A 58-year-old male presents with sudden-onset substernal chest pressure radiating to the left jaw. The ECG demonstrates 2.5 mm ST-segment elevations in leads II, III, and aVF. Which coronary artery is most likely occluded?
Answer and explanation
Correct answer: A. Right Coronary Artery (RCA)
- Step 1: ST-segment elevations in leads II, III, and aVF indicate transmural injury of the inferior wall of the left ventricle.
- Step 2: In approximately 85% to 90% of individuals with right-dominant circulation, the inferior myocardial wall and the posterior descending artery are perfused by the Right Coronary Artery (RCA).
- Step 3: Therefore, acute occlusion of the Right Coronary Artery is the underlying cause of this inferior STEMI.
Answer
Right Coronary Artery (RCA).
Why not the others: Left anterior descending occlusion causes anterior STEMI (V1-V4), left circumflex causes lateral infarction (I, aVL, V5-V6), and left main occlusion causes widespread ST depressions with aVR elevation.
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