BLOOD SUPPLY OF THE BLOOD SUPPLY OF THE HEARTHEART

BLOOD SUPPLY OF THE BLOOD SUPPLY OF THE HEARTHEART

Dr Jamila EL medany

& Dr Essam Salama

ObjectivesObjectives At the end of the lecture the student should At the end of the lecture the student should

be able to know about;be able to know about; The arterial supply of the cardiac muscle The arterial supply of the cardiac muscle

regarding (origin, course, distribution and regarding (origin, course, distribution and branches). branches).

The coronary anastmosis.The coronary anastmosis. The arterial supply to the conducting The arterial supply to the conducting

system of the heart.system of the heart. The venous drainage of the heart regarding The venous drainage of the heart regarding

(origin, tributaries and termination). (origin, tributaries and termination).

Arterial SupplyArterial SupplyArterial SupplyArterial Supply

The arterial supply of The arterial supply of the heart is provided by the heart is provided by

TwoTwo Coronary Coronary Arteries : Arteries : Right Coronary Right Coronary artery &artery &Left Coronary Left Coronary arteryarteryThey are distributed They are distributed over the cardiac surface, over the cardiac surface, within the subepicadium within the subepicadium connective tissue. connective tissue.

L Coronary artery

They arise fromThey arise from the the initial part of theinitial part of the Ascending Aorta Ascending Aorta (Aortic Sinuses),(Aortic Sinuses), immediately above immediately above the aortic valve.the aortic valve.

AA

RCA LCA

Origin of Coronary Arteries

Origin of Coronary Arteries

Right Coronary Right Coronary Artery Artery

Arises from the Arises from the anterior aortic anterior aortic sinussinus of the ascending aorta. of the ascending aorta.Descends in the right Descends in the right atrioventricular groove atrioventricular groove between between the Right Auricle and the the Right Auricle and the

Pulmonary trunkPulmonary trunk..At the inferior border of the At the inferior border of the heart it heart it continues posteriorly continues posteriorly to to anastomose with the left anastomose with the left coronary.coronary.

(RCA ) Supplies: (RCA ) Supplies: Right atrium, Right atrium, Right ventricle, Right ventricle, part of Left Atrium, part of Left Atrium, Left ventricle & Left ventricle &

Atrioventricular septum. Atrioventricular septum. Most of conducting system Most of conducting system

BranchesBranchesBranchesBranches

Right Conus;Right Conus;

For infundibulum and upper For infundibulum and upper part of anterior wall of the part of anterior wall of the right ventricle.right ventricle.

Anterior ventricular Anterior ventricular branches;branches;

2-3 branches supply anterior 2-3 branches supply anterior surface of the right ventricle.surface of the right ventricle.

Marginal arteryMarginal artery is the is the largest branch, runs along largest branch, runs along the lower margin of the the lower margin of the sternocostal surface.sternocostal surface.

It is accompanied by the It is accompanied by the small cardiac vein.small cardiac vein.

Right Conus;Right Conus;

For infundibulum and upper For infundibulum and upper part of anterior wall of the part of anterior wall of the right ventricle.right ventricle.

Anterior ventricular Anterior ventricular branches;branches;

2-3 branches supply anterior 2-3 branches supply anterior surface of the right ventricle.surface of the right ventricle.

Marginal arteryMarginal artery is the is the largest branch, runs along largest branch, runs along the lower margin of the the lower margin of the sternocostal surface.sternocostal surface.

It is accompanied by the It is accompanied by the small cardiac vein.small cardiac vein.

Right conus

Atrial branches; Atrial branches;

Supply anterior and lateral surfaces Supply anterior and lateral surfaces of the right atrium of the right atrium

One branch supplies posterior surface One branch supplies posterior surface of both atria of both atria

Artery of the Sinuatrial Node Artery of the Sinuatrial Node

Supplies the SAN and both atria Supplies the SAN and both atria

In 35% it arises from the left In 35% it arises from the left coronary.coronary.

Posterior ventricular branches;Posterior ventricular branches;

About 2 supply the diaphragmatic About 2 supply the diaphragmatic surface of the right ventricle.surface of the right ventricle.

Posterior Interventricular Posterior Interventricular artery;(accompanied by artery;(accompanied by middle cardiac vein)middle cardiac vein)Lies in the posterior interventricular Lies in the posterior interventricular groove, it supplies the Right and Left groove, it supplies the Right and Left Ventricles, including their inferior Ventricles, including their inferior wall, posterior part of ventricular wall, posterior part of ventricular septum, septum, Not the Apical part, Not the Apical part,

Atrial branches; Atrial branches;

Supply anterior and lateral surfaces Supply anterior and lateral surfaces of the right atrium of the right atrium

One branch supplies posterior surface One branch supplies posterior surface of both atria of both atria

Artery of the Sinuatrial Node Artery of the Sinuatrial Node

Supplies the SAN and both atria Supplies the SAN and both atria

In 35% it arises from the left In 35% it arises from the left coronary.coronary.

Posterior ventricular branches;Posterior ventricular branches;

About 2 supply the diaphragmatic About 2 supply the diaphragmatic surface of the right ventricle.surface of the right ventricle.

Posterior Interventricular Posterior Interventricular artery;(accompanied by artery;(accompanied by middle cardiac vein)middle cardiac vein)Lies in the posterior interventricular Lies in the posterior interventricular groove, it supplies the Right and Left groove, it supplies the Right and Left Ventricles, including their inferior Ventricles, including their inferior wall, posterior part of ventricular wall, posterior part of ventricular septum, septum, Not the Apical part, Not the Apical part,

Left Coronary Left Coronary ArteryArteryThe Larger of the two The Larger of the two coronaries.coronaries.Arises from the Arises from the left left posterior aortic sinusposterior aortic sinus of the of the ascending aorta. ascending aorta. DescendsDescends: : 1. Between the pulmonary 1. Between the pulmonary trunk and the left auricle.trunk and the left auricle.2. In the 2. In the IV groove IV groove to the to the apex of the heart.apex of the heart.

