For an introduction to anatomy and physiology of cardio-vascular system You need to visit the section "Anatomy of the cardiovascular system".

The blood supply to the heart is carried out through two main vessels - the right and left coronary arteries, starting from the aorta immediately above the semilunar valves.

Left coronary artery

The left coronary artery starts from the left posterior sinus of Vilsalva, goes down to the anterior longitudinal groove, leaving the pulmonary artery to the right, and the left atrium and the ear surrounded by adipose tissue, which usually covers it, to the left. It is a wide, but short trunk, usually no more than 10-11 mm long.

The left coronary artery is divided into two, three, in rare cases, four arteries, of which the anterior descending (LAD) and circumflex branch (OB), or arteries, are of the greatest importance for pathology.

The anterior descending artery is a direct continuation of the left coronary artery.

Along the anterior longitudinal cardiac sulcus, it goes to the region of the apex of the heart, usually reaches it, sometimes bends over it and passes to the back surface of the heart.

Several smaller lateral branches depart from the descending artery at an acute angle, which are directed along the anterior surface of the left ventricle and can reach the blunt edge; in addition, numerous septal branches depart from it, perforating the myocardium and branching in the anterior 2/3 of the interventricular septum. Lateral branches feed the anterior wall of the left ventricle and give branches to the anterior papillary muscle of the left ventricle. The superior septal artery gives a branch to the anterior wall of the right ventricle and sometimes to the anterior papillary muscle of the right ventricle.

Throughout the entire length of the anterior descending branch lies on the myocardium, sometimes plunging into it with the formation of muscle bridges 1-2 cm long. The rest of its anterior surface is covered with fatty tissue of the epicardium.

The envelope branch of the left coronary artery usually departs from the latter at the very beginning (the first 0.5-2 cm) at an angle close to a right one, passes in the transverse groove, reaches the blunt edge of the heart, goes around it, passes to the posterior wall of the left ventricle, sometimes reaches the posterior interventricular sulcus and in the form of the posterior descending artery goes to the apex. Numerous branches depart from it to the anterior and posterior papillary muscles, the anterior and posterior walls of the left ventricle. One of the arteries that feed the sinoauricular node also departs from it.

Right coronary artery

The right coronary artery originates in the anterior sinus of Vilsalva. First, it is located deep in adipose tissue to the right of pulmonary artery, goes around the heart along the right atrioventricular sulcus, passes to the posterior wall, reaches the posterior longitudinal sulcus, then, in the form of a posterior descending branch, descends to the apex of the heart.

The artery gives 1-2 branches to the anterior wall of the right ventricle, partly to the anterior septum, both papillary muscles of the right ventricle, the posterior wall of the right ventricle and the posterior interventricular septum; the second branch also departs from it to the sinoauricular node.

The main types of myocardial blood supply

There are three main types of myocardial blood supply: middle, left and right.

This subdivision is based mainly on variations in the blood supply to the posterior or diaphragmatic surface of the heart, since the blood supply to the anterior and lateral regions is fairly stable and not subject to significant deviations.

At middle type all three main coronary arteries are well developed and fairly evenly developed. The blood supply to the entire left ventricle, including both papillary muscles, and the anterior 1/2 and 2/3 of the interventricular septum is carried out through the system of the left coronary artery. The right ventricle, including both right papillary muscles and the posterior 1/2-1/3 septum, receives blood from the right coronary artery. This appears to be the most common type of blood supply to the heart.

At left type blood supply to the entire left ventricle and, in addition, to the entire septum and partially rear wall of the right ventricle is carried out due to the developed circumflex branch of the left coronary artery, which reaches the posterior longitudinal groove and ends here in the form of the posterior descending artery, giving part of the branches to the posterior surface of the right ventricle.

