During intraoperative transoesophageal echocardiography (TOE), a new regional wall motion abnormality (RWMA) is noted in the anterolateral wall. Which coronary artery territory is MOST likely affected?

• A Left circumflex artery (LCx) ✓
• B Right coronary artery (RCA)
• C Left anterior descending artery (LAD)
• D Posterior descending artery (PDA)

Explanation

The left circumflex artery (LCx) supplies the lateral and posterior walls of the left ventricle. Anterolateral wall motion abnormalities correspond to LCx territory ischaemia. The LAD territory predominantly involves the anterior wall, apex, and anterior interventricular septum. The RCA supplies the inferior wall, right ventricle, and posterior septum in most patients. TOE is highly sensitive for detecting new RWMAs as an early sign of myocardial ischaemia, preceding ECG changes and haemodynamic compromise, making it a valuable perioperative monitoring tool in high-risk cardiac surgery patients.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.