Anterior interventricular branch of left coronary artery

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Anterior interventricular branch of left coronary artery
Gray492.png
Sternocostal surface of heart. Anterior descending branch labeled at upper right
Details
Latin ramus interventricularis anterior arteriae coronariae sinistrae
Source left coronary artery
Branches septals, diagonals
Supplies anterolateral myocardium, apex, interventricular septum, 45-55% of the left ventricle (LV)
Identifiers
Dorlands
/Elsevier		 r_02/12690388
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Anatomical terminology
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The left anterior descending artery (also LAD, anterior interventricular branch of the left coronary artery, or anterior descending branch), also known as the "widow maker", is an artery of the heart.[1][dubious – discuss]

Structure

It passes at first behind the pulmonary artery and then comes forward between that vessel and the left auricula to reach the anterior interventricular sulcus, along which it descends to the incisura apicis cordis.

Although rare, multiple anomalous courses of the LAD have been described. These include the origin of the artery from the right sinus of valsalva.[2]

In 78% of cases, it reaches the apex of the heart.

Branches

The LAD gives off two types of branches: septals and diagonals.

  • Septals originate from the LAD at 90 degrees to the surface of the heart, perforating and supplying the anterior 2/3rds of the interventricular septum.
  • Diagonals run along the surface of the heart and supply the lateral wall of the left ventricle and the anterolateral papillary muscle.

Function

The artery supplies the anterolateral myocardium, apex, and interventricular septum. The LAD typically supplies 45-55% of the left ventricle (LV) and is therefore considered the most critical vessel in terms of myocardial blood supply.

EKG changes associated with left anterior descending territory ischemia include ST segment changes in leads V1-V4, 1 and AVL.[citation needed]

Tight, critical stenosis (95%) of the proximal LAD in a patient with Wellens' Warning

Widow maker

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Further information: Wellens' sign

The widow maker is an alternate name for the anterior interventricular branch of left coronary artery.[3][1] The name widow maker may also apply to the left coronary artery[4] or severe occlusions to that artery.[5][6]

This term is used because the left main coronary, and/or the left anterior descending supply blood to large areas of the heart. This means that if these arteries gets abruptly and completely occluded it will cause a massive heart attack that will likely lead to a sudden death. The blockage that kills is made up of platelets streaming to the site of a ruptured cholesterol plaque. Even a small amount of plaque in this area can (for a variety of poorly understood reasons) rupture and cause death; bypassing chronic blockages or trying to open them up with angioplasty does not prevent heart attack but it can restore blood flow in case of a sudden blockage or heart attack and if performed within a rapid time period can minimize the damage done. An example of the devastating results of a complete occlusion of the LAD artery was the sudden death of former NBC News Washington Bureau Chief Tim Russert.[7]

From the minute a widow maker heart attack hits, survival time ranges from minutes to several hours. Rapidly progressing symptoms should signal the need for immediate attention. Symptoms of initial onset may include nausea, shortness of breath, pain in the head, jaw, arms or chest, numbness in fingers, often of a novel but imprecise sensation which builds with irregular heart beat. Early symptoms may be mistaken for food poisoning, flu or general malaise until they intensify. A widow maker cannot kill instantly but induces cardiac arrest which may do so within 10 to 20 minutes of no circulation. A victim with no pulse or breath is still alive, living off oxygen stored in the blood and may be able to be rescued if treatment is begun promptly within this window.[8]

Additional images

  • Coronary arteries (labeled in red text)

  • The arch of the aorta, and its branches.

  • Heart attack

  • Cardiac vessels

  • Human heart with coronary arteries

  • Heart coronary territories

References

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

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External links


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