Blood Supply of the Heart

Arterial Supply of the Heart

The Coronary Arteries supply both the
myocardium and epicardium, they course
deep to the epicardium and are normally
embedded in fats, there are two coronary
arteries found in the heart (the left and
the right coronary arteries), which arise
from the aortic sinuses at the proximal
part of the ascending aorta (just superior
to the aortic valve).

Right Coronary Artery

Arises from the right aortic sinus and runs in the coronary groove (coronary sulcus), and in the
atrioventricular groove (atrioventricular sulcus). Its branches include the following:

Branch Supplies
SA Nodal Branch SA Node
Right Marginal Branch Right border of the heart towards the apex
AV Nodal Branch AV Node
Post. Interventricular / Descending Branch Adjacent areas of both ventricles and transmits
perforating interventricular septal branches into
the interventricular septum.

Left Coronary Artery

Arises from the left aortic sinus of the ascending aorta and passes between the left auricle and the left side
of the pulmonary trunk and runs in the coronary sulcus. The branches of the left coronary artery are the:

Branch Supplies
SA Nodal Branch SA Node (from Cx branch of the LCA, descends
posterior to the left atrium)
Ante. Interventricular / Descending Branch Adjacent parts of both ventricles.
Circumflex Branch May supply SA node, may also supply a branch
running adjacent to post. IV groove.
Left Marginal Branch Left Ventricle.

1 | by Mohammed Essam Abas Eljack (2020MSSMB0041)

Coronary Artery Anastomoses

Anastomosis occurs in a few places of the heart even though the coronary arteries are considered end
arteries.

• One anastomosis is between the branches of the LAD from the LCA and the branches of the PDA
from the RCA.
• Another one is between the RCA and the left circumflex artery in the coronary sulcus.
• A third anastomosis occurs with the septal branches of both arteries at the interventricular septum.

Coronary Artery Structure

It’s important to note that sometimes the structure of the coronary artery branches varies from person to
person. Some examples are:

• Coronary arteries are usually surrounded by a layer of fat but in some people the arteries are within
the heart muscle itself.
• Blood supply to the SA and AV nodes comes from the LCMA, not the RCA, in about 10% of people.
• Sometimes a single coronary artery arises from the aorta, then divides into right and left branches.

Most of these variations aren’t harmful and don’t produce symptoms. But in rare cases (less than 1% of
people) coronary artery abnormalities can lead to serious problems or even death.

Cardiac Veins

The venous drainage of the heart is mostly

through the coronary sinus – a large
venous structure located on the posterior
aspect of the heart. The cardiac veins drain
into the coronary sinus, which in turn,
empties into the right atrium. There are
also smaller cardiac veins which pass
directly into the right atrium.

The arrangements of the drainage pathway

of the coronary veins are less predictable
than that of the arterial supply. Most cases
will have the majority of the veins (except
the anterior cardiac and Thebesian veins) converging into the coronary sinus; while about one-third of all
cases will have all veins except the Thebesian veins draining into the coronary sinus. In other cases, some
of the Thebesian veins may receive some of the anterior cardiac veins before draining into the coronary
sinus.

2 | by Mohammed Essam Abas Eljack (2020MSSMB0041)

The main tributaries of the coronary sinus are:

Vein Receives Drain To

Great Cardiac Vein (Anterior IV
Vein)
Small Cardiac Vein
Middle Cardiac Vein
Posterior Cardiac Vein
Oblique Vein of the Left Atrium
(Marshall’s Vein)
Anterior Cardiac Vein
Smallest Cardiac Veins (Thebsian’s
Vein)
Coronary Sinus
From left marginal vein and other Coronary Sinus
tributaries that drain both
ventricles and the left atrium
sometimes joined by the right Coronary Sinus
marginal vein (which travels along
the acute cardiac border) as they
drain the posterior aspect of the
right chambers.
from the ventricular septum and Coronary Sinus
the inferior walls of both
ventricles.
Left Ventricle. Coronary Sinus
from the lateral and inferior Coronary Sinus
regions of the left atrium
Sternocostal surface of the right Right Atrium & Coronary
ventricle Sinus
Inner surface of the myocardium Left Heart Chambers
From all the veins of the heart, Right Atrium
except the thebesian vein in some
cases.

Lymphatic Drainage:
The lymphatic channels of the heart drain to the tracheobronchial and brachiocephalic lymph nodes.

Clinical Note:
Coronary artery disease (CAD) is the most common condition that affects your coronary arteries. CAD is
often the result of atherosclerosis, which is plaque build-up inside your arteries. Clogged arteries
prevent blood from getting to your heart, which can lead to a heart attack.

3 | by Mohammed Essam Abas Eljack (2020MSSMB0041)

4 | by Mohammed Essam Abas Eljack (2020MSSMB0041)
References:
• https://www.ncbi.nlm.nih.gov/books/NBK470522/
• https://socratic.org/questions/what-arteries-supply-blood-to-the-myocardium
• https://www.kenhub.com/en/library/anatomy/blood-supply-of-the-heart
• http://www.vhlab.umn.edu/atlas/coronary-system-tutorial/coronary-venous-anatomy.shtml
• https://teachmeanatomy.info/thorax/organs/heart/heart-vasculature/
• https://my.clevelandclinic.org/health/body/22973-coronary-arteries

5 | by Mohammed Essam Abas Eljack (2020MSSMB0041)