A 62-year-old man presents with sudden syncope and ECG showing ST elevation in leads II, III and aVF with sinus bradycardia. Coronary angiography is performed. Which coronary artery is most likely occluded?
- A Left anterior descending artery
- B Left circumflex artery
- C Right coronary artery ✓
- D Diagonal branch of the left anterior descending artery
Correct answer: C. Right coronary artery
Explanation
ST elevation in II, III and aVF indicates an inferior wall infarction, which most commonly results from right coronary artery occlusion. The RCA also supplies the SA node in about 60% of individuals and the AV node in over 80%, explaining the bradycardia. The LAD territory is the anteroseptal and apical walls, producing ST elevation in V1 to V4, which kills distractor A.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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