1. CORONARY VASCULATURE DR. NIVIN SHARAF MD LMCC

2. OBJECTIVES This lecture covers the ILO titled: Enlist the arteries, veins and nerves supplying the heart. By the end of this lecture we will be able to: Define Right/ left or Coronary co dominance Enlist areas of the heart supplied by the right andd left coronary arteries Define the origins of coronary artery Recognize innervation of the heart

3. ORIGIN

4. ORIGIN CONT.

7. LEFT CORONARY ARTERY

9. VENOUS DRAINAGE

10. VENOUS DRAINAGE CONT. The heart is drained by veins that empty in the coronary sinus, partly by small veins that empty in the right atrium Coronary sinus: Main vein of the heart Runs left to right in the coronary groove

11. CORONARY SINUS

12. INNERVATION OF THE HEART Autonomic nervous system from superficial and deep Cardiac plexuses Nerve networks lie anterior to the bifurcation of the trachea, posterior to ascending aorta Superior to bifurcation of Pulmonary trunk

13. INNERVATION OF THE HEART Parasympathetic supply: Presynaptic fibers of the vagus nerves Post synaptic fibers also end in the SA,& AV nodes, and directly on the coronary arteries Stimulation results in  Saving energy between periods of increased demands) Decreased heart rate Reduce the force of heart beats Constrics cornoray arteries

14. INNERVATION OF THE HEART CON. Sympathetic stimulation  Increases heart rate, and the force of contraction, and inhibits contraction of the coronary arteries”Passively dilates “ Presynaptic fibers with cell bodies in the lateral horn of T1-6 segments of spinal cord Postsynaptic: cervical, and superior thoracic prevertebral ganglia of the sympathetic trunk( end in SA, and AV nodal tissue)

17. LYMPHATIC TRAINAGE Subepicardial lymphatic plexus Pass to the coronary groove, and follow the coronary arterie End in the inferior tracheobronchial lymphnodes, usually on the right side

18. REFERENCES http://www.youtube.com/watch?v=Rcn3ZV-Iy6o Myocardial blood supply http://www.youtube.com/watch?v=tBQa8IBzP6I Anatomy of the heart http://www.youtube.com/watch?v=960_mAShiXQ Part II http://www.youtube.com/watch?v=Vr-DAhgq75w&feature=relmfu CLINICALLY ORIENTED ANATOMY FOURTH EDITION/ KEITH L. MOORE RECOMMENDED READING PAGES 132-139