関: anterior descending branch、LAD、left anterior descending coronary artery

WordNet

a part of a forked or branching shape; "he broke off one of the branches" (同)leg, ramification
divide into two or more branches so as to form a fork; "The road forks" (同)ramify, fork, furcate, separate
a division of a stem, or secondary stem arising from the main stem of a plant
a division of some larger or more complex organization; "a branch of Congress"; "botany is a branch of biology"; "the Germanic branch of Indo-European languages" (同)subdivision, arm
a stream or river connected to a larger one
of or near the head end or toward the front plane of a body
earlier in time (同)prior
broken husks of the seeds of cereal grains that are separated from the flour by sifting
food prepared from the husks of cereal grains
resembling the branches of a tree
the act of branching out or dividing into branches (同)ramification, fork, forking
having branches (同)branching, ramose, ramous, ramate

PrepTutorEJDIC

『枝』 / 『支流』,支脈,支線;分家 / 『支店』,『支部』,支局 / (学問の)『部門』,分科 / 枝を出す,枝を広げる / (川・道・鉄道などが)分岐する
(場所などが)前の,前部の;(…より)前に位置する《+『to』+『名』》 / (時・事件などが)以前の,先の;(…より)前の《+『to』+『名』》
ふすま,ぬか

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/05/11 15:03:10」(JST)

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The anterior interventricular branch of left coronary artery, (also left anterior descending artery (LAD), or anterior descending branch) is a branch of the left coronary artery. Occlusion of this artery is often called the widow-maker infarction.^[1]

Structure

It passes at first behind the pulmonary artery and then comes forward between that vessel and the left atrium to reach the anterior interventricular sulcus, along which it descends to the notch of cardiac apex.

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

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

Widow maker

The widow maker is an alternate name for the anterior interventricular branch of the 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 are abruptly and completely occluded it will cause a massive heart attack that will likely lead to 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)

^ ^a ^b Topol, Eric J.; Califf, Robert M. (2007). Textbook of Cardiovascular Medicine. Lippincott Williams & Wilkins. p. 283. ISBN 9780781770125. Retrieved 6 November 2014. The most worrisome type is the proximal left anterior descending (LAD) MI, often referred to as the widow-maker infarction, which carries a high mortality and is attributed to an occlusion of the LAD before or at the first septal perforator.
^ Ropers, D. (12 February 2002). "Anomalous Course of the Left Main or Left Anterior Descending Coronary Artery Originating From the Right Sinus of Valsalva: Identification of Four Common Variations by Electron Beam Tomography". Circulation. 105 (6): 42e–43. doi:10.1161/hc0602.102020.
^ Lewis, Kathryn (1 December 2009). Multiple Lead ECGs: A Practical Analysis of Arrhythmias. Cengage Learning. p. 10. ISBN 9781435441248. Retrieved 6 November 2014. The LAD is frequently implicated in sudden cardiac death, predominantly in adult males. Clinicians often refer to the LAD as the widow maker because obstruction here predisposes to a high incidence of sudden death.
^ Barbara J. Aehlert; Robert Vroman (2011). "22". Paramedic Practice Today: Above and Beyond (1st ed.). Jones & Bartlett Publishers. p. 819. ISBN 978-0-323-08535-9. Retrieved 2 March 2015.
^ Richard Beebe; Jeff Myers (11 December 2009). "34". Professional Paramedic, Volume I: Foundations of Paramedic Care. Cengage Learning. p. 764. ISBN 1-4283-2345-7. Retrieved 2 March 2015.
^ Carlos S Restrepo; Dianna M. E. Bardo (1 January 2011). Cardiac Imaging. Thieme. p. 188. ISBN 978-1-60406-186-4. Retrieved 2 March 2015.
^ Morgan, David (June 13, 2008). "TV newsman Tim Russert dies of heart attack". Reuters. Archived from the original on June 24, 2008. Retrieved June 13, 2008.
^ Kearl, Mary (June 2009). "Surviving a Widow-Maker Heart Attack". AOL Health. Retrieved June 2009. Check date values in: |access-date= (help)

External links

Anatomy photo:20:09-0102 at the SUNY Downstate Medical Center - "Heart: The Left Coronary Artery and its Branches"
Anatomy figure: 20:03-08 at Human Anatomy Online, SUNY Downstate Medical Center - "Anterior view of the heart."

