Trifascicular Block Explained Simply - WHY, WHEN, HOW?

[@ECGDoc]

I'm very sorry for the delay in getting started... I had serious technical problems getting my stream out to KZbin. I had to do it as a non-scheduled stream so I was not able to check for comments. However, if you have questions, please feel free to post them here. Thanks for watching!

[@kristinh4388]

Wow, this is the best explanation of trifascicular block I've found. Don't shut off the video because of the slow start!

[@ECGDoc]

Hey Kristin! Thanks for the compliment!! Livestreams are always tough to do...

[@itsmejulia1]

Amazing video, answers so many questions that used to confuse me about this topic. Thank you!

[@Alfared-m9h]

Wonderful explanation sir

[@themightycyclone3]

Thank you for taking the time to share with us your knowledge!

[@hieuhuynh9358]

Thank you for doing this. So lucky to have found you. Great content!

[@ECGDoc]

Thank you for the positive comment! I'm glad you enjoyed it!

[@rafikchaira3824]

Fantastic explanation

[@ECGDoc]

Hey, Thanks, Rafik! I'm glad you enjoyed it!

[@iimnana]

I really really love your explanation 🤩 I love learning things from you. Thank you so so so so so much🙏🏻

[@draksingh8034]

sorry sir for some reason it was not streaming live here in Nepal. Anyways it was just awesome once again. It was exciting that you have included the intracardiac electrogram for the lecture. The way you criticize 'incomplete RBBB' as 'half pregnant' I think will really stop people from writing so. I always mention it as RBBB type IVCD or LBBB type IVCD if its not fitting in the proper criteria of one of them Thank you once again sir.

[@ECGDoc]

Amit -- Thank you for watching, and thanks also for your positive comments!

[@thomaslapsley8145]

Doctor I'm a much older medical student without a school so far but, I have the medical books and the internet. I need biology, organic and I have to take the MCAT. I have a physics degree and electrical engineering degree but I've been out of school a long time. I'd appreciate appreciate any advice. How do I approach a Cardiologist in NYC to ask if I could shadow etc...? When most people my age are retiring. I'm gearing up to go to a Caribbean medical school. I can't afford your classes at this time but, I love your videos. The level is good for me but, tough for some. I'm a poor student that buys used medical books to learn. I did get a old copy of Braunwald. I also have Dubin's EKG book and thing it's a very good introductory book despite the unprofessional rumors and the fact that Dr Dubin was in trouble some time ago. Recently I took out the video from th NY Public Li bray called "Something the Lord has Made." I'm not religious but, I was shocked to find that the religious community attacked the doctor that was pioneering the first cardiac surgery at Johns Hopkins Medical school on blue babies. Sad to learn that it was taboo to even think of cutting into the heart from the religious community. Since millions of people's lives have been saved with the advances in cardiology. I agree with your statement that reading an EKG is tricky and only pattern recognition is wrong. Your videos made me think. I fear others don't. Cardiology has a responsibility to teach this fact. Reading EKG's requires careful thought and that is what the patient is paying for and what a good cardiologist does. Except for my books and good people like yourself I'm on my own. A guilty medical education and practice is important to me and if it takes me long that's ok and I'm not doing it for the money. If people think I'm crazy that's their problem. I'm not. I think we should all think for our self's and march to the beat of our own drummer not some Charles Manson or Adolf Hitler. Sincerely, Tom TL

[@louisvarre2197]

Thomas Lapsley wow. Was there a question here?

[@dimahjar]

Thank you sooooo much ..

[@Sickdude420]

That was incredible!!!

[@Strongcardiology]

Is Very long PR interval against the diagnosis of trifascular disease ?

[@ECGDoc]

Thanks for the question. A very long PR interval tells you there must be delay in the AV node (since the HV interval cannot extend more than 50-80 ms without failing completely). You just cannot tell what part contributes more to the long PR.. the AH or the HV prolongation.

[@draksingh8034]

Sir I think there is some controversy regarding HV interval. I think as it Sodium dependent we can have infra-hisian block without prolongation of HV interval. In that case increased PR interval and AH is prolonged we get to a diagnosis but less likely if the patient is asymptomatic and his/her HV interval is say 80-90ms and tell that there is disease in infrahisian region and requires a pacemaker.. Please give your comment on this sir.

[@ECGDoc]

I agree that infranodal block can occur without prolongation of the HV interval. You can especially see that in intraHisian block -- although sometimes you will be lucky enough to see a split His potential. There are many potential pitfalls of relying on the ECG as well as the HV interval. The His bundle study is but one piece of information that you can use to weigh the risks vs. benefits when trying to make a reasonable recommendation to an individual patient.