Supply to papillary muscles The papillary muscles attach the mitral valve (the valve between the left atrium and the left ventricle) and the tricuspid valve (the valve between the right atrium and the right ventricle) to the wall of the heart. If the papillary muscles are not functioning properly, the mitral valve may leak during contraction of the left ventricle. This causes some of the blood to travel "in reverse", from the left ventricle to the left atrium, instead of forward to the aorta and the rest of the body. This leaking of blood to the left atrium is known as mitral regurgitation. Similarly, the leaking of blood from the right ventricle through the tricuspid valve and into the right atrium can also occur, and this is described as tricuspid insufficiency or tricuspid regurgitation. The anterolateral papillary muscle more frequently receives two blood supplies: left anterior descending (LAD) artery and the left circumflex artery (LCX). It is therefore more frequently resistant to<unk>  ischemia (insufficiency of oxygen-rich blood). On the other hand, the posteromedial papillary muscle is usually supplied only by the PDA. This makes the posteromedial papillary muscle significantly more susceptible to ischemia. The clinical significance of this is that a myocardial infarction involving the PDA is more likely to cause mitral regurgitation. Changes in diastole During contraction of the ventricular myocardium (systole), the subendocardial<unk>  vessels (the vessels that enter the myocardium) are compressed due to the high ventricular pressures. This compression results in momentary retrograde blood flow (i.e., blood flows backward toward the aorta) which further inhibits perfusion of myocardium during systole. However, the epicardial<unk>  vessels (the vessels that run along the outer surface of the heart) remain open. Because of this, blood flow in the subendocardium stops during ventricular contraction. As a result, most myocardial perfusion occurs during heart relaxation (diastole) when the subendocardial<unk>  vessels are open and under lower pressure. Flow never comes to zero in the right<unk>  artery, since the right ventricular pressure is less than the diastolic blood pressure. Changes in oxygen demand The heart regulates the amount of vasodilation or vasoconstriction of the<unk>  arteries based upon the oxygen requirements of the heart. This contributes to the filling difficulties of the<unk>  arteries. Compression remains the same. Failure of oxygen delivery caused by a decrease in blood flow in front of increased oxygen demand of the heart results in tissue ischemia, a condition of oxygen deficiency. Brief ischemia is associated with intense chest pain, known as angina. Severe ischemia can cause the heart muscle to die from hypoxia, such as during a myocardial infarction. Chronic moderate ischemia causes contraction of the heart to weaken, known as myocardial hibernation. In addition to metabolism, the<unk>  possesses unique pharmacologic characteristics. Prominent among these is its reactivity to adrenergic stimulation.
Coronary circulation
Cardiac cycle
Arterial tree
Electrical conduction system of the heart
Myocardial contractility
Autonomic nervous system
Limb perfusion
Vagal tone