Coronary circulation - LAD, LCX and RCA.pptx

coronary arteries are the blood vessel that supplies blood to the heart. this presentation provide insight of the same

1. Coronary Arteries By Viresh Mahajani M.Sc. Medical Surgical Nursing (CVTN).

2. The word coronary is derived from the Latin word, ‘Corona’, which means The crown of a king. As the structure of blood vessels supplying blood to the heart resembles the structure of a crown, these blood vessels are referred as Coronary arteries.

3. Origin of Coronary arteries Coronary arteries arise from the coronary sinus, which is just superior to the aortic valves. Aorta has 3 Cusps of which - The Right Coronary Artery arises above the right cups of the aortic valve Left Main Coronary Artery arises from above the left cusp of aortic valve Right Cusp Right Coronary Artery Left Cusp Left Main Coronary Artery Posterior Cusp Aortic Valve

4. Branches of coronary arteries Left main coronary artery arises from the ostium behind the left cusp of the aorta, and passes between the aorta and pulmonary artery to divide into main two branches Left Anterior Descending branch Left Circumflex artery The right coronary artery arises behind the right cups of the aorta. It passes behind the pulmonary artery, coursing along the atrioventricular groove, moving laterally towards the right along the margin and then posteriorly.

5. Left Anterior Descending Artery (LAD) The Left Anterior Descending artery is a branch of left main coronary artery. As its name depicts, the course of LAD is directed towards the anterior region of the heart and descends towards its apex. It mainly supplies the area of the anterior region of the heart. It is further branched in various small arteries.

6. Major Branches of LAD – Diagonal Branch There are usually two to three diagonal branches, Diagonal 1, Diagonal 2 and some time Diagonal # The First Diagonal branch originates just below the bifurcation of LAD and LCX and passes diagonally towards the left lateral side of the heart. It supplies blood to the walls of the left ventricle. The second diagonal originates just below the first diagonal artery. It is small in size and runs parallel to the first diagonal artery. It also supplies to the left ventricle of the heart. Some patients may have D3 artery that arises below D2 and follows same course.

7. Major Branches of LAD – Septal and Apical Branches There are a varied number of branches that arise at the angle of 90 degrees from the LAD, which runs medially to the heart and supplies the anterosuperior section of the intra-ventricular septum. (The inferior posterior section of the intraventricular septum is supplied by the Posterior Descending artery). Small branches arise from the distal end of LAD that supply blood to the Apex of the heart. They are referred to as Apical branches of the LAD.

8. Left Circumflex Artery - LCX Left circumflex is the second major branch that arises from the left main coronary artery. As it exits the LM artery, it courses first laterally and then posteriorly along the atrioventricular groove to reach the posterior side of the heart. This artery during its course, supplies blood mainly to the lateral and the posterior section of the heart. LCX further give rise to many small branches

9. Branches of LCX – Left Atrial branch It is a small branch that arises from the LCX and supplies blood to the left atrial walls. In 45 -50% of people SA artery arises from the LCX. It runs superiorly or cranially and then descends to the base of the superior vena cava to supply the SA node of the heart Branches of LCX – SA Node branch

10. Branches of LCX – Marginal Branch During the course of LCX from the lateral to the posterior side of the heart, one to four branches arise over the lateral side of the heart. As these branches arise at the obtuse angle from the circumflex artery, and supply to the left lateral or marginal area of the heart, these branches are referred to as Obtuse marginal branches of LCX. These branches mainly supply blood to the left lateral and some part of the posterior side of the heart.

11. Branches of LCX – Posterolateral Branch In 70 – 80 % of people, the posterolateral artery arises from the terminal portion of the LCX artery. It supplies blood to the posterior and diaphragmatic wall of the heart. Branches of LCX – Posterodescending Branch In 20 % of the people Posterior descending artery arises from LCX while in 80 % people, it arises from Right circumflex artery

12. Right Coronary Artery RCA arises behind the right cups of the aorta. It passes behind the pulmonary artery, coursing along the atrioventricular groove, moving laterally towards the right along the margin and then posteriorly. It supplies blood to the Right atrium, right ventricle, posterior and the inferior surface of the heart. RCA also supplies blood to the SA node, AV node and the bundle of Hiss. Many major branches arise from the RCA.

13. Branches of RCA Right atrial branch – It originates from the RCA and proceeds cranially towards the right atrium and perfuse it. Right ventricular branch – It arises from the RCA, courses along the AV groove and Perfuses the Right ventricular wall of the heart. Right Acute Marginal branch – It arises at the lateral margin of the right ventricle, and courses towards the apex from the right lateral margin. It supplies blood to the right marginal border of the heart.

14. Branches of RCA SA nodal branch – It originates from the RCA in 55 % of people. It courses from the opening of the RCA and proceeds cranially and then to the right, encircling the superior vena cava, supplying the right atrium and SA node of the heart. AV nodal branch – It originates from the crux of the heart and proceeds towards the centre of the heart, posteriorly perfusing the AV node and lower portion of the interatrial septum

15. Branches of RCA - PDA Posterior Descending Artery – It originates from the posterior and distal part of the RCA. It proceeds posteriorly and descends towards the apex along the interventricular groove. Due to its position, it gets its name as a Posterior descending artery. In almost 80% of the people PDA arises from the RCA, while in 15% from LCX. In around 5% of people, PDA arises from the anastomosis of RCA and LCX.

16. Summery Main Branch Sub branch Area Supplies Left Anterior Descending Artery Diagonal (D1, D2, D3) Left Ventricle Septal (S1, S2) Interventricular Septum Apical Apical Region of the heart Right Ventricular Branch (Sometimes) Some part of right ventricle

17. LAD and their branches view in Angiogram

18. Summery Main Branch Sub branch Area Supplies Left Circumflex Artery Atrial Left atria SA nodal In 45 % people. Supplies SA node Obtuse Marginal Left lateral margin of left ventricle Posterior Marginal Posterior and Marginal wall of Left ventricle In 20 % of people Posterior descending artery arises from LCX while in 80 % of people, it arises from the Right circumflex artery

19. LCX and their branches view in Angiogram

20. Summery Main Branch Sub branch Area Supplies Right Coronary Artery SA nodal Right atrium and SA node AV nodal Lower part of intraatrial septum and AV node Acute Marginal Right lateral margin of heart and posterior side of heart Posterior Descending Posterior interventricular septum and related parts.

21. RCA and their branches view in Angiogram

22. Complete View of coronary arteries in Coronary Angiography