Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again,

Welcome back on HCM!

Now for explaining what a triple branch block is, I would describe it as a severe impairment of electrical impulses through the special conductance system within the heart.

To make it more simple and clear, I would explain that in such circumstances there is an important conductance delay along the three main fascicle:

- right bundle branch (RBB)
- left anterior fascicular branch (LAFB)
- left posterior fascicular branch (LPFB).
(The above are the branches which spread the electrical impulse within the cardiac chambers called ventricles.)

Depending on the severity of the conductance disturbance, tri-fascicular block may appear in several patterns such as:

a) RBB block + LAFB/LPFB block + first, second or third degree AV block
b) RBB block + alternating LAFB/LPFB block

In the above circumstances the main risk for the suffering individual is the occurrence of complete heart block with syncope and even cardiac arrest.

That's why it is important to closely monitor periodically the heart rate in order to timely detect the above mentioned complications.

The main treatment for this health condition may be pacemaker implantation, which helps in providing the absent cardiac electrical impulses within the ventricles.

Regarding low blood pressure, I would explain that it is important making some tests to investigate for the possible causes:

- a cardiac ultrasound to exclude heart failure
- complete blood count for anemia
- cortisol plasma level for the adrenal gland dysfunction
- blood electrolytes for possible imbalances.
- kidney and liver function tests.

Besides, there are a lot of drugs which can cause decrease in blood pressure.

I would like to know your actual therapy (do you use any other drugs besides coreg?).

Coreg can also lower your blood pressure and also your physical performance, as it is a beta blocker. What are your actual heart rate values?

The main treatment for low blood pressure are:

- avoid or treat possible triggering factors (underlying medical conditions or drugs that cause decrease in blood pressure).
- increase salt intake with your diet
- take plenty of fluids to stay well hydrated
- increase caffeine intake during the day
- compressive socks if all your tests result normal and no other cause of low blood pressure is found.
- avoid staying in hot places and prolonged standing up position, avoid straining physical activity during the day.

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri

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