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DRT Oe SL Tahoe aa ct MRI ip ay ee ore NY 92-057 We are dealing with degenerative heart disease including: A. ‘tne appearance of rignt BB Block under observation as noted before, B, Cuanges in AV conduction which seem to vary although -digitalis nas been given constantly and therefore some damage of the septal region would appear probable. C. Cnanges in the RS-T level in chest leads from tne rignt whica hardly can be accounted for by other conditions although digitalis mignt confuse the issue nere put some anterlor ischemic condition would appear probaple, D. A drug effect which in general is ratner less now than before except in V5 and V6. Electrocardlogram: December 5, 1960 Sinus rnytiim, rate 72. Grade I AV Block: PR-2 equals 0,22 - 0,24 sec, There is a tendency to rignt axis deviation. As compared to November 2cth, 1960, In tne standard limb leads we still see the broad S waves in I and II related to the right BB Block observed before, In the augmented limb leads the general contour is the same as it was, In tne chest leads we have a typical of late activation in Vl and beyond this. There is still some elevation of RS-T in V2 and even in V3 but less than it was on November 22nd, and here I suspect that we are dealing with a coronary change. Whether or not it has come down as the result of digitalis or natural evolution cannot of course be determined but as noted, I have suspected some ischemic damage anterior in location. Beyond this the chest leads seem to be fairly similar to what they were and the same remarks apply to this record as noted in regard to the preceeding one. Evidence of myocardial abnormality: 2 plus to 3 plus.