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Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Right coronary artery Right anterior oblique (RAO)Left anterior oblique (LAO)
Functions of the Cardiovascular System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The left and right coronary arteries, which are end arteries, arise from the aortic root behind the cusps of the aortic valve. The aortic root has three dilatations (aortic sinuses) just above the aortic valve. The right coronary artery arises from the anterior aortic sinus and supplies blood to the right ventricle, the right atrium, the SA node in 60% of people and the AV node in 85% of people. It passes between the right atrium and pulmonary trunk and descends along the atrioventricular groove to the inferior border of the heart. The right coronary artery divides into smaller branches, including the right posterior descending (posterior interventricular) artery and the acute marginal artery. Together with the left anterior descending artery, the right coronary artery helps supply blood to the septum of the heart (Figure 23.4).
The heart
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
The area of the heart affected by a myocardial infarction will be determined by which coronary blood vessel is occluded. The two main coronary arteries supplying the myocardium are the left coronary artery (which subdivides into the left anterior descending and circumflex branches) and the right coronary artery. The left anterior descending artery supplies blood to the bulk of the anterior left ventricular wall, while the left circumflex artery provides blood to the left atrium and the posterior and lateral walls of the left ventricle. The right coronary artery mainly provides blood to the right atria and right ventricles. Nearly 50% of all myocardial infarctions involve the left anterior descending artery that supplies blood to the main pumping mass of the left ventricle. The next most common site for myocardial infarction is the right coronary artery, followed by the left circumflex. A myocardial infarction may be transmural, meaning it involves the full thickness of the ventricular wall or subendocardial, in which the inner one-third to one-half of the ventricular wall is involved. Transmural infarcts tend to have a greater effect on cardiac function and pumping ability because a greater mass of ventricular muscle is involved.
Double right coronary artery: a plea for a standardized nomenclature
Published in Acta Chirurgica Belgica, 2022
Sotirios D. Moraitis, Apostolos C. Agrafiotis, Panagiotis Strempelas, Georgios Kagialaris, Pantelis Tsipas
While reviewing the literature we discovered that there is a lot of controversy and debate. A PubMed research was conducted by using the term ‘double right coronary artery’. More than 50 case reports and small case series were identified. When using this term, authors do not always refer to the same entity. Different definitions and classifications have been proposed without, however, gaining wide acceptance. In fact, there is a lot of confusion in the literature and cases that are rather common are presented as being ‘extremely rare’. More specifically, what is often reported as ‘double RCA’ is in fact a split RCA. There are not two RCAs but only split portions of the posterior descending branch of the RCA, with two proximal courses [2]. Consequently, the rate of double RCA is overestimated. On the other hand, there are cases (as in the case of our patient) where two separate ostia in the right coronary sinus are encountered (revealed by coronarography, computed tomography arteriography or during surgery). In fact, this could be the conus artery with separate orifice as advocated by Schlesinger, which is a rather common variation [3].
Giant right coronary artery aneurysm fistulising to the superior vena cava
Published in Acta Cardiologica, 2021
Luis E. Lezcano-Gort, Zineb Kounka, Imara Herrera-Denis, Benjamín Roque-Rodríguez, María V. Mogollón-Jiménez, Sergio Moyano-Calvente
A 78-year-old woman was referred to our service by her primary care physician with exertional chest pain, progressive dyspnoea, and a heart murmur. Her medical record was relevant for hypertension, dyslipidemia, and permanent atrial fibrillation. Physical examination revealed a loud continuous murmur at the left sternal border. On transthoracic echocardiography, unusual flow originating from the right sinus of Valsalva was noted, and confirmed with transesophageal echocardiography (Figure 1(A)). Coronary angiography showed normal left coronary artery, and selective catheterisation of the right coronary artery was not successful. However, this artery was filled from the left coronary artery. Aortography revealed a giant para-aortic aneurysm (Figure 1(B)). Oximetry showed increased oxygen saturation at the lower end of the superior vena cava, and the QP/QS ratio was calculated at 3.5:1. Computed tomography scan with 3D volume-rendering reconstruction showed a giant aneurysm (diameter 7 cm) arising from the proximal segment of the right coronary artery, and fistulising to the superior vena cava (Figure 1(C–E)). Surgical intervention successfully resected the aneurysm and closed the fistula (Figure 1(F)).
Coronary vasospasm complicating atrial fibrillation ablation: a case report and review of the literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Nirmal Guragai, Upamanyu Rampal, Rahul Vasudev, Pragya Bhandari, Atul Prakash, Hartaj Virk, Mahesh Bikkina, Shamoon Fayez
Ablative procedures have been developed as a curative approach for various arrhythmias including atrial fibrillation. Such procedures focus on the interruption of the electrical pathways that contribute to atrial fibrillation through modifying the arrhythmia triggers [1]. Percutaneous catheter-based radiofrequency ablation (RFA) is a widely used technique for atrial fibrillation where intracardiac mapping identifies a discrete arrhythmogenic focus that is the target of ablation. The ablation can be done, either endocardial or epicardial approach. Coronary artery spasm following ablation is rare and has been reported previously. Most of the case reports involve transient one vessel spasm with spontaneous resolution or requiring administration of IC nitroglycerin. However, ventricular fibrillation due to diffuse spasm of multiple coronary vessels after RFA is exceedingly rare. Upon our literature review (Table 1) we found only two cases (Fujiwara et al. and Kagawa et al.) that developed cardiac arrest [1–9]. Among all the reported cases of coronary artery spasm, only the case by Kagawa et al. had the involvement of multiple coronary vessels. Analyzing the published case reports, it was found that the most commonly involved artery was the right coronary artery. Usage of nitroglycerine either intravenous or intracoronary was noted to be the most common management for such spasms. ST-segment elevation in inferior leads was the most commonly noted ECG findings.