Coronary arteries. Heart vessels Right coronary artery of the heart

The right coronary artery originates from the right sinus of Valsalva, is clearly visible and can be easily catheterized in the left oblique projection. In this projection, the right coronary artery is directed at an acute angle to the left of the observer for several millimeters, approaches the sternum and then turns downward, following in the right atrioventricular groove towards the acute edge of the heart and the diaphragm (Fig. 3). After the RCA reaches the sharp edge of the heart, it turns back and travels along the posterior atrioventricular groove towards the cross of the heart. In the left oblique projection, this change in direction appears as a slight angle, sometimes crossed by a branch of a sharp edge.

In the right oblique projection, this angle is sharper (Figure 4).

In 84% of cases, RCA reaches the cross of the heart and then gives rise to LAD, LA, AV, and left ventricular branches. In 12% of cases, RCA may not even reach the cross of the heart, but, which is important, it goes parallel with the branch to the OC. In the remaining 4% of cases, both LAD are present, one of the right the other of the OV.

From a surgical point of view, the RCA is divided into three segments: the proximal segment - from the orifice to the pronounced right ventricular branch, the middle segment - from the RV branch to the sharp edge, and the distal segment - from the acute edge to the beginning of the IVV. ZMZHV is considered the fourth and last segment of the RCA (Fig. 5).

Normal RCA in the proximal and middle segment is well defined and usually exceeds 2–3 mm in diameter. In the direction from the orifice, the main branches of the RCA are as follows: conical branch, sinus c., Right ventricular branch, branch of the acute edge, PWV, ZMZHV, AV-branch, left atrial c.

In almost 60% of cases, the first branch of the RCA is cone branch... In the remaining 40%, it begins with a separate mouth at a distance of one millimeter from the mouth of the PKA (Fig. B). Whenever a tapered branch departs on its own, it does not fill up or fills poorly with selective coronary angiography. Since the ostium is small, catheterization is usually difficult, although possible.

The conical branch is a rather small vessel that goes in the opposite direction from the RCA and runs ventrally, bending around the excretory tract of the right ventricle approximately at the level of the pulmonary artery valves.

fig. 6

In the right oblique projection, it goes to the right (Fig. 7). The distal parts of this branch can connect with the branches of the LCA, forming a Vujens circle. IN normal heart This network of collaterals is not always detected angiographically, but becomes visible and becomes of great importance in the case of RCA occlusion or LAD lesion, which contributes to the preservation of blood flow distal to the occlusion.

fig. 7

In the left oblique view, the tapered branch appears to be an extension of the catheter tip, follows towards the sternum, often curving upward, mainly heading towards the upper left corner of the frame.

In most cases, this vessel divides into two branches and is directed by a short segment down and to the right of the observer.

The second branch of the PKA, or the first in the case when the conical branch departs as an independent mouth, is also of great importance. This is the branch of the sinus node, which departs from the RCA in 59%, and in 39% of the OS.

In a small percentage of cases (2%), there are two branches of the SU, one of which starts from the PCA, the other from the OV. When the branch of the sinus node is a branch of the RCA, it usually departs from the proximal segment and goes in the opposite direction from the conical branch, i.e., cranial, dorsal and right. The sinus branch is divided into two independent branches, which are usually well contrasting and have a relatively standard configuration and distribution The one that goes up and then makes a loop is actually the branch of the sinus node (supplying it with blood), and the branch that goes back is the left atrial branch.

The direction of this branch in the left oblique projection is towards the right edge of the frame (Fig. 9A and B).

When the sinus branch is visible in the left oblique projection, its division resembles a wide -U "or, more precisely, the shape of ram's horns. The horn, which is located to the left of the observer, bends around the superior vena cava and passes through the sinus node, while the other, heading to the right, blood supply to the superior and posterior walls of the left atrium. Fig. 9B shows how the branches of the sinus artery are distributed. The cone branch is also shown here. It can be easily identified as it departs in the opposite direction from the artery of the sinus node, i.e. to the left from the observer towards the excretory tract of the right ventricle and pulmonary artery.

The branch of the sinus node in the right oblique projection is directed to the upper left corner of the frame (Fig. 10). This branch approaches the mouth of the superior vena cava and bends around this vessel clockwise or counterclockwise. As already mentioned, the branches to the right and left atrium begin from this vessel. These branches play an important role in the case of occlusion of the RCA or OV, since they carry out collateral blood flow to the OV or to the distal parts of the RCA.

fig. ten

When the branch of the sinus node is a branch of the LCA, very often it departs from the proximal segment 0B. It rises to the right, below the left atrial appendage and behind the aorta, passes through the posterior wall of the left atrium and reaches the atrial septum. It ends around the base of the superior vena cava, in the same way as if it departed from the RCA. In the case when the artery of the sinus node departs from the OS, it plays an important role in ensuring collateral blood flow in the case of RCA or LCA occlusion. Sometimes the sinus branch can branch off from the distal RCA or OV.

The case shown in Fig. 11A is an example of how the sinus branch starts from the distal RCA. In this case, the terminal atrial branch of the RCA continues to the posterior atrioventricular groove, then rises along the posterior wall of the left atrium, crosses the entire posterior wall of the right atrium and reaches the sinus node region behind it.

Figure: 11B shows another case of an unusual branch of the sinus node, in which it departs slightly distal to the branch of the sharp edge, then follows the lateral and posterior wall of the right atrium, reaching the sinus node and the left atrium.

fig. 11B

In fig. 12 shows another case, shown in the right oblique projection, in which the EA branch departs from the middle third of the PKA.

