PRESENTED BY:

MS.ANU SARANNYA
M.SC(N) II YEAR
APOLLO COLLEGE OF NURSING
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Coronary Artery & their Branches

Coronary arteries arises form coronary
sinus at the base of the aorta
LCA
Left Anterior Descending (LAD)
Marginal Artery
Circumflex Artery
RCA
Marginal Artery
Posterior descending Branch
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Coronary Arteries
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CORONARY BLOOD FLOW
Coronary blood flow in Humans at rest is
about 225-250 ml/minute, about 5% of
cardiac output.

At rest, the heart extracts 60-70% of
oxygen from each unit of blood delivered
to heart [other tissue extract only 25% of
O
2
.
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CORONARY BLOOD FLOW
Why heart is extracting 60-70% of O
2
?
Because heart muscle has more
mitochondria, up to 40% of cell is occupied
by mitochondria, which generate energy for
contraction by aerobic metabolism,
therefore, heart needs O
2
.
When more oxygen is needed e.g.
exercise, O
2
can be increased to heart only
by increasing blood flow.

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Blood flow to Heart during
Systole & Diastole
During systole when heart muscle
contracts it compresses the
coronary arteries therefore blood
flow is less to the left ventricle
during systole and more during
diastole.
To the subendocardial portion of
Left ventricle it occurs only during
diastole
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Phasic changes in coronary bld flow
Effect of cardiac muscle contraction






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Coronary blood flow to the right side is
not much affected during systole.
Reason---Pressure difference
between aorta and right ventricle is
greater during systole than during
diastole, therefore more blood flow to
right ventricle occurs during systole.
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CORONARY
BLOOD
FLOW
DURING
SYSTOLE
AND
DIASTOLE
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Factors Affecting Blood Flow to
CORONARY ARTERIES
-Pressure in aorta
-Chemical factors
-Neural factors

NOTECoronary blood flow
shows considerable Autoregulation.
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Chemical factors affecting
Coronary blood flow

Chemical factors causing
Coronary vasodilatation
(Increased coronary blood flow)

NOTE Adenosine, which is formed
from ATP during cardiac metabolic
activity, causes coronary
vasodilatation.
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Neural factors affecting Coronary Blood
Flow
1. -Effect of Sympathetic stimulation
2. -Effect of Parasympathetic stimulation

Sympathetic stimulation
Coronary arteries have
Alpha Adrenergic receptors which mediate
vasoconstriction
Beta Adrenergic receptors which mediate
vasodilatation

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Effect of Parasympathetic stimulation
-Vagus nerve stimulation (Parasympathetic)
causes coronary vasodilatation
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CARDIAC MUSCLE METABOLISM

Heart uses primarily free fatty acids and
to lesser extent glucose and lactate for
metabolism.
in ischemic / anaerobic conditions


Derives energy from
Anaerobic glycolysis

Forms lactic acid (one of cause of
cardiac pain )


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CORONARY ARTERY HEART
DISEASE
ISCHEMIC HEART DISEASE (IHD) (ANGINA
PECTORIS)
MYOCARDIAL INFARCTION

ANGINA PECTORIS:
THERE IS REDUCED CORONARY ARTERY
BLOOD FLOW DUE TO ATHEROSCLEROSIS
(CHOLESTROL DEPOSITION
SUBENDOCARDIALLY -- Plaque)
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RISK FACTORES OF IHD:

CIGARETTE SMOKING
HYPERTENSION
DIABETES MELLITUS
INCREASED LIPIDS ( CHOLESTROL)
OTHER FACTORS: LACK OF
EXERCISE, ANXIETY etc.
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IHD:
IHD IS USED TO DESCRIBE DISCOMFORT IN
THE CHEST DUE TO DECREASED CORONARY
BLOOD FLOW (TRANSIENT MYOCARDIAL
ISCHEMIA).

PATIENT COMPLAINS OF TIGHTNESS OR PAIN
IN THE MIDDLE OF CHEST (RETROSTERNAL)
FOR FEW MINUTES. PAIN OFTEN RADIATES
TO INNER SIDE OF LEFT ARM.

PAIN IS PRECIPETED BY EFFORT AND
RELIEVED BY REST.
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MYOCARDIAL INFARCTION (MI):

IT IS DUE TO OBSTRUCTION TO THE
CORONARY BLOOD FLOW, ATLEAST 75 % OF
LUMEN OF CORONARY ARTERY IS BLOCKED
BY THROMBUS.

MI IS THE COMMON CAUSE OF DEATH.
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Applied Aspect
THE C A D.
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Electrocardiographic changes during
exercise test. Upper trace significant
horizontal ST segment depression during
exercise.

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INVESTIGATIONS:
ECG
CARDIAC ENZYMES e.g. CK, LDH, TROPONIN
etc.
ECHOCARDIOGRAPHY
TREADMILL EXERCISE TEST
THALLIUM STRESS TEST
CORONARY ANGIOGRAPHY

NOTE:
ECG CHANGES IN IHD:
ST DEPRESSION OCCURS IN ECG IN RESPECTIVE LEADS
ECG CHANGES IN MI:
ST ELEVATION OCCURS IN ECG IN RESPECTIVE LEADS
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TREATMENT:
CORONARY DILATORS E.g. NITRATES
BETA-BLOCKERS
ANGIOPLASTY (DILATE AREA OF
CONSTRICTION)
STENT
BYPASS SURGERY
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Percutaneous transluminal coronary angioplasty (PTCA). (a)
Coronary angiography demonstrates a severe stenosis in the
proximal left anterior descending artery. (b) During PTCA a soft
guidewire is passed across the stenosis and then a balloon is
expanded that dilates the stenosis. (c) Post-PTC
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An intracoronary stent.

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CORONARY ARTERY
BYPASS SURGERY
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NAME :Mrs.Indirani
AGE :71 years
DEMOGRAPHIC DATA
DIABETES MELLITUS- 15 years
HYPERTENSION - 2 years
CAD - 2 months
Has family history of diabetes mellitus
Diet history- non vegetarian( junk food
consumption, fat rich diet )
Life style- sedentary life style
HISTORY COLLECTION-HIGHLIGHTS

TRIPLE VESSEL DISEASE

GRAFT SITE

CORONARY ARTERY BYPASS
GRAFT
Thanks
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