This document discusses the blood supply of the heart. It begins by describing the origins of the main coronary arteries - the right coronary artery arises from the right coronary sinus of the aorta, while the left coronary artery arises from the left coronary sinus. It then details the branches and course of each coronary artery, including the right coronary artery supplying parts of the right atrium and ventricle while the left coronary artery supplies parts of the left atrium and ventricle. The document also discusses coronary dominance patterns and variations in coronary artery anatomy. It concludes by outlining some clinical applications like coronary angiography, angioplasty, and bypass surgery for coronary artery disease.

1. Blood supply of
heart
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2. Learning objectives
 Coronary Arteries – Origin, Course & Branches
 Coronary dominance
 Coronary anastomosis
 Variations
 Applied anatomy
 Venous return
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3. Introduction:
 Coronary arteries -
VASAVASORUM arising
from aortic sinuses of
Valsalva of Ascending
aorta
 Rt CA - from Rt aortic
sinus (ant)
 Lt CA from Lt aortic
sinus(left post)
 Post Aortic sinus - non
coronary
 Max filling of sinuses - in
diastole
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4. Basic considerations
• A-V groove
• I-V groove
• Crux of Heart
• SA node & its location
• A-V node & its location
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5. Rt Atrioventricular Groove,
Ant Interventricular groove
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6. Atrioventricular groove (CS) &
Post Interventricular groove
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7. Crux
Posteroinferior view
Meeting point of
•IA groove
• Post AV groove
•Post IV groove
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8. SA Node & AV Node location
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9. 9

10. Rt Coronary Artery
 Passes to rt & forwards
b/w infundibulum of rt
ven & rt auricle
 Runs downwards in ant
AV groove
 Reaches inf margin of
heart; winds around it to
the diaph surface; runs in
post AV groove
 Ends by anastomosing
with circumflex br of LCA
-60%
Conus brs
Ventricular brs
AV nodal br
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11. Branches of Rt coronary Artery
 Rt conus artery-
Annulus of Vieussens
 SA Nodal br – 60%
 Ant atrial branches
 Ant ventr branches
 Rt Marginal artery:
(Largest br)
 Post ventr branches
 Post IV br arises near
CRUX – 70% br of RCA
 Post atrial branches
 AV Nodal artery – 80%
Conus brs
Ventricular brs
AV nodal br
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12. Conus brs
Ventricular brs
AV nodal br
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13. Lt Coronary Artery
 Origin: Lt Aortic
sinus
 Passes behind
infundibulum of Rt
ventricle
 Length: 0 to 10mm
 Bifurcates into Ant
IV branch (LAD) &
Circumflex artery
Conus brs
Ventricular brs
AV nodal br
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14. LAD (Ant IV) artery
 Continuation of
LCA
 Extends beyond the
apex, ends by
anastamosing with
post IV artery (br of
RCA)
Branches:
 Ant ventr brs:
i. Diagonal arteries
ii. Lt Conus artery
 Septal branches
Conus brs
Ventricular brs
AV nodal br
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15. Circumflex artery
 Runs in Ant AV groove and post AV groove
 Terminates by anastamosing with RCA near crux
Branches:
i. Atrial brs
ii. Ventr branches
iii. SA nodal
(40% cases)
iv. Lt Marginal
v. Post IV br
(only 10% cases)
vi. Kugel’s artery
vii.AV nodal br
(10-20%)
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16. Branches of
Coronary arteries
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17. Coronary dominance
 CA that gives post IV branch is supposed to be
dominant
 Misleading term as LCA supplies greater part of
myocardium, but in 70% cases post IV is a br of RCA (Rt
coronary dominance)
 3 types – Rt (70%), Lt (20%) & Balanced (10%)
Clinical importance:
In Lt dominance a block in LCA affect entire Lt ventricle and IV
septum, while in Rt or balanced dominance a block in RCA at
least spares part (2/3) of septum and lt ventricle
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18. Summary:
RCA:
• Rt atrium
• Lt atrium (ant part)
• Rt ventr except a small strip along the Ant IV groove
• Diaphragmatic surface of Rt ventricle
• Post 1/3 of IV septum
• SA Node and AV Node in majority
• Most conducting system of heart except Lt branch of
Bundle of His
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19. LCA:
• Post part of Lt Atrium
• Ant and Lat walls of Lt ventricle
• Ant 2/3 of IV septum
• Lt br of Bundle of His
• SA & AV Nodes in 30% cases
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20. 20

