Anatomy - Occlusion in the LAD distal to the first diagonal branch and proximal to the first septal

Occasionally, the LAD gives off the first diagonal branch before giving off the first septal branch. An occlusion between these two branches results in an ischemia vector that points to the right and inferiorly, approximately to the direction of the positive pole of lead III. Consequently, the amplitude of ST elevation is greatest in lead III. Also this occlusion results in ST elevation in leads II, aVF, and aVR and ST depression in the lateral leads I and aVL.

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