BLOOD SUPPLY TO THE

HEART
RONO .W
ARTERIAL SUPPLY OF THE HEART

• The heart is mostly supplied by the two coronary arteries, which

arise from the ascending aorta immediately above the aortic valve.

• The coronary arteries and their branches run on the surface of

heart lying within the subpericardial fibrofatty tissue
RIGHT CORONARY ARTERY

ORIGIN
• The right coronary artery arises from the anterior aortic sinus of the ascending
aorta, immediately above the aortic valve.
COURSE
• After arising from the ascending aorta, the right coronary artery first runs
forwards between the pulmonary trunk and the right auricle, then it descends
almost vertically in the right atrioventricular groove (right anterior coronary
sulcus) up to the junction of the right and the inferior borders of the heart.
• At the inferior border of the heart, it turns posteriorly and runs in the posterior
atrioventricular groove (right posterior coronary sulcus) up to the posterior
interventricular groove where it terminates by anastomosing with the left
coronary artery.
BRANCHES AND DISTRIBUTION

• 1. Right conus artery: It supplies the anterior surface of the

pulmonary conus (infundibulum of the right ventricle).

• 2. Atrial branches: They supply the atria.

• One of the atrial branches—the artery of sinuatrial node (also

called sinuatrial nodal artery) supplies the SA node in 60% cases.
• In 40% of individuals it arises from the left coronary artery
CONT..
3. Anterior ventricular branches: They are two or three and
supply the anterior surface of the right ventricle.

• The marginal branch is the largest and runs along the lower
margin of the sternocostal surface to reach the apex.

4. Posterior ventricular branches: They are usually two and

supply the diaphragmatic surface of the right ventricle.
CONT…
• 5. Posterior interventricular artery: It runs in the posterior
interventricular groove up to the apex.
It supplies the:
• (a) posterior part of the interventricular septum,
• (b) atrioventricular node (AV node) in 60% of the cases, and
• (c) right and left ventricles.
LEFT CORONARY ARTERY

ORIGIN
• The left coronary artery arises from the left posterior aortic sinus of
the ascending aorta, immediately above the aortic valve.
COURSE
• After arising from ascending aorta, the left coronary artery runs
forwards and to the left between the pulmonary trunk and the left
auricle.

• It then divides into an anterior interventricular and circumflex

artery
CONT…
The anterior interventricular artery (left anterior descending/LAD)
runs downwards in the anterior interventricular groove to the apex of the
heart.
• It then passes posteriorly around the apex of the heart to enter the
posterior interventricular groove to terminate by anastomosing with the
posterior interventricular artery—a branch of right coronary artery.

• The circumflex artery winds around the left margin of the heart and
continues in the left posterior coronary sulcus up to the posterior
interventricular groove where it terminates by anastomosing with the
right coronary artery.
BRANCHES AND DISTRIBUTION

• 1. Anterior interventricular artery/left anterior descending

(LAD) artery:

• It supplies
(a) anterior part of interventricular septum,

(b) greater part of the left ventricle and part of right ventricle, and

(c) a part of left bundle branch (of His).

CONT….
• 2. Circumflex artery: It gives a left marginal artery that supplies
the left margin of the left ventricle up to the apex of the heart.

• 3. Diagonal artery: It may arise directly from the trunk of the left
coronary artery.

• 4. Conus artery: It supplies the pulmonary conus.

• 5. Atrial branches: They supply the left atrium.

VENOUS DRAINAGE OF THE HEART

Venous blood from the heart is drained into right atrium by the
following:
• 1. Coronary sinus.

• 2. Anterior cardiac veins.

• 3. Venae cordis minimae (Thebesian veins).

