Coronary circulation

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Coronary circulation

Cardiovascular system


Coronary circulation


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Coronary circulation

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A 65-year-old man presents to the emergency department because of episodic, burning substernal chest pain. According to past medical records, the patient has a right-dominant circulation. A myocardial perfusion scan reveals inducible ischemia in the posteroinferior surface of the heart. This region of the heart is supplied by which of the following vessels?  

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Codominant coronary circulation p. 290

Coronary arteries

anatomy of p. 291

atherosclerosis in p. 308

occlusion of p. 291

Coronary artery

atherosclerosis in p. 728

Left anterior descending artery

coronary circulation p. 290

Left-dominant coronary circulation p. 290

Right coronary artery (RCA)

coronary circulation p. 291

Right-dominant coronary circulation p. 290



With coronary circulation, coronary comes from the Latin word “coronarius,” meaning "crown." This is because the coronary blood vessels surrounding the heart resembles a little crown! And circulation refers to “the flow of blood.” So, coronary circulation is the movement of blood throughout the vessels that supply the myocardium also known as the heart muscle.

Now, the heart is a pump, primarily made up of cardiac muscle cells known as cardiomyocytes. And like any other cell, they require a steady supply of oxygen, nutrients, and a way to eliminate wastes. And although the heart is continually pumping blood throughout its chambers, the myocardium is too thick for the diffusion of blood to happen effectively. So, instead, the coronary circulation provides an efficient way for the exchange of substances to occur.

Coronary Circulation

Okay, the coronary circulation system is mainly made up of arteries and veins. To begin, the arterial supply of the heart starts with the branching out of the left and right coronary arteries from the base of the aorta. It’s like a superhighway that carries oxygenated blood from the heart to the rest of the body.

Left Coronary Artery

Now, the left coronary artery heads along the left coronary sulcus, a groove on the outer surface of the heart that marks the point of division between the ventricles and the atria. Not too far along the sulcus, the left coronary artery divides into two major branches. The first is the left anterior descending artery or LAD. It travels down the anterior interventricular sulcus, and it supplies the anterior 2/3 of the interventricular septum, the anterolateral papillary muscle, and the anterior surface of the left ventricle. The second branch is the left circumflex artery or LCX. It goes along the coronary sulcus, around the left side of the heart and supplies the left atrium and the posterior walls of the left ventricle.


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