This ECG is the same as the previous tracing with the addition of right sided chest leads. V1R is actually the same as the former V2 and V2R is the same as the former V1. Leads V3R-V6R are placed to the right of the sternum in the same interspaces and positions as leads V3-V6. The ST elevation in leads V2R-V6R is diagnostic of acute transmural ischemia/infarction of the right ventricle.