of blockage. If the damage is extensive, coronary replacement with a donor heart or coronary assist device, a sophisticated mechanical device that supplements the pumping activity of the heart, may be employed. Despite the attention, development of artificial hearts to augment the severely limited supply of heart donors has proven less than satisfactory but will likely improve in the future.

MIs may trigger cardiac arrest, but the two are not synonymous. Important risk factors for MI include cardiovascular disease, age, smoking, high blood levels of the low-density lipoprotein (LDL, often referred to as “bad” cholesterol), low levels of high-density lipoprotein (HDL, or “good” cholesterol), hypertension, diabetes mellitus, obesity, lack of physical exercise, chronic kidney disease, excessive alcohol consumption, and use of illegal drugs.

Questions & Answers

How does the male organ develop
MADUBULA Reply
Hw does the male organ develop
MADUBULA
Review your questions madam
Aliyu
what is anaphylaxis?
Rugut Reply
different between drug and medicine
ado Reply
drugs have no medical application (cocaine, heroin, crystal meth). medicine have medical purpose (fentanyl, albuterol, aspirin, ect ect)
Jordan
medicine is a substance or preparation used in treating disease,drug is chemical compound medicine are drugs but all drugs are not medicines
Wafa
assalam o alaikum
Sidra
what happen to ECF and ICF regarding to OEDEMA
Zwanga Reply
what are the smooth muscles of the heart
Sintung Reply
stomach
Sidra
identify external features of kidney
saba Reply
kidney weight on males?
saba
3 to4 onz and 140 gram kidney wight.adult
StudyTime
and female ?
saba
Sle full name & treatment
Samim
Syplymic lupw erythematous
Samim
blood supply to spleen ?
saba
I known this disease of treatment
Samim
saba
StudyTime
g..
saba
do u know female kidney wight?
StudyTime
ya 135 g females
saba
Please help me
Samim
130 on male
saba
130g on male
saba
g samim
StudyTime
approximate 140grms in adultkidny wight
StudyTime
g samim
saba
no 130grms on male
saba
ok saba
StudyTime
yaha number ya email id send nh krty kia ?
StudyTime
wese saba kia krti Hyn ap?
StudyTime
mbbs
saba
good kaha sy
StudyTime
good saba khan
Shahab
Tom kya krti ho st?
saba
st means
StudyTime
your name?
saba
nursing
StudyTime
muskan
StudyTime
ok
saba
g
StudyTime
tum kya krti ho? muskan
saba
sis nursing
StudyTime
ok
saba
gv
StudyTime
good muskan
Shahab
ok bye I m studying
saba
sis contact number mil skts hy help kyliye,?
StudyTime
thanks
StudyTime
g saba
StudyTime
Define cranial nerves with oder
Javid
O-olfactory O-optic O-occumulator T-trochlear T-trigemenal A-abducent F-facial A-auditory G-glossopharyngeal V-vagus A-acessory
Aniee
opd mean?
Shahab
out patient department
mahesh
thnxx
Shahab
Ty Aniee singh
Javid
Ap sb us book s parhte h
Areeej
Read KD Tripathi book of Pharmacology.
mayank
Hello
mayank
CT Scan means
Sintung
what's health?
Sintung
hello
Philip
hi
Sintung
CT means - computerized tomography
Vivek
connective tissue
Dee
they link some body organs
Sintung
Difference between drug and medicine
Javid
hiii muskan
saba
what is tomography?
Gideon
tomography ☝
shahid
yes
Gideon
how hemolytic anemia cause due to gas gangrene?
Huma Reply
what's gangrene?
Sidra
why retro abdominal region called or named "flank "?
Huma Reply
list types epithelial tissue
Sangu Reply
Squeamus epithelial tissu Cubidal Columna Cilliated columna
Aliyu
squamous cuboidal columnar ciliated stratified
Ken
psuedostratified ciliated columnar stratified squamous transitional epithelium
Espinoza
peace maker of heart is?
shahid
electrical conduction ... sa node
Dee
squamous epithelial tissue.
Tariq
squamous, stratified epithelial tissue
Sintung
explain how hormonal control aids in homeostasis regarding fluids and electrolytes, internal organs, clinical application, edema electrolyte imbalance?
Hensheal Reply
someone to help me explain those
Hensheal
parathyroid hormone : Calcium uptake, H+ and PO-4 wasting thyroid hormone, cortisol for temperature regulation by acting on B.V
Kartik
also renin
Kartik
thanks
Hensheal
why retro abdominal region called flank?
Huma
it is just Anatomical terminology
Kartik
meaning side of body b/w rib cage and hip bone
Kartik
list down all the hormones secreted by adrenal gland
Odong Reply
adrenaline hormones
Sangu
adrenaline and noradrenaline
Sintung
The amount of blood pumped by the left ventricle of the heart in one contraction.
Javid Reply
how we can calculate the cardiac output
khater
and how do we calculate the strock valume
khater
stroke volume is not all the blood contained in the left ventricle; normally, only about two-thirds of the blood in the ventricle is expelled with each beat.
Javid
Cardiac output 5.5 l S. V 68.75 ml H. R 80bpm
Javid
If we consider SV 70, end systolic vol is about 15% of total(approx always) out of a total of 80-85 ml only 70ml is pumped per systole
Kartik
what is macrophages?and its function
Sajjad Reply
macrophages they are white blood cells that engulf dead cells in the body
patience
what is power stroke?
muravha
no idea
patience
what is the stroke volume of heart?
up
the amount of blood that enters the heart
Sintung
wrong^^ stroke volume is the amount of blood ejected from the left ventricle on a single contraction.
Jordan
If an autoimmune disorder targets the alpha cells, production of which hormone would be directly affected?
Samantha Reply
what is a muscle?
Gideon Reply
A band or bundle of fibrous tissue in a human or animal body that has the ability to contract, producing movement in or maintaining the position of parts of the body
Mody
ok
Gideon
what's endolphthamities and panophthalmities?
Gideon

Get the best Anatomy & Physiology course in your pocket!





Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
Google Play and the Google Play logo are trademarks of Google Inc.

Notification Switch

Would you like to follow the 'Anatomy & Physiology' conversation and receive update notifications?

Ask