Which ECG lead would best detect occlusion of the right coronary artery?

The lead that best detects occlusion of the right coronary artery is lead II. This lead usually provides a view of the inferior wall of the heart, which is predominantly supplied by the right coronary artery in right-dominant coronary systems. When there is an occlusion in the right coronary artery, it can lead to inferior wall ischemia, which is most clearly represented in lead II.

In terms of ischemic changes, lead II is particularly sensitive in detecting ST segment elevations or depressions that may indicate inadequate blood flow to the areas supplied by this artery. Furthermore, the P-wave morphology can also change, which is indicative of electrical activity alterations associated with right coronary artery issues.

While other leads, such as leads V4 and V5, primarily view the anterior and lateral walls of the heart, they are less likely to provide information about inferior wall damage resulting from right coronary artery occlusion. Lead I primarily monitors the lateral aspects and is not effective for observing changes from a right coronary artery blockage. Thus, lead II is the most suitable choice for identifying issues linked to the right coronary artery.