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bene nae wee, NY 92-657 Tne record is cnanging and seems to be coming more Slurred witn lower amplitude in some leads and this gives tne impression of an acute degenerated change. Nothing is entirely typical because largely of the BB Block but an acute process which probably is chiefly anterior is suggested, Evidence of myocardial abnormality: 3 plus to 4 plus. Infarction: An acute coronary process would appear quite possible if not probable and may well be anterior in location, Electrocardiogram: November 26, 1960 Sinus rhythm, rate 62-85, Grade I. AV Block: PR-2 equals 0.23 sec. Tiere is a little rignt axis deviation. Tne overall appearance of this record 18 fairly similar to tne last one of November 22nd and includes particularly the changes due to right BB Block of broad Sl type. At present we may note the following: The PR interval was normal on November 22nd and is now prolonged up to 6.23 sec., a slight degree of Grade I AV Block, However PR time of 0,22 sec. WaS noted on November lotn, In any event this could well be a . Agitalis effect but tne patient is getting more digitalis day by day and actually prolongation of PR up to 0,24 sec, was seen earlier in tnis series, Therefore a damage in the septal region would appear probable, Today depression of RS-T in II seems less marked although this was apparently a drug effect and would be expected to continue, In the chest leads from tiie right side from the cnaracteristic changes due to right BB Block we note that less elevation of RS-T especially in V2 but also in V3. This would suggest that we are dealing with a coronary cuange that is improving, presumably some anterior or subandocardial ischemia, Beyond this the T waves are rather smaller than they were in V5 and V6 with a low RS-T in Vo but here again of course digitalis would account for wnat we see, -6-