Which electrocardiogram leads reflect the inferior wall?

• A. Leads I, aVL
• B. Leads V2-V4
• C. Leads II, III, and aVF
• D. Lead aVR

Answer: (C)

The blood supply and orientation of the heart determine which ECG leads best visualize a given region. The inferior wall sits on the diaphragmatic surface, so the view from below—the limb leads that measure electrical activity toward the feet—best captures this area. Those inferior-viewing leads are the ones that reflect the inferior wall: II, III, and aVF. When the inferior wall is affected, you typically see ST elevations in these leads, with possible reciprocal changes in the opposite leads such as I and aVL. Leads that look from the sides or front of the chest (I and aVL for lateral, V1-V4 for anterior) do not reflect the inferior wall. Lead aVR looks at the upper right portion of the heart and isn’t used to assess the inferior wall.