Which EKG change is most consistent with inferior MI with right ventricular involvement?

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Multiple Choice

Which EKG change is most consistent with inferior MI with right ventricular involvement?

Explanation:
When an inferior-wall heart attack also involves the right ventricle, the electrical injury current shifts toward the right heart, changing how the ST elevations appear in the inferior leads. In this scenario, the pattern often shows greater ST elevation in lead III than in lead II, reflecting the rightward vector from RV involvement. That makes the finding of ST elevation in III larger than in II the most consistent clue. The other patterns don’t fit as well. ST elevation in aVL points to a high lateral/anterolateral area rather than the inferior region. ST depression in II would be a reciprocal change, not a direct sign of RV involvement. In practice, right-sided leads (like V4R) would help confirm RV infarction, but those aren’t provided here.

When an inferior-wall heart attack also involves the right ventricle, the electrical injury current shifts toward the right heart, changing how the ST elevations appear in the inferior leads. In this scenario, the pattern often shows greater ST elevation in lead III than in lead II, reflecting the rightward vector from RV involvement. That makes the finding of ST elevation in III larger than in II the most consistent clue.

The other patterns don’t fit as well. ST elevation in aVL points to a high lateral/anterolateral area rather than the inferior region. ST depression in II would be a reciprocal change, not a direct sign of RV involvement. In practice, right-sided leads (like V4R) would help confirm RV infarction, but those aren’t provided here.

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