Lead aVL also has a Q-wave, so there is an old lateral MI. Put this together with the anterior LV aneurysm, and the fact that many (old or acute) anterior MIs are due to an occlusion of the proximal LAD, with involvement of the lateral wall (and thus with reciprocal ST depression in II, III, and aVF), and it becomes apparent that this is probably part of his LV aneurysm. LV aneurysm, just like acute STEMI, may have reciprocal ST depression. In this case, the old high lateral MI manifests as chronic reciprocal ST depression in II, III, and aVF.
His echo confirmed dyskinesis and myocardial thinning diagnostic of LV aneurysm. The troponin was negative.