UpToDate Contents

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Lead I R-wave amplitude to differentiate idiopathic ventricular arrhythmias with left bundle branch block right inferior axis originating from the left versus right ventricular outflow tract.

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Journal of cardiovascular electrophysiology.J Cardiovasc Electrophysiol.2018 Nov;29(11):1515-1522. doi: 10.1111/jce.13747. Epub 2018 Oct 8.
PMID 30230106
AuthorsHarkness WT1, Hicks M2.
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PMID 29939649

Percutaneous Intramyocardial Septal Radiofrequency Ablation for Hypertrophic Obstructive Cardiomyopathy.

Liu L1, Li J2, Zuo L2, Zhang J3, Zhou M2, Xu B3, Hahn RT4, Leon MB4, Hsi DH5, Ge J6, Zhou X2, Zhang J2, Ge S7, Xiong L8.
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Japanese Journal

Anomalous great cardiac vein draining directly into the boundary between the superior vena cava and right atrium

Mine Kazuharu,Ogata Shigemitsu,Shimada Kazuyuki,シモタカハラリエ,ミネカズハル,オガタシゲミツ,SHIMOTAKAHARA Rie,MINE Kazuharu,OGATA Shigemitsu
鹿児島大学医学部保健学科紀要 23(1), 1-4, 2013-03
… The great cardiac vein usually ascends to the anterior interventricular sulcus and turns leftward in the coronary sulcus to transition into the coronary sinus. … The great cardiac vein originated from the apex cordis at the distal 1/3 of the interventricular sulcus, ascended along the anterior interventricular sulcus and drained directly into the boundary between the superior vena cava and the right atrium. …
NAID 120005324782

COMPOSITIONAL CHANGES OF THE CORONARY ARTERIES WITH AGING IN JAPANESE, THAI, AND MONKEYS

Tohno Yoshiyuki,Tohno Setsuko
Journal of Nara Medical Association 60(1-2), 15-25, 2009-04-30
… The anterior interventricular branch was used as the left coronary artery. … The anterior interventricular branches were also resected from rhesus and Japanese monkeys bred in the Primate Research Institute, Kyoto University. …
NAID 120004973249

David-Komeda法を応用し救命しえたblow out型左室自由壁破裂の1治験例

鈴木龍介,小柳俊哉,渡辺俊明,平山亮,野畑一郎
日本心臓血管外科学会雑誌 36(3), 145-149, 2007-05-15
症例は61歳,女性.急性心筋梗塞の診断で当院へ加療目的に救急車で搬送中にショック状態となり,緊急カテーテル検査を施行した.左前下行枝#6の完全閉塞をきたしており,同時に施行された経胸壁心エコー検査で心嚢液の貯留が確認されて急性心筋梗塞に伴った心破裂の診断で緊急手術を施行した.手術はF-F bypassで体外循環を確立し,左室前壁に約1cmの破裂部位を認め,梗塞部の心筋は広範囲にわたっていたため,心 …
NAID 110006273344

Related Pictures

★リンクテーブル★

リンク元	「前室間枝」「anterior descending branch」
関連記事	「branch」「anterior」「branched」「branching」「bran」

「前室間枝」

Anterior interventricular branch of left coronary artery
	Sternocostal surface of heart. Anterior descending branch labeled at upper right
Details
Source	left coronary artery
Branches	septals, diagonals
Supplies	anterolateral myocardium, apex, interventricular septum, 45-55% of the left ventricle (LV)
Identifiers
Latin	ramus interventricularis anterior arteriae coronariae sinistrae
Dorlands; /Elsevier	r_02/12690388
TA	A12.2.03.202
FMA	3862
	Anatomical terminology; [edit on Wikidata]