Right type observed with a weak development of the circumflex branch, which either ends without reaching the obtuse edge, or passes into the coronary artery of the obtuse edge, not spreading to the posterior surface of the left ventricle. In such cases, the right coronary artery, after leaving the posterior descending artery, usually gives a few more branches to the posterior wall of the left ventricle. In this case, the entire right ventricle, the posterior wall of the left ventricle, the posterior left papillary muscle and partly the apex of the heart receive blood from the right coronary arteriole.

Myocardial blood supply is carried out directly:

A) capillaries lying between the muscle fibers braiding them and receiving blood from the system coronary arteries through arterioles;

B) a rich network of myocardial sinusoids;

C) Viessant-Tebesia vessels.

With an increase in pressure in the coronary arteries and an increase in the work of the heart, the blood flow in the coronary arteries increases. The lack of oxygen also leads to a sharp increase in coronary blood flow. The sympathetic and parasympathetic nerves seem to have little effect on the coronary arteries, with their main action directly on the heart muscle.

Outflow occurs through the veins, which are collected in the coronary sinus

Venous blood in the coronary system is collected in large vessels usually located near the coronary arteries. Some of them merge, forming a large venous canal - the coronary sinus, which runs along the back surface of the heart in the groove between the atria and ventricles and opens into right atrium.

Intercoronary anastomoses play important role in the coronary circulation, especially in pathological conditions. There are more anastomoses in the hearts of people suffering from ischemic disease, so the closure of one of the coronary arteries is not always accompanied by necrosis in the myocardium.

In normal hearts, anastomoses are found only in 10-20% of cases, and they are of small diameter. However, their number and magnitude increase not only in coronary atherosclerosis, but also in valvular defects hearts. Age and gender by themselves have no effect on the presence and degree of development of anastomoses.

On this moment There are many variants of classifications of coronary arteries adopted in different countries and centers of the world. But, in our opinion, there are certain terminological differences between them, which creates difficulties in the interpretation of coronary angiography data by specialists of different profiles.

We have analyzed the literature on the anatomy and classification of the coronary arteries. Data from literary sources are compared with their own. A working classification of the coronary arteries has been developed in accordance with the nomenclature adopted in the English literature.

coronary arteries

From an anatomical point of view, the coronary artery system is divided into two parts - right and left. From a surgical standpoint, the coronary artery is divided into four parts: the left main coronary artery (trunk), the left anterior descending artery or anterior interventricular branch (LAD) and its branches, the left circumflex coronary artery (OC) and its branches, the right coronary artery (RCA) ) and its branches.

The large coronary arteries form an arterial ring and loop around the heart. The left circumflex and right coronary arteries are involved in the formation of the arterial ring, passing through the atrioventricular sulcus. The anterior descending artery from the system of the left coronary artery and the posterior descending artery from the system of the right coronary artery, or from the system of the left coronary artery - from the left circumflex artery with the left dominant type of blood supply participate in the formation of the arterial loop of the heart. The arterial ring and loop are a functional device for the development of collateral circulation of the heart.

The right coronary artery (right coronary artery) departs from the right sinus of Valsalva and passes in the coronary (atrioventricular) groove. In 50% of cases, immediately at the place of origin, it gives off the first branch - the branch of the arterial cone (conus artery, conus branch, CB), which feeds the infundibulum of the right ventricle. Its second branch is the sinoatrial node artery (S-A node artery, SNA), leaving from the right coronary artery back at a right angle into the gap between the aorta and the wall of the right atrium, and then along its wall to the sinoatrial node. As a branch of the right coronary artery, this artery occurs in 59% of cases. In 38% of cases, the artery of the sinoatrial node is a branch of the left circumflex artery. And in 3% of cases there is a blood supply to the sino-atrial node from two arteries (both from the right and from the circumflex). In the anterior part of the coronary sulcus, in the region of the acute edge of the heart, the right marginal branch departs from the right coronary artery (acute marginal artery, acute marginal branch, AMB), more often from one to three, which in most cases reaches the apex of the heart. Then the artery turns back, lies in the back of the coronary sulcus and reaches the "cross" of the heart (the intersection of the posterior interventricular and atrioventricular sulcus of the heart).

