[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Chest](https://durgical.com/en/anatomy/region/chest/) › LAD (anterior descending artery) [Cardiovascular system](https://durgical.com/en/anatomy/system/cardiovascular-system/) · [Chest](https://durgical.com/en/anatomy/region/chest/) # LAD (anterior descending artery) The left anterior descending artery runs down the front of the heart; it feeds the front of the [left ventricle](https://durgical.com/en/anatomy/left-ventricle/) and most of the septum. Official name: Anterior interventricular artery [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=thorax&select=lad&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The left anterior descending artery, running down the front groove between the ventricles, with diagonal and septal branches. ## What it does Feeds the front of the left ventricle and most of the septum. A sudden blockage near its start is sometimes called the 'widow-maker'. ## Key points - Anterior MI: ST elevation in V1–V4; a proximal occlusion (the 'widow-maker') also involves the diagonals, with changes extending to I, aVL and V5–V6 - A left internal thoracic (mammary) artery graft to the LAD is the most durable bypass graft and the standard in coronary artery bypass surgery - Its septal perforators supply the [bundle branches](https://durgical.com/en/anatomy/right-bundle-branch/), so an anterior MI can bring bundle branch block or infranodal (Mobitz II or complete) block, a sign of a large infarct - Wellens pattern: deep symmetrical or biphasic T waves in V2–V3 after [chest](https://durgical.com/en/anatomy/region/chest/) pain point to a critical proximal LAD stenosis ## Key facts **Origin** Left main coronary artery; runs in anterior interventricular groove to apex **Branches** Diagonal branches; septal perforators; conus branch **Supplies** Anterior LV wall, apex, anterior 2/3 of septum and bundle branches; strip of anterior RV ## Relations **Course** From the [left main coronary artery](https://durgical.com/en/anatomy/left-coronary-artery/) it passes to the left of the [pulmonary trunk](https://durgical.com/en/anatomy/pulmonary-trunk/) and descends in the anterior interventricular groove to the apex **Superficial** Epicardial fat and visceral [pericardium](https://durgical.com/en/anatomy/pericardium/); the [great cardiac vein](https://durgical.com/en/anatomy/great-cardiac-vein/) ascends alongside it in the groove **Deep** [Interventricular septum](https://durgical.com/en/anatomy/interventricular-septum/), which its septal perforators enter at right angles ## How to find it Seen on the front of the heart once the pericardium is opened: it runs in the anterior interventricular groove toward the apex, often buried in fat or under a muscle bridge, with the great cardiac vein beside it. Surgeons find it there to sew the [internal thoracic artery](https://durgical.com/en/anatomy/internal-thoracic-artery/) graft, usually in its middle third. ## On imaging On coronary angiography the right and left anterior oblique cranial views separate it from its diagonal and septal branches; it is described as proximal (up to the first septal perforator or first diagonal), mid and distal segments. CT coronary angiography shows plaque and any myocardial bridge. ## Common problems - Coronary artery disease: fatty plaque narrows them, causing chest pain on exertion (angina). - Heart attack: a plaque breaks open and a clot suddenly blocks the artery. ## How it is diagnosed ECG and troponin for a heart attack; stress test, CT coronary angiography or a catheter angiogram to see narrowings. ## Treatment - Medicines (aspirin, statins, blood-pressure control) and stopping smoking. - Angioplasty and stent through a catheter. - Bypass surgery (CABG) for several or complex blockages. ## Clinical notes - Revascularization is by stenting through a catheter or by a bypass graft, usually the left internal thoracic artery sewn to the mid LAD - Large anterior infarcts can lead to an apical aneurysm with mural thrombus, rupture of the interventricular septum and pump failure - In a chronic LAD occlusion, septal collaterals from the posterior descending artery often refill it ## Anatomical variants - Myocardial bridging: a segment, most often the mid LAD, runs within the heart muscle and is squeezed in systole; usually harmless, occasionally linked to ischemia - A long 'wrap-around' LAD curls round the apex into the posterior groove, so its occlusion can also affect the inferior wall ## Related conditions - [Familial hypercholesterolemia](https://durgical.com/en/conditions/familial-hypercholesterolemia/) - [Familial dysbetalipoproteinemia (type III hyperlipoproteinemia)](https://durgical.com/en/conditions/familial-dysbetalipoproteinemia/) - [Familial combined hyperlipidaemia](https://durgical.com/en/conditions/familial-combined-hyperlipidaemia/) - [Cardiogenic shock](https://durgical.com/en/conditions/cardiogenic-shock/) - [Vasospastic (Prinzmetal) angina](https://durgical.com/en/conditions/vasospastic-angina/) - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) - [Stable angina](https://durgical.com/en/conditions/stable-angina/) ## Test yourself Think of the answer, then tap the question to see it. ## Where does the LAD run, and which branches does it give? From the left main coronary artery down the anterior interventricular groove to the apex; it gives diagonal branches and septal perforators. ## What ECG changes mark an anterior myocardial infarction from LAD occlusion? ST elevation in V1–V4; a proximal («widow-maker») occlusion also involves the diagonals, with changes extending to I, aVL and V5–V6. ## Which bypass graft to the LAD is the most durable? The left internal thoracic (mammary) artery graft, the standard in coronary artery bypass surgery. ## What is the Wellens pattern? Deep symmetrical or biphasic T waves in V2–V3 after chest pain, pointing to a critical proximal LAD stenosis. ## What is myocardial bridging, and which artery is most often involved? A segment that runs within the heart muscle and is squeezed in systole, most often the mid LAD; usually harmless. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/anatomy/anterior-interventricular-artery/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** arteria interventricularis anterior; ramus diagonalis arteriae interventricularis anterioris TA2 4143 **Official Spanish (DeCS)** Arteria interventricular anterior DeCS D003331 **English (TA2)** Anterior interventricular artery **Also called** anterior interventricular branch of left coronary artery · lateral branch of anterior interventricular artery · LAD · left anterior descending artery · ramus interventricularis arteriae coronariae sinistrae · ramus descendens anterior ## Related - [Great cardiac vein](https://durgical.com/en/anatomy/great-cardiac-vein/) - [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) - [Interventricular septum](https://durgical.com/en/anatomy/interventricular-septum/) - [Bundle branches](https://durgical.com/en/anatomy/right-bundle-branch/) - [Left ventricle papillary muscles](https://durgical.com/en/anatomy/superior-papillary-muscle-of-left-ventricle/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=3346); [Anatomy, Thorax, Heart Left Anterior Descending (LAD) Artery](https://www.ncbi.nlm.nih.gov/books/NBK482375/); [19.1 Heart Anatomy](https://openstax.org/books/anatomy-and-physiology-2e/pages/19-1-heart-anatomy) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/anterior-interventricular-artery/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/anterior-interventricular-artery/