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For quick screening of right ventricular involvement, obtaining V4R alone (fifth intercostal space, right midclavicular line) is commonly sufficient and practical. Many protocols add a complete right-sided set (V1R–V6R) when more information is needed, but the single most sensitive lead for acute right ventricular infarction is V4R. Standard left-sided limb leads remain unchanged; only the specified chest lead(s) move. Mirroring all precordials is valid for a full right-sided ECG but is not required when a targeted V4R is requested. Elevating leads by two interspaces distorts anatomic representation and may create false ST changes. Proper labeling on the tracing (e.g., “V4R” or “Right-sided ECG”) is essential to avoid misinterpretation. Right-sided leads are particularly important in inferior STEMI scenarios where right ventricular infarction affects preload sensitivity and nitroglycerin use. Prompt, accurate placement supports appropriate hemodynamic management.