Which leads reflect an inferior wall ischemia commonly associated with the right coronary artery?

• A. Leads II, III, and aVF
• B. Leads I, aVL, and V5
• C. Leads V1-V3
• D. Leads aVR

Answer: (A)

Inferior wall ischemia presents on the ECG with ST-segment elevation in the inferior leads, which are the inferior-most placements: II, III, and aVF. The right coronary artery most often supplies the inferior wall of the left ventricle, especially in a right-dominant circulation. When the RCA is occluded, ischemia or infarction tends to involve that region, producing the classic ST elevations in those inferior leads.

The other lead groups map to different regions: anterior/septal (V1–V3) reflects left anterior descending artery territory; lateral (I, aVL, V5, V6) reflects left circumflex artery territory; and aVR is not a primary view of the inferior wall and can show reciprocal changes or unusual patterns. So the pattern pointing to RCA-related inferior ischemia is elevations in II, III, and aVF.