Coronary Circulation Anatomy: Everything You Need to Know

1. Definition

Coronary circulation is the blood supply system of the heart. It consists of arteries and veins that deliver oxygenated blood to the heart muscle (myocardium) and drain deoxygenated blood.


2. Origin of Coronary Arteries

  • Both right and left coronary arteries arise from the ascending aorta just above the aortic valve, from the right and left aortic sinuses.

3. Coronary Arteries

A. Right Coronary Artery (RCA)

  • Origin: Right aortic sinus
  • Branches:
    • Conus branch (to infundibulum of RV)
    • Right marginal artery (to right ventricle)
    • Posterior interventricular artery (in 85% of people)
  • Supplies:
    • Right atrium & ventricle
    • SA node (in 60% cases)
    • AV node (in 80% cases)
    • Posterior part of interventricular septum

B. Left Coronary Artery (LCA)

  • Origin: Left aortic sinus
  • Short main stem → divides into:
    • Left anterior descending (LAD) artery
      • Supplies anterior 2/3 of interventricular septum, anterior walls of ventricles
    • Circumflex artery
      • Gives left marginal artery
      • Supplies left atrium, lateral & posterior walls of left ventricle
  • SA node (in 40% cases, via circumflex)

Mnemonic for Branches:

“LAD supplies the LADder (septum), Circumflex circles around.”


4. Coronary Artery Dominance

Type

Based on origin of posterior interventricular artery

Right dominant (85%)

From RCA

Left dominant (8%)

From LCA (circumflex branch)

Co-dominant (7%)

From both RCA and LCA


5. Venous Drainage of Heart

Main vein: Coronary Sinus

  • Opens into right atrium
  • Receives:
    • Great cardiac vein (along LAD)
    • Middle cardiac vein (along posterior interventricular groove)
    • Small cardiac vein (along right margin)
    • Posterior vein of LV
    • Oblique vein of LA

Other veins:

  • Anterior cardiac veins → directly into right atrium
  • Thebesian veins → tiny veins draining directly into heart chambers

6. Functional Features

Feature

Description

End arteries

Coronary arteries have poor anastomosis

Max flow

Occurs during diastole

Autoregulated

Adjusted based on myocardial O₂ demand

7. Clinical Anatomy

Condition

Description

Angina pectoris

Chest pain due to reduced coronary blood flow

Myocardial infarction (MI)

Death of heart tissue due to blockage

Coronary artery bypass graft (CABG)

Surgery to bypass blocked arteries

Atherosclerosis

Fatty plaque buildup in coronary vessels



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