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* * Deoxygenated blood from the heart collects in the cardiac veins which turn into the coronary sinus then empty into the right atrium. The artery that reaches and crosses the “crux” (where right and left atrioventricular groove crosses the posterior interatrial and interventricular grooves) is “dominant”. The graphic displays a right dominant system. * * * * Coronary artery disease is part of a systemic illness called atherosclerosis. Atherosclerosis is a condition in which plaque deposits build up on the intima (inner walls) of the coronary arteries. The inner layer becomes injured through attack by numerous factors including nitric and cholesterol oxides. This disruption in the vessel lumen can be caused by physical abrasion (PTCA, etc), hypertension, or abnormal blood substances. This allows other cells to leak down inside this lining. These lipid rich cells multiply which eventually creates a bump beneath the lining. Smooth muscle cells release connective tissue to form fibrous plaque resulting in increased pressure and possible rupture. As the plaque ages, a cholesterol core forms as more lipid substances are deposited on the lesion. Thrombus may also begin to adhere to the plaque. Both may become covered by a fibrous cap. As more fibroblasts infiltrate the lesion, the plaque hardens. The plaque narrows the intima of the vessels and can compromise blood flow. Decreased blood flow through the coronary arteries means that less oxygen is reaching the myocardium. In response to this disease, the artery compensates by enlarging the diameter in an attempt to maintain normal flow. This is called “positive remodeling”. Ultimately, it will reach its maximum diameter and plaque growth will restrict flow. Plaque is more frequently seen in the LAD, RCA, LCx, and LM than other arteries. The most common lesions are in the proximal LAD. Severe lesions tend to involve a greater length of the RCA than any other artery. Plaque tends to appear at curves and near branches,