(Case 2) Reciprocal ST segment depression—the ECG demonstrated early anterolateral AMI with reciprocal ST segment depression in the inferior leads. (Case 2) Reciprocal ST segment depression—the ECG demonstrated early anterolateral AMI with reciprocal ST segment depression in the inferior leads. Reciprocal ST segment depression in the setting of STE on the ECG strongly suggests an ST segment elevation AMI; furthermore, the presence of reciprocal change is also associated with an increased chance of poor outcome. T Pollehn et al. Emerg Med J 2002;19:129-135 Copyright © BMJ Publishing Group Ltd and the College of Emergency Medicine. All rights reserved.