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Trifascicular Block Presentation

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  • 1. Trifascicular Block Candice Reyes Cardiology July 17, 2009
  • 2. Subjective • 57 y/o male transferred to RLAH for eval and treatment of R 3rd met plantar ulcer and gangrene of R 3rd toe • Pt has no h/o cardiac dz, he has no cardiac sx • PMHx: DM x2yrs w/o tx
  • 3. Objective • Vitals: BP 128/75 P 86 T99 O2Sat 99% Wt 95.6 F.S. 286 • CV: decr heart tones w/RRR S1S2 w/o murmur • Resp: LCTA B/L • Extremities: RLE has erythema and 2+ pitting edema
  • 4. EKG Discussion • Prolongation of PR interval – 1st Degree AV Block • RBBB • LAFB • Findings suggest trifascicular block
  • 5. Trifascicular Block • Conduction blocks in all 3 fascicles – Can be permanent or transient • Criteria: – 1) RBB and LASF w/1st degree AV block – 2) RBB and LPIF w/1st degree AV block – 3) LBB w/1st degree AV block or – 4) Alternating RBBB and LBBB
  • 6. Trifascicular Block • Trifascicular, along w/bifascicular, blocks indicate advanced heart dz • BUT long-term follow-up studies of ambulatory patients indicate that risk of sudden progression to complete heart block and sudden death d/t ventricular asystole is not great Bolton Edmund, "Chapter 28. Disturbances of Cardiac Rhythm and Conduction" (Chapter). Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6e: http://www.accessmedicine.com/content.aspx?aID=587596.
  • 7. Assessment and Plan • Dr. Quesada’s Assessment and Plan: These findings suggest a trifascicular block. Progression of chronic bifasicular or trifascicular block to complete heart block is infrequent. This pt is asx and was very active prior to hospitalization • Per guidelines, the pt has intermediate to high clinical predictors (DM asx trifascicular block) and is scheduled for a low risk surgical procedure