Effects of the collateral circulation of the heart

Collateral circulation minimizes the myocardial injury which results from narrowing of a coronary artery. A large collateral circulation has disadvantages, however. It may divert so much of the limited blood flow through the adjacent nonarteriosclerotic coronary artery that the blood supply of the normal muscle supplied by that artery may be inadequate during heavy exercise. In the presence of a large collateral circulation, both the normal and ischemic regions of the heart may be extremely vulnerable to small arteriosclerotic changes narrowing the patent artery near the aorta. The effective increase in flow which results from arteriolar vasodilatation produced by drugs may be much greater in the presence of a small collateral circulation than a large one.