With the so-called right type of blood supply to the heart, observed in 90% of people, the right coronary artery gives off the posterior descending artery (PDA), which runs along the posterior interventricular groove for a different distance, giving branches to the septum (anastomosing with similar branches from the anterior descending artery, the latter usually longer than the first), the right ventricle and branches to the left ventricle. After the posterior descending artery (PDA) originates, the RCA continues beyond the cross of the heart as the right posterior atrioventricular branch along the distal part of the left atrioventricular sulcus, terminating in one or more posterolateral branches (posterolateral branches) feeding the diaphragmatic surface of the left ventricle. . On the posterior surface of the heart, immediately below the bifurcation, at the point of transition of the right coronary artery into the posterior interventricular sulcus, an arterial branch originates from it, which, piercing the interventricular septum, goes to the atrioventricular node - the artery of the atrioventricular node artery (AVN).

The branches of the right coronary artery vascularize: the right atrium, part of the anterior, the entire posterior wall of the right ventricle, a small portion of the posterior wall of the left ventricle, the interatrial septum, the posterior third of the interventricular septum, the papillary muscles of the right ventricle and the posterior papillary muscle of the left ventricle.

The left coronary artery (left coronary artery) originates from the left posterior surface of the aortic bulb and exits to left side coronal sulcus. Its main trunk (left main coronary artery, LMCA) is usually short (0-10 mm, diameter varies from 3 to 6 mm) and is divided into anterior interventricular (left anterior descending artery, LAD) and envelope (left circumflex artery, LCx) branches . In 30-37% of cases, the third branch departs here - the intermediate artery (ramus intermedius, RI), which crosses obliquely the wall of the left ventricle. LAD and OB form an angle between them, which varies from 30 to 180°.

Anterior interventricular branch

The anterior interventricular branch is located in the anterior interventricular sulcus and goes to the apex, giving off the anterior ventricular branches (diagonal, diagonal artery, D) and the anterior septal (septal branch)) along the way. In 90% of cases, one to three diagonal branches are determined. Septal branches depart from the anterior interventricular artery at an angle of approximately 90 degrees, perforate the interventricular septum, feeding it. The anterior interventricular branch sometimes enters the thickness of the myocardium and again lies in the groove and often reaches the apex of the heart along it, where in about 78% of people it turns back to the diaphragmatic surface of the heart and for a short distance (10-15 mm) rises up along the posterior interventricular groove. In such cases, it forms a posterior ascending branch. Here it often anastomoses with the terminal branches of the posterior interventricular artery, a branch of the right coronary artery.

circumflex artery

The circumflex branch of the left coronary artery is located in the left part of the coronary sulcus and in 38% of cases gives the first branch to the artery of the sinoatrial node, and then the artery of the obtuse marginal artery (obtuse marginal artery, obtuse marginal branch, OMB), usually from one to three. These fundamentally important arteries feed the free wall of the left ventricle. In the case when there is a right type of blood supply, the circumflex branch gradually becomes thinner, giving branches to the left ventricle. With a relatively rare left type (10% of cases), it reaches the level of the posterior interventricular sulcus and forms the posterior interventricular branch. With an even rarer, so-called mixed type there are two posterior ventricular branches of the right coronary and circumflex arteries. The left circumflex artery forms important atrial branches, which include the left atrial circumflex artery (LAC) and the large anastomosing auricular artery.

The branches of the left coronary artery vascularize the left atrium, the entire anterior and most of the posterior wall of the left ventricle, part of the anterior wall of the right ventricle, the anterior 2/3 of the interventricular septum, and the anterior papillary muscle of the left ventricle.

Types of blood supply to the heart

The type of blood supply to the heart is understood as the predominant distribution of the right and left coronary arteries on the posterior surface of the heart.

