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4 + Be x See eee ca sf a Sor Nien Pane BS oe meee et NY 92-657 AS compared to tne last record of November 16, 1960: In tne standard limb leads the R wave is smaller in II and the S wave broader witn a different type of slurring and lowering of the RS-T segments. However,tne patient is getting digitalis which might account for this RS-T depression. Two ventricular extra-systoles are recorded in III. Tne augmented limb leads do not show any new change except in AVF where the ORS group is smaller and the RS-T segment still depressed and here again we may suspect digitalis, In the chest leads we do note changes witn more definite elevation of BS-T in Ve and V3 althougn in V3 the T wave is more definitely upright. Beyond this the broad S waves are seen in V5 and Vo but are simply characteristic of the right BB Block. Depression of RS-T in V6 may again be due to digitalis. 1. Tne BB Block in this case developed some time between March @nd, 1900 and July 22, 1900 and this development during a period of observation is strong evidence of derenerative heart disease and not the simple benign ae ee ee ae ee ee ee re type of Right EB Block whicn we find in routine health examinations in subjects otnerwise apparently normal, 2. Depression of the T waves in chest leads from the last is of course incidental to the BB Block of this type. ‘Also eLevation of RS-T seems to have been a fairly constant feature in V2 and V3 and this series and is not a fresn development since November 16, 1960 although it seems to be getting more marked, Tnis has a rather coronary appearance and mignt point to subandocardial or anterior ischemic damage but as it is not entirely anew finding, we must be cautious in assigning Significance to it. 3. Tne low RS-T segment would rather suggest coronary §tneuffirctonsey or sunandtonrarcdial farneamia hut nant we ara dealins wit, SUNDGNIUCCaAPUital a2nstciemsa Ou NnerTe We ale dealing with digitalis administration which could well account for tunis cnange. ri {e) ec acre ee te