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, i ' J 4 aE NY 92-657 Some damage in tne septal region is probably involving botn the main stem and the Right BB Branch. However the presence of right axis deviation with a right BB Block is further abnormality and might be evidence of some tight slded strain. As compared to November 3, 1900: I believe tnere is a little more sagging of the RS-T segment in II and again in AVF which presumably is a digitalis effect. Chest leads show minor differences but tne overall pattern is about tne same. Evidence of myocardial abnormality: 2 plus - 3 plus: Heart block of two types due to degenerative arteriosclerotic diseases including coronary changes. Electroeardiogram: November 16, 1960 Sinus rhythm rate 66-70, Tnere is no definite axis deviation. Grade I AV Block: PR-2 cauals 0,22 sec, Right BB Block of broad 3. type. Some evidence of a digitalts effect, presumably responsible for instances for tne lowering of RS-T in II. Also tie drug protably makes some of the T waves a little smaller tnan they otherwise would be, Cnest leads from the rignat show tne characteristic evidence of late activation of the right ventricle, Beyond this tne chest leads on the left show a little more depression of kKS-T and T in V5 and VO which 1s presumably a drug effect. Infarction: A coronary background would appear probably but cannot be proven by tiis record. Evidence of myocardial abnormality: 2 plus - 3 plus. Electrocurdiogram: November 22, 1900 Sinus rhythm, rate 90. AV conduction is normal; PR-2 equals 0,20 sec. wnich may pe relatively long for tiis dominant rate but stili is teciunically witiiin the normal range. Tnere is rignt axis deviation with right BB Block of broad Si type. -4-