Coronary Circulation

Coronary Arteries
Two major arteries arise from aorta just above the aortic valve: a. Right Coronary Artery Provides blood to right atrium, right ventricle, SA, AV

nodes; sometimes part of posterior LV.

b. Left Coronary Artery

branches into left anterior descending and circumflex

arteries. Supplies LA, LV, septum

Posterior Descending Artery

Arises from Right coronary - 50 % (right dominance) Left Coronary - 20 % (left dominance) Both - 30 %

Coronary Arteries
1. Course over epicardial surface before branching within the

myocardium
2. Shortest circulation in body: blood transit time = 6-8 secs 3. End arteries 4. Functional anastamosis are present and become active under abnormal conditions like IHD

Venous Drainage of the Heart

1. Superficial system Coronary Sinus 70 -80 % Great Cardiac vein Anterior Cardiac Vein

2.

Deep System - rise with in the myocardium and opens directly into cardiac chamber via Arterio Sinusoidal vessels

Arterio Luminal vessels

Thebesian vessels

Characteristic features
The heart

has a very high basal oxygen consumption (8-10 ml

O2/min/100g)

the highest A-V O2 difference of a major organ (10-13 ml/100

ml)

Normal Coronary blood flow : 60-80ml/100gm/min or 250

ml/min viz, 5% of resting cardiac output

 O2 consumption(VO2) of myocardium - very high (10% of whole body VO2 ) Resting whole body Myocardium (3/4 in systole) Co-efficient of O2 utilization whole body - 26% Myocardium - 70% O2 saturation in venous blood whole body - 70 % Myocardium - 35% 250ml/min 25ml/min

Phasic Coronary Flow

Blood flows to RA, LA , RV & Superficial portion of LV through out the

cardiac cycle
subendocardial portion of LV only in diastole Increased surface area of endothelium Decreases diffusion distance to only 9mm Oxygen transport enhanced by high myoglobin content High density of myocardial capillaries: 3000-5000/mm2 (1 capillary per myocyte)

Pressure Gradient and Blood flow in the Coronary Vessels

Phase of cardiac cycle Pressure (mm Hg) Pressure Difference between Aorta &

Aorta Systole 120

LV 121

RV 25

LV -1 CBF 80
CBF

RV 95
CBF

Diastole

80

80
CBF

CBF during different phases of cardiac cycle

* The peak left coronary flow occurs at the end of isovolumetric relaxation

*
Left coronary blood flow Right coronary blood flow

Regulation of Coronary Blood Flow

Auto regulation
Chemical Neural

Autoregulation
It is the capacity of the tissue to regulate their blood flow intrinsic basal myogenic tone Local Metabolism is the primary controller of coronary flow O2 demand is a major factor This mechanism works well even when the nerves are removed

Chemical regulation of CBF

Fall in arterial PO2 causes release of vasodilator substances (METABOLIC
HYPERAEMIA)

Adenosine (ATP AMP Adenosine) Adenosine Phosphate compounds K+ , H+, CO2, bradykinin, Prostaglandin Nitric oxide is also an important regulator of CBF
continuously produced by the endothelium help - maintain basal flow

Neural regulation
Sympathetic Direct Depend on the receptor constriction (epicardial vessels) dilatation (intramuscular vessels) HR, Contractility, metabolic rate Cardiac O2 consumption Dilate - coronary artery Parasympathetic slight effect mild vasodilatation

Indirect

Slows HR, Contractility Cardiac O2 consumption Constrict - coronary artery

Measurements of coronary blood flow

1. Kety Method or Nitrous Oxide Technique:
Breathe - 15% N2O for 10 mins Sample - arterial & coronary venous sinus blood is collected

Fick Principle
Coronary flow / 100gm / min = 100 x Amt. of N2O taken up by myocardium

(A-V) N2O concentration.

2. Radionuclides utilization Technique

Radioactive tracers are detected using camera

Isotopes :
Thallium 201- distribution is directly proportional to

myocardial blood flow (Ischemia low uptake)

Technetium 99m stannous pyrophosphate selectively

taken up by infarcted tissue (hot spots)

3. Coronary Angiography 133Xe is injected into coronary arteries x rays and scintillation cameras are used to study the distribution and washout of 133Xe It provides detailed analysis of coronary blood flow

Coronary artery disease,

Signs and Symptoms

None

Chest Pain

Signs & Symptoms

Chest pain: If coronary arteries cant supply enough blood to meet the oxygen demands of the heart, it may result in chest pain called angina. Heart attack: Results when an artery to the heart muscle becomes completely blocked and the heart muscles fed by that artery dies.

Shortness Of Breath

Heart Attack

Thrombosis

Coronary vasospasm

a thrombolytic drug that coronary vasodilators can dissolves clots may be be given administered. (e.g., nitrodilators, calciumchannel blockers) to reverse Anti-platelet drugs and aspirin and prevent vasospasm. are commonly used to prevent the re-occurrence of clots.

Blood flow can be improved within that vessel by :

placing a stent within the vessel to expand the lumen

using an intracoronary balloon angioplasty to stretch the

vessel open
bypassing the diseased vessel with a vascular graft

Further Reading
Textbook of Medical Physiology , Guyton & Hall Review of Medical Physiology, William F. Ganong