Heading towards the anterolateral part of the atrioventricular groove, RCA gives rise to one or more right ventricular branches extending to the wall of the right ventricle. The number and size of these branches is very diverse. They often reach the interventricular sulcus and anastomose with the branches of the LAD in case of occlusion. In the right oblique projection, they depart from the PKA at an angle open to the right (Fig. 13)

In the left oblique projection, they are directed to the sternum, as shown in Fig. 14. Here, in descending order from the left edge of the frame, we see a conical branch, the first right ventricular branch, which goes up and then turns inward. Finally, the other two right ventricular branches are directed forward and downward.

Another example of right ventricular branches is shown in the left oblique projection in Fig. 15. In most cases, the inferior of the two right ventricular branches can be described as a sharp-edged branch, since its orifice and distribution in the wall of the right ventricle is almost the same.

A branch of the sharp edge is a relatively large and permanent right ventricular branch that starts from the RCA at the level of the lower part of the right atrium, from the sharp edge of the heart or slightly below. This branch goes to the top. Figure: 16 shows a variant when the VOC (in the left oblique projection) departs from the RCA at the level of the sharp edge and is represented by a rather extended and large vessel, which is directed to the base of the frame, along its left edge.

In the next example in Fig. 17 branch of the sharp edge begins proximal to it and goes to the apex of the right ventricle, having an oblique direction to the left bottom corner frame. The right ventricular branches, the conical branch and the branch of the sharp edge can be represented by at least two, at most seven vessels, but usually three to five.

In 12% of cases, RCA is a small vessel that gives off branches to the right atrium and the anterior wall of the right ventricle, and then ends at or above the sharp edge of the heart (Fig. 18).

The right atrial artery departs approximately at the level of the sharp edge of the heart, but goes in the opposite direction, cranially and towards the right edge of the heart (in the left oblique projection, to the right of the observer, and in the right oblique projection to the left). Branches from the artery of the sinus node are suitable for this vessel and, in the case of occlusion of the proximal segment of the RCA, it is a bypass anastomosis.

Figure: 19 shows a typical PKA case. It is shown in the right oblique projection and gives rise to the small conical and right ventricular branches.

Another example of a non-dominant RCA is shown in the right oblique projection in Fig. 20. After a very short segment, the RCA divides into three small branches of approximately the same diameter. The top one, which heads towards the top left corner of the frame, is a sine branch. The other two are the right ventricular branches. You can also see several well-defined vessels - one of them is a conical branch, and the other right atrial branches.

The distal third of the RCA gives several branches to the posterior wall of the left ventricle. Note the characteristic inverted Y "-like loop formed by the RCA in the interventricular groove below the posterior interventricular vein. This loop is often seen in the anteroposterior and left oblique views (Fig. 21). ), although it can only be seen in the right oblique projection.

In the left oblique projection, the RCA continues to the posterior wall of the heart to the place where the interatrial and interventricular grooves intersect at right angles the atrioventricular groove (the so-called cross of the heart "). Here the right coronary artery forms an inverted-U" branch of the AV node, ZMZHV, left ventricular and left atrial branches. The branch of the AV node is usually a thin and rather long vessel, which in most cases runs vertically (in the left oblique projection), heading towards the center of the heart shadow (Fig. 22). This vessel, like other posterior right coronary branches, is not clearly visible in the right oblique projections due to their overlap with larger vessels - the RCA itself or the left atrial branches. This part of the RCA is a very important landmark, since it is easily recognized and can serve to determine the predominant role of RCA in the blood supply to the posterior part of the interventricular septum and the posterior wall of the left ventricle.

The most important branch of the RCA, starting at the level of the cross of the heart, more often proximal to the “Y” -loop, is the ZM-VV, from which the septal arteries depart, which are the only arteries that supply blood to the upper part of the interventricular septum. ZMZHV is significantly shortened in the left oblique projection, since it is directed simultaneously down and towards the observer (Figs. 22 and 23).

The right oblique projection is most convenient for determining the LMZ. Although confusion may arise in this projection due to the overlapping of the branches of the sharp edge and the distal left ventricular branches, IVV can be identified by short septal branches extending at right angles and heading into the thickness of the postero-superior part of the interventricular septum (Figure 24). An anteroposterior projection that may be useful in identifying LAD is anteroposterior, possibly with a slight obstruction to the right to separate the LAD from other ventricular branches and the spine.

Prolonged imaging until the parenchymal phase is obtained is a very useful way to determine that the zone of the interventricular sulcus is supplying blood to the IVLV (Fig. 25). In the form of a triangle, that part of the interventricular septum, which is supplied with blood by the IVF (in the right oblique projection), will stand out. The base of the triangle is on the diaphragm, the leg is adjacent to the spine, and the hypotenuse is located on top and contacts that part of the non-contrasting interventricular septum, which is supplied with blood by the LAD.

In 70%, LMZH does not reach the apex of the heart, but continues for approximately two-thirds of the posterior interventricular sulcus. The posterior part of the interventricular septum, adjacent to the apex, is supplied with blood by the return branch of the LAD. Sometimes the LMV is a very short vessel that supplies blood only to the postero-superior portion of the septum (Fig. 26). In this case, the rest of the posterior part of the interventricular septum is supplied with blood by the branch of the OB or, more rarely, by the distal segment of the branch of the sharp edge.

Sometimes, two vessels run parallel in the posterior interventricular sulcus if their mouths are close to each other. In several cases, these branches start from the distal RCA, midway between the sharp edge and the posterior interventricular groove (Fig. 27).

When there are two branches, the proximally outgoing LMV is directed at an angle along the posterior wall of the right ventricle and reaches the posterior interventricular sulcus and then follows towards the apex (Fig. 28).

In such cases, the postero-superior part of the interventricular septum is supplied with blood by the more distally located IVV, while the postero-inferior part of the interventricular septum is supplied with blood by the proximally located IVV (Fig. 29).

