Module 4 Logbooks - Trifasicular Block

Front 1

Module 4 - logbook 10: definition trifasicular block

Back 1

Bifasicular block: RBBB+ L anterior/L posterior block

Incomplete: bifasicular block + 1st*/2nd degree AV block or RBBB and alternating LA/LP block (both)

Complete: 3rd degree AV block

Front 2

Module 4 - logbook 10: aetiology

Back 2

IHD, hypertension, aortic stenosis, anterior MI, congenital heart disease and hyperkalaemia

Front 3

Module 4 - logbook 10: epidemiology

Back 3

X

Front 4

Module 4 - logbook 10: risk factors

Back 4

Age (fibrosis) and heart disease

Front 5

Module 4 - logbook 10: common presentation

Back 5

Often asymptomatic. Syncope, fatigue, hypotension and dyspnoea. HR needs to be < 50bpm to affect CO

Front 6

Module 4 - logbook 10: investigations

Back 6

ECG, 12 lead ECG,echocardiogram and possibly electrophysiology (catheter which measures electrical activity of heart - detects whether PR interval is coming from AV or lower down)

Front 7

Module 4 - logbook 10: pathophysiology

Back 7

AV node: fibrosis or ischaemia (AV node is often supplied by RCA)

Below AV node: Ischaemia/infarction and disrupts ventricular depolarisation producing wider QRS complexes.

LBBB - septum depolarises L > R but reversed

RBBB (normal septal depolarisation R > L but LV depolarises before RV)

Front 8

Module 4 - logbook 10: prognosis

Back 8

Can develop to complete heart block but not often

Front 9

Module 4 - logbook 10: management

Back 9

Medication, cardiovascular risk and pacemaker:

3 types

1. standard (different chamber combinations) sense (what's going on) and capture (depolarize)

2. ICD defibrillator

3. CRT co-ordination

Front 10

Module 4 - logbook 10: drugs - CANDESARTAN

Back 10

ARB - stops AT II from binding to smooth muscle

Front 11

Module 4 - logbook 10: drugs - BISOPROLOL

Back 11

Beta blocker inhibits sympathetic stimulus on beta 1 adrenergic receptors

Front 12

Module 4 - logbook 10: drugs - WARFARIN

Back 12

Vitamin K antagonist, precursor of clotting facotrs

Front 13

Module 4 - logbook 10: drugs - ASPIRIN

Back 13

Antiplatelet - COX inhibitor reducing the amount of thromboxane A2

Front 14

Module 4 - logbook 10: drugs - PARACETAMOL

Back 14

Non opioid analgesic - COX 1,2 (and 3?) inhibitor - reducing prostaglandin synthesis

Front 15

Module 4 - logbook 10: drugs - FUROSEMIDE

Back 15

Loop diuretic - acting on loop of Henle, blocks sodium potassium chloride co-trnasporter. Less sodium, reduces osmotic gradient >> less water retention

Front 16

Module 4 - logbook 10: drugs - SIMVASTATIN

Back 16

Statin - enzyme inhibitor. competes HMG coA for HMG co-A reductase. Works on mevalonic pathway, reduces mevalonic acid which is precursor of cholesterol

Front 17

Module 4 - logbook 10: drugs - AMIODERONE

Back 17

Anti - arrhythmic (class III). Prolongs phase 3 of cardiac action potential where there is decreased calcium and increased potassium. Also acts on sodium and potassium channels in the SA and AV nodes

Front 18

Module 4 - logbook 10: anti-arrhythmic drugs (general)

Back 18

Class 1 - sodium channel blockers (3 classes) 1. delays and prolongs, 2. delays a bit + shortens, 3. delays a lot but plateau the same

Class 2 - Beta blockers

Class 3 - potassium channel blockers

Class 4 - calcium

Calcium is slow - AV and SA

Sodium is fast - ventricles