21. Coronary Anastomosis
-Anatomically CA are not end arteries but functionally
they behave like end arteries.
-Anastomosis occur at:
• superficial
• subepicardial
• Myocardial
• subendocardial levels
Important sites:
i) b/w terminations of RCA & LCA near crux of heart
ii) b/w their IV brs (in septum)
iii) b/w conus As
iv) apex
Prognosis better in slow occlusion
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22. Variations
Congenital anomalies
- LCA arising from Pul trunk; cyanosis occurs
- LCA arises from right aortic sinus; may get compressed b/w
Pul trunk & aorta in strenuous exercise; may cause sudden
cardiac death
- Post IV A arising from Cx A (left dominance)
- SA nodal A in 40% from Cx A; AV nodal A in 20% from Cx A
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23. Post IV A arising from Circumflex br of LCA
Post IV Artery
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24. Venous Drainage
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25. Coronary Sinus
 Heart is drained by CS - empties into Rt Atrium.
 Two set of veins empty directly into Rt Atrium
 Venae cordis minimi
 Ant cardiac vein,
 s/t Rt marginal vein also
 CS - dilatation of Great Cardiac Vein located in post part of AV
groove
 Opens into Rt atrium b/w IVC and Tricuspid opening guarded
by incomplete semicircular “Thebasian valve”
 Tributaries- all have valves except oblique V of lt atrium
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26. Tributaries of Coronary sinus:
1. Great Cardiac vein
• Begins near apex of
heart; acc. Ant IV A &
more proximally cx
artery
• Terminates at lt end of
coronary sinus
2. Middle cardiac vein
• Accompanies Post IV
artery and opens at
termination of coronary
sinus
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27. 3. Small Cardiac vein
• Accompanies rt marginal artery
• Runs in AV groove to end into rt end of CS
• May open directly into rt atrium
4. Oblique Vein of Lt Atrium (of Marshall)
• Runs in the post surface of Lt Atrium and drains into Lt end of Coronary sinus
5. Post Vein of Lt Ventricle
• Runs on diaphragmatic surface of Lt ventricle and ends in middle of coronary
sinus
6. Rt Marginal vein
• Accompanies Rt Marginal artery and drains into Small Cardiac vein or directly
into the Rt Atrium 27

28. Oblique Vein of Lt Atrium (of Marshall)
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29. Veins directly emptying into Rt Atrium
1. Ant Cardiac Veins:
• 3-4 in no .drains the infundibulum of Rt ventricle
• opens into Rt Atrium through its Ant wall
2. Venae Cordis Minimi/ Thebasian veins
• Numerous small veins opening into the Post wall of
Rt Atrium
3. Small cardiac vein – may open directly into Rt atrium
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30. Applied Anatomy:
• Coronary Artery Disease (CAD)
• Coronary Angiography
• PTCA (Percutaneus Transluminal
Coronary Angioplasty)
• CABG ( Coronary Artery Bypass Graft)
• Cardiac catheterisation
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31. Coronary Artery Disease (CAD) & Ischaemic Heart
Diseases (IHD) – due to atherosclerosis
- Angina Pectoris – transient myocardial ischemia
- Myocardial Infarction – occlusive thrombus
Investigations for CAD & IHD
a) ECG
b) Coronary Angiography
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32. Treatment of CAD
1. Medical T/t for angina
2. Stents- simple or drug-eluting (vasodilators)
3. Coronary Angioplasty (PTCA) - single vessel disease
4. Coronary Artery Bypass Graft (CABG) – triple vessel disease
-median sternotomy
-thymus incised
-pericardium incised
-SVC & IVC cannulated, venous blood goes to bypass
machine
-graft used: reversed Gr Saph V or Int Th A
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33. 33

34. M. I.
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35. STENTING
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36. 36

37. 37

38. CABG
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39. CABG
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40. CORONARY
CATHETRISATION
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42. Thank
you
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