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**Follow up by Dr Smer**
Great job guys, you all got it right. Faysal, you dissected this EKG very well…! I’d add that the ST-depression in V1-3 could be related to subendocardial ischemia, either due to critical coronary stenosis or demand ischemia. In both conditions you still have blood flow to that myocardial/coronary territory where you see ST depression. However, having Positive T wave in the setting of ST-depression in V1-3 should make you think of Posterior STEMI, NO BLOOD FLOW, totally occluded artery.
The Mirror sign is what Faysal mentioned by flipping the EKG, so the r wave becomes q wave, ST depression becomes elevation and positive T wave becomes inverted. Simple, yet helpful to identify posterior MI. You still need to obtain posterior EKG V7-9 to see ST elevation. This patient did have ST elevation in the posterior lead and he went to cath lab, which showed totally occluded left circumflex artery treated with drug eluting stent.