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The Coronary Arteries: Atherosclerosis and Ischaemic Heart Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The majority of the complications listed so far are directly related to transmural large infarcts. Papillary muscle rupture is an exception in that the infarcts can be small and may not be transmural. Either papillary muscle can rupture. The anterolateral papillary muscle is supplied by the left marginal branch of the left circumflex artery and a distinct entity exists of left marginal artery thrombosis producing papillary rupture without significant infarction of the rest of the left ventricle. The posteromedial papillary muscle is supplied from the right coronary artery. Rupture may involve either one subhead or the whole papillary muscle across the base. The stump of the papillary muscle passes backward and forward across the mitral valve in life and the chords become twisted and tangled. The stump is found in the left atrium at autopsy (Fig. 2.69).
Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Left coronary artery: after originating from the left aortic sinus, it passes forwards and to the left and emerges between pulmonary trunk and the left atrium and gives off two main branches. Anterior interventricular artery (AIVA), also known as the left anterior descending artery (LAD), runs downwards in the anterior interventricular groove and anastomoses with the PIVA. This is the major branch, as it supplies most of the muscle bulk. During its course, the AIVA gives off one or two large diagonal branches.Circumflex branch, which runs to the left in the left atrioventricular sulcus, winds around the left border of heart and terminates by anastomosing with right coronary artery. The left marginal artery is the large branch of the circumflex.
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
The majority of the complications listed so far are directly related to transmural large infarcts. Papillary muscle rupture (see Case History 7.1) is an exception in that the infarcts can be small and may not be transmural. Either papillary muscle can rupture. The anterolateral papillary muscle is supplied by the left marginal branch of the left circumflex artery, and there is a distinct entity of left marginal artery thrombosis producing papillary rupture without significant infarction of the rest of the left ventricle. The posteromedial muscle is supplied from the right coronary artery. Rupture may involve either one subhead or the whole papillary muscle across the base. The stump of the ruptured papillary muscle passes back and forward across the mitral valve in life and the chordae become twisted and tangled. The stump is found in the left atrium post mortem.
Cardiac computed tomography in asymptomatic siblings of patients with premature coronary disease: illustrations and current knowledge
Published in Acta Cardiologica, 2020
Julien Higny, Michaël Dupont, Antoine Guédès
In Figure 3, we present the case of a 50-year-old man referred to cardiology consultation by occupational medicine for the assessment of high blood pressure. At that time, he had performed no previous cardiac investigations. He presented no significant past medical history. He was not receiving antihypertensive therapy. Other cardiac risk factors such as diabetes and smoking were not seen, but laboratory analysis revealed dyslipidaemia as follows: total cholesterol of 209 mg/dl, HDL-C of 43 mg/dl, LDL-C of 162 mg/dl, and triglycerides of 107 mg/dl. On physical examination, the heart rate was 76 and the blood pressure was 150/80 mmHg. Here, the 10-year cardiac risk using the Framingham Risk Score was 6.5%, which corresponds to the low-risk category (<10%). The examination of the cardiopulmonary system was normal, except for a lipoma of the left chest wall. The body mass index was in safe limits (25 kg/m2). His family history was positive for early-onset CAD. In fact, both his father and grandfather died before age 50 from sudden cardiac death. The exercise stress test was maximal and revealed discrete repolarization changes in V4-V5-V6 leads, with a slight ST-segment depression of approximately one millimetre. Nonetheless, the patient did not develop symptoms suggestive of underlying coronary disease during the examination. Afterwards, we decided to perform cardiac computed tomography in order to exclude occult CAD. Non-contrast-enhanced imaging revealed two-vessel CAD with extensive coronary calcifications, predominantly at the level of the LAD proximal segment, the LAD mid segment, and the LCX proximal segment. The Agatston score was calculated at 540. The effective radiation dose was 0.86 millisieverts. Accordingly, the patient underwent cardiac catheterisation because high levels of coronary artery calcium scoring do not allow a reliable non-invasive visualisation of luminal stenoses. Diagnostic coronary angiography confirmed the presence of significant coronary lesions as follows: 70% stenosis in the mid LAD, 70% stenosis in the distal LAD, 60% ostial stenosis in the first diagonal branch, 60% stenosis in the proximal LCX, and 70% ostial stenosis in the left marginal artery. The patient was treated by coronary artery bypass grafting and optimal medical management, including aspirin and statin therapy.