History of a recent myocardial infarction There is association of myocardial infarction with bundle branch block. E.g. Right bundle branch block (RBBB) and left anterior hemiblock (LAH) are likely to occur in anterior or anteroseptal infarction.
Bradycardia Is a sign that can be detected in patients with trifascicular block.
Cannon ‘a’ waves When the atria contract against closed tricuspid and mitral valves, it gives rise to a cannon 'a' wave in the jugular venous pulse, which may be felt as a 'pounding' in the neck.
Variable intensity S1 Intensity of first heart sound may vary according to ventricular rate comparative to atrial rate. It will be heard aloud intermittently when the ventricles happen to contract shortly after the atria.
Hypotension Patient may develop hypotension due to reduced cardiac out put and hypoperfusion.
Signs of cardiac failure such as tachypnea, elevated jugular venous pressure, bibasal crackles on lung auscultation These signs may arise in a patient who develops congestive cardiac failure and pulmonary congestion secondary to reduced cardiac out put.
Atrioventricular block Can present with syncope, pre syncope, dizziness etc. similar to trifascicular block.
24 hour Holter monitoring 24 hour Holter monitoring is done to detect ECG abnormalities in symptomatic patients with normal initial ECG. A device called a Holter monitor which continuously records the heart's rhythm is usually worn for 24 - 48 hours during normal activity.