In a small number of cases - in 3% - PCA, even without reaching a sharp edge, is divided into two branches of approximately equal diameter. The superior and more neutral one runs along the atrioventricular sulcus, reaches the posterior wall of the heart, and gives rise to the LAD. The lower branch, running diagonally along the anterior surface of the right ventricle to the acute edge, then passes at an angle to the posterior wall of the right ventricle. In such cases, the most proximal branches of the coronary artery supply blood to the inferior and posterior part of the right ventricle, while the branch running along the posterior atrioventricular sulcus gives rise to IVR (Figure 30).

Along with LMZH, other branches depart distal to the cross, supplying blood to the diaphragmatic part of the LV. These branches are best seen in the left oblique projection (at an angle of 45 degrees) (Fig. 31).

In this projection, the bend of the RCA resembles a sickle, the blade of which is the RCA itself, and the handle is the ZMZHV and the left ventricular branches (Fig. 32).

The most distal branch of the RCA is usually the left atrial branch, which follows the length of the left atrioventricular groove, making a loop above the cross of the heart and, then, follows up and posteriorly away from the RCA. This branch in the left oblique projection is visible as a loop directed up to the spine in the upper right corner of the frame (Fig. 33).

PKA behavior has been a rather controversial issue. According to a number of authors (Bianchi, Spaltehols, Schlesinger), the coronary circulation is divided into right and left types in accordance with which artery reaches the cross of the heart. When both arteries reach the cross of the heart, the type is called balanced. In 84% of cases, LMZV is a branch of the RCA and in 70% of them it passes in the posterior interventricular sulcus, reaching its middle part and even further towards the apex (Fig. 34). Thus, from a purely anatomical point of view, RCA is dominant in 84%.

In fact, on the basis of a large number of angiograms, the LCA gives rise to a greater number of branches spreading in the thickness of the left ventricular wall, to most of the interventricular the septum, the atrium, and a small portion of the right ventricle. Thus, the LCA is the dominant artery. In turn, the RCA gives rise to a branch of the sinus node in 59% of cases and a branch to the AV node in 88%, thus representing a vessel supplying blood to a highly differentiated myocardium.

From a surgical point of view, it is very important whether RCA produces LMV or large left ventricular branches. If these branches are expressed, then in case of their defeat, it is possible to perform bypass grafting of the most distally located area. If the RCA does not give rise to the branches described above, then it is considered an inoperable artery.

The heart is a muscular organ that circulates blood in the body according to the principle of a pump. The heart is provided with autonomous innervation, which determines the involuntary, rhythmic work of the muscular layer of the organ - the myocardium. In addition to nerve structures, the heart also has its own blood supply system.

Most of us know that the heart vascular system a person consists of two main circles of blood circulation: large and small. However, specialists in cardiology consider the vascular system that feeds the tissues of the heart as the third or coronary circle of blood circulation.

If we consider the volumetric model of the heart with the vessels feeding it, then we can see that the network of arteries and veins surrounds the heart like a crown or crown. Hence the name of this circulatory system - the coronary or coronal circle.

The coronary circle of hemocirculation is made up of vessels, the structure of which does not fundamentally differ from other vessels of the body. The vessels through which oxygenated blood moves to the myocardium are called coronary arteries. Vessels providing the outflow of deoxygenated, i.e. venous blood are coronary veins. The coronary vessels receive about 10% of all blood passing through the aorta. The anatomy of the vessels of the coronary circle of hemocirculation differs in each person and is individual.

The coronary circulation can be schematically expressed as follows: aorta - coronary arteries - arterioles - capillaries - venules - coronary veins - right atrium.

Let us consider the scheme of hemocirculation along the crown circle in stages.

Arteries

The coronary arteries branch off from the so-called Valsalva sinuses. This is an enlarged section of the aortic root just above the valve.

The sinuses are named according to the arteries leaving them, i.e. the right sinus gives rise to the right artery, the left sinus gives rise to the left artery. The right one runs along the coronary groove on the right, then stretches back and towards the apex of the heart. Along the branches extending from this highway, blood rushes into the thickness of the myocardium of the right ventricle, washes the tissues of the posterior part of the left ventricle and a significant proportion of the cardiac septum.

The left coronary artery, leaving the aorta, is divided into 2, and sometimes 3 or 4 vessels. One of them - ascending, runs along the furrow dividing the ventricles, in front. Multiple small vessels extending from this branch provide blood flow to the anterior walls of both ventricles. Another vessel - descending, runs along the coronary sulcus on the left. This line carries the enriched blood to the tissues of the atrium and ventricle on the left.

Further, the artery bends around the heart on the left and rushes to its apex, where it forms an anastomosis - the fusion of the right cardiac artery and the descending branch of the left. In the course of the descending anterior artery, smaller vessels branch off, supplying blood to the anterior region of the myocardium of the left and right ventricles.

4% of the population has a third coronary artery. An even rarer case is when a person has only one heart artery.

Review of our reader - Alina Mezentseva

Recently I read an article that tells about the natural cream "Bee Spas Kashtan" for the treatment of varicose veins and cleaning blood vessels from blood clots. With the help of this cream, you can FOREVER cure varicose veins, eliminate pain, improve blood circulation, increase the tone of veins, quickly restore the walls of blood vessels, cleanse and restore varicose veins at home.

I was not used to trusting any information, but I decided to check and ordered one package. I noticed the changes in a week: the pain went away, the legs stopped "buzzing" and swelling, and after 2 weeks the venous cones began to decrease. Try it too, and if anyone is interested, then below is the link to the article.

Doubling of the cardiac arterial trunks is also sometimes observed. In this case, instead of one arterial trunk, two parallel vessels go to the heart.

The coronary arteries are characterized by partial autonomy, expressed in the fact that they are able to independently maintain the required level of blood flow in the myocardium. This functional feature of the coronary arteries is extremely important because the heart is an organ that works constantly, continuously. That is why a violation of the condition of the heart arteries (atherosclerosis, stenosis) can lead to fatal consequences.

