In a patient presenting with substernal chest pain and ST segment elevation in leads II, III, and AVF, which wall of the ventricle is most likely at risk?

The presence of substernal chest pain along with ST segment elevation in leads II, III, and AVF indicates that the patient is likely experiencing an inferior ST elevation myocardial infarction (STEMI). The leads involved—II, III, and AVF—are indicative of the inferior wall of the heart, which is primarily supplied by the right coronary artery in most individuals.

When there is ST segment elevation in these leads, it signifies that the inferior wall is not receiving adequate blood supply due to an obstruction or injury to the coronary vessels. Consequently, the inferior wall is at risk of ischemia or infarction. Recognizing the correlation between specific ECG changes and the corresponding wall of the heart is crucial in diagnosing and managing acute coronary syndromes effectively.

The other walls—anterior, lateral, and posterior—are not implicated by the specific lead involvement noted in this scenario, thus making them less relevant in the context of the question. Understanding these associations is essential for accurate interpretation of cardiac events in clinical practice.