The standard limb leads and the right sided chest leads, V1R-V6R, of the same patient are shown here. Remember that lead V1R is the same as lead V2 and that lead V2R is the same as V1. There is definite elevation of the ST segment in leads V3R-V6R. This consistent with a right ventricular infarction. The P waves can no longer be seen, making the AV junctional rhythm more apparent. The coronary angiogram revealed a total occlusion in the proximal portion of a dominant right coronary artery.