Acute Coronary Syndrome: The Daily PANCE Blueprint

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Acute Coronary Syndrome: The Daily PANCE Blueprint

A 58-year-old man arrives at a PCI-capable hospital with 45 minutes of crushing substernal chest pain radiating to his left arm, with diaphoresis and nausea. He is pale and anxious; blood pressure is 148/90 mm Hg and heart rate 96/min. The 12-lead ECG shows 3-mm ST-segment elevation in leads II, III, and aVF. Occlusion of which coronary artery is most likely?

A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
E. Pulmonary artery

Answer and topic summary

The answer is B. Right coronary artery.

ST elevation in the inferior leads (II, III, and aVF) indicates an inferior-wall myocardial infarction, which is most often caused by occlusion of the right coronary artery (about 80% of people, who are right-dominant); the left circumflex artery causes the minority. The left anterior descending artery supplies the anterior wall (V1-V4), and left main occlusion produces widespread anterior and lateral changes with hemodynamic collapse. Because an inferior infarct can extend to the right ventricle, obtain a right-sided ECG and use nitrates and morphine cautiously (these patients are preload-dependent).

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Covered under ⇒ PANCE Blueprint Cardiology ⇒ Coronary Heart Disease ⇒ Acute Coronary Syndrome (ACS)

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