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.
Isolated right marginal artery occlusion causes right ventricular infarction, producing the triad of hypotension, elevated JVP without pulmonary oedema, and ST elevation in right-sided leads (V3R-V6R). Right ventricular infarction is haemodynamically treated differently from left-sided MI: preload must be maintained with IV fluids, and vasodilators and diuretics are contraindicated. RV infarction complicates approximately 30-50% of inferior STEMIs when the RCA supplies the right marginal territory.
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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