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The papillary muscles are muscles located in the ventricles of the heart. There are five in total, with three in the right ventricle and two in the left ventricle. The left ventricle papillary muscles play an important role in the functioning of the mitral valve and the left ventricle. The anterolateral papillary muscle is supplied by the left anterior descending and the diagonal or a marginal branch of the circumflex artery. The posteromedial papillary muscle is supplied by the left circumflex or right coronary artery, depending on dominance. The posteromedial papillary muscle is more prone to injury from myocardial infarction due to its single system of blood supply.
| Characteristics | Values |
|---|---|
| Location | Ventricles of the heart |
| Number | 5 in total: 3 in the right ventricle and 2 in the left ventricle |
| Types | Anterolateral, Posteromedial, Anterior, Posterior, Septal |
| Blood supply | Anterolateral: left anterior descending artery, diagonal branch (LAD), marginal branch of the circumflex artery; Posteromedial: left circumflex or right coronary artery |
| Dysfunction | Can be caused by rupture through infarction or trauma, fibrosis or ischemia |
| Rupture | Rare but severe mechanical complication of acute myocardial infarction; requires immediate medical intervention |
| Treatment | Coronary revascularization, hemodynamic stabilization, afterload reduction, management of acute pulmonary edema, treatment of arrhythmias, percutaneous intervention for the infarct-related artery |
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What You'll Learn
- The right coronary artery supplies blood to the posterior papillary muscle
- The left anterior descending artery supplies the anterolateral papillary muscle
- The marginal branch of the circumflex artery supplies the anterolateral papillary muscle
- The left circumflex coronary artery supplies the posteromedial papillary muscle
- The right coronary artery supplies the posteromedial papillary muscle
The right coronary artery supplies blood to the posterior papillary muscle
The heart contains five papillary muscles: three in the right ventricle and two in the left ventricle. The right coronary artery supplies blood to the posterior papillary muscle, also known as the inferoseptal papillary muscle, of the left ventricle. This papillary muscle usually has two heads or bodies and, along with the anterolateral papillary muscle, plays a key role in maintaining mitral valve function. The mitral valve is integrally related to the ventricle as the chordae tendinae are connected to the ventricle via the papillary muscles.
The anterolateral papillary muscle is often composed of one body or head and is supplied by one or more branches of the left circumflex artery or diagonal branches of the left anterior descending artery. The posterior papillary muscle, on the other hand, is supplied by a single branch of the left circumflex artery or the right coronary artery, depending on the dominance of the vessel. This single blood supply makes the posterior papillary muscle particularly prone to injury and rupture from myocardial infarction.
The posterior papillary muscle is involved in about 75% of papillary muscle dysfunction cases, while the anterior is involved in about 25%. Papillary muscle dysfunction refers to a murmur of mitral regurgitation that develops in the setting of myocardial ischemia. It can also occur either with rupture through infarction or trauma, generally leading to sudden death, or with fibrosis or ischemia.
The right coronary artery is one of the three main coronary vessels and their branches that supply blood to the heart. The other two are the left anterior descending artery and the left circumflex artery.
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The left anterior descending artery supplies the anterolateral papillary muscle
The left anterior descending (LAD) artery is a branch of the left coronary artery. It is the largest coronary artery and supplies the anterior portion of the left ventricle with blood. The LAD artery is the biggest supplier of oxygenated blood to the heart's lower left pumping chamber or ventricle. It also supplies blood to the septum, the muscular tissue that separates the heart walls.
The LAD artery has two branches: diagonal and septal. The diagonal branch supplies blood to the front and bottom of the heart's lower left ventricle, while the septal branch provides blood to the front two-thirds of the septum. The LAD artery is responsible for supplying blood to the anterolateral papillary muscle, which is one of the two papillary muscles in the left ventricle. The anterolateral papillary muscle is often composed of one body or head, while the other papillary muscle in the left ventricle, the posteromedial papillary muscle, usually has two bodies or heads.
The anterolateral papillary muscle plays an important role in the functioning of the mitral valve and the left ventricle. It attaches to the cusps of the mitral valve via the chordae tendineae and contracts to prevent inversion or prolapse of the valve during ventricular contraction. The mitral valve function is integrally related to the ventricle due to the connection between the chordae tendinae and the ventricle via the papillary muscles.
A blockage in the LAD artery can lead to a fatal type of heart attack known as the widowmaker. This occurs because the LAD artery supplies a significant amount of blood to the left side of the heart. The artery is also at risk for plaque buildup (atherosclerosis) and coronary artery disease. Stable and unstable angina, characterised by chest pain or pressure, are other potential issues that can arise from a narrow or blocked LAD artery.
