USMLE Answer 53

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53. The correct answer is B. A right dominant coronary circulation is present when the posterior descending branch originates from the right coronary artery (80% of individuals). On the contrary, the posterior descending artery originates from the left circumflex artery in a left dominant circulation (20% of individuals). The posterior descending branch gives blood to the posterior half of the interventricular septum. Occlusion of the left circumflex artery in a left dominant circulation will therefore lead to ischemic necrosis in the left ventricular wall and the posterior interventricular septum.

The apex of the left ventricle (choice A) is dependent on the anterior descending branch; thus, occlusion of the left circumflex does not affect this portion of the left ventricle.

Infarction of the lateral (free) wall alone (choice C) will result from occlusion of the circumflex in a right dominant circulation.

An isolated infarct of the posterior interventricular septum (choice D) arises from occlusion of the posterior descending branch.

Isolated infarcts of the right ventricular wall (choice E) are very rare and would be caused by occlusion of branches of the right coronary artery.