Differential Diagnosis for Segment Elevation in Leads 2,3, and AVF
Single Most Likely Diagnosis
- A. Right Coronary: The involvement of leads 2,3, and AVF typically points towards an inferior wall myocardial infarction, which is most commonly supplied by the right coronary artery (RCA). The RCA wraps around the heart to supply the inferior wall, making it the primary culprit in this scenario.
Other Likely Diagnoses
- B. Left Anterior Descending (with wraparound): Although less common, a dominant left coronary system where the left anterior descending artery (LAD) wraps around to supply the inferior wall could also be responsible for this pattern of segment elevation. However, this would be less typical than RCA involvement.
- C. Left Main: While left main coronary artery disease can lead to widespread ischemia, it is less likely to cause isolated inferior wall elevation without additional leads being involved, given its proximal location and supply to both the left anterior descending and left circumflex arteries.
Do Not Miss Diagnoses
- Right Coronary with Possible Right Ventricular Involvement: It's crucial not to miss the potential involvement of the right ventricle, as this can have significant implications for treatment, including the need for higher right ventricular filling pressures and avoidance of certain medications like nitrates.
- Left Main or Multivessel Disease: Although less likely based on the leads involved, missing left main or multivessel disease could have severe consequences, including higher mortality and the need for urgent revascularization strategies like CABG.
Rare Diagnoses
- Anomalous Coronary Artery: Rarely, an anomalous coronary artery could supply the inferior wall and cause this pattern of segment elevation. This might involve an anomalous origin of the right coronary artery from the left sinus of Valsalva or other variations.
- Coronary Artery Spasm or Vasospasm: While not typically causing persistent segment elevation, coronary artery spasm could potentially mimic this pattern, especially if it involves the RCA and causes transient inferior wall ischemia.