Left Anterior Descending Artery

What is the left anterior descending (LAD) artery?

Your left anterior descending (LAD) artery is one of two branches of your left main coronary artery. Anterior means the artery supplies blood to the front portion of your heart. It's the biggest supplier of oxygenated blood to your heart’s lower left pumping chamber or ventricle. It also supplies blood to the septum, the muscular tissue that separates the heart walls.

Your healthcare provider may also refer to this blood vessel as the anterior interventricular branch. A complete blockage of your left anterior descending artery can cause a heart attack, commonly known as a widowmaker. This type of heart attack is often fatal.

What does the left anterior descending artery do?

The left anterior descending artery is your largest coronary artery. It’s a type of cardiac blood vessel that’s part of your circulatory system. This network of blood vessels circulates blood throughout your body. Your left anterior descending artery carries almost half the blood to your heart.

Where is the left anterior descending artery located?

The two branches of your left main coronary artery are the left anterior descending artery and the circumflex artery. Providers call this type of arterial branching “bifurcation.”

The left anterior descending artery is within your heart’s outer protective layer, the epicardium. It runs in a groove along the septum, traveling from the base of your heart to the apex.

What are the branches of the left anterior descending artery?

The left anterior descending artery has two branches:

• Diagonal branches supply blood to the front and bottom of the heart’s lower left pumping chamber or ventricle.
• Septal branches provide blood to the front two-thirds of the septum.

What is left-dominant circulation?

You have a posterior descending artery (PDA) that carries blood to the inferior (lower) and posterior (back) portions of your heart and part of your septum. In as many as 8 in 10 people, the right main coronary artery supplies blood to the PDA. Providers call this right-dominant circulation.

Other types of coronary arterial dominance include:

• Left-dominant circulation: A branch of the left main coronary artery (either the LAD artery or the circumflex artery) supplies blood to the PDA. Left-dominant circulation occurs in approximately 1 in 10 people.
• Codominant circulation: The LAD artery or the circumflex artery, along with the right coronary artery, provide blood to the PDA. Codominant circulation occurs in approximately 2 in 10 people.

What conditions affect the left anterior descending artery?

Fatty deposits of plaque can build up inside the LAD artery, leading to atherosclerosis or “hardening of the arteries.”

In some people, so much plaque accumulates inside the LAD artery that a complete blockage occurs. Oxygenated blood can’t reach the heart, causing an often-fatal heart attack known as a widowmaker. Despite the male-centric term, this type of heart attack affects both people assigned female and male at birth.

A small number of people have a LAD artery that's too narrow or short. This condition, known as hypoplastic left anterior descending artery, increases your risk of:

• Arrhythmia.
• Heart attack.
• Myocardial ischemia.
• Sudden cardiac death.

What are the signs of a blockage in the left anterior descending artery?

A narrow or blocked LAD artery can cause stable and unstable angina — two types of chest pain.

A heart attack is a medical emergency. You should call 911 if you’re experiencing heart attack symptoms like:

• Angina (chest pain or pressure).
• Cold sweats or clamminess.
• Dizziness or feeling lightheaded.
• Fatigue and weakness.
• Heart palpitations.
• Nausea.
• Shortness of breath.
• Shoulder or arm pain.

How do healthcare providers check the health of your left anterior descending artery?

Healthcare providers use these imaging tests to assess the health of your coronary arteries:

• Cardiac catheterization to check for coronary artery disease.
• Coronary computed tomography angiogram (CCTA) to produce 3D images of blood flow to your heart.
• Intravascular optical coherence tomography (IVOCT) or intravascular ultrasound (IVUS) to obtain high-definition images from inside an artery.
• Fractional flow reserve (FFR) to measure blood pressure inside an artery.

How do providers treat conditions that affect the left anterior descending artery?

You may need cardiac catheterization and angioplasty and stent (interventional procedures) to open a blocked left anterior descending artery. Angioplasty expands the artery, while a stent (tiny wire mesh tube) keeps it open.

How can I protect my left anterior descending artery?

You can take these steps to keep your circulatory system healthy:

• Consume a heart-healthy diet to lower cholesterol levels.
• Cut back on alcohol and seek help for alcohol use disorder.
• Exercise and maintain a healthy weight.
• Know your fats and eat fewer unhealthy fats.
• Take steps to manage diabetes and high blood pressure, including reducing your sodium.
• Seek help to quit smoking.

A note from Cleveland Clinic

A blockage in your left anterior descending artery can lead to a fatal type of heart attack known as the widowmaker. As the largest coronary artery, the left anterior descending artery supplies a lot of blood to the left side of your heart. This artery is at risk for plaque buildup (atherosclerosis) and coronary artery disease. You may need angioplasty and stenting to open the artery and lower your risk of heart attack. Your healthcare provider can help you make dietary and lifestyle changes to protect your heart health.