Anterior precordial lead ST segment depression in inferior STEMI

Dr. Smith discusses such a case in his ECG blog. He makes some teaching points on various aspects of the case. Concerning the anterior precordial ST depression frequently seen in inferior STEMI we were formerly taught that it signifies “ischemia at a distance,” that is, in the distribution of the left coronary system. That was a myth. We now know that it's the mirror image of posterior STEMI. In fact, as a rule, true ST segment depression does not localize an ischemic process. ST elevation does, T wave inversion does but ST depression does not. It can signify ischemia somewhere but doesn't tell you specifically where.