Veins

"Spent", i.e. saturated with carbon dioxide and other products of tissue metabolism, blood from the tissues of the heart flows into the coronary veins.

The greater coronary vein begins at the apex of the heart, stretches along the anterior (ventral) interventricular sulcus, turns to the left along the coronary sulcus, rushes back and flows into the coronary sinus.

This is a venous structure with a size of about 3 cm, located on the posterior (dorsal) part of the heart in the coronary groove, has an outlet in the cavity of the right atrium, the mouth does not exceed 12 mm in diameter. The structure is considered to be part of a large vein.

The middle coronary vein comes out at the apex of the heart, next to the great vein, but runs along the dorsal interventricular sulcus. The middle vein also flows into the coronary sinus.

For the treatment of varicose veins and cleaning blood vessels from thrombosis, Elena Malysheva recommends new method based on Cream of Varicose Veins. It contains 8 useful medicinal plants that are extremely effective in the treatment of VARICOSIS. At the same time, only natural ingredients are used, no chemicals and hormones!

The small coronary vein is located in the groove separating the right ventricle and the atrium, usually passes into the middle vein, and sometimes directly into the coronary sinus.

The oblique heart vein collects blood from the posterior region of the left atrial myocardium. Through the posterior vein, venous blood flows from the tissues of the posterior wall of the left ventricle. These are small vessels that also drain into the coronary sinus.

The anterior and small cardiac veins are also distinguished, which have independent exits into the cavity of the right atrium. The anterior veins drain venous blood from the muscle layer of the right ventricle. Through the small veins there is an outflow of blood from the intracavitary tissues of the heart.

Blood flow rate

As mentioned above, coronary vessels have individual anatomical features in each person. The limits of the norm are wide enough, if we are not talking about serious structural anomalies, when the vital activity of the heart suffers to a large extent.

In cardiology, there is such a concept as the dominance of blood flow, an indicator that determines which arteries give off the posterior descending (or interventricular) artery.

If the supply of the posterior interventricular branch occurs at the expense of the right and one of the branches of the left arteries, they speak of codominance - typically 20% of the population. In this case, uniform nutrition of the myocardium occurs. Most often, the right type of dominance is found - it is inherent in 70% of the population.

In this case, the dorsal descending artery departs from the right coronary artery. Only 10% of the population has a left type of dominance of blood flow. In this case, the posterior descending artery branches off from one of the branches of the left coronary artery. With the right and left dominance of blood flow, an uneven blood supply to the heart muscle occurs.

The intensity of cardiac blood flow is variable. So, at rest, the blood flow rate is 60 - 70 mg / min per 100 g of the myocardium. During the load, the speed increases 4-5 times and depends on the general condition of the heart muscle, the degree of its endurance, heart rate, the functioning of the nervous system of a given person, and aortic pressure.

Interestingly, during the systolic contraction of the myocardium, the movement of blood in the heart practically stops. This is a consequence of the powerful compression of all vessels by the muscle layer of the heart. With diastolic relaxation of the myocardium, blood flow in the vessels resumes.

The heart is a unique organ. Its uniqueness lies in the almost complete autonomy of its work. So, the heart has not only an individual hemocirculation system, but also its own nervous structures that set the rhythm of its contractions. Therefore, it is necessary to create conditions for maintaining the health of all systems that ensure the full functioning of this important organ.

DO YOU STILL THINK THAT IT IS IMPOSSIBLE TO GET RID OF VARICOSIS !?

Have you ever tried to get rid of VARICOSIS? Judging by the fact that you are reading this article, the victory was not on your side. And of course you know not by hearsay what it is:

feeling of heaviness in the legs, tingling ...
swelling of the legs, worse in the evening, swollen veins ...
bumps on the veins of the arms and legs ...

Now answer the question: does this suit you? Can ALL THESE SYMPTOMS be tolerated? And how much effort, money and time have you already "wasted" on ineffective treatment? After all, sooner or later the SITUATION WILL BE DECREASED and the only way out will be only surgical intervention!

That's right - it's time to start ending this problem! Do you agree? That is why we decided to publish an exclusive interview with the head of the Institute of Phlebology of the Ministry of Health of the Russian Federation - V.M.Semenov, in which he revealed the secret of a penny method of treating varicose veins and full recovery vessels. Read the interview ...

34430 0

The main source of blood supply to the heart is coronary arteries (fig. 1.22).

The left and right coronary arteries branch off from the initial part of the ascending aorta in the left and right sinuses. The location of each coronary artery varies both in height and in the circumference of the aorta. The mouth of the left coronary artery can be at the level of the free edge of the semilunar valve (42.6% of observations), above or below its edge (in 28 and 29.4%, respectively).

For the mouth of the right coronary artery, the most common location is above the free edge of the semilunar valve (51.3% of observations), at the level of the free edge (30%) or below it (18.7%). The displacement of the orifices of the coronary arteries upward from the free edge of the semilunar valve is up to 10 mm for the left and 13 mm for the right coronary artery, downward - up to 10 mm for the left and 7 mm for the right coronary artery.

In isolated observations, more significant vertical displacements of the coronary artery orifices are noted, up to the beginning of the aortic arch.

Fig. 1.22. Blood supply system of the heart: 1 - ascending aorta; 2 - superior vena cava; 3 - the right coronary artery; 4 - aircraft; 5 - left coronary artery; 6 - large vein of the heart

In relation to the midline of the sinus, the mouth of the left coronary artery in 36% of cases is displaced to the anterior or posterior edge. A significant displacement of the beginning of the coronary arteries along the circumference of the aorta leads to the divergence of one or both coronary arteries from the uncharacteristic sinuses of the aorta, and in rare cases, both coronary arteries originate from the same sinus. A change in the location of the coronary artery orifices along the height and circumference of the aorta does not affect the blood supply to the heart.

