Introduction:

Cardiac dominance refers to a characteristic of heart anatomy and blood supply, where one coronary artery system supplies a significant portion of the heart. This article provides a comprehensive overview of cardiac dominance, including its types, significance, and implications for heart function.

Understanding Cardiac Dominance:

• Coronary Arteries: The heart is supplied with oxygen-rich blood through two main coronary arteries, the left coronary artery (LCA) and the right coronary artery (RCA).
• Cardiac Dominance Types: Cardiac dominance can be categorized into two types: right dominance, where the RCA supplies the majority of the heart, and left dominance, where the LCA supplies the majority.

Right Dominance:

• Blood Supply: In right dominance, the RCA gives rise to the posterior descending artery (PDA) and supplies the posterior part of the interventricular septum, the right ventricle, and a portion of the left ventricle.
• Prevalence: Right dominance is the more common type, observed in approximately 70-90% of individuals.

Left Dominance:

• Blood Supply: In left dominance, the LCA gives rise to the PDA and supplies the posterior part of the interventricular septum, the left ventricle, and a portion of the right ventricle.
• Prevalence: Left dominance is less common, observed in approximately 10-30% of individuals.

Clinical Significance:

• Impact on Coronary Artery Disease: The dominant coronary artery system is more vulnerable to the development of coronary artery disease. For example, if the RCA is dominant, a blockage in this artery can have a more significant impact on overall heart function.
• Diagnostic Importance: Understanding the dominant coronary artery system is important during diagnostic tests and interventions such as angiography and coronary artery bypass grafting.

Implications for Heart Function:

• Variations in Blood Supply: Cardiac dominance can lead to variations in blood supply to different areas of the heart, potentially affecting the distribution of oxygen and nutrients.
• Collateral Circulation: In cases of coronary artery blockage, collateral circulation—the development of alternative blood vessels—may play a more significant role in maintaining blood flow in the non-dominant territory.

Clinical Assessment and Intervention:

• Diagnostic Tests: Cardiac dominance can be determined through diagnostic tests such as coronary angiography, which visualizes the coronary arteries and their branches.
• Interventional Procedures: Knowledge of cardiac dominance helps guide interventional procedures such as percutaneous coronary intervention or coronary artery bypass grafting, allowing targeted treatment in the affected coronary artery system.

Conclusion:

Cardiac dominance refers to the predominant blood supply to the heart by either the right or left coronary artery system. Understanding the type of cardiac dominance is important for assessing coronary artery disease and guiding interventional procedures. By recognizing the implications of cardiac dominance, healthcare professionals can provide targeted care and interventions for individuals with heart conditions.

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