The anatomical criterion for assessing the predominant type of distribution of the coronary arteries is the avascular zone on the posterior surface of the heart, formed by the intersection of the coronary and interventricular sulci - crux. Depending on which of the arteries - right or left - reaches this zone, the predominant right or left type of blood supply to the heart is distinguished. The artery reaching this zone always gives off a posterior interventricular branch, which runs along the posterior interventricular sulcus towards the apex of the heart and supplies blood to the posterior part of the interventricular septum. Another anatomical feature is described to determine the predominant type of blood supply. It is noted that the branch to the atrioventricular node always departs from the predominant artery, i.e. from the artery, which is of the greatest importance in the supply of blood to the posterior surface of the heart.

Thus, with the predominant right type of blood supply to the heart, the right coronary artery supplies the right atrium, the right ventricle, the posterior part of the interventricular septum, and the posterior surface of the left ventricle. The right coronary artery is represented by a large trunk, and the left circumflex artery is poorly expressed.

With the predominant left type of blood supply to the heart, the right coronary artery is narrow and ends in short branches on the diaphragmatic surface of the right ventricle, and the posterior surface of the left ventricle, rear end the interventricular septum, the atrioventricular node and most of the posterior surface of the ventricle receive blood from the well-defined large left circumflex artery.

In addition, a balanced type of blood supply is also distinguished, in which the right and left coronary arteries contribute approximately equally to the blood supply to the posterior surface of the heart.

The concept of "predominant type of blood supply to the heart", although conditional, is based on anatomical structure and distribution of the coronary arteries in the heart. Since the mass of the left ventricle is much larger than the right one, and the left coronary artery always supplies blood to most of the left ventricle, 2/3 of the interventricular septum and the wall of the right ventricle, it is clear that the left coronary artery is predominant in all normal hearts. Thus, in any type of coronary blood supply, the left coronary artery is predominant in the physiological sense.

Nevertheless, the concept of "the predominant type of blood supply to the heart" is valid, is used to assess anatomical findings during coronary angiography and has a large practical value when determining indications for myocardial revascularization.

For topical indication of lesions, it is proposed to divide the coronary bed into segments.

Dotted lines in this scheme highlight the segments of the coronary arteries.

Thus, in the left coronary artery in the anterior interventricular branch, it is distinguished by three segments:

1. proximal - from the place of origin of the LAD from the trunk to the first septal perforator or 1DV.
2. medium - from 1DV to 2DV.
3. distal - after the discharge of 2DV.

In the circumflex artery, it is also customary to distinguish three segments:

1. proximal - from the mouth of the OB to 1 VTK.
2. medium - from 1 VTK to 3 VTK.
3. distal - after the discharge of 3 VTC.

The right coronary artery is divided into the following main segments:

1. proximal - from the mouth to 1 wok
2. medium - from 1 wok to the sharp edge of the heart
3. distal - up to the RCA bifurcation to the posterior descending and posterolateral arteries.

Coronary angiography

Coronary angiography (coronary angiography) is an X-ray visualization of the coronary vessels after the introduction of a radiopaque substance. The x-ray image is immediately recorded on 35 mm film or digital media for further analysis.

Currently, coronary angiography is the "gold standard" for determining the presence or absence of stenosis in coronary disease.

The purpose of coronary angiography is to determine coronary anatomy and the degree of narrowing of the lumen of the coronary arteries. Information obtained during the procedure includes determining the location, extent, diameter and contours of the coronary arteries, the presence and degree of coronary obstruction, characterization of the nature of the obstruction (including the presence of an atherosclerotic plaque, thrombus, dissection, spasm or myocardial bridge).

The data obtained determine the further tactics of the patient's treatment: coronary bypass grafting, intervention, drug therapy.

To conduct high-quality angiography, selective catheterization of the right and left coronary arteries is necessary, for which a large number of diagnostic catheters of various modifications have been created.

The study is performed under local anesthesia and NLA through arterial access. The following arterial accesses are generally recognized: femoral arteries, brachial arteries, radial arteries. Transradial access to Lately won a strong position and became widely used due to its low trauma and convenience.

