neurovascular supply of CVS with Dr. Ameera Al-Huimidi.pptx

neurovascular supply of
cvs
NEUROVASCULAR SUPPLY OF CVS
2

3
O
B
J
E
C
T
I
V
E
S
Arterial supply of the cardiac muscle regarding
(origin, course, distribution and branches)
The coronary anastomosis
The lymphatic drainage of the heart.
The venous drainage of the heart regarding
(origin, tributaries and termination).
The innervation of the heart.

5
I
N
T
R
O
D
U
C
T
I
O
N

6
I
N
T
R
O
D
U
C
T
I
O
N
The blood carries oxygen, nutrients, cell wastes,
hormones and many other substances vital
for body homeostasis.

7
I
N
T
R
O
D
U
C
T
I
O
N
The heart provides forces to move the blood
around the body by the beating Heart.

8
I
N
T
R
O
D
U
C
T
I
O
N

9
I
N
T
R
O
D
U
C
T
I
O
N

10
I
N
T
R
O
D
U
C
T
I
O
N
The coronary circulation refers to the vessels
that supply and drain the heart.
Coronary arteries are named due to the way
they encircle the heart, much like a crown.

11
A
R
T
E
R
I
A
L
Supply
Of
Heart

12
A
R
T
E
R
I
A
L
Supply
Of
Heart
Importance of coronary circulation:
One third of all deaths in the world result from
coronary artery disease
Almost all elderly people have at least some
impairment of the coronary artery
Circulation.
Heart uses primarily free fatty acids and to lesser
extent glucose for metabolism

13
A
R
T
E
R
I
A
L
Supply
Of
Heart
Importance of coronary circulation:
Two third of coronary blood flow occurs during
diastole.
70% of oxygen is extracted by the myocardial
tissue of the heart, while rest of the
body extract 25%

14
The arterial supply of the heart is provided
by Two Coronary Arteries:
• Right Coronary artery
• Left Coronary artery
A
R
T
E
R
I
A
L
Supply
Of
Heart

15
They arise from the initial part of the ascending
aorta (aortic sinuses) or (sinuses of Valsalva) ,
immediately above the aortic valve.
A
R
T
E
R
I
A
L
Supply
Of
Heart

16
There may be variations in the number, shape,
& location of coronary ostia or origins of the
coronary arteries, most of which are of NO
clinical significance.
A
R
T
E
R
I
A
L
Supply
Of
Heart

17
They arise from the initial part of the ascending
aorta (aortic sinuses) or (sinuses of Valsalva) ,
immediately above the aortic valve.
A
R
T
E
R
I
A
L
Supply
Of
Heart

18
The aortic sinuses are small openings found
within the aorta behind the left and right
flaps of the aortic valve.
A
R
T
E
R
I
A
L
Supply
Of
Heart

19
When the heart is relaxed, the back-flow of
blood fills these valve pockets, therefore
allowing blood to enter the coronary
arteries.
A
R
T
E
R
I
A
L
Supply
Of
Heart

20
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
Arises from the anterior aortic cusp of the
ascending aorta.

21
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
Descends in the right atrioventricular groove
between the right auricle and the pulmonary
trunk.

22
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
At the inferior border of the heart, it
continues posteriorly to anastomose with the
left coronary.

23
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
It supplies the followings: • Right atrium •
Right ventricle • Part of left atrium • Left
ventricle and atrioventricular septum • Most
of conducting system

24
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
It supplies the followings: • Right atrium •
Right ventricle • Part of left atrium • Left
ventricle and atrioventricular septum • Most
of conducting system

25
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
Branches of RCA
For infundibulum
and upper part of
anterior wall of the
right ventricle

26
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
Branches of RCA
It is the largest branch,
runs along the lower
margin of the sternocostal
surface.
• It is accompanied by the
Small Cardiac vein.

27
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
Branches of RCA
Supplies the SAN
and both atria.

28
R
I
G
H
T
C
O
R
O
N
A
R
Y
Artery
Branches of RCA
Accompanied by
middle cardiac vein.
• Lies in the posterior
interventricular groove.

29
A
R
T
E
R
I
A
L
Supply
Of
Heart

30
L
E
F
T
C
O
R
O
N
A
R
Y
Artery
The largest of the two coronary arteries.
Arises from the left posterior aortic cusp of
the ascending aorta.

31
L
E
F
T
C
O
R
O
N
A
R
Y
Artery
Descends:
• Between the pulmonary trunk and the left
auricle.
• Run in the atrioventricular groove and then
down to the apex of the heart

32
L
E
F
T
C
O
R
O
N
A
R
Y
Artery
Branches of LCA
Descends in the
anterior
interventricular
groove to the apex of
the heart
(accompanied by the
great cardiac vein)

33
L
E
F
T
C
O
R
O
N
A
R
Y
Artery
Branches of LCA
Winds around the left
margin of the heart in
the
atrioventricular groove.

