A patient with an acute inferior wall myocardial infarction shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

• A Right coronary artery ✓
• B Left circumflex artery
• C Left anterior descending artery
• D Left main coronary artery

Explanation

The right coronary artery supplies the inferior wall of the left ventricle in right-dominant circulation (85 percent of individuals). ST elevation in leads II, III, and aVF localizes to the inferior wall. The left anterior descending artery supplies the anterior wall and septum (ST elevation in V1 to V4). The left circumflex supplies the lateral wall (ST elevation in I, aVL, V5 to V6). Left main occlusion causes widespread ST changes and is often fatal. Inferior STEMI is most commonly due to RCA occlusion.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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