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Left circumflex
16%
45/286
Left anterior descending
9%
27/286
Diagonal perforators
1%
4/286
Septal perforators
5%
13/286
Right main
66%
190/286
Select Answer to see Preferred Response
The artery supplying the posterior 1/3 of the ventricular septum is referred to as the "dominant" artery. In approximately 80% of people, the right main coronary artery (RCA) is dominant. The coronary arteries originate as the right and left main coronary arteries, which exit the ascending aorta just above the aortic valve. Both the right and left coronary arteries subdivide into progressively smaller branches that then progress inward to penetrate the epicardium and supply blood to the transmural myocardium. The artery that supplies the posterior descending artery (PDA) determines the coronary dominance. The coronary circulation is "right dominant" if the PDA is supplied by the RCA. American Family Physician published an article discussing the risks of heart attacks. Major risk factors for coronary heart disease include diabetes, high blood pressure, high cholesterol, male gender, advanced age, current or previous smoking, and either a father who had a heart attack before 55 years of age or a mother who had a heart attack before 65 years of age. Eating a healthy diet, exercising, stopping smoking, using lipid lowering medications if necessary, daily aspirin (for some individuals), and maintaining a healthy weight could help lower one's risk of heart attacks. Maraj et al. discuss the management of a high cardiovascular risk population. Since hypertension (HTN) has the largest impact on cardiovascular morbidity and mortality and since approximately 1/4 of the US population has HTN, it is imperative to manage HTN appropriately. The target blood pressure in hypertensive patients with CHD, HF, and DM is <130/80mmHg. Pharmacologic treatment would include beta-blockers, ACE inhibitors, ARBs, and diuretics (thiazide diuretics). Nitrates should be used to relieve any ischemic pain. Illustration A depicts the anatomy of the vasculature of the heart. Illustration B is a right anterior oblique view of the cardiac arterial supply. Be familiar with identifying various cardiac anatomy in different orientations. Incorrect Answers: Answers 1-4: Occlusion of any of these vessels would be unlikely to produce a posterior MI.
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