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Why is the left ventricle more commonly affected by ischemic heart disease than the right ventricle or atria?


Why is the left ventricle more commonly affected by ischemic heart disease than the right ventricle or atria?

It is more affected because it works the hardest...it is responsible for the force necessary to pump blood out of the heart to the systemic circulation and when blood flow to the left ventricular myocardium (muscle) is impaired, it is more affected. Think of a person with lung disease who needs enough oxygen to walk to the bathroom and back, versus one who needs enough oxygen to run around the block...the one most affected by the lung disease is the one that runs around the block. The one just going to the bathroom and back is comparable to the r. ventricle and atria.

This is beacause the left ventricular myocarium is the thickest. Right ventricle and atria get some perfusion directly from the cavity by sinusoids and reverse perfusion through Thebesian veins. Left ventricle gets perfusion mostly in diastole while other chambers get perfused in diastole and systole. This is because the high intracavitary pressure in systole squeezes the intramyocardial blood vessels of the left ventricle in systole.

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