The left coronary artery is located between the beginning of the pulmonary trunk and the left ear of the heart and is divided into the enveloping and anterior interventricular branches.

The latter follows to the apex of the heart, located in the anterior interventricular groove. The enveloping branch is directed under the left ear in the coronary sulcus to the diaphragmatic (posterior) surface of the heart. After leaving the aorta, the right coronary artery lies under the right ear between the beginning of the pulmonary trunk and the right atrium. Then it turns along the coronary groove to the right, then back, reaches the posterior longitudinal groove, along which it descends to the apex of the heart, already being called the posterior interventricular branch. The coronary arteries and their large branches lie on the surface of the myocardium, located at different depths in the epicardial tissue.

The branching of the main trunks of the coronary arteries is divided into three types - main, loose and transitional. The main type of branching of the left coronary artery is observed in 50% of cases, loose - in 36% and transitional - in 14%. The latter is characterized by the division of its main trunk into 2 permanent branches - the envelope and the anterior interventricular. The loose type includes cases when the main trunk of the artery gives off the interventricular, diagonal, accessory diagonal and enveloping branches at the same or almost at the same level. From the anterior interventricular branch, as well as from the envelope, 4-15 branches depart. The angles of discharge of both primary and subsequent vessels are different and range from 35–140 °.

According to the International Anatomical Nomenclature, adopted at the Congress of Anatomists in Rome in 2000, the following vessels supplying the heart are distinguished:

Left coronary artery (arteria coronaria sinistra)

Anterior interventricular branch (r. Interventricularis anterior)
Diagonal branch (r. Diagonalis)
Branch of the arterial cone (r. Coni arteriosi)
Lateral branch (r. Lateralis)
Septal interventricular branches (rr. Interventricularis septales)
The envelope branch (r. Circumfl exus)
Anastomotic atrial branch (r. Atri alis anastomicus)
Atrioventricular branches (rr. Atrioventricularis)
Left marginal branch (r. Marginalis sinister)
Intermediate atrial branch (r. Atrialis intermedius).
Posterior branch of the LV (r. Posterior ventriculi sinistri)
Branch of the atrioventricular node (r. Nodi atrioventricularis)

Right coronary artery (arteria coronaria dextra)

Branch of the arterial cone (ramus coni arteriosi)
Branch of the sinus-atrial node (r. Nodi sinoatrialis)
Atrial branches (rr. Atriales)
Right marginal branch (r. Marginalis dexter)
Intermediate atrial branch (r. Atrialis intermedius)
Posterior interventricular branch (r. Interventricularis posterior)
Septal interventricular branches (rr. Interventriculares septales)
Branch of the atrioventricular node (r. Nodi atrioventricularis).

By the age of 15-18, the diameter of the coronary arteries (Table 1.1) approaches that of adults. At the age of over 75 years, there is a slight increase in the diameter of these arteries, which is associated with the loss of the elastic properties of the arterial wall. In most people, the diameter of the left coronary artery is larger than the right one. The number of arteries extending from the aorta to the heart can decrease to 1 or increase to 4 due to additional coronary arteries that are not normal.

The left coronary artery (LCA) originates in the posterior sinus of the aortic bulb, passes between the left atrium and the PA, and after about 10–20 mm divides into the anterior interventricular and circumflex branches.

The anterior interventricular branch is a direct continuation of the LCA and runs in the corresponding groove of the heart. From the anterior interventricular branch of the LCA, there are diagonal branches (from 1 to 4), which are involved in the blood supply of the LV lateral wall and can anastomose with the circumflex branch of the LV. The LCA gives off 6 to 10 septal branches, which supply the anterior two-thirds of the interventricular septum with blood. The anterior interventricular branch of the LCA itself reaches the apex of the heart, supplying it with blood.

Sometimes the anterior interventricular branch passes to the diaphragmatic surface of the heart, anastomosing with the posterior interventricular artery of the heart, carrying out collateral blood flow between the left and right coronary arteries (with right or balanced types of blood supply to the heart).

Table 1.1

The right marginal branch was previously called the artery of the acute edge of the heart - ramus margo acutus cordis. The left marginal branch is the branch of the blunt edge of the heart - ramus margo obtusus cordis, since a well-developed LV myocardium of the heart makes its edge rounded, blunt).

Thus, the anterior interventricular branch of the LCA supplies blood to the anterolateral LV wall, its apex, most of the interventricular septum, and also the anterior papillary muscle (due to the diagonal artery).

The enveloping branch, departing from the LCA, located in the AV (coronary) sulcus, bends around the heart on the left, reaches the intersection and the posterior interventricular sulcus. The enveloping branch can either end at the blunt edge of the heart or continue in the posterior interventricular groove. Passing in the coronary sulcus, the circumflex ramus sends large branches to the lateral and posterior walls of the LV. In addition, important atrial arteries (including r. Nodi sinoatrialis) depart from the circumflex branch. These arteries, especially the sinus artery, anastomose abundantly with the branches of the right coronary artery (RCA). Therefore, the branch of the sinus node is of "strategic" importance in the development of atherosclerosis in one of the main arteries.

RCA begins in the anterior-internal sinus of the aortic bulb. Departing from the anterior surface of the aorta, the RCA is located in the right part of the coronary sulcus, approaches the acute edge of the heart, bends around it and goes to the crux and then to the posterior interventricular sulcus. In the area of \u200b\u200bintersection of the posterior interventricular and coronary grooves (crux), the RCA gives off the posterior interventricular branch, which goes towards the distal part of the anterior interventricular branch, anastomosing with it. Rarely RCA ends at the sharp edge of the heart.