After puncture of the artery, diagnostic catheters are inserted through the introducer, followed by selective catheterization of the coronary vessels. The contrast agent is dosed using an automatic injector. Shooting is performed in standard projections, the catheters and intraduser are removed, and a compression bandage is applied.

Basic angiographic projections

During the procedure, the goal is to obtain the most complete information about the anatomy of the coronary arteries, their morphological characteristics, the presence of changes in the vessels with an accurate determination of the location and nature of the lesions.

To achieve this goal, coronary angiography of the right and left coronary arteries is performed in standard projections. (Their description is given below). If it is necessary to conduct a more detailed study, shooting is carried out in special projections. This or that projection is optimal for the analysis of a certain section of the coronary bed and allows you to most accurately identify the features of the morphology and the presence of pathology in this segment.
Below are the main angiographic projections with an indication of the arteries for visualization of which these projections are optimal.

For the left coronary artery, the following standard projections exist.

1. Right anterior oblique with caudal angulation.
RAO 30, Caudal 25.
OV, VTK,

2. Right anterior oblique view with cranial angulation.
RAO 30, cranial 20
LAD, its septal and diagonal branches

3. Left anterior oblique with cranial angulation.
LAO 60, cranial 20.
Orifice and distal segment of the LCA trunk, middle and distal segment of the LAD, septal and diagonal branches, proximal segment of the OB, VTK.

4. Left anterior oblique with caudal angulation (spider).
LAO 60, caudal 25.
LCA trunk and proximal LAD and OB segments.

5. To determine the anatomical relationships, a left lateral projection is performed.

For the right coronary artery, images are taken in the following standard projections.

1. Left oblique projection without angulation.
LAO 60, straight.
Proximal and middle segment of RCA, VOC.

2. Left oblique with cranial angulation.
LAO 60, cranial 25.
The middle segment of the RCA and the posterior descending artery.

3. Right oblique without angulation.
RAO 30, straight.
Middle segment of the RCA, branch of the conus arteriosus, posterior descending artery.

Professor, Dr. med. Sciences Yu.P. Ostrovsky

The coronary arteries are the vessels that provide the heart muscle with the necessary nutrition. Pathologies of these vessels are very common. They are considered one of the main causes of death in the elderly.

The scheme of the coronary arteries of the heart is branched. The network includes large branches and a huge number of small vessels.

The branches of the arteries originate from the aortic bulbs and go around the heart, providing an adequate supply of blood. different areas hearts.

Vessels consist of endothelium, muscular fibrous layer, adventitia. Due to the presence of such a number of layers, the arteries are characterized by high strength and elasticity. This allows blood to move normally through the vessels even if the load on the heart is increased. For example, during training, when athletes' blood moves five times faster.

Types of coronary arteries

The entire arterial network consists of:

• main vessels;
• adnexal.

The last group includes such coronary arteries:

1. Right. She is responsible for the flow of blood to the cavity of the right ventricle and the septum.
2. Left. From her blood comes to all departments. It is divided into several parts.
3. bending branch. It departs from the left side and provides nutrition to the septum between the ventricles.
4. Anterior descending. Thanks to it, nutrients enter different parts of the heart muscle.
5. Subendocardial. They pass deep into the myocardium, and not on its surface.

The first four views are located on top of the heart.

Types of blood flow to the heart

There are several options for blood flow to the heart:

1. Right. This is the dominant view if this branch originates from the right artery.
2. Left. This method of nutrition is possible if the posterior artery is a branch of the circumflex vessel.
3. Balanced. This type is isolated if blood flows simultaneously from the left and right arteries.

Most people have the right type of blood supply.

Possible pathologies

The coronary arteries are blood vessels that provide the vital organ with sufficient oxygen and nutrients. The pathologies of this system are considered one of the most dangerous, as they gradually lead to more serious illnesses.

angina pectoris

The disease is characterized by attacks of suffocation with severe pain in the chest. This condition develops when the vessels are affected by atherosclerosis and the heart does not receive enough blood.

