00:01
So we think about the heart being
responsible for pumping blood
throughout all of our arteries
that it's easy to forget sometimes
that it's a muscle that
needs its own arteries.
00:11
So, that's why
we're going to talk about
the arteries supply
the heart itself,
the coronary arteries.
00:18
Last time, we mentioned there are
these holes that exist right above
the aortic valve called ostia.
00:25
We had one on the left called
the left coronary ostium.
00:28
And it's going to
feed coronary artery
called the left main
coronary artery.
00:34
Similar,
we had an opening on the right
called the right coronary ostium,
that's going to feed into
the right coronary artery.
00:42
And that other cusp, that's called
the posterior one is also called
the non coronary cusp because no
coronary arteries originate from it.
00:52
So let's look at the right
coronary artery and its branches.
00:56
So we have the right
coronary ostium on the aorta,
giving rise to the
right coronary artery
going down between the groove
that exists between the right
atrium and the right ventricle.
01:08
And it's giving off branches
along the way.
01:11
And one such branch
we see here is called
the right or acute marginal artery.
01:17
And if we swing around to
the posterior/inferior side,
we see again, that right or acute
marginal artery on the edge there.
01:26
And the right coronary artery
continues along
that groove between
atrium and ventricle
until it reaches that
groove we talked about
called the posterior
interventricular sulcus
that represents the groove
in between the atria.
01:42
And there, it usually forms the
posterior descending artery or PDA,
also known as the posterior
interventricular artery
because of its location.
01:54
And it's going to
go along that groove
along the inferior
portion of that septum
all the way out to the apex.
02:01
Now, I say this is formed by
the right coronary artery,
because that's the
usual orientation,
about 80% of the time,
that's what happens.
02:10
And if that is the case,
we say a heart is right dominant.
02:14
But a heart can have
its PDA supplied by
the left coronary system,
in which case
it's called left dominant.
02:23
And on rare occasions,
the PDA can be fed equally
by the right and left
in which case
it's called codominant.
02:32
And on the other side,
we have the left coronary
artery and its branches.
02:37
But in order to see that,
we're going to have to fade out
the left atrial appendage
to really see what's going on.
02:44
Here we have the left coronary
ostium coming off of the aorta,
giving rise to the
left main coronary artery.
02:52
In the same sort of distribution
that we saw for the right in that
groove between atrium and ventricle,
but it's going to be very short,
only about a centimeter
before it branches.
03:02
And one of those branches is
going to be a very prominent one
going down the anterior
interventricular sulcus.
03:08
Hence, one of its names
anterior interventricular artery
was more commonly known
as the left anterior
descending artery, or the LAD,
providing a lot of the blood
supply to the left ventricle.
03:21
The other branch is going
along that groove still,
between the atrium
and the ventricle,
that branch is going to be
called the circumflex artery,
because it's going to head
around to the posterior surface.
03:35
It's both of these arteries
are going to give off
some branches along the way.
03:38
Some of the important ones
are the diagonal branch or
branches that come off of the LAD
as they cover the surface
of the left ventricle.
03:47
And they're quite
important clinically,
because they're often involved
by atherosclerosis.
03:52
And the left ventricle,
well, that's the one that's pumping
all the blood out to the body.
03:56
So it's a really important
ventricle in that sense.
04:00
The circumflex is
giving off an artery
called the left or
obtuse marginal artery,
which you might imagine
is sort of a mirror image
of the right or acute
marginal artery.
04:11
Now that we've covered the arterial
supply of the heart itself.
04:15
We're going to have to deal with the
veins that drain the heart itself.
04:18
And we call those
the cardiac veins.
04:22
So if we again look
at the right side,
we see the right atrium
and that groove between
the right atrium and
ventricle or that sulcus,
and that's where the right
coronary artery was traveling.
04:36
Right in that same area,
we see some veins draining
the right ventricle called
anterior cardiac veins.
04:43
And these veins are
a little different
than the other ones we're
going to talk about,
because all the other ones
head towards
something called
the coronary sinus.
04:51
But the anterior cardiac veins,
they actually just take a shortcut
and go straight into the
right atrium themselves.
04:57
There's another vein down here
that we see
called the small cardiac vein.
05:02
And despite its name,
it actually does a lot of drainage.
05:05
And it's more typical in the
sense that it usually will drain
into that structure
we call the coronary sinus.
05:11
We swing around to
the posterior surface.
05:15
We see our right atrium where all
this venous blood is headed toward,
and the inferior vena cava.
05:21
That's providing the
deoxygenated blood from below.
05:25
And a little bit of
that small cardiac vein
we saw on the other side.
05:31
Now we see the largest vein,
in fact, the largest vessel
on the surface of the heart,
which is the coronary sinus.
05:38
Training most of the veins.
05:40
Again, other than the
anterior cardiac veins.
05:45
We see our coronary artery,
the posterior descending artery
running along the posterior
interventricular groove.
05:53
And it's got a vein
running right along with it
called the middle cardiac vein,
which is a pretty good name because
it's in between the ventricles.
So it's sort of in the middle.
06:03
So it's a descriptive
name in that sense.
06:06
We also see another big vein
here, that's descriptive,
because it's the posterior vein
of the left ventricle.
06:12
Tells you exactly where it is
and what it's draining.
06:16
And then a little
tiny bit of something
called the Great cardiac vein.
06:20
Doesn't look like much here.
06:22
And so why would it be called great
if it's just a tiny little thing?
Well, we have to swing around to the
other side to see the rest of it.
06:29
So if we look at it
from the left side,
where we have the left atrium,
and there's our inferior vena
cava, over on the right,
we have our coronary sinus
heading to that junction,
where the right atrium is going to
receive all of our venous blood.
06:45
And it's receiving this really big
thing called the Great cardiac vein.
06:49
And that's why it's called Great.
06:52
It's quite a bit larger
than the other ones.
06:53
And it makes sense because
we're on the left side now.
06:56
And so the left ventricle
is doing a lot more work.
06:58
It's a lot thicker than
the right ventricle.
07:00
It's pumping out
into the entire body
as opposed to just
out to the lungs.
07:05
So it's going to use more blood,
it's going to need
more venous drainage.
07:09
That's why the great cardiac vein
is so great.