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Overview

Anatomy
  • Right coronary artery (RCA)
    • arises from the right aortic sinus of the ascending aorta
    • passes to the right side of the pulmonary trunk, running in the atrioventricular (coronary) sulcus
    • branches
      • sinoatrial nodal artery
        • supplies the sinoatrial (SA) node
      • right marginal artery
        • supplies the right ventricle
      • posterior descending artery (PDA) aka posterior interventricular artery
        • supplies the right ventricle, posterior interventricular septum (IVS), and left ventricle (minor)
  • Left coronary artery (LCA)
    • arises from the left aortic sinus of the ascending aorta
    • passes to the left side of the pulmonary trunk, running in the atrioventricular (coronary) sulcus
    • branches
      • left circumflex artery (LCX)
        • supplies the left atrium and posterior left ventricle 
      • left anterior descending artery (LAD) aka anterior interventricular artery
        • supplies the left ventricle (major), right ventricle, and anterior interventricular septum (IVS)
  • Coronary Sinus
    • final endpoint of coronary flow
    • continuous with the right atrium
    • receives the great cardiac vein
    • becomes dilated in chronic pulmonary hypertension 
    • blood in the coronary sinus has the lowest oxygen content in the body with oxygen saturation levels of 30% 
  • Coronary arterial system dominance
    • dominance is defined by which artery gives rise to the PDA that supplies the left ventricle, right ventricle, and posterior interventricular septum
    • right dominance
      • (80%) RCA gives rise to the PDA 
    • left dominance
      • (20%) CFX artery gives rise to the PDA
Complications
  • Coronary artery occlusion
    • occlusion most commonly occurs in the anterior interventricular artery (LAD artery)
  • Left atrial enlargement   
    • left atrium is the posterior-most aspect of the heart
      • enlargement compresses posterior structures
        • compression of esophagus → dysphagia
        • compression of left recurrent laryngeal nerve → hoarseness
          • left recurrent laryngeal nerve is a branch of the vagus nerve
  • Coronary steal phenomenon 
    • myocardial ischemia as a result of a narrowing of coronary arteries with subsequent use of a coronary vasodilator
    • results from microvessel dilation "stealing" blood away from other parts of the heart 
    • associated with use of dipyridamole
 

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