Pain is associated with oxygen starvation heart muscle. Physical and mental stress, stress and overeating aggravate the symptoms.

myocardial infarction

This is a dangerous problem in which certain parts of the heart die. The condition develops when the blood supply stops completely. This usually occurs when the coronary arteries of the heart are clogged with a blood clot. Pathology has vivid manifestations:

The area that was subject to necrosis can no longer contract, but the rest of the heart works as before. Because of this, the damaged area may rupture. Lack of medical assistance will lead to the death of the patient.

Causes of defeat

Damage to the coronary arteries in most cases is associated with insufficient attention to the state of one's own health.

Every year, such violations lead to the death of millions of people around the world. At the same time, most people are residents of developed countries and are well off.

The provoking factors contributing to violations are:

Not less than important influence render age-related changes, hereditary predisposition, gender. Such diseases in an acute form affect men, so they die from them much more often. Women are more protected due to the influence of estrogen, so they are more likely to have a chronic course.

Blood, thanks to the "internal motor" - the heart, circulates through the body, saturating each of its cells with nutrients and oxygen. And how does the heart itself receive nourishment? Where does it draw reserves and strength for work? And do you know about the so-called third circle of blood circulation or cardiac? For a better understanding of the anatomy of the vessels that supply the heart, let's look at the main anatomical structures that are usually distinguished in the central organ of the cardiovascular system.

1 External device of the human "motor"

First-year students of medical colleges and medical universities memorize by heart, and even in Latin, that the heart has an apex, a base and two surfaces: anterior-upper and lower, separated by edges. With the naked eye, you can see the cardiac grooves by looking at its surface. There are three of them:

1. coronal furrow,
2. anterior interventricular,
3. Posterior interventricular.

The atria are visually separated from the ventricles by the coronal sulcus, and the border between the two lower chambers along the anterior surface is tentatively the anterior interventricular sulcus, and along the posterior interventricular posterior sulcus. The interventricular grooves join at the apex slightly to the right. These furrows were formed due to the vessels lying in them. In the coronal sulcus, which separates the cardiac chambers, there is the right coronary artery, the sinus of the veins, and in the anterior interventricular sulcus, which separates the ventricles, there is a large vein and the anterior interventricular branch.

The posterior interventricular sulcus is the receptacle for the interventricular branch of the right coronary artery, the middle cardiac vein. From the abundance of numerous medical terminology, the head can go round: furrows, arteries, veins, branches ... Still, we are analyzing the structure and blood supply of the most important human organ - the heart. If it had been arranged in a simpler way, would it have been able to perform such a complex and responsible job? Therefore, we will not give up halfway, and analyze in detail the anatomy of the vessels of the heart.

2 3rd or cardiac circulation

Every adult knows that there are 2 circles of blood circulation in the body: large and small. But anatomists say that there are three of them! So, is the basic anatomy course misleading people? Not at all! The third circle, figuratively named, refers to the blood vessels that fill and “serve” the heart itself. It deserves personal vessels, doesn't it? So, the 3rd or cardiac circle begins with the coronary arteries, which are formed from the main vessel human body- Her Majesty's aorta, and ends with cardiac veins that merge into the coronary sinus.

It in turn opens in . And the smallest venules open into the atrial cavity on their own. It was noticed very figuratively that the vessels of the heart entwine, envelop it like a real crown, a crown. Therefore, the arteries and veins are called coronary or coronary. Note: These are synonymous terms. So what are major arteries and veins has the heart at its disposal? What is the classification of the coronary arteries?

3 Major arteries

The right coronary artery and the left coronary artery are two pillars that deliver oxygen and nutrients. They have branches and branches, which we will discuss next. In the meantime, let us understand that the right coronary artery is responsible for the blood supply to the right heart chambers, the walls of the right ventricle and the posterior wall of the left ventricle, and the left coronary artery supplies the left heart sections.

