Right coronary artery

Two-vessel coronary artery disease (60% right coronary artery [RCA] and 80% left anterior descending artery [LAD] occlusion) after intracoronary CYPHER stent placement to the mid-LAD artery lesion 10 months ago. 

PERL Pupils equal, react to light RCA Right coronary artery... 

Right atrium Right ventricle Right coronary artery Inferior vena cava Marginal branch... 

Abbreviations AMI, acute myocardial infarction LAD, left anterior descending LCX, left circumflex LMCA, left main coronary artery RCA, right coronary artery pt, patient. 

Abbreviations BMS. bare metal stent LAD. left anterior descending artery LCX, left circumflex coronary artery LM. left main MVD. multiple vessel disease RCA. right coronary artery. 

The most frequent locations of the target lesion were the mid-left anterior descending vessel (39 patients, 23%), proximal left descending vessel (37 patients, 21 %), and mid-right coronary artery (35 patients, 20%). Mean lesion length was I 1.5 5.0 mm (range from 4 to 25 mm). The most commonly recorded target lesion classification was type BI (86 patients, 50%). 

A and B) Angiographic and intravascular ultrasound follow-up at six months after stent in proximal portion of right coronary artery. Abbreviation FU, follow-up. 

Coronary angiography in two patients who had an asymptomatic occlusion of the right coronary artery with extensive collaterals from the left coronary system. The right coronary artery (black arrows) fills by intramyocardial collaterals (left, white arrows) or large bore epicardial collaterals (right white arrows) underscoring the native collateralization process. 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

Intracoronary adenosine has been compared with intravenous adenosine for the measure of fractional flow reserve in 52 patients with coronary artery lesions (44). The intravenous dose was 140 micrograms/kg/minute and the intracoronary bolus dose was 15-20 micrograms to the right coronary artery and 18-24 micrograms to the left coronary artery. The two routes of administration were equally effective in measuring hyperemic flow, and adverse effects were limited to two patients who received intravenous adenosine one patient had severe nausea and one patient with asthma had an episode of bronchospasm. 

A 62-year-old woman developed chest pain and sinus bradycardia (41/minute). She had third-degree heart block and was given atropine 1 mg intravenously. Three minutes later, her chest pain increased and the electrocardiogram now showed an acute inferior myocardial infarction, confirmed by serum markers. Angioplasty recanalized the right coronary artery. 

A 30-year-old woman collapsed and died after a first dose of bromocriptine 2.5 mg. She had severe atheroma narrowing the right coronary artery proximal to the site of thrombosis. The only obvious risk factor was heavy smoking, 30 cigarettes per day. 

A 41-year-old man employed in a munitions factory was admitted with crushing chest pain on a Sunday morning. There was evidence of an acute inferior myocardial infarction, and cardiac catheterization showed 80% narrowing of the proximal right coronary artery, which was reduced to 10% by intracoronary administration of glyceryl trinitrate. The electrocardiogram became normal. 

The myocardium and specific conduction system (SCS) are perfused by the right coronary artery (RCA), the left anterior descending coronary artery (LAD) and the circumflex coronary artery (LCX). Figure 1.1 shows the great correlation of coronary angiography and CMDCT in normal coronary tree and some pathologic cases. 

RCA or the LCX, depending on which of them is dominant (the RCA in >80% of the cases). Segment 15 often receives blood from LAD. (E) Correspondence of ECG leads with the bull s-eye image. Abbreviations LAD, left anterior descending coronary artery SI first septal branch D1 first diagonal branch RCA, right coronary artery PD, posterior descending coronary artery PL, posterolateral branch ... 

LAD, left anterior descending RV, right ventricle LCX, circumflex artery RCA, right coronary artery LV, left ventricle. See algorithm in Figure 4.43. f See algorithm Figure 4.45. 

Bairey CN, Shah PK, Lew AS, Hulse S. Electrocardiographic differentiation of occlusion of the left circumflex versus the right coronary artery as a cause of inferior acute myocardial infarction. Am J Cardiol 1987 60 456. 

Fiol M, Carrillo A, Cygankiewicz I et al. New criteria based on ST changes in 12 leads surface ECG to detect proximal vs distal right coronary artery occlusion in case of an acute inferoposterior myocardial infarction. Ann Nonin-vasive Electrocardiol 2004a 9 383. 

Shen Wei, Xing Hui, Wang Man, Gong Lan. Myocardial infarction due to isolated left circumflex or right coronary artery occlusion. Chin Med J 1991 104 369. 

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