Subendocardial injury (SI) on the 12-lead ECG reflects reduced subendocardial blood flow, but standard ST/T criteria for the anteroseptal (INJAS) and anterolateral (INJAL) regions do not reliably localize the ischemic myocardium. We tested whether the moving equivalent dipole (MED), reconstructed from the 12-lead ECG with a boundary element torso model, can improve this localization. MEDs were determined during the ST segment in PTB-XL recordings with annotated INJAS/INJAL (learning set) and in STAFF III patients undergoing elective balloon coronary occlusion, comparing MED behavior during baseline SI and occlusion ischemia. MED vectors were projected onto a 12-segment ventricular model to obtain ventricular surface points (VSPs). SI-related VSPs clustered mainly in the anteroseptal-basal and inferior segments, mostly pointing toward the base rather than the apex. During occlusion, VSPs shifted toward segments consistent with the occluded vessel and largely reverted after restitution. An enhanced MED model with non-dipole factors reproduced measured potentials with RNMSE 3.7–4.5%, preserving 95.5–96.3% of ECG information. MED-based vectorcardiography can add spatial information beyond ST-segment analysis for characterizing SI