The RCA with its branches supplies the right atrium, part of the anterior and the entire posterior surface of the LV, the interatrial septum and the posterior third of the interventricular septum. Of the important branches of the RCA, the branch of the cone of the pulmonary trunk, the branch of the sinus node, the branch of the right edge of the heart, and the posterior interventricular branch should be noted.

The branch of the cone of the pulmonary trunk often anastomoses with the conical branch, which departs from the anterior interventricular branch, forming the Viessen ring. However, in about half of the cases (Schlesinger M. et al., 1949), the artery of the cone of the pulmonary trunk departs from the aorta on its own.

The branch of the sinus node in 60–86% of cases (Ariev M.Ya., 1949) departs from the RCA, however, there is evidence that in 45% of cases (James T., 1961) it can depart from the envelope branch of the LCA and even from the LCA itself ... The branch of the sinus node is located along the wall of the pancreas and reaches the place where the superior vena cava flows into the right atrium.

At the sharp edge of the heart, the RCA gives off a fairly constant branch - a branch of the right edge, which runs along the sharp edge to the apex of the heart. At about this level, a branch departs to the right atrium, which supplies blood to the anterior and lateral surfaces of the right atrium.

At the junction of the RCA into the posterior interventricular artery, a branch of the AV node departs from it, which supplies this node with blood. Branches to the pancreas extend perpendicularly from the posterior interventricular branch, as well as short branches to the posterior third of the interventricular septum, which anastomose with similar branches extending from the anterior interventricular artery of the LCA.

Thus, the RCA supplies blood to the anterior and posterior walls of the pancreas, partly to the posterior wall of the LV, the right atrium, the upper half of the interatrial septum, sinus and AV nodes, as well as the posterior part of the interventricular septum and the posterior papillary muscle.

V.V. Bratus, A.S. Gavrish "The structure and functions of the cardiovascular system"

The heart is a muscular organ with a hollow structure that provides blood flow through the blood vessels using rhythmic contractions. Thanks to this, human organs receive the required amount of oxygen and other nutrients. The saturation of the heart with oxygen and the outflow of blood from the organ is provided by the coronary vessels. In case of dysfunction of the coronary arteries, various diseases occur, manifested by many unpleasant symptoms. Treatment of the cardiovascular system should be timely, since in the absence of therapy, complications arise, sometimes incompatible with life.

The structure of the blood vessels of the heart

Coronary arteries are blood vessels that saturate the heart muscle with oxygen. Thanks to them, the normal contractile function of the organ is ensured, the saturation of the body with the components necessary for its healthy functioning. The anatomy of the coronary arteries is very complex. The structure of the vessels is as follows:

right coronary artery and its branches - the vasculature that feeds the right side of the organ. Thanks to the right coronary artery, the right ventricle, atrium and part of the posterior part of the left ventricle are saturated with oxygen;
left artery - divided into anterior descending, circumflex and protruding edge artery. Thanks to them, the blood supply to the left side of the organ occurs.

If the functioning of the vessels of the heart is impaired, serious diseases develop, the common name of which is ischemic heart disease.

Coronary heart disease

Ischemic heart disease or ischemic heart disease is an acute violation of the blood supply to the heart due to a decrease in the functioning of the coronary vascular system. Most common reason diseases - atherosclerosis of the coronary arteries. The disease is accompanied by the formation of plaques, narrowing of the lumen of the arteries. IHD has a chronic or exacerbated course.

The concept of ischemic disease includes:

angina pectoris;
myocardial infarction;
arrhythmia;
embolism;
coronary insufficiency;
arteritis;
stenosis;
deformation of the coronary arteries;
heart death.

Ischemic heart disease is the common name for many cardiovascular disorders, such as angina pectoris, arrhythmia, stenosis, and others.

Ischemic heart disease. It occurs in patients between the ages of 40 and 60. Recently, pathology is increasingly common at a younger age. This happens against the background of an increase in the influence of provoking factors of the disease, such as tobacco smoking, the use of drugs, alcohol, overweight, and an inactive lifestyle.

Ischemic disease is accompanied by an undulating course, in which the acute phase is replaced by a chronic one. The initial stage of pathology often causes an attack of angina pectoris, in which the patient feels discomfort or pain in the region of the heart during physical exertion or during strong emotional excitement. Angina pectoris causes shortness of breath, difficulty breathing, fear of death. After a while, attacks occur more often, while excitement or hard work is not necessary, a chronic form of the disease develops.

In the absence of proper therapy, there is a risk of developing the following complications:

heart failure;
heart rhythm disturbances;
myocardial infarction;
disability of the patient;
lethal outcome.

Important! According to medical statistics, more than 2 million people on the planet die from coronary artery disease every year.

How pathology manifests itself

Ischemic heart disease is the most common pathology that includes many forms. Symptoms of the disease depend on the condition that a person experiences as a result of coronary artery disease.

Angina pectoris

People often call angina pectoris angina pectoris. This is explained by manifestations of pathology. The attack is accompanied by pains of various nature, which spread to the region of the heart, behind the sternum, to the left shoulder blade, collarbone, and sometimes the jaw. Discomfort occurs after physical exertion, while eating, with strong excitement. The causes of pain are poor blood supply to the heart muscle. In this case, the coronary arteries, for various reasons, carry an insufficient amount of blood and oxygen to the organ. Circulatory deficiency is called ischemia.

Myocardial infarction

A heart attack is one of the formidable forms of coronary heart disease, accompanied by necrosis of certain parts of the myocardium. In this case, there is a complete or partial absence of blood supply to the organ. More often, the pathology develops against the background of coronary artery thrombosis. The risk of death is high. If in the first few hours the patient is not provided with health care, death often occurs.

Symptoms of coronary artery disease are heart pain, a general deterioration in well-being, a decrease in performance

Symptoms:

sharp painextending to the region of the heart, sternum. Often, pain is given to the left shoulder blade, neck, collarbone;
shortness of breath, shortness of breath;
cold sweat, severe weakness;
decline blood pressure;
nausea, often accompanied by vomiting;
the patient experiences panic, a feeling of fear.