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The marginal branch of the circumflex artery supplies the anterolateral papillary muscle
The papillary muscles are muscles located in the ventricles of the heart. Typically, there are two groups of papillary muscles: the anterolateral and the posteromedial groups. The marginal branch of the circumflex artery supplies the anterolateral papillary muscle.
The circumflex artery is a branch of the left coronary artery. It winds around the left side of the heart along the atrioventricular groove (coronary sulcus). The number of circumflex artery branches varies from person to person. There may be as many as three lateral branches called obtuse marginal branches. These smaller branches typically travel along the outside margin of the left ventricle toward its tip or apex.
The left anterior descending artery and the diagonal or marginal branch of the circumflex artery supply blood to the anterolateral papillary muscle. The left circumflex or right coronary artery (depending on dominance) provides the blood supply to the posteromedial papillary muscle. Because of its single system of blood supply, this papillary muscle is particularly prone to injury from myocardial infarction.
The circumflex artery is within the heart's outer protective layer, the epicardium. It travels in a groove between the heart's left upper and lower pumping chambers. The circumflex artery is also at risk for atherosclerosis and coronary artery disease. A buildup of plaque in the circumflex artery can slow blood flow to the coronary artery and, therefore, the heart.
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The left circumflex coronary artery supplies the posteromedial papillary muscle
The left ventricle of the heart has two papillary muscles: the anterolateral and the posteromedial. The posteromedial muscle has a single system of blood supply, making it particularly vulnerable to injury from myocardial infarction. The blood supply to the posteromedial papillary muscle is provided by the left circumflex artery or the right coronary artery, depending on dominance.
The circumflex artery is a branch of the left coronary artery. It winds around the left side of the heart along the atrioventricular groove (coronary sulcus). It delivers oxygenated blood to the back and sides of the left pumping chambers of the heart. The circumflex artery supplies the posterolateral left ventricle and the anterolateral papillary muscle. It also supplies the sinoatrial nodal artery in 38% of people.
In a minority of individuals (15%), the left circumflex artery gives rise to the posterior interventricular artery, in which case the heart is deemed left-dominant. In the other 85% of cases, the posterior interventricular artery comes from the right coronary artery. When the left circumflex supplies the posterior descending artery in those 15% of cases, it is known as a left-dominant circulation.
The left circumflex artery follows the left part of the coronary sulcus, running first to the left and then to the right, reaching nearly as far as the posterior longitudinal sulcus. It curves to the left around the heart within the coronary sulcus, giving rise to one or more left marginal arteries as it curves toward the posterior.
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The right coronary artery supplies the posteromedial papillary muscle
The coronary arteries are the blood vessels that supply blood to the heart. The heart has four main blood vessels: the left coronary artery, the right coronary artery, the left coronary vein, and the right coronary vein. The right coronary artery specifically supplies blood to the posteromedial papillary muscle.
The papillary muscles are muscles located in the ventricles of the heart. They attach to the cusps of the atrioventricular valves (also known as the mitral and tricuspid valves) via the chordae tendineae and prevent inversion or prolapse of these valves during systole (or ventricular contraction). There are five total papillary muscles in the heart; three in the right ventricle and two in the left ventricle. The left ventricle contains the anterolateral and posteromedial papillary muscles, which attach to the mitral valve.
The posteromedial papillary muscle has a single arterial supply, while the anterolateral papillary muscle has a dual arterial supply. The left circumflex or right coronary artery (depending on dominance) provides the blood supply to the posteromedial papillary muscle. Because of its single system of blood supply, this papillary muscle is particularly prone to injury from myocardial infarction.
Papillary muscle fibrosis/necrosis without rupture is common, as the papillary muscles are the last portion of the heart to be perfused. Coronary atherosclerosis is the most common cause, but this condition can also be caused by shock, infective endocarditis, acute valvar regurgitation, anemia, LVOT obstruction, systemic hypertension, cardiomyopathies, endocardial fibroelastosis, endomyocardial fibrosis, myocardial disorders, and anomalous origin of the coronary arteries.
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Frequently asked questions
Papillary muscles are muscles located in the ventricles of the heart. There are a total of five, three in the right ventricle and two in the left ventricle.
The anterolateral papillary muscle is irrigated by the first obtuse marginal branch of the circumflex artery and the first diagonal branch of the anterior descending artery.
The posteromedial papillary muscle is irrigated by the posterior descending artery, a branch of the right descending coronary artery, in 90% of cases and by the circumflex artery in the remaining 10%.
The blood supply to the papillary muscles is segmental in distribution, with the tip, mid-portion, and base generally receiving their vascular supply from separate tributaries.
Papillary muscle dysfunction or rupture is a rare but catastrophic consequence of acute myocardial infarction. The posterior papillary muscle is involved in about 75% of cases and the anterior in about 25%.