Cont…
1.Coronary sinus: It is the principal
vein of the heart.
• Most of the venous blood from the
walls of the heart is drained into the
right atrium through coronary sinus.
• The coronary sinus is the largest
vein of the heart and lies in the
posterior part of the atrioventricular
groove (left posterior coronary
sulcus).
• It develops from the left horn of the
sinus venosus and a part of the left
common cardinal vein.
Tributaries
• 1.Great cardiac vein: It
accompanies anterior
interventricular and
circumflex arteries to join the
left end of the coronary sinus.
• 2. Middle cardiac vein: It
accompanies the posterior
interventricular artery and
joins the coronary sinus near
its termination.
Cont…
• 3. Small cardiac vein: It
accompanies the right
ventricular artery in the
right posterior coronary
sulcus and the right end of
the coronary sinus.
• 4. Posterior vein of the
left ventricle: It runs on
the diaphragmatic surface
of the left ventricle and
joins the sinus to the left of
the middle cardiac vein.
CONT…
5. Oblique vein of the left atrium (vein of Marshall:it’s a small
vein which runs downwards on the posterior surface of the left
atrium to enter the left end of the coronary sinus.
• It develops from the left common cardial vein (duct of Cuvier).
6. Right marginal vein: It accompanies the marginal branch of the
right coronary artery and joins the small cardiac vein or drains
directly into the right atrium.
• 7. Left marginal vein: It accompanies the marginal branch of the
left coronary artery and drains into the coronary
CONT…
2.Anterior cardiac veins: These are series of small veins (3 or 4)
which run parallel to each other across the surface of right ventricle
to open into the right atrium.

3.Venae cordis minimae (Thebesian veins): These are extremely

small veins in the walls of all the four chambers of the heart. They
open directly into the respective chambers.

• They are most numerous in the in right atrium .

LYMPHATIC DRAINAGE OF THE HEART

• The lymphatics of the heart accompany the coronary arteries,

emerge from the fibrous pericardium along with the ascending
aorta and pulmonary trunk in the form of two trunks.
• The right trunk drains into brachiocephalic nodes and left
trunk drains into tracheobronchial nodes (at the bifurcation of
the aorta)
NERVE SUPPLY OF THE HEART

• The heart is supplied by sympathetic and parasympathetic fibers via the

superficial and deep cardiac plexuses formed by parasympathetic and
sympathetic fibers.
• The parasympathetic fibers are derived from vagus nerves.
• They are cardioinhibitory; hence their stimulation causes slowing of the
heart rate and constriction of the coronary arteries.
• The sympathetic fibers are derived from upper 3–5 thoracic spinal
segments.
• They are cardioacceleratory, hence their stimulation increase the heart
rate and causes the dilatation of the coronary arteries.
• The sympathetic fibers also cause dilatation of the coronary arteries.
CARDIAC PLEXUSES

SUPERFICIAL CARDIAC PLEXUS

• The superficial cardiac plexus. lies below the arch of aorta in front of the
bifurcation of pulmonary trunk, just to the right of ligamentum arteriosum.
• The cardiac ganglion (of Wrisberg) lies close to the ligamentum
arteriosum.
• It is formed by the
(a) superior cervical cardiac branch of left cervical sympathetic trunk, and

(b) inferior cervical cardiac branch of left vagus nerve.

.
CONT..
Distribution
• The superficial cardiac
plexus gives branches
to
• (a) deep cardiac
plexus,
• (b) right coronary
artery, and
• (c) left anterior
pulmonary plexus
DEEP CARDIAC PLEXUS
The deep cardiac plexus lies in front of the bifurcation of the
trachea, behind the arch of the aorta.
• It is formed by
(a) all the cardiac branches derived from three cervical and upper 4
or 5 thoracic ganglia of the sympathetic chains except the superior
cervical cardiac branch of left cervical
(b)all the cardiac branches of vagus and recurrent laryngeal nerves
except the inferior cervical cardiac branch of the left vagus nerve.
CONT…
Distribution
• The right and left halves of the plexus distributes branches to
(a) corresponding coronary arteries and pulmonary plexus, and

(b) separate branches to the atria.

PAIN AND REFLEX PATHWAYS OF THE HEART

PAIN PATHWAYS
• The sensations of pain arising due to the ischemia of the heart
pass through the sympathetic fibers to reach the upper five
thoracic spinal segments (T1–T5) through cervical and thoracic
sympathetic ganglia and follow the usual somatosensory pathway
to the central nervous system.
• The pain fibers pass from thoracic ganglia to the spinal nerves via
white rami communicantes
Cont…
• The cell bodies of the first order sensory neurons are located in
the dorsal root ganglia of T1–T5 spinal nerves.

• Hence cardiac pain is referred mainly in the area of distribution of

these nerves, i.e. pectoral region and medial aspect of the arm and
forearm.
PATHWAYS FOR CARDIOVASCULAR REFLEXES

• The afferent fibers from heart subserving the cardiovascular

reflexes pass by the parasympathetic fibers of vagal nerves to the
reticular formation