Heart - Cardiac Veins

Review of systemic vs. pulmonary circulation

Review of blood flow through the heart

The cardiac veins carry deoxygenated blood from the myocardium to the right atrium.

Cardiac veins are classified by their blood-flow return to the heart:

The coronary sinus (and its four major tributaries) drains into the right atrium.
The anterior cardiac veins drain directly into the right atrium.
The small cardiac veins drain directly into the nearest chamber.

Pathway of venous return to the coronary sinus:

The coronary sinus is a wide, short vessel that drains directly into the right atrium. It runs in the posterior coronary sulcus.

Four major tributaries:

Great cardiac vein
Left posterior ventricular vein
Middle cardiac vein
Small cardiac vein

Anterior interventricular vein

Arises near the apex of the heart and travels superiorly (within the anterior interventricular sulcus).
Once it reaches the coronary sulcus, the anterior interventricular vein becomes the great cardiac vein.

Travels posteriorly to drain directly into the left end of the coronary sinus (be aware that some texts do not name the anterior interventricular vein separately; instead, they refer to this entire vessel as the great cardiac vein).

Right marginal vein

Travels superiorly along the right side of the heart.
At the coronary sulcus, the right marginal vein becomes the small cardiac vein.

Wraps posteriorly to drain directly into the right end of the coronary sulcus (in some individuals, the right marginal vein drains directly into the right atrium).

Middle cardiac vein

Arises near the apex and runs in the posterior interventricular sulcus (hence, it is also called the posterior interventricular vein).

Left posterior ventricular vein

Arises between the great and middle cardiac veins.

Anterior cardiac veins

Arise on the superior surface of the right ventricle, and drain directly into the right atrium.

Smallest cardiac veins

aka, venae cordis minimae, aka, thebesian veins

Valveless vessels that drain directly into the cardiac chambers, particularly the right atrium.

Vein - Artery Associations:

The anterior interventricular vein travels with the anterior interventricular artery.
The middle cardiac vein travels with the posterior interventricular artery.
The small cardiac vein travels with the right coronary artery.
The right marginal vein travels with the right marginal artery.

In Summary:

The great cardiac and left posterior ventricular veins drain regions of the myocardium supplied by the left coronary artery; The middle and small cardiac veins drain regions of the myocardium supplied by the right coronary artery.

Heart - Cardiac Veins

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