34
L
E
F
T
C
O
R
O
N
A
R
Y
Artery
Branches of LCA
Supplies the left margin
of the left ventricle
down to the
apex.

35
Variations of the Coronary Arteries
Right Dominance:
• In (90%) of population, the posterior
interventricular artery is a branch of the right
coronary artery.
Left Dominance:
• In the rest (10%), the posterior interventricular
artery arises from the circumflex branch of
the left coronary artery
A
R
T
E
R
I
A
L
Supply
Of
Heart

36
A
R
T
E
R
I
A
L
Supply
Of
Heart

37

38
V
E
N
O
U
S
Drainage
Of
Heart

39
C
O
R
O
N
A
R
Y
Sinus
The main vein of the heart.
It lies in the posterior part of the

40
C
O
R
O
N
A
R
Y
Sinus
The main vein of the heart.
It lies in the posterior part of the

41
C
O
R
O
N
A
R
Y
Sinus
Origin:
• It is the direct continuation of the Great
Cardiac Vein.

42
C
O
R
O
N
A
R
Y
Sinus
Termination:
• It empties into right atrium.
• Its opening is inferior and to the left of the
IVC opening.
• It is guarded by a valve..

43
C
O
R
O
N
A
R
Y
Sinus
Tributaries
The main tributary of
coronary sinus.
It follows the anterior
interventricular groove

44
C
O
R
O
N
A
R
Y
Sinus
Tributaries
Located on the posterior
surface of the heart.
Drains the right side of the
heart

45
C
O
R
O
N
A
R
Y
Sinus
Tributaries
Located on the anterior
surface of the heart

46
C
O
R
O
N
A
R
Y
Sinus
Tributaries
It is a small vein present
on the posterior surface of
the left atrium

47
C
O
R
O
N
A
R
Y
Sinus
Tributaries
The final two cardiac veins
• Left marginal vein on the
left posterior side.
• Left posterior ventricular
vein which runs along the
posterior interventricular
sulcus

48
C
O
R
O
N
A
R
Y
Sinus
Tributaries

49
C
O
R
O
N
A
R
Y
Sinus
Veins Draining Outside Coronary Sinus
Open directly into the right
atrium

50
C
O
R
O
N
A
R
Y
Sinus
Veins Draining Outside Coronary Sinus
Open directly into the right
atrium

51
C
O
R
O
N
A
R
Y
Sinus
Last station is right atrium

52
Posterior interventricular artery

53

54
L
Y
M
P
H
A
T
I
C
S

55
L
Y
M
P
H
A
T
I
C
S
The lymphatics accompany
the coronary arteries and
form two trunk
The right trunk terminates in
the brachio-cephalic nodes
the left trunk terminates in
the tracheobronchial lymph
nodes

56
I
N
N
E
R
V
A
T
I
O
N
S

57
I
N
N
E
R
V
A
T
I
O
N
S
The superficial cardiac plexus lies between the arch of aorta and
the right pulmonary artery, whereas the deep cardiac plexus is
sandwiched deeply, between the arch of aorta and the tracheal
bifurcation

58
I
N
N
E
R
V
A
T
I
O
N
S
Give branches To the deep cardiac plexus
AND To the right coronary artery
AND To the left anterior pulmonary plexus

59
I
N
N
E
R
V
A
T
I
O
N
S
TWO HALVES Give branches to the corresponding coronary and
pulmonary plexuses
AND To the atria.

60
I
N
N
E
R
V
A
T
I
O
N
S

61
M
A
J
O
R
V
E
S
S
E
L
S

A
O
R
T
A
62

A
O
R
T
A
63

S
V
C
64

65

66

67

68
Multiple ostia
NO left common coronary artery.

69
Single Coronary Artery
showing a single coronary artery (yellow arrow
and dividing into the RCA (white arrow
LAD artery (blue arrow
LCX (red arrow

70
Anomalous origin
of the coronary
artery from the
pulmonary
artery
with the RCA arising
normally

71
Percutaneous coronary intervention (PCI)
The goal of this
procedure is to relieve
the narrowing or
occlusion of the
coronary artery

72

73

74

75

76
Acute aortic syndromes

77
Aortic arch syndrome

78
Right aortic arch anomalies

79

BE AS YOUR HEART ALWAYS HARD
WORKING
80

t.me/BMS2020_AMEERAALHUMIDI
@Dr_Ameeraalhumidi
81

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