Coronary anatomy and correlating ECG leads

Original chalk talk by Brandon Fainstad, MD
Edits and graphics by Yilin Zhang, MD

  1. Review coronary anatomy and associated distributions on an ECG
  2. Practice cases with pearls and pitfalls

Coronary anatomy, vessel distribution and associated leads on an ECG

Fill in the coronary anatomy:

  • Right coronary artery (RCA)
  • Posterior descending artery (PDA)
  • Left main artery
  • Left anterior descending (LAD)
  • Circumflex artery

For additional points:

  • R marginal artery
  • L marginal artery
  • Diagonal branch of the LAD

Associate the leads of an ECG with the vessel distribution. 


Practice cases with pearls and pitfalls

Case 1 
Nathanson LA, et al

Is this a STEMI?  What is the distribution? 

What is the next step in evaluating this MI and why?

Case 2
Nathanson LA, et al

What is the best explanation(s) for these ST changes?

Case 3
Nathanson LA, et al. 

Is there evidence of new or old infarct on this ECG?  If so, what distribution?


Nathanson LA, McClennen S, Safran C, Goldberger AL. ECG Wave-Maven: Self-Assessment Program for Students and Clinicians.