| Left anterior descending artery | |
|---|---|
 Sternocostal surface of heart. Anterior descending branch labeled at upper right | |
 | |
| Details | |
| Location | Heart |
| Source | Left coronary artery |
| Branches | Septals, diagonals |
| Supplies | Anterolateralmyocardium, apex,interventricular septum, 45–55% of theleft ventricle (LV) |
| Identifiers | |
| Latin | ramus interventricularis anterior arteriae coronariae sinistrae |
| Acronym | LAD |
| TA98 | A12.2.03.202 |
| TA2 | 4143 |
| FMA | 3862 |
| Anatomical terminology | |
Theleft anterior descending artery (LAD, oranterior descending branch), also calledanterior interventricular artery (IVA, oranterior interventricular branch of left coronary artery)[1] is a branch of theleft coronary artery. It supplies the anterior portion of theleft ventricle.[2] It provides about half of the arterial supply to the left ventricle and is thus considered the most important vessel supplying the left ventricle.[citation needed]Blockage of this artery is often called thewidow-maker infarction due to a high risk of death.[3]
It first passes at posterior to thepulmonary artery, then passes anteriorward between that pulmonary artery and theleft atrium to reach theanterior interventricular sulcus, along which it descends to thenotch of cardiac apex. In 78% of cases, it reaches theapex of the heart.[citation needed]
Although rare, multiple anomalous courses of the LAD have been described. These include the origin of the artery from the rightaortic sinus.[4]
The LAD gives off two types of branches:septals anddiagonals.
The artery supplies the anterior region of the left ventricle, including: the anterolateralmyocardium, apex, anteriorinterventricular septum, and anterolateralpapillary muscle.[8] The LAD typically supplies 45–55% of theleft ventricle and is therefore considered the most critical vessel in terms of myocardial blood supply.[citation needed]
Widow maker is an alternative name for the anterior interventricular branch of theleft coronary artery.[9][3] The namewidow maker may also apply to the left coronary artery[10] or severe occlusions to that artery.[11][12]
This term is used because the left main coronary and/or the left anterior descending supply blood to large areas of the heart. This means that if these arteries are abruptly and completely occluded it will cause a massiveheart attack that will likely lead to sudden death. The blockage that kills is made up ofplatelets streaming to the site of a ruptured cholesterol plaque. Even a small amount of plaque in this area can (for a variety of poorly understood reasons) rupture and cause death;bypassing chronic blockages or trying to open them up withangioplasty does not prevent heart attack but it can restore blood flow in case of a sudden blockage or heart attack and if performed within a rapid time period can minimize the damage done. An example of the devastating results of a complete occlusion of the LAD artery is the sudden death of former NBC News Washington Bureau ChiefTim Russert,[13] as well as the near-deaths of film directorKevin Smith[14] and actor and screenwriterBob Odenkirk.[15]
From the minute a widow maker heart attack hits, survival time ranges from minutes to several hours. Rapidly progressing symptoms should signal the need for immediate attention. Symptoms of initial onset may include nausea, shortness of breath, pain in the head, jaw, arms or chest, numbness in fingers, often of a novel but imprecise sensation which builds with irregular heart beat. Early symptoms may be mistaken for food poisoning, flu or general malaise until they intensify. A widow maker cannot kill instantly but induces cardiac arrest which may do so within 10 to 20 minutes of no circulation. A victim with no pulse or breath is still alive, living off oxygen stored in the blood and may be able to be rescued if treatment is begun promptly within this window.[16]
This article incorporates text in thepublic domain frompage 547 of the 20th edition ofGray's Anatomy(1918)
The most worrisome type is the proximal left anterior descending (LAD) MI, often referred to as the widow-maker infarction, which carries a high mortality and is attributed to an occlusion of the LAD before or at the first septal perforator.
{{cite journal}}:Cite journal requires|journal= (help)The LAD is frequently implicated in sudden cardiac death, predominantly in adult males. Clinicians often refer to the LAD as the widow maker because obstruction here predisposes to a high incidence of sudden death.
