Coronary Circulation

3/21/12

Anatomy of coronary vessels

Arterial supply Right and left coronary arteries

3/21/12

Anatomy of coronary vessels

Venous drainage Superficial venous system Deep venous system

3/21/12

Normal coronary blood flow

At rest

Exercise

3/21/12

225 ml/min 4-5% of COP

4-5 folds 1000ml/min

3/21/12

In strenuous exercise , the work of the heart may increase as much as 6-8 folds. The coronary blood flow increases only 4-5 folds. How the heart obtains its extrarequirements of oxygen and

By having high coefficient of oxygen utilization

3/21/12

Phasic Changes in coronary blood flow

Filling of the coronaries is affected by: 1- diastolic blood pressure 2- duration of 3/21/12 diastolic

Phasic Changes

3/21/12

Phasic Changes in coronary blood flow

Venous drainage from the coronary sinus is increased in: 1- ventricular systole 2- atrial systole 3-isometric contraction phase.
3/21/12

3/21/12

Control of coronary blood flow

l factors Loca ulation) (autoreg

Coronary blood flow is regulated by the vascular response to the local needs of the cardiac muscle to nutrition.
3/21/12

Control of coronary blood flow

factors 1-Local ulation) (autoreg
1- oxygen demand
hypoxia perhaps degrades ATP to adenosine which is a potent vasodilator. Or Hypoxia leads to lack of energy required to keep the coronaries contracted against the high arterial pressure.

3/21/12

3/21/12

3/21/12

Control of coronary blood flow

l factors Loca ulation) (autoreg

2- metabolic waste products,

e.g. CO2,H+, K+, lactic acid,prostaglandins and adenosine
3/21/12

Control of coronary blood flow

l factors 2-neura

1- sympathetic supply 2- parasympathetic

direct
3/21/12

re di in ct

Control of coronary blood flow

l factors 2-neura

c re i d in t
3/21/12

Control of coronary blood flow

pressure 3- Aortic changes

Decreased Diastolic blood pressure

Decreased coronary blood flow

3/21/12

3/21/12