SBA Answers and Explanations
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury in SBAs for the MRCS Part A, 2018
The heart is composed of cardiac muscle. This cardiac muscle receives the oxygen and nutrients that it requires to pump effectively through the coronary arteries. There are two principal coronary arteries: the right and the left. The right coronary originates from the anterior aortic sinus, whereas the left coronary artery originates from the left posterior aortic sinus. The left coronary artery divides into an anterior interventricular (or left anterior descending) artery and circumflex branches. The right coronary gives off the posterior interventricular (posterior descending) artery. The right coronary supplies the right atrium and part of the left atrium, the SA node in 60 per cent of cases, the right ventricle, the posterior part of the interventricular septum, and the AV node in 80 per cent of cases. The left coronary artery supplies the left atrium, left ventricle, anterior interventricular septum, SA node in 40 per cent of cases, and AV node in 20 per cent of cases.
Thorax
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
Right coronary artery: arises from the right aortic sinus, runs between the right atrium and the pulmonary trunk to descend in the right atrioventricular groove. It winds around the inferior border to reach the diaphragmatic surface of the heart and runs backwards and left to reach the posterior interventricular groove. It terminates by anastomosing with branches of the left coronary artery. Right marginal branchPosterior interventricular artery (PIVA): this anastomoses with the AIVA in the posterior interventricular groove. It is the PIVA that determines the dominance of the arterial system. In this case the right coronary is dominant. If it arises from the left coronary or the left circumflex, then there is left coronary dominance.Branch to the sino-atrial nodeBranch to the atrioventricular node
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 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).
Kounis syndrome presenting as ST elevation acute myocardial infarction
Published in Baylor University Medical Center Proceedings, 2021
Michael Engheta, Jonathan Urbanczyk, Erica Fidone, Yissela Escobedo, Timothy Mixon
Case 3. A 67-year-old man with a history of mild nonobstructive coronary disease presented to the emergency department following more than 100 bee stings. He developed anaphylactic shock and was treated appropriately. He developed chest pain and ST elevation in leads II, III, and aVF on ECG and was taken emergently for cardiac catheterization. There was a large thrombus burden in the left main, LAD, first diagonal, and right coronary arteries. The LAD was completely occluded distal to the first diagonal (Figures 1c–1e). The right coronary artery had sequential moderate to severe stenoses with distal vessel thrombus and a 100% occluded posterior descending artery (Figure 1f). Aspiration thrombectomy was performed in the above vessels, as well as angioplasty and bare metal stenting of the proximal LAD and the mid right coronary artery.
Association of E-Selectin gene polymorphisms and serum E-Selectin level with risk of coronary artery disease in lur population of Iran
Published in Archives of Physiology and Biochemistry, 2023
Mobin Khoshbin, Seyyed Amir Yasin Ahmadi, Mostafa Cheraghi, Negar Nouryazdan, Mehdi Birjandi, Gholamreza Shahsavari
In the present case-control study, 154 cases of CAD and 145 cases without CAD were selected through convenient sampling from Shahid Madani cardiovascular disease hospital of Khorramabad, Lorestan province, west of Iran, during first half of 2017. The reference population of the both groups was all the patients undergoing coronary angiography. The inclusion criteria of the both groups was being resident of Lorestan province, having Lur ethnicity and diagnostic or therapeutic indication for coronary angiography. The groups of study were classified by observation of stenosis or narrowing of the main epicardial arteries including right coronary artery (RCA), left coronary artery (LCA), circumflex coronary (CFX), left anterior descending (LAD), marginal coronary artery, posterior descending artery (PDA) and some diagonal arteries. The control group consisted of the patients who underwent coronary angiography because of any indication, but CAD was not found. The exclusion criteria of the both groups were congenital heart disease, malignancies, chronic kidney disease, pulmonary obstruction, using corticosteroids, lack of informed consent and any other ethical problems. Information including body mass index (BMI), smoking, history of alcohol use, history of substance abuse, history of cardiovascular disease, diabetes mellitus, familial history of special diseases, and hypertension were taken in a researcher-designed checklist approved by the cosupervisors.
Bilateral vas deferens calcification in a patient with multi-vessel coronary artery disease and severe aortic stenosis: linking infertility with cardiovascular disease
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Amartya Kundu, Adedotun A. Ogunsua, Jennifer Walker, Waqas T. Qureshi, Nikolaos Kakouros
A month later, the patient presented to the hospital with fatigue and lightheadedness. He was diagnosed with a non-ST segment elevation myocardial elevation (NSTEMI) and underwent cardiac catheterization which showed severe calcific coronary artery disease (CAD) in the right posterior descending artery, ostial left circumflex, proximal-mid left anterior descending artery with left main involvement (Figure 1). He was subsequently evaluated by the multidisciplinary heart team for either coronary artery bypass surgery and surgical aortic valve replacement, or transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI). Due to patient-preference, a decision was made to undergo PCI with atherectomy and TAVR. STS score was 2.5% with estimated morbidity/mortality of 15.6%. As part of his pre-procedure access planning, a CT scan of the abdomen and pelvis was performed to evaluate the femoral arteries and aorta for procedural access planning. An incidental finding of severe bilateral calcification of the vas deferens was noted (Figure 2). The patient ultimately underwent successful multivessel PCI with orbital atherectomy, followed by implantation of a # 26 Edwards-Sapien bioprosthetic valve with a reduction in mean gradient to 2.7 mm Hg and no para-valvular regurgitation.
Related Knowledge Centers
- Anastomosis
- Coronary Circulation
- Interventricular Septum
- Left Coronary Artery
- Right Coronary Artery
- Heart
- Artery
- Posterior Interventricular Sulcus
- Left Anterior Descending Artery
- Circumflex Branch of Left Coronary Artery