Functions of the Cardiovascular System
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
The left coronary artery arises from the posterior aortic sinus and supplies blood to the left ventricle and left atrium. The left main coronary divides into branches: The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart. It passes along the anterior interventricular groove towards the apex, turns round the inferior border of the heart and anastomoses with the posterior interventricular artery.The circumflex artery branches off the left coronary artery and encircles the heart muscle around the left heart border to anastomose with the posterior interventricular artery. This artery supplies blood to the left atrium and the side and back of the left ventricle.
The heart
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
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.
Nelumbo nucifera
Dilip Ghosh, Pulok K. Mukherjee in Natural Medicines, 2019
Extensive basic and clinical studies on higenamine (50) (a compound isolated from N. nucifera) showed valuable therapeutic effects on different disorders. Higenamine appears to be a useful pharmacological stress agent in myocardial perfusion imaging (MPI). A phase 2 trial was conducted to compare higenamine stress MPI with an adenosine stress test (Yanrong et al. 2014). Their study suggested that higenamine SPECT was comparable with adenosine SPECT at detecting areas of the heart with reduced blood flow. They also found a similar effect on the detection of left anterior descending coronary artery, left circumflex coronary artery and right coronary artery.
Diagnostic efficacy of fractional flow reserve with coronary angiography in dual-source computed tomography scanner
Published in Acta Cardiologica, 2018
Guozhi Xia, Di Fan, Xiaowei Yao, Gongchang Guan, Junkui Wang
Selective ICA was performed by standard protocol, via either the femoral or the radial approach, with a minimum of two projections obtained per vessel distribution and with the projection angles optimised based on the cardiac position [11]. Intracoronary nitroglycerine (200 μg) was administered to minimise vasospasm prior to the angiographic acquisitions. The ICA images were transferred to an angiographic core laboratory for blinded analysis of all assigned vessels. ICA was evaluated for maximum patients- and vessels-based diameter stenosis by luminal estimation. Per-patient and per-vessel lesions were the maximum stenosis identified in all segments or in all segments within a vessel distribution, respectively. Vessel distributions were categorised as the left anterior descending artery, the left circumflex artery and the right coronary artery.
Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study
Published in Acta Cardiologica, 2021
Frederic De Roeck, Benjamin Scott, Carl Convens, Paul Vermeersch
A total of 102 coronary angiograms in ACS were reviewed. The diagnosis of SCAD was established in 27 patients, accounting for 26% of all ACS in this young female population (Figure 1, Tables 1 and 2). The mean age was 45 (38–50) years and the mean body mass index was 24.5 (20–32) kg/m2. SCAD was diagnosed in all ACS subgroups: 2 unstable angina (UA, 7%), 11 non-ST-elevation myocardial infarction (NSTEMI, 41%) and 14 ST-elevation myocardial infarction (STEMI, 52%). The total amount of documented SCADs was 29, as two patients presented with two affected arteries. The main culprit vessel was the left anterior descending coronary artery (LAD, 59%). Angiographic presentation was predominantly type 2B (55%), manifested as an intramural haematoma extending towards the apical coronary tip [1]. SCAD types 1 (7%), 2 A (17%) and 3 (21%) were less common. Increased coronary tortuosity was common in SCAD patients. Underdiagnosis was notable, as only 33% of SCADs were correctly diagnosed during index procedure. Nevertheless, due to growing awareness, a positive trend over time was clearly observed in terms of accurate diagnosis (2013–2016: 2/15 patients = 13% vs 2016–2017: 7/12 = 58%). Eighteen patients (67%) were managed conservatively with excellent outcome. Primary percutaneous coronary intervention (PCI) was performed in 9 patients (33%) because of TIMI 0-1 flow, ongoing ischaemia or erroneously presumed atherosclerotic plaque rupture. Five performed PCIs were uncomplicated (56% success rate), while 4 PCIs led to progressive dissection and extensive additional stenting. No fatalities were documented.
Transcatheter Aortic Valve Implantation and Concurrent Leadless Pacemaker Implantation
Published in Structural Heart, 2019
Ryosuke Higuchi, Tetsuya Tobaru, Mike Saji, Kanki Inoue, Itaru Takamisawa, Shuichiro Takanashi, Morimasa Takayama
An 80-year-old male with severe aortic stenosis was admitted to our hospital due to congestive heart failure. A pre-procedural electrocardiogram showed a sinus rhythm with a prolonged PQ interval and a complete right bundle branch block (RBBB) (Figure 1A). Because of refractory Parkinson’s disease, the patient’s entire body had been constantly shaking. We performed enhanced computed tomography with difficulty, but we could not perform coronary angiography due to a risk of vascular injury. Under general anesthesia without tracheal intubation, we performed coronary angiography and transfemoral TAVI. Coronary angiography revealed severe stenosis of the mid-left anterior descending artery suitable for coronary stenting (Figure 1B). We deployed a 29-mm Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) and a second-generation drug-eluting coronary stent (Figure 1C,D). The patient experienced complication of advanced atrioventricular block immediately after the valve deployment. Considering the pre-procedural atrioventricular conduction disturbance, repetitive general anesthesia in an invasive procedure, and the risk of an implanted temporary pacemaker (e.g. pacing lead dislodgement, cardiac perforation, and/or restriction of activity), we seamlessly implanted the Micra Transcatheter Pacing System using the femoral approach (Figure 1E,F). The pacemaker worked well, and no further complications occurred; the patient was discharged the day following TAVI.
Related Knowledge Centers
- Anterior Interventricular Sulcus
- Aortic Sinus
- Interventricular Septum
- Left Coronary Artery
- Pulmonary Artery
- Vascular Occlusion
- Atrium
- Ventricle
- Heart
- Notch of Cardiac Apex