Coronary arteries

introduction

The coronary arteries, also popularly known as the coronary arteries, supply the heart with oxygen-rich blood. Immediately after the aortic valve, the two main branches of the coronary arteries arise from the ascending part of the aorta. The left coronary artery primarily supplies the anterior cardiac wall and the right coronary artery supplies the posterior wall of the heart. Although some of the coronary arteries lie relatively superficially on the heart muscle, they also supply the heart in depth via smaller arteries.
If there is an impairment of the coronary arteries, e.g. in the context of arteriosclerosis, in the worst case a heart attack with fatal consequences can occur.

Systematics of the coronary vessels

They arise from the aorta Coronary arteries dextra (right coronary artery) and sinistra (left coronary artery), which in their course divide into further branches.

Originating from the left coronary artery:

• Ramus interventricularis anterior/ RIVA (English synonym: LAD / "left anterior descending")
• Ramus circumflexus/ RCX
• Ramus intermedius (does not always exist, but relatively often)

Originating from the right coronary artery:

• Ramus interventricularis posterior /RIP
• Ramus marginalis dexter/ RMD

Both the left and the right coronary artery can produce a Ramus posterolateralis / RPL that runs along the back of the heart.

This is followed by numerous other small branches that supply the heart muscle tissue comprehensively as a whole.

Segments

The American Heart Association has the coronary arteries in total 15 segments divided. Segments 1 to 4 correspond to the right Coronary artery, during the left coronary artery segments 5 to 10 can be attributed. The segments 11 to 15 belong to left circumflex branch. This subdivision can help with orientation (e.g. with the description of the findings).

Anomalies

A anomaly the coronary artery is one in about 1% of the population mostly since birth existing malformation. One can see anomalies in Origin, mouth and course anomalies divide the coronary arteries. For example, one of the coronary arteries can originate at a different point in the aorta or even the pulmonary artery and have a different course to the supply area.

In most cases, they do not cause discomfort for a long time. If they do not pose a potential risk, such anomalies are identified as benign / benign designated.
Malignant / malignant Anomalies can cause symptoms like Heart pounding or Fainting spells cause and even in the course life threatening become. In the worst case, they can go to Heart attack or even to sudden cardiac death to lead.

Often will you accidentally diagnosed. If one then wants to initiate further steps for the exact collection of a finding, one is Multi-line spiral computed tomography the most sensible and accurate imaging.
Depending on how the anomaly is then classified will, whether benign or malignant, can further treatment options to prevent a cardiac event discussed and introduced.

Illustration of an artery

1. Outer layer of
   Arterial wall -
   Tunica externa
2. Outer elastic layer -
   External elastic membrane
3. Middle layer of the arterial wall -
   Tunica media
4. Inner elastic layer -
   Internal elastic membrane
5. Inner layer of the arterial wall -
   Tunica intima
6. Endothelial cells - Endotheliocyti
7. Blood vessels in the adventitia -
   Vasa vasorum
8. Autonomous nerve plexus of the
   Vessel wall -
   Vascular plexus

You can find an overview of all Dr-Gumpert images at: medical illustrations

Coronary artery diseases

root cause

A major cause of coronary artery disease is the Coronary heart disease (CHD) which to one insufficient oxygen supply to the heart muscle tissue leads.

The heart muscle's need for oxygen increases with physical exertion. In healthy people, the coronary arteries would widen so that more oxygen-rich arterial blood could supply the heart muscles. In patients with CHD, however, this is usually not possible, so that the resilience is greatly reduced. After all, is that complete coronary artery occludedso this leads to Die of the to be supplied Heart muscle tissuewhich is only reversible to a certain extent and in a certain time. The Cardiac output can underneath drop sharply.

There is usually one behind a CHD arteriosclerosisthat become a Stiffening of the coronary arteries leads and sooner or later also in one Vascular occlusion can end. Depending on how quickly a closure develops, the consequences can vary in severity. In addition to the CHD, a Coronary artery spasm lead to complaints, which are, however, reversible.
Atherosclerosis is one Disease of the arteries, in the case of the coronary arteries, which are located primarily in the inner layer of the blood vessel, the so-called "Intima“Is playing. Most of the time the cause is a violation of this layer, what is called "Endothelial lesionThis triggers a settlement of blood platelets at the injured area, which in turn leads to the emission of certain substances that promote the attachment and penetration of other cells at this point of the intima. In the course of the process, the structure builds into one Plaque um, which is not very elastic and rather hard due to the connective tissue structure. This has a tremendous impact on the coronary arteries, as both the entire blood vessel loses elasticity, as well as that The risk of a heart attack increases.
Atherosclerosis is mainly caused by one unhealthy lifestyle promoted, i.e. by excessively high blood lipid levels, smoking, lack of exercise and high blood pressure. If the above-mentioned risk factors of arteriosclerosis are determined, their extent can be reduced, for example, by changing one's diet, exercising or using certain medications, thus reducing the risk of arteriosclerosis.