Taking medications does not help, while the part of the heart, deprived of blood supply, loses its elasticity, the ability to contract normally. The healthy half of the organ works with the same intensity, which causes the risk of rupture of the dead part of the organ. Physical stress during this period often provokes the risk of death of the patient.

Violation of the rhythm of the heart

The condition occurs against the background of a decrease in the conductivity of impulses in the heart system, vasospasm. In this case, the following symptoms occur:

feeling of heart pushes;
sometimes patients complain of a feeling of freezing of the heart muscle;
darkening in the eyes, dizziness;
shortness of breath occurs at rest;
decreased activity in children;
weakness, chronic fatigue;
heart pains of a different nature.

The causes of the violation are diseases of the endocrine system, a decrease in the metabolic processes of the body, long-term intake some medications.

Heart failure implies a decrease in contractile activity heart, as a result of which the blood circulation of the whole organism is disturbed. The causes of the pathology are myocardial infarction, disturbance of the rhythm and conduction of the heart muscle. Depending on the rate of development of pathology, chronic and acute insufficiency... Acute is often associated with intoxication of the body, trauma, heart disease. If untreated, there is a risk of death of the patient.

Chronic develops over a long time, accompanied by the following manifestations:

shortness of breath;
arrhythmia;
swelling of the cervical veins;
darkening in the eyes;
swelling and soreness of the legs;
fainting.

Against the background of coronary artery disease, the development of heart failure is often diagnosed

Many people with heart failure are diagnosed with an enlarged liver, an accumulation of fluid in the abdomen (ascites). A characteristic symptom of the disease is a paroxysmal cough that appears mainly after physical work. A person's labor activity decreases, the condition causes severe fatigue, irritability, poor sleep and other signs.

Important! Heart failure is not diagnosed in people with diabetes or high blood pressure.

Coronary insufficiency

Heart failure is the most common type of coronary artery disease. In this case, the coronary bed is disrupted or completely stops.

Symptoms of the disease:

feeling of discomfort and strong pain in the area of \u200b\u200bthe heart;
stiffness chest;
clarification of urine and an increase in its amount;
change in skin tone (pallor);
shortness of breath, slow breathing;
vomiting, nausea, increased salivation.

Coronary insufficiency is acute or chronic form... In the first case, an attack occurs due to a spasm of the vessels supplying blood and oxygen to the heart.

The chronic type of pathology is a consequence of a combination of angina pectoris and atherosclerosis. Allocate the initial, expressed and severe degree coronary insufficiency. In the absence of the necessary therapy, the patient's condition worsens, there is a risk of death.

The reasons for the development of heart disorders

The factors that provoke coronary heart muscle disorders include an increase in blood cholesterol levels, a violation of metabolic processes in the body. Congenital vascular anomaly often causes the onset of the disease. At risk are people who eat large amounts of fatty, spicy, fried, salty foods. Against this background, calcification often develops (deposition of salts in soft tissues organism). Low physical activity of a person causes a decrease in blood circulation. At risk are office workers, truckers and other patients forced to long time be in a static position. The development of pathology is influenced by the use of alcohol and cigarettes. Factors such as anatomical aging of the body and stress cannot be ignored.

Bad habits are one of the causes of human coronary artery disease

These reasons provoke vascular atherosclerosis. In people suffering from arterial hypertension, against this background, vasospasm occurs, which provokes damage to their membrane, an increase in the size of the left ventricle of the heart. The risk of occurrence of severe complications in smokers. This is explained by the development in smokers arterial hypertension, increased blood pressure, increased blood coagulation. At the same time, the heart rate increases, the myocardial oxygen demand increases.

Methods for the treatment of ischemic heart disease

Therapy of pathology begins after its diagnosis. For this, it is necessary to conduct a thorough examination of the patient using laboratory and instrumental research methods.

The mainstay of coronary heart disease treatment is drug therapy... It provides for the use the following medications:

diuretics. Drugs in this group contribute to the removal of excess fluid from the body, which reduces the load on the myocardium (Furosemide, Indapamide);
anticoagulants. These medicines help to reduce the viscosity of the blood, which helps to get rid of existing blood clots, prevent the appearance of new ones (Heparin);
nitrates. This is the name of the vasodilators used to relieve angina pectoris (Nitroglycerin);
beta-blockers - medications that reduce heart rate (Metoprolol, Carvedilol);
fibrators. Prescribed to lower blood cholesterol levels (Lovastatin, Rosuvastatin).

The drugs are selected by the attending physician. Self-medication for coronary heart disease is by no means allowed.

To normalize the patient's well-being with ischemic disease, medications are used, prescribed in accordance with the patient's well-being

If conservative therapy is ineffective, doctors resort to surgical treatment. To improve the nutrition of the heart muscle, coronary artery bypass grafting is used - an operation during which external and coronary veins are combined. The connections are made in those areas where the vessels are not damaged.

Another type of intervention is balloon dilatation of blood vessels. The operation consists in the introduction of special balloons that ensure the expansion of the damaged vessels.

Important! Success surgical intervention depends not only on strict adherence to the operating technique, but also on the actions of the patient and doctors during the rehabilitation period.

Home treatment rules

To reduce the risk of severe consequences of coronary disorders at home, it is important to adhere to the rules of prevention. These include:

Quitting smoking and drinking alcohol.
Compliance with a healthy diet.
Saturation of the diet with foods rich in magnesium, potassium.
Elimination of foods that provoke an increase in cholesterol levels.
Walking in the fresh air, physical education.
Hardening.
Quality sleep for at least 8 hours.

