CORONARY VENOUS SYSTEM DISEASES

Coronary_Venous_System_Diseases

CORONARY VENOUS SYSTEM PHYSIOLOGY, MICROCIRCULATION AND VENOUS RETURN

Anosh S. Sivashanmugarajah1 Ross Roberts-Thomson2

1Royal Adelaide Hospital, Department of Cardiology, SA, Australia
2Royal Adelaide Hospital, Department of Cardiology, SA, Australia

Sivashanmugarajah AS, Roberts- Thomson R. Coronary Venous System Physiology, Microcirculation and Venous Return. In: Altay S, Akşit E, Kemaloğlu Öz T editor. Coronary Venous System Diseases. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.27-38.

ABSTRACT

A fundamental yet often underappreciated component of coronary circulation is the coronary venous system. It plays a crucial role in returning deoxygenated blood to the right atrium, maintaining ad- equate cardiac function and metabolic equilibrium. This chapter will outline the physiology of the coronary venous system, highlighting the regulation of blood flow in the myocardium and venous return. Comprised of small veins, venules and the coronary sinus, the coronary venous network works in tandem with the coronary arteries to regulate myocardial perfusion and subsequently maintain a homeostatic balance between oxygen supply and metabolic demand.

The microcirculation which includes arterioles, capillaries and venules, help in facilitating oxygen, nutrient and waste exchange. This is important given the heart’s continual high metabolic activity. The coronary microcirculation is predominantly governed by metabolic, endothelial, neurogenic and myogenic mechanisms. Metabolic alterations at a local level including but not limited to increased levels of lactic acid, carbon dioxide and adenosine lead to vasodilation. This simultaneously augments coronary blood flow to match myocardial oxygen demand. Similarly, venous return is primarily affect- ed by a combination of pressure gradients and the myocardial contraction-relaxation cycle. This leads to efficient removal of deoxygenated blood from the coronary circuit. When coronary sinus pressure is elevated in disease states such as heart failure, the impaired venous return can consequently disrupt circulation and potentially lead to myocardial ischaemia. Venous return is also influenced by the auto- nomic nervous system with venous tone and blood flow distribution being affected by parasympathetic and sympathetic effects.

A comprehensive understanding of the physiology of the coronary venous system will assist in the timely diagnosis and management of cardiovascular diseases including but not limited to coronary artery disease and heart failure. This chapter will also review the role of dysfunction of the venous system in the exacerbation of these conditions, reinforcing the significance of appreciating it’s role in cardiovascular health. Advances in research and diagnostics are essential to better delineate the role of coronary venous function and physiology and thereby develop targeted therapies and treatment strate- gies for a range of cardiovascular diseases.

Keywords: Coronary venous system; Coronary microcirculation; Venous return; Myocardial perfusion; Coronary veins; Coronary sinus, Venous congestion, Cardiac venous drainage

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