Coronary artery anatomy

FIGURE 4-2. Coronary artery anatomy with sternocostal and diaphragmatic views. (Reproduced from Talbert RL. Ischemic heart disease. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 263, with permission.)... 

FIGURE 11-1. Coronary artery anatomy. (From Tintinalli JE, Kelen CD, Stapczynski JR, eds. Tintinalli s Emergency Medicine A Comprehensive Study Guide, 6th ed. New York McGraw-Hill, 2004 344.)... 

We have attempted to find evidence for gender differences that could alter the information we have provided in this chapter but we could not find reliable human studies in this regard, This does not include differences that may exist in the endothelium or in the coronary artery anatomy or in the pathophysiology of atherosclerosis, but refers to effectiveness of antiplatelet and anticoagulation drugs as compared to the opposite sex. 

FIGURE 15-1. Coronary artery anatomy with sternocostal and diaphragmatic... 

Cardiac catheterization and coronary arteriography are used to determine coronary artery anatomy and if the patient would benefit from angioplasty, coronary artery bypass grafting (CABG), or other revascularization procedures. 

Exercise tolerance (stress) testing (ETT) is recommended for patients with intermediate pretest probability of CAD based on age, gender, and symptoms, including those with complete right bundle branch block or less than 1 mm of rest ST-segment depression (Fig. 15-3). Although ETT is insensitive for predicting coronary artery anatomy, it does correlate well with outcome, such as the likelihood of... 

Cardiovascular anatomy and physiology Ventricular performance Electrophysiology Coronary artery distribution Human skin... 

James TN. Anatomy of the coronary arteries. New York Hoeber, Harper Row, 1961. 

Anterior view of coronary arteries. From Tortora and Derrickson Principles of Anatomy and Physiology, Eleventh Edition 2006. Reproduced with permission of John Wiley Sons, Inc. 

The surface electrocardiography (ECG) in both acute and chronic phase of ischaemic heart disease (IHD) may give crucial information about the coronary artery involved and which is the area of myocardium that is at risk or already infarcted. This information jointly with the ECG-clinical correlation is very important for prognosis and risk stratification, as will be demonstrated in this book. Therefore, we will give in the following pages an overview of the anatomy of the heart, especially the heart walls and coronary tree, and emphasise the best techniques currently used for its study. 

Fig. 15.2. Volume rendering is helpful in cardiac CTA datasets to display the anatomy of coronary arteries. After semi-automated segmentation of the coronary arteries out of the entire scan volume, standardviewing projections may be created such as the LAO, RAO and spider...

Third, perfusion defects could better be allocated to their specific culprit lesion, which is not possible with MPI alone. Accordingly, in the presence of hemody-namically relevant coronary artery stenoses, accurate treatment stratification could be provided. Particularly in patients with known CAD and a more complex coronary anatomy with intracoronary stents or bypass grafts, exact morphological information has shown to be very useful. 

Coronary artery disease remains the main killer. The mortality from coronary artery disease has decreased by 28% in the last 20 years. A first acute myocardial infarction had mortality of 28% in 1963 and today it is about 7%. The price of life has become more and more valuable. We are only on the threshold of understanding the pathogenic and biological principles of the generation of atheroma, but once established, obstructive lesions need coronary artery dilatation, coronary artery bypass or arterial replacement. The saphenous vein is an excellent bypass conduit but its life expectancy is 3 to 10 years only until it thromboses, or becomes atheromatous and is blocked or obliterated by cholesterol filled intima or clot. The internal mammary artery is ideal but flow is too small to sustain adequate flow to the entire heart. Here too, there is the need for new non-thrombogenic materials to reconstruct artificial arteries, substances which are durable, non-thrombotic and do not promote atherogenesis. There is also the need for simple, non-invasive techniques to measure coronary blood flow and the anatomy of the coronary arteries to plan subsequent surgical procedures. 

MRA is already used routinely in many centres for evaluation of the carotid arteries and intracerebral vasculature, aortography and assessment of the ileofemoral system. MRA of the coronary arteries is technically more difficult due to their relatively small size, their complex 3D anatomy and their constantly changing position within the thoracic cavity due to cardiac motion and respiration. 

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