The prognosis for patients is often unfavorable, the pathology is constantly progressing, its symptoms are exacerbated. Compliance with the doctor's recommendations, a healthy lifestyle and nutrition allows you to strengthen the heart muscle, improve the patient's quality of life, and prevent serious complications.

Diseases of the heart and the associated vascular system have now become a huge problem in modern human civilization. Moreover, the more prosperous the society in terms of living standards, the more serious the situation in terms of the number of people suffering from coronary heart disease.

What is coronary heart disease?

The human heart is a very complex, finely tuned and sensitive mechanism, the purpose of which can be reduced to one function - the delivery of substances necessary for proper vital activity to every cell of the body.

In addition to the heart itself, vessels are also involved in this activity, the system of which permeates the human body, which completely ensures the uninterrupted delivery of everything necessary to the cells of the organs farthest from the heart.

Crown

natal artery and its role in the human life support system

The full work of this system is ensured by the heart muscle, the rhythm and completeness of contractions of which also depend on the normal supply of blood - the carrier of everything necessary for the normal functioning of the human body. Blood flows to the heart muscle through vessels called coronary vessels.

Hence the name: artery, etc. And if the required blood flow in the coronary arteries is reduced, the heart muscle is deprived of nutrition, which leads to coronary diseases such as heart failure, abnormal heart rhythms and heart attacks. The reason for this is coronary atherosclerosis.

What is it and how is it scary?

Over time and under the influence of many factors, which will be discussed later, fats and lipids settle on the walls of the arteries, forming constantly growing sticky plaques that interfere with the normal blood flow.

Thus, the lumen of the artery gradually decreases, and less and less oxygen is supplied to the heart, which leads to the appearance of pain in the retrosternal region - angina pectoris. At first, these pains can bother a person only under heavy loads, but gradually they become a response to even small efforts, and subsequently they can occur at rest.

Complications and diseases accompanying atherosclerosis

Atherosclerosis of the coronary arteries inevitably leads to diseases such as the heart. It is worth noting that the so-called heart diseases claim lives incomparably more than oncological or infectious diseases - and it is in the most developed countries.

Damage to the coronary arteries naturally has a negative effect on the heart muscle, which in turn causes angina pectoris, heart attacks, heart attacks, heart rhythm disturbances, heart failure and, worst of all, heart death.

Symptoms of Coronary Heart Disease

The human body has an individual anatomical structure. And the anatomy of the heart, the arteries that feed it, each have their own characteristics. The heart feeds on two coronary arteries - the right and left. And it is the left coronary artery that provides the heart muscle with oxygen in the amount required for its normal functioning.

With a decrease in blood flow in it, chest pains occur - symptoms of angina pectoris, and their appearance is often not associated with special loads. A person can experience them both while at rest, such as in sleep, and while walking, especially over rough terrain or stairs. Such pains can also be provoked by weather conditions: in winter, in cold and windy weather, they can disturb more often than in summer.

What you need to know about angina

First of all, this disease is the result of acute heart failure, provoked by insufficient blood supply to the heart muscle due to the fact that the left coronary artery is affected. Another name for the disease, known to many from Russian classical literature, is angina pectoris.

Pain already described earlier becomes a characteristic manifestation of this disease. But it is also possible (most often in the initial stages) not to feel pain as such, but to feel pressure in the chest, burning. Moreover, the amplitude of pain has rather wide boundaries: from almost insignificant to unbearably acute. Its distribution area is mainly in the left side of the body and rarely in the right. Painful sensations can appear in the arms, shoulders. Affects the neck and lower jaw.

The painful sensations are not constant, but paroxysmal, and their duration is mainly from 10 to 15 minutes. Although there are up to half an hour - in this case, a heart attack is possible. Attacks can be repeated at intervals from 30 times a day to once a month, or even years.

Factors contributing to the development of coronary heart disease

As discussed earlier, coronary heart disease is the result of damage to the coronary arteries. There are several generally recognized factors in which the coronary artery that feeds the heart muscle becomes unusable.

The first of them can rightfully be called an excessively high level of cholesterol in human blood, which, due to its viscosity, is the primary cause of the formation of plaques on the walls of an artery.

The next risk factor contributing to the development of heart disease, namely heart attack, is hypertension - excessive blood pressure.

The coronary arteries of the heart receive enormous damage from smoking. The risk of damage to the walls of arteries increases many times due to the harmful effects on them of chemical compounds that make up tobacco smoke.

The next risk factor that increases the likelihood of coronary artery disease is a disease such as diabetes... With this disease, the entire vascular system of a person is exposed to atherosclerosis, and the likelihood of heart disease at an earlier age increases significantly.

Heredity can also be attributed to risk factors for the occurrence of heart disease. Especially if the fathers of potential patients had heart attacks, or death occurred as a result of coronary diseases before the age of 55, and in mothers - up to 65 years.

Prevention and treatment of coronary heart disease

It is possible to avoid or reduce the risk of developing coronary heart disease if you follow, and rigorously and continuously, a few simple recommendations, which include healthy image life, giving up bad habits, reasonable physical activity and passing annual preventive examinations.

The treatment of coronary heart disease includes several options: medication therapy and cardiac surgery. The most common is coronary artery bypass grafting, in which blood is directed to the heart muscle along a bypass path: along a section of a healthy vessel taken from the patient himself, sutured parallel to the affected area of \u200b\u200bthe aorta. The operation is complicated, and after it the patient needs a long period of rehabilitation.

Another type of treatment is laser-assisted coronary artery angioplasty. This option is more gentle and does not require the dissection of large body segments. The affected area of \u200b\u200bthe coronary artery is reached through the vessels of the shoulder, thigh or forearm.

Unfortunately, no matter what operations are performed, but even the most successful of them do not relieve atherosclerosis. Therefore, in the future, it is necessary to comply with all medical prescriptions, this applies not only to medicines, but also to the recommended diet.