The right marginal artery (acute marginal branch) arises from the right coronary artery at the acute margin of the heart and runs along the right ventricular free wall toward the apex. It supplies the anterior and inferior right ventricular free wall and is the dominant blood supply to the right ventricle in most individuals. It is named for the acute angle (sharp margin) of the right heart border.
| Origin | Right coronary artery at the acute margin of the heart |
|---|---|
| Course | Runs along the acute (inferior right) margin of the heart toward the apex, supplying the right ventricular wall |
Right ventricular infarction usually follows occlusion of the proximal right coronary artery above the origin of the right marginal (acute marginal) branch, and complicates a large share of inferior STEMIs; occlusion beyond it tends to spare the right ventricle. The classic triad is hypotension, raised JVP and clear lungs, with ST elevation in right-sided leads (especially V4R). Treatment differs from left-sided MI: preload is maintained with IV fluids, nitrates and diuretics are avoided because they can cause profound hypotension, and the culprit artery is reopened promptly.
Occlusion of the right marginal branch or the proximal RCA compromising right marginal territory produces RV infarction with hypotension, raised JVP, clear lung fields, and ST elevation in right precordial leads, treated with aggressive IV fluid loading to maintain RV preload, avoiding nitrates and diuretics.
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