Coronary Heart Disease (CHD), also known as coronary artery disease or coronary ischemia, is a prevalent cardiovascular condition. The term "coronary," meaning the arteries supplying blood to the heart, signifies the narrowing or blockage of these vessels, restricting blood flow. This limitation can result in chest pain (angina), heart attacks, and complications like Acute Coronary Syndrome (ACS).

Acute Coronary Syndrome typically occurs when a plaque in a coronary artery ruptures, forming a blood clot that can partially or completely block blood flow to the heart. Understanding the causes, diagnosis, treatment, and post-care of CHD is crucial for effectively managing this condition in a timely manner. 

Coronary Artery Disease (CAD) encompasses a spectrum of conditions characterized by the narrowing or blockage of coronary arteries, impacting the blood flow to the heart muscle. 

Each type of coronary heart disease presents distinct challenges and requires specific diagnostic and therapeutic strategies. A comprehensive understanding of these variations is essential for healthcare professionals to provide optimal care tailored to individual patients.

What is coronary circulation of heart? 


Coronary circulation involves the intricate network of vessels within the heart, responsible for the continuous flow of blood. It comprises both coronary arteries and coronary veins.


  • The primary function is to ensure the heart muscle receives a constant supply of oxygen and essential nutrients.

  • Simultaneously, it plays a crucial role in removing deoxygenated blood and waste products from the heart.

Coronary Arteries Anatomy 

Understanding the intricate branching pattern of these coronary arteries is essential for comprehending the nuanced coronary supply of the heart. 

Major Conduits

The cardiovascular system is intricately served by the Left Coronary Artery (LCA) and Right Coronary Artery (RCA), acting as major conduits.

Left Coronary Artery (LCA):

The LCA plays a pivotal role and further divides into two significant branches, each serving distinct regions of the heart.

  • Left Anterior Descending Artery (LAD): Extends down the anterior surface of the heart and supplies blood to the front and major portion of the left ventricle.

  • Left Circumflex Artery: Wraps around the heart's left side and provides blood to the left atrium and lateral wall of the left ventricle.

Right Coronary Artery (RCA):

The RCA ensures the blood supply to the right side of the heart.

Branches of Right Coronary Artery

These branches encompass arteries supplying the right atrium and right ventricle.

  •  Posterior Descending Artery (PDA): A vital branch of the RCA, travels along the back of the heart and supplies the posterior portion of the ventricles.
  • Atrial Branch: Another important branch originating from the RCA, supplies blood to the right atrium, contributing to the overall coronary circulation.

Coronary Veins 

Coronary veins are blood vessels that play a crucial role in returning deoxygenated blood from the heart muscle (myocardium) back to the right atrium of the heart.

How does coronary vein function? 

  • These veins, including the great cardiac vein and small cardiac veins, form a network that collects and channels the deoxygenated blood away from the myocardium.
  • The ultimate destination is the right atrium, where the blood will be subsequently pumped into the pulmonary circulation for oxygenation in the lungs.

Coronary Circulation Steps 

Oxygenated Blood Supply

The coronary arteries deliver oxygenated blood rich in nutrients to nourish the heart muscle.This constant supply is essential for the myocardium's metabolic needs and overall functioning.

Deoxygenated Blood Collection

Coronary veins, including the great cardiac vein, efficiently collect deoxygenated blood and waste products from the heart muscle.

Return Path

Deoxygenated blood is transported back to the right atrium, completing the circulatory cycle.

Structural Support

Ligaments surrounding coronary vessels provide essential structural support.These ligaments not only secure arteries and veins but also contribute to the stability and proper positioning of these vital blood vessels within the heart.

Pecularities of Coronary Circulation 

Explore the unique aspects of coronary circulation, from its constant perfusion needs to dual blood supply, highlighting autoregulatory mechanisms that ensure optimal cardiac function.

Constant Perfusion Needs

  • Coronary circulation exhibits unique characteristics due to the heart's continuous demand for oxygen and nutrients.

  • Unlike other organs, the heart experiences minimal variations in blood flow, ensuring a constant and uninterrupted supply.

Dual Blood Supply

  • The coronary arteries, specifically the Left Coronary Artery (LCA) and Right Coronary Artery (RCA), deliver oxygenated blood to different regions of the heart.

  • This dual blood supply ensures comprehensive nourishment and oxygenation, contributing to the heart's efficient function.

Autoregulation Mechanisms

  • Coronary circulation possesses autoregulatory mechanisms to adjust blood flow based on the heart's needs.

  • These mechanisms help maintain a consistent blood supply, adapting to changes in cardiac workload and metabolic demands.

Integral Role

Coronary circulation is indispensable for maintaining optimal cardiac health and function.

A well-functioning coronary circulation system is vital for preventing ischemic events and ensuring the heart's continuous and efficient operation.