Symptoms

Symptoms related to coronary artery disease are expressed in a number of ways. In part they are rather unspecific, that is, they cannot always be automatically associated with the coronary arteries.
For some, the symptoms are already evident at reduced resilience in sports or even in everyday life or also already in peace. Others only react in Stressful situation with complaints.
Relatively unspecific symptoms are malaise with nausea or water retention in the legs (edema).
A typical symptom on the other hand it is Tightness in the chestwhich as Angina pectoris referred to as. It sometimes occurs with drawing, burning and stabbing pains. Hcommon radiate the pain into the left arm off, alternatively also in the neck, the jaw or the move. Here should be best a doctor promptly, be visited in order to carry out further diagnostics or to already provide help.
in the worst case damage to the coronary arteries is manifested in the Heart attack with or without result of death.

diagnosis

If typical symptoms of a disease of the coronary arteries occur, the diagnosis is made first EKG written. This is done first in peace, then for further clarification even under stress.
If one now suspects an impairment of the coronary arteries, one follows depending on the urgency Echocardiography, one Magnetic resonance imaging, one Spiral computed tomography or one Coronary angiography with contrast medium, in which therapy could also be initiated quickly. Here is especially the Coronary artery patency and the Blood circulation and vitality of the heart muscle judged.
In addition to EKG and imaging, certain blood valueslike about that Troponin or the Creatine kinase of the heart muscle provide information about the state of health.

therapy

On the one hand, the therapy consists of the Reduction of risk factors.
The Setting the blood pressure values and the Reduction in blood lipids in the foreground. The patient should also be aware of the Use of exercise and the Harmfulness of smoking be cleared up.
For acute tightness in the chest can Medicationhow about a Nitro preparation are given, which are intended to expand the coronary arteries in a short time.

Is the Coronary heart disease already advanced, depending on the extent of the closure, an insert of a Stents or the creation of a Bypasses be considered in order to the Reliable blood supply to the heart becomes.
A Stent is the English technical term for "Stent“And is mostly a wire mesh, which for keeping a blood vessel open is used. It is folded up on a catheter and brought either via the inguinal artery or the pulse artery to the affected coronary artery and then pressed against the blood vessel wall with the help of a balloon in order to reopen the vessel and secure the blood supply to the heart. To know which coronary artery is affected and where to place the stent, you use the Coronary angiography, with which the coronary arteries can be precisely displayed using contrast media.
Because the platelets of the blood clot like to lay on the surface of the stent and insert Blood clots form, is it important before the procedure already with a dual Inhibition of platelet aggregation to start and this continue even after the stent has been insertedso that the stent stays open as long as possible. Suitable drugs are Acetylsalicylic acid in combination with about Clopidogrel. There are also coated stents, which should not allow blood platelets to accumulate.
The stent comes first used for fresh heart attacks or if the coronary arteries are about to occlude and has comparatively high chances of success. In addition, the patient is not so stressed during this procedure, since only one of the arteries is punctured and no general anesthesia necessary is.
Possible Side effects are a quick reclosure of the stent, the detachment of a blood clot or the obstruction of an artery that branches off through the stent. Overall, however, this occurs rarely.

forecast

The prognosis of CHD is difficult to assess because of both genetic, as well as Environmental factors play a major role in the creation.
CHD still often leads to deaths, especially in industrialized countries.
Although you can at timely diagnosis of risk factors get these under control thanks to a healthy lifestyle and medication, often express themselves Coronary artery damage however at a late stage. So it applies preventive by Exercise, a healthy diet and regular health checks to prevent coronary artery disease at an early stage with a doctor.

prophylaxis

To prevent coronary artery disease, one should look to one healthy lifestyle pay attention to what includes, among other things, a balanced diet and sufficient physical activity. In addition, it should Quit smoking immediately become. If you have a pre-existing illness regular medical checks and the correct intake of the prescribed medication important.