Divides into two terminal Divides into two terminal branches: branches:

Anterior Interventricular & Anterior Interventricular & CircumflexCircumflex arteries.arteries...

BranchesBranchesCircumflex artery;Circumflex artery;Winds around the left margin of Winds around the left margin of the heart in the atrioventricular the heart in the atrioventricular groove groove

Anterior InterventricularAnterior InterventricularDescends in the anterior Descends in the anterior interventricular groove to the apex of interventricular groove to the apex of the heart (accompanied by the the heart (accompanied by the Great Great cardiac vein) cardiac vein) in most individuals it passes around the in most individuals it passes around the apex to anastomose with terminal apex to anastomose with terminal branches of the right coronary , in 1\3 it branches of the right coronary , in 1\3 it ends at the apex ) It supplies the right ends at the apex ) It supplies the right and left ventricles and anterior part of and left ventricles and anterior part of ventricular septumventricular septum

It gives: It gives: 1.1.Left conus Left conus artery for pulmonary artery for pulmonary conus.conus.2.2.2. Atrial branches 2. Atrial branches ;;Supply greater part of left atrium Supply greater part of left atrium

BranchesBranchesCircumflex artery;Circumflex artery;Winds around the left margin of Winds around the left margin of the heart in the atrioventricular the heart in the atrioventricular groove groove

Anterior InterventricularAnterior InterventricularDescends in the anterior Descends in the anterior interventricular groove to the apex of interventricular groove to the apex of the heart (accompanied by the the heart (accompanied by the Great Great cardiac vein) cardiac vein) in most individuals it passes around the in most individuals it passes around the apex to anastomose with terminal apex to anastomose with terminal branches of the right coronary , in 1\3 it branches of the right coronary , in 1\3 it ends at the apex ) It supplies the right ends at the apex ) It supplies the right and left ventricles and anterior part of and left ventricles and anterior part of ventricular septumventricular septum

It gives: It gives: 1.1.Left conus Left conus artery for pulmonary artery for pulmonary conus.conus.2.2.2. Atrial branches 2. Atrial branches ;;Supply greater part of left atrium Supply greater part of left atrium

3.. Anterior & Posterior 3.. Anterior & Posterior ventricularventricular;;

Supply left ventricleSupply left ventricle

4. Left diagonal artery 4. Left diagonal artery one of the ventricular branches one of the ventricular branches

or may arises from left or may arises from left coronary,coronary,

5. Left marginal artery ;5. Left marginal artery ; Supplies the left margin of the Supplies the left margin of the

left ventricle down to the apexleft ventricle down to the apex

Variations of the Coronary Variations of the Coronary ArteriesArteries

Variations of the Coronary Variations of the Coronary ArteriesArteries

Right DominanceRight Dominance: : In (90 %) of population, In (90 %) of population,

the Posterior the Posterior Interventricular artery is a Interventricular artery is a branch of the Right branch of the Right Coronary.Coronary.

Left Dominance: Left Dominance: In the rest (10%), the In the rest (10%), the

Posterior Interventricular Posterior Interventricular artery arises from the artery arises from the Circumflex branch of the Circumflex branch of the Left Coronary ALeft Coronary A

Coronary AnastomosisCoronary AnastomosisCoronary AnastomosisCoronary Anastomosis In MOST of people, theIn MOST of people, the

terminal branches of the terminal branches of the right and left coronariesright and left coronaries anastomose in the anastomose in the posterior posterior part of the IV groovepart of the IV groove

However this anastomoses However this anastomoses is not large enough to is not large enough to provide adequate blood provide adequate blood supply in case of coronary supply in case of coronary occlusion, (occlusion, (Functional End Functional End arteries) arteries)

Arterial Supply ofArterial Supply ofConducting SystemConducting System

SAN, AVN & AVB SAN, AVN & AVB are are usually supplied by usually supplied by Right coronaryRight coronary..

Right Bundle Branch Right Bundle Branch (RBB) of (AVB) (RBB) of (AVB) is is supplied by supplied by Left Left coronarycoronary

LBB of (AVB) LBB of (AVB) is is supplied by both Right supplied by both Right and Left coronariesand Left coronaries

Drains most of the Venous Drains most of the Venous Blood of the heart.Blood of the heart.

It lies in the Posterior part It lies in the Posterior part of the AV groove.of the AV groove.

Origin :Origin : It is the direct continuation It is the direct continuation

of the of the Great Cardiac Vein.Great Cardiac Vein. Tributaries:Tributaries: (3) Cardiac Veins:(3) Cardiac Veins: A. Great.A. Great. B. Middle. B. Middle. C. Small. C. Small. Oblique vein of left atrium Oblique vein of left atrium

(vein of Marshall).(vein of Marshall).

Coronary SinusCoronary Sinus

Termination:Termination: It empties into Right It empties into Right

AtriumAtrium. . Its opening is inferior & to Its opening is inferior & to

the left of the IVC opening.the left of the IVC opening. It is guarded by a valve.It is guarded by a valve.

1. Anterior cardiac veins:1. Anterior cardiac veins: Open directly into the Right Open directly into the Right

Atrium.Atrium. 2. 2. Venae Cordis minime Venae Cordis minime

(small cardiac veins):(small cardiac veins): Open into the heart Open into the heart

chambers.chambers.

Veins Draining outside Coronary

Sinus

Veins Draining outside Coronary

Sinus

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