3. Physiology
        3.2. Cardiovascular
            3.2.5. Special circulations
                3.2.5.2. Coronary blood flow
3.2.5.2.2. Myocardial perfusion

Myocardial perfusion

Pathway of coronary blood flow

Supply of coronary blood flow

Drainage of coronary blood flow

 

Left coronary artery vs right coronary artery

Coronary perfusion pressure
= Aortic blood pressure - (intraventricular pressure or right atrial pressure, whichever is higher)

Left ventricle

Because the pressure is much higher in left ventricle in systole

Also,

Transmural pressure is greatest in the endocardium

e.g.

Right ventricle

Difference in perfusion during systole and diastole less marked in the RV
* Intra-ventricular pressure is much lower (SBP=25)
* Perfusion pressure is same as LV

RV wall is thinner too

 

Regulation of coronary perfusion

Metabolic autoregulation overrides the neural factors.

--> Metabolic demands of the heart regulate coronary blood flow

Metabolites involved include:

[BL8:p233-234]

NB:

 

Other notes

 

Coronary steal

... when administration of vasodilator can fully dilate normal vessel branches parallel to the narrowed segment and divert blood away from it.

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