The coronary arteries supply the heart muscle with oxygenated blood, paradoxically being filled during diastole when the aortic sinuses trap blood above the cusps during ventricular relaxation. The LAD is the most clinically important coronary artery, supplying the anterior left ventricular wall and interventricular septum — its occlusion produces the widow-maker anterior STEMI. Right-dominant coronary anatomy (PDA from RCA) is present in 85 percent of people.
| Origin | Right and left coronary arteries from the right and left aortic sinuses (sinuses of Valsalva) just above the aortic valve |
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Acute myocardial infarction from coronary artery thrombosis is treated with primary percutaneous coronary intervention (primary PCI) within 90 minutes of first medical contact — door-to-balloon time. LAD occlusion produces anterior STEMI with ST elevation in V1-V4. RCA occlusion produces inferior STEMI in II, III, aVF with right ventricular involvement. Fractional flow reserve (FFR) measurement during coronary angiography guides decisions about revascularisation of intermediate severity stenoses.
Coronary artery thrombotic occlusion producing ST-elevation or non-ST elevation myocardial infarction managed with primary PCI or thrombolysis within the appropriate time window.
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