Coronary Arteries

The coronary arteries provide blood to the heart tissues, carrying blood first across the epicardium, then the myocardium and finally terminating in the endocardium. The epicardium forms the outer layer of the heart. The myocardium forms the middle layer and the endocardium the innermost layer of the heart.

The endocardium claims the dubious position as the terminus for the coronary arteries. Since the coronary arteries begin along the epicardial surface, enter the myocardium and terminate in the endocardium, myocardial ischemia rarely occurs without endocardial ischemia. While the endocardium is damaged in most every myocardial infarction, the epicardium’s location in the blood flow hierarchy increases its safety factor.

In order to beat over 100,000 times daily, the heart muscle requires a substantial blood and oxygen supply. The coronary arteries distribute the oxygen and nutrients necessary to provide energy to meet the workload demands of the heart. Even at rest, the cardiac cells extract 75% of the oxygen from the coronary arteries to meet energy demands. Essentially, the heart is entirely dependant on increased coronary artery blood flow to meet any increases in cardiac workload.

About 4-5% of the body’s blood volume is contained by the heart’s arteries and veins. This is a large volume considering that the heart comprises less than 1% of an adult’s body mass.The heart’s blood supply is provided mostly as the heart relaxes and dilates during diastole. This is unique – most organs receive pulsations of new oxygen-rich blood during cardiac systole (contractile phase of the heart).

The quantity of blood circulating through the coronary arteries is directly related to the coronary perfusion pressure, the difference between aortic diastolic pressure and central venous pressure (right atrial pressure). During events with increased central venous pressure and lower aortic diastolic pressure (i.e. right ventricular infarction) coronary perfusion often suffers.

The right coronary artery (RCA), sprouts off of the aorta superior to the aortic valve, primarily serving the right ventricle and the right atria. In about 50% of the population, the RCA branches early on to form the conus artery to further serve the right side of the heart. The RCA serves the right ventricle, the right atrium, the SA node (50-60% of people) and the AV node (90% of people). Note that the AV node and the bundle of His are often served by both the RCA and the circumflex artery.

The left main begins at the left border of the aorta opposite the entrance to the RCA. The left main soon splits into 2 arteries: 1) the circumflex wraps around the surface of the left heart; and 2) the left anterior descending artery travels down the anterior surface of the left ventricle. The circumflex also serves the SA node (40-50% of people) and the AV node (10% of people).

The coronary veins exit into the right atrium via the coronary sinus. A one-way valve covers the coronary sinus, called the Thebesian valve (now this is definitely trivia).

Figure 1.5 Coronary Arteries

1. Six Second ECG Guidebook (2012), T Barill, p. 10, 14

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Dynamic ECG rhythm interpretation
Static ECG rhythm interpretation
Clinical Impact Mapping
Acute Coronary Syndromes Overview
Acute Coronary Syndromes In-Depth
ST Segment & T Wave Differential
Identify Bundle Branch Blocks
15 | 18 Lead View Mapping
Electrical Axis
R Wave Progression
Left Bundle Branch Blocks with ACS
Atypical Findings
Acute Non-Ischemic Disease Conditions
Special Cases

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