What Causes Coronary Artery Disease? 

CHD develops gradually due to a buildup of cholesterol, fat, and other substances, forming plaques on the inner walls of coronary arteries.  These plaques can then narrow the arteries, reducing blood flow. Causes of coronary heart disease include


Involves the gradual buildup of fatty deposits (plaques) in artery walls, restricting blood flow. Over time, these plaques can harden and narrow arteries, increasing the risk of heart-related complications.


High Blood Pressure

Elevated blood pressure strains arteries, promoting the formation of plaques. The increased force on vessel walls raises the risk of vessel damage, contributing to atherosclerosis progression

High Cholesterol

Elevated LDL cholesterol levels lead to plaque accumulation in arteries.Managing cholesterol levels is crucial to prevent the development and progression of atherosclerosis.


Tobacco smoke damages blood vessel walls, promoting inflammation and plaque formation. This accelerates atherosclerosis and significantly increases the risk of coronary heart disease (CHD).


Diabetes heightens the risk of atherosclerosis, impacting both large and small arteries.It accelerates the progression of CHD, emphasizing the importance of diabetes management in heart health.


Excess weight increases the strain on the heart and exacerbates other risk factors. It is closely linked to insulin resistance, inflammation, and unfavorable lipid profiles, contributing to CHD.

Sedentary Lifestyle

Lack of physical activity contributes to weight gain and worsens risk factors. Regular exercise is essential for maintaining cardiovascular health and preventing the onset or progression of CHD.

Family History

Genetic factors play a role in predisposing individuals to heart disease.

Understanding family history aids in assessing personal risk and adopting preventive measures.

Coronary Vasospasm

An additional phenomenon where the coronary arteries can experience temporary constriction or spasm, leading to a reduction in blood flow to the heart. While not a plaque-related blockage, it is an important aspect to consider in the comprehensive understanding of CHD.

Coronary Cameral Fistula

A rare condition where an abnormal connection (fistula) forms between a coronary artery and a cardiac chamber or a nearby blood vessel. This can disrupt normal blood flow and oxygen supply to the heart, potentially leading to complications.

How is Coronary Heart Disease Diagnosed? 

CHD's diagnosis involves a combination of symptoms assessment, medical history, and diagnostic tests:


Common coronary artery disease symptoms encompass chest pain or discomfort (angina), shortness of breath, fatigue, and irregular heartbeats. Some cases may remain asymptomatic until a heart attack occurs, emphasizing the importance of timely diagnosis.

Diagnostic Procedures

Diagnostic procedures play a crucial role in identifying and assessing CHD. The Electrocardiogram (ECG/EKG) records the heart's electrical activity, aiding in the detection of abnormal rhythms and signs of reduced blood flow. A Stress Test provides insights into heart performance during exertion, revealing inadequate blood flow under stress conditions.

Coronary Angiography Test

In the Invasive procedure of coronary angiography, dye is injected into arteries to visualise blockages using X-rays. A CT Coronary Angiography (CTCA) may also be used for diagnosis. It is a non-invasive imaging technique that uses computed tomography (CT) to create detailed images of the coronary arteries.It is also important to note possible CT Angiography side effects. While it is generally considered safe, there can be rare instances of allergic reactions to the contrast dye. It's essential to inform healthcare providers about any known allergies or previous adverse reactions to contrast agents before undergoing the procedure. Additionally, the radiation exposure during CTCA is a consideration, although modern machines are designed to minimize radiation doses.


An Echocardiogram, employing ultrasound imaging, provides a comprehensive assessment of heart structure, function, and blood flow. These diagnostic tools collectively contribute to the accurate identification and evaluation of CHD, guiding appropriate interventions and treatment strategies.

Cornary Calcium scoring

Calcium scoring is another valuable diagnostic tool in assessing coronary heart disease risk. This non-invasive imaging technique measures the amount of calcium in the coronary arteries, providing an indication of plaque buildup. Learn more about coronary calcium scoring and its importance. 

The profound influence of Coronary Artery Disease on heart health and overall well-being underscores the urgency of early diagnosis, which is guided by vigilant recognition of signs and symptoms and thorough diagnostic tests. Once identified, a meticulously tailored treatment strategy comes into play, encompassing a spectrum from embracing lifestyle adjustments to implementing precise medical interventions. This comprehensive approach effectively manages arrhythmias, fostering a sense of control over heart health. 

However, the journey doesn't conclude there. The commitment to post-treatment care accelerates the momentum of recovery. This not only ensures the enduring well-being of the heart but also enriches the quality of life for individuals navigating the disease. 

Learn more about the various types of treatment and the precautions to be taken post-treatment for a healthy recovery. 

Listen to your heart! Schedule a checkup with Dr. Manjinder Sandhu for personalized cardiac care as early intervention is crucial. Your heart deserves only the best. 

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