The right coronary artery goes around the heart along the coronary sulcus on the right, gives off the posterior interventricular branch (posterior descending artery), which descends to the apex, located in the posterior interventricular sulcus. The left coronary also lies in the coronary groove, but on the other, opposite side - in front of the left atrium. It is divided into two major branches - the anterior interventricular (anterior descending artery) and circumflex artery.

The path of the anterior interventricular branch runs in the depression of the same name, to the apex of the heart, where our branch meets and merges with a branch of the right coronary artery. And the left circumflex artery continues to "hug" the heart on the left along the coronary sulcus, where it also combines with the right coronary. Thus, nature created on the surface of the human "motor" an arterial ring of coronary vessels in a horizontal plane.

This is an adaptive element, in case a vascular accident suddenly occurs in the body and blood circulation deteriorates sharply, then despite this, the heart will be able to maintain blood supply and its work for some time, or if one of the branches is blocked by a thrombus, the blood flow will not stop, but will go differently heart vessel. The ring is the collateral circulation of the organ.

The branches and their smallest branches penetrate the entire thickness of the heart, supplying blood not only to the upper layers, but to the entire myocardium, and the inner lining of the chambers. Intramuscular arteries follow the course of the muscular heart bundles, each cardiomyocyte is saturated with oxygen and nutrition due to a well-developed system of anastomoses and arterial blood supply.

It should be noted that in a small percentage of cases (3.2-4%), people have such an anatomical feature as a third coronary artery or an additional one.

4 Forms of blood supply

There are several types of blood supply to the heart. All of them are a variant of the norm and a consequence individual features bookmarks of the vessels of the heart and their functioning in each person. Depending on the prevailing distribution of one of the coronary arteries on the posterior heart wall, there are:

1. Legal type. With this type of blood supply to the heart, the left ventricle (the back surface of the heart) is filled with blood mainly due to the right coronary artery. This type of blood supply to the heart is the most common (70%)
2. Left-handed type. Occurs if the left coronary artery prevails in the blood supply (in 10% of cases).
3. Uniform type. With an approximately equivalent "contribution" to the blood supply of both vessels. (20%).

5 Major veins

Arteries branch into arterioles and capillaries, which, having completed cellular exchange, and taking decay products and carbon dioxide from cardiomyocytes, are organized into venules, and then more large veins. Venous blood can flow into the venous sinus (from which the blood then enters the right atrium), or into the atrial cavity. The most significant cardiac veins that pour blood into the sinus are:

1. Big. picks up venous blood from the anterior surface of the two lower chambers, lies in the interventricular anterior sulcus. The vein starts at the top.
2. Average. It also originates at the top, but runs along the back furrow.
3. Small. It can flow into the middle, is located in the coronal sulcus.

The veins that drain directly into the atria are the anterior and smallest cardiac veins. The smallest veins are not named so by chance, because the diameter of their trunks is very small, these veins do not appear on the surface, but lie in the deep tissues of the heart and open mainly into the upper chambers, but can also pour into the ventricles. The anterior cardiac veins supply blood to the right upper chamber. So, in the most simplified way, you can imagine how the blood supply to the heart occurs, the anatomy of the coronary vessels.

Once again, I would like to emphasize that the heart has its own, personal, coronary circle of blood circulation, thanks to which a separate blood circulation can be maintained. The most important cardiac arteries are the right and left coronary arteries, and the veins are large, medium, small, and anterior.

6 Diagnosis of coronary vessels

Coronary angiography is the "gold standard" in the diagnosis of coronaries. This is the most exact method, it is produced in specialized hospitals highly qualified medical workers, the procedure is performed according to indications, under local anesthesia. Through the artery of the arm or thigh, the doctor inserts a catheter, and through it a special radiopaque substance, which, mixing with blood, spreads, making both the vessels themselves and their lumen visible.

