[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/) › Right coronary artery [Cardiovascular system](https://durgical.com/en/anatomy/system/cardiovascular-system/) · [Chest](https://durgical.com/en/anatomy/region/chest/) # Right coronary artery The right coronary artery circles the right side of the heart; it feeds the right ventricle, the underside of the heart and usually its pacemaker. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=thorax&select=rca&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The right coronary artery, running in the right groove around to the back of the heart; in most people it gives the posterior descending artery. ## What it does Feeds the right ventricle, the bottom of the [left ventricle](https://durgical.com/en/anatomy/left-ventricle/) and, in most people, the SA and AV nodes (so its blockage can slow the heart). ## Key points - Inferior MI (ST elevation in II, III and aVF, higher in III than in II) points to the right coronary artery; ST elevation in the right-sided lead V4R adds right ventricular infarction - Right ventricular infarction: low blood pressure with clear lungs and raised jugular venous pressure; the heart depends on filling, so nitrates and diuretics can drop the pressure sharply - Bradycardia and AV block in an inferior MI come from ischemia of the SA and AV nodal branches and from vagal reflexes (Bezold–Jarisch reflex) - Because it arises from the right (anterior) aortic sinus, it is the coronary most often involved when a type A aortic dissection extends into the root ## Key facts **Origin** Right aortic sinus (above right coronary cusp); runs in right coronary groove **Branches** Conus (infundibular) branch, usually first (own ostium in some hearts); SA nodal (~60%); right marginal (acute marginal); AV nodal (~80%); posterior descending in right-dominant hearts (~70%, varies); posterolateral branches to inferior LV wall **Supplies** Right atrium, right ventricle, inferior LV wall, posterior 1/3 of septum, usually SA and AV nodes ## Relations **Course** From the right aortic sinus it passes forward between the [pulmonary trunk](https://durgical.com/en/anatomy/pulmonary-trunk/) and the right [auricle](https://durgical.com/en/anatomy/auricle/), descends in the right coronary groove to the acute margin, then follows the inferior surface to the crux **Above** Right auricle and [right atrium](https://durgical.com/en/anatomy/right-atrium/) **Below** [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/), along whose acute margin the right (acute) marginal branch runs **Superficial** Epicardial fat and the small cardiac vein, which shares the right coronary groove ## How to find it After opening the [pericardium](https://durgical.com/en/anatomy/pericardium/) it is followed in the right part of the coronary groove, between the right atrium and right ventricle, embedded in fat; it then turns onto the diaphragmatic surface, where its distal part and the posterior descending artery are reached for grafting by lifting the apex. ## On imaging On coronary angiography it looks like a 'C' in the left anterior oblique view and an 'L' in the right anterior oblique view; it is divided into proximal, mid and distal segments, ending in the posterior descending and posterolateral branches. CT coronary angiography shows dominance and anomalous origins. ## Common problems - Coronary artery disease: fatty plaque narrows them, causing [chest](https://durgical.com/en/anatomy/region/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 - AV block in an inferior MI is usually at the AV node, with a narrow-QRS escape rhythm, and often resolves; in an anterior MI, block is lower and carries a worse outlook - A proximal occlusion, before the right ventricular branches, adds right ventricular infarction; a distal occlusion spares the right ventricle - Bypass grafts usually go to its distal part or to the posterior descending artery - Its conus branch meets the conus branch of the LAD on the front of the right ventricular outflow tract (Vieussens' arterial ring), a collateral route that can open when either artery is blocked ## Anatomical variants - The conus branch often has its own opening in the right aortic sinus (the 'third coronary artery') - Anomalous origin from the left aortic sinus with a course between the aorta and the pulmonary trunk: linked to ischemia and sudden death in young athletes ## Development Coronary arteries grow from a vessel plexus laid down by the epicardium, which then links up with the aortic sinuses; a faulty link-up explains the anomalous origins listed under variants. ## Related conditions - [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - [Vasospastic (Prinzmetal) angina](https://durgical.com/en/conditions/vasospastic-angina/) - [Kawasaki disease](https://durgical.com/en/conditions/kawasaki-disease/) - [Multisystem inflammatory syndrome in children (MIS-C)](https://durgical.com/en/conditions/multisystem-inflammatory-syndrome-in-children/) - [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. ## Which ECG pattern points to an inferior myocardial infarction from right coronary artery occlusion? ST elevation in II, III and aVF, higher in III than in II. ## Why can nitrates and diuretics drop the blood pressure sharply in right ventricular infarction? The heart depends on filling; the picture is low blood pressure with clear lungs and raised jugular venous pressure. ## Why do bradycardia and AV block occur in an inferior myocardial infarction? Ischemia of the SA and AV nodal branches of the right coronary artery, plus vagal reflexes (Bezold–Jarisch reflex). ## Which nodal and septal branches does the right coronary artery usually give? SA nodal (about 60%), AV nodal (about 80%) and, in right-dominant hearts, the posterior descending artery to the posterior 1/3 of the septum. ## What shape does the right coronary artery have on angiography? A «C» in the left anterior oblique view and an «L» in the right anterior oblique view. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/anatomy/right-coronary-artery/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** arteria coronaria dextra; arteria interventricularis inferior TA2 4131 **Official Spanish (DeCS)** Arteria coronaria derecha DeCS D003331 **English (TA2)** Right coronary artery **Also called** posterior interventricular artery · inferior intervenricular branch of right coronary artery · posterior interventricular branch of right coronary artery · RCA · PDA · arteria coronaria cordis dextra ## Related - [Posterior descending artery (PDA)](https://durgical.com/en/anatomy/inferior-interventricular-artery/) - [Right atrium](https://durgical.com/en/anatomy/right-atrium/) - [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) - [Sinoatrial (SA) node](https://durgical.com/en/anatomy/sinuatrial-node/) - [Atrioventricular (AV) node](https://durgical.com/en/anatomy/atrioventricular-node/) - [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) - [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](https://www.ncbi.nlm.nih.gov/books/NBK470256/); [Anatomy, Thorax, Sinoatrial Nodal Artery](https://www.ncbi.nlm.nih.gov/books/NBK541008/); [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/); Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV Angiología, sección 1, cap. I Corazón (arts. VI–IX) y cap. II Pericardio. ## **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/right-coronary-artery/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/right-coronary-artery/