Rosh Internal Medicine Boost Practice Exam

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Which diagnosis is suggested by ST-segment elevation in leads II, III, and aVF during an evaluation for chest pain?

Anterior wall myocardial ischemia
Inferior wall myocardial ischemia
Lateral wall myocardial ischemia
Posterior wall myocardial ischemia

The correct answer is: Inferior wall myocardial ischemia

The presence of ST-segment elevation in leads II, III, and aVF is indicative of inferior wall myocardial ischemia. These leads correspond to the inferior portion of the heart, which is predominantly supplied by the right coronary artery in a right-dominant coronary system. When evaluating a patient for chest pain, ST-segment changes in this area suggest that there is likely ischemia affecting the inferior part of the heart muscle. The elevation of the ST segment in these specific leads is a critical finding that can point towards conditions such as inferior ST-elevation myocardial infarction (STEMI). In contrast, anterior wall myocardial ischemia would typically be reflected in changes seen in leads V1 to V4, while lateral wall ischemia would show changes in leads I, aVL, V5, and V6. Posterior wall ischemia is often indicated by reciprocal changes in the anterior leads, which would not primarily manifest as ST-segment elevation in the leads that monitor the inferior wall. Understanding the leads and their corresponding anatomical regions is crucial in diagnosing the specific type of myocardial ischemia based on electrocardiographic findings.