Photographs and video recording of the filling of vessels with a substance are made. The results allow the doctor to make a conclusion about the patency of the vessels, the presence of pathology in them, to assess the prospect of treatment and the possibility of recovery. Also to diagnostic methods studies of coronary vessels include MSCT - angiography, ultrasonography with doppler, electron beam tomography.

Anatomy of the coronary circulation highly variable. Features of the coronary circulation of each person are unique, like fingerprints, therefore, each myocardial infarction is "individual". The depth and prevalence of a heart attack depend on the interweaving of many factors, in particular on congenital anatomical features coronary bed, the degree of development of collaterals, the severity of atherosclerotic lesions, the presence of "prodromes" in the form of angina pectoris, which first appeared during the days preceding the infarction (ischemic "training" of the myocardium), spontaneous or iatrogenic reperfusion, etc.

As is known, heart receives blood from two coronary (coronary) arteries: the right coronary artery and the left coronary artery [respectively a. coronaria sinistra and left coronary artery (LCA)]. These are the first branches of the aorta that depart from its right and left sinuses.

Barrel LKA[in English - left main coronary artery (LMCA)] departs from the upper part of the left aortic sinus and goes behind the pulmonary trunk. The diameter of the LCA trunk is from 3 to 6 mm, the length is up to 10 mm. Usually the trunk of the LCA is divided into two branches: the anterior interventricular branch (AMV) and the circumflex (Fig. 4.11). In 1/3 of cases, the LCA trunk is divided not into two, but into three vessels: the anterior interventricular, circumflex, and median (intermediate) branches. In this case, the median branch (ramus medianus) is located between the anterior interventricular and envelope branches of the LCA.
This vessel- analogue of the first diagonal branch (see below) and usually supplies the anterolateral sections of the left ventricle.

Anterior interventricular (descending) branch of the LCA follows the anterior interventricular sulcus (sulcus interventricularis anterior) towards the apex of the heart. In English literature, this vessel is called the left anterior descending artery: left anterior descending artery (LAD). We will adhere to the more accurate anatomically (F. H. Netter, 1987) and the term "anterior interventricular branch" accepted in the domestic literature (O. V. Fedotov et al., 1985; S. S. Mikhailov, 1987). At the same time, when describing coronarograms, it is better to use the term "anterior interventricular artery" to simplify the name of its branches.

main branches latest- septal (penetrating, septal) and diagonal. The septal branches depart from the PMA at a right angle and deepen into the thickness of the interventricular septum, where they anastomose with similar branches extending from below the posterior interventricular branch of the right coronary artery (RCA). These branches may differ in number, length, direction. Sometimes there is a large first septal branch (going either vertically or horizontally - as if parallel to the PMA), from which branches extend to the septum. Note that of all areas of the heart, the interventricular septum of the heart has the thickest vascular network. The diagonal branches of the PMA run along the anterolateral surface of the heart, which they supply with blood. There are from one to three such branches.

In 3/4 cases of PMV does not end in the region of the apex, but, bending around the latter on the right, wraps itself on the diaphragmatic surface of the posterior wall of the left ventricle, supplying both the apex and partially the posterior diaphragmatic sections of the left ventricle, respectively. This explains the emergence of wave ECG Q in lead aVF in a patient with extensive anterior infarction. In other cases, ending at the level or not reaching the apex of the heart, PMA does not play a significant role in its blood supply. Then the apex receives blood from the posterior interventricular branch of the RCA.

proximal area front The interventricular branch (PMV) of the LCA is called the segment from the mouth of this branch to the origin of the first septal (penetrating, septal) branch or to the origin of the first diagonal branch (less stringent criterion). Accordingly, the middle section is a segment of the PMA from the end of the proximal section to the departure of the second or third diagonal branch. Next is the distal section of the PMA. When there is only one diagonal branch, the boundaries of the middle and distal sections are approximately defined.

Educational video of the blood supply of the heart (anatomy of arteries and veins)

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