Thecoronary arteriesrun along the surface of theheartand supply the heart muscle with blood. Usually, two main coronary arteries, the left and the right, arise from the base of the aorta and form a circle around the base of the heart.

A large coronary artery called the posterior interventricular artery, or posterior descending artery (PDA), runs lengthwise along the back of the heart, supplying blood to its posterior (bottom) portion.

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hands holding a plastic heart, posterior interventricular artery

Anatomy

Structure

The heart is roughly cone-shaped, with a base (the wider part of the cone) and apex (the tip of the cone). There are fourcardiac chambers: the smaller atria toward the base of the heart, and the larger ventricles toward the apex.

A groove that runs lengthwise along the heart, from the base to the apex, divides the right and left ventricles—this is called the interventricular groove, or sulcus. A groove that runs around the base of the heart divides the atria from the ventricles—this is called the atrioventricular groove.

At the cardiac apex, small branches of the PDA may meet branches of the large artery that supplies the front of the heart, the left anterior descending.

Location

Therightandleftmain coronary arteries arise from the base of theaorta, from bulges called the coronary sinuses of Valsalva. The term “coronary” derives from the Latin for “crown,” and the two main coronary arteries encircle the base of the heart, along the atrioventricular groove, a bit like an incomplete crown.

Several large coronary artery branches arise from this crown, supplying blood to different portions of the heart. The major arteries that run along the interventricular groove are the left anterior descending artery and the posterior interventricular artery.

Anatomical Variations

Coronary artery anatomy varies a great deal from person to person. Most patients (about 60% to 85%) have a right-dominant circulation, in which theright coronary arterygives rise to the posterior descending artery. In people with a left-dominant circulation, the posterior descending artery arises from a large branch of the left coronary artery, the circumflex.

There are cases where both theleft coronary arteryand right coronary artery contribute to the posterior descending artery, a situation called codominant circulation.

The posterior descending artery arises near the crux cordis, where the atrioventricular groove meets the posterior interventricular sulcus. It travels along the sulcus, lengthwise along the cone, along the bottom of the heart.

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Function

The posterior interventricular artery supplies blood to the heart’s posterior, or bottom, portion.

Clinical Significance

The coronary arteries can vary with respect to their origin, number, and course, and many variants have been described in medical literature. While many variants cause no symptoms, some may be significant.

The posterior interventricular artery may be very small in some patients. In this case, blood is supplied to the bottom of the heart via other branches of the right and left coronary arteries.

About 1% of patients have a split right coronary artery, in which the right coronary artery divides early and gives rise to two separate posterior descending arteries. This anomaly usually does not cause symptoms.

Surgery

Like other coronary arteries, the posterior interventricular artery may be involved in coronary artery disease, in whichatherosclerosisof the coronary arteries leads to an inadequate supply of blood to the heart muscle. Atherosclerosis occurs when there is a buildup of plaque—fatty deposits—in your arteries, leading to narrowing and hardening of the arteries.

Coronary artery disease is the leading cause of death in both developed and developing countries. It can lead toheart failure,arrhythmias,myocardial infarction, and other complications. In a myocardial infarction (heart attack), ruptured atherosclerotic plaque in a coronary artery cuts off the blood supply to the heart muscle.

Depending on coronary dominance, plaque in the right coronary artery or circumflex artery can cause a loss of blood supply to the posterior interventricular artery, resulting inischemiato the bottom heart wall.

Types of Heart Disease

2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D.Overview of coronary artery variants, aberrations and anomalies.World J Cardiol. 2018;10(10):127-140. doi:10.4330/wjc.v10.i10.127Dewey M, Kroft LJM.Anatomy. In:Cardiac CT. Springer Berlin Heidelberg; 2011:13-28.Additional ReadingFaletra FF, Araco M, Leo LA, et al.The coronary arteries and veins. In: Faletra FF, Narula J, Ho SY, eds.Atlas of Non-Invasive Imaging in Cardiac Anatomy.Springer International Publishing; 2020:107-130.Kannam JP, Aroesty JM, Gersh BJ.Chronic coronary syndrome: overview of care. Updated June 3, 2021.Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S.A review on coronary artery disease, its risk factors, and therapeutics.J Cell Physiol.2019;234(10):16812-16823. doi: 10.1002/jcp.28350Rabin DN, Rabin S, Mintzer RA.A pictorial review of coronary artery anatomy on spiral CT.Chest. 2000;118(2):488-491. doi: 10.1378/chest.118.2.488

2 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D.Overview of coronary artery variants, aberrations and anomalies.World J Cardiol. 2018;10(10):127-140. doi:10.4330/wjc.v10.i10.127Dewey M, Kroft LJM.Anatomy. In:Cardiac CT. Springer Berlin Heidelberg; 2011:13-28.Additional ReadingFaletra FF, Araco M, Leo LA, et al.The coronary arteries and veins. In: Faletra FF, Narula J, Ho SY, eds.Atlas of Non-Invasive Imaging in Cardiac Anatomy.Springer International Publishing; 2020:107-130.Kannam JP, Aroesty JM, Gersh BJ.Chronic coronary syndrome: overview of care. Updated June 3, 2021.Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S.A review on coronary artery disease, its risk factors, and therapeutics.J Cell Physiol.2019;234(10):16812-16823. doi: 10.1002/jcp.28350Rabin DN, Rabin S, Mintzer RA.A pictorial review of coronary artery anatomy on spiral CT.Chest. 2000;118(2):488-491. doi: 10.1378/chest.118.2.488

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D.Overview of coronary artery variants, aberrations and anomalies.World J Cardiol. 2018;10(10):127-140. doi:10.4330/wjc.v10.i10.127Dewey M, Kroft LJM.Anatomy. In:Cardiac CT. Springer Berlin Heidelberg; 2011:13-28.

Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D.Overview of coronary artery variants, aberrations and anomalies.World J Cardiol. 2018;10(10):127-140. doi:10.4330/wjc.v10.i10.127

Dewey M, Kroft LJM.Anatomy. In:Cardiac CT. Springer Berlin Heidelberg; 2011:13-28.

Faletra FF, Araco M, Leo LA, et al.The coronary arteries and veins. In: Faletra FF, Narula J, Ho SY, eds.Atlas of Non-Invasive Imaging in Cardiac Anatomy.Springer International Publishing; 2020:107-130.Kannam JP, Aroesty JM, Gersh BJ.Chronic coronary syndrome: overview of care. Updated June 3, 2021.Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S.A review on coronary artery disease, its risk factors, and therapeutics.J Cell Physiol.2019;234(10):16812-16823. doi: 10.1002/jcp.28350Rabin DN, Rabin S, Mintzer RA.A pictorial review of coronary artery anatomy on spiral CT.Chest. 2000;118(2):488-491. doi: 10.1378/chest.118.2.488

Faletra FF, Araco M, Leo LA, et al.The coronary arteries and veins. In: Faletra FF, Narula J, Ho SY, eds.Atlas of Non-Invasive Imaging in Cardiac Anatomy.Springer International Publishing; 2020:107-130.

Kannam JP, Aroesty JM, Gersh BJ.Chronic coronary syndrome: overview of care. Updated June 3, 2021.

Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S.A review on coronary artery disease, its risk factors, and therapeutics.J Cell Physiol.2019;234(10):16812-16823. doi: 10.1002/jcp.28350

Rabin DN, Rabin S, Mintzer RA.A pictorial review of coronary artery anatomy on spiral CT.Chest. 2000;118(2):488-491. doi: 10.1378/chest.118.2.488

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