Blockade on the leg. Danger of bundle branch block

Complete blockade of the right leg of the heart is a rare pathological process in the human body. It is not a separate disease, but becomes an auxiliary symptom that is detected during electrocardiography. Although the symptom poses a health hazard, complaints from the patient about bad feeling however, they are absent.

Most often, the blockade is provoked by infectious diseases suffered in childhood. Among them are:

• measles;
• flu;
• chickenpox;
• angina;
• scarlet fever.

During the examination of the patient, the doctor identifies residual manifestations of disturbances in the activity of the heart muscle that were not diagnosed in time. However, these myocardial changes that appear in childhood no longer require treatment in adulthood.

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On the other hand, it is very important to diagnose pathological changes in the functioning of the heart muscle in childhood in order to avoid complications during adult life. Therefore, pediatricians are required to be attentive to patients and take heart problems seriously.

Functions of the cardiac bundle of His

Every organ in the human body for normal functioning requires oxygen, which it receives from the blood. Blood circulation is maintained due to the ability of the heart to contract autonomously in a strictly defined rhythm.

Nerve impulses that cause the muscle fibers of the heart to contract are transmitted through the conduction system in the organ. One of the important sections along its length is the His bundle. This element is located in the thickness of the muscular septum, which is located between the left and right ventricles.

The bundle of His has a special structure in which two legs are distinguished - left and right. Nerve impulses pass through them, rushing into one of the heart ventricles. If the nerve conduction of the impulse is disrupted, they speak of a pathology that doctors call bundle branch block.

This pathology in different cases expressed stronger or weaker. Incomplete heart block is characterized by partial difficulty in the passage of the exciting impulse; complete block is diagnosed when the impulse stops passing through the structures of the legs of the heart.

Depending on the location of the disorder, blockade of one leg is distinguished - right or left, or both at the same time. Very often in childhood blockages form for no apparent reason.

In most cases, such a blockade is incomplete and is in no way associated with any diseases. The pathological process develops asymptomatically. In addition, sometimes it can even be considered a variant of the norm.

If the right leg of the heart is completely blocked, then in this case the nerve impulse is conducted along individual muscle fibers, starting from the left ventricle and the left part of the septum between the ventricles.

Symptoms

Incomplete block of the right leg of the heart of the isolated type is in no way associated with current disorders of internal organs and diseases. In this regard, the pathology occurs without pronounced symptoms and is therefore difficult to diagnose. Violations are most often discovered accidentally during a routine inspection.

When the right leg of the heart is completely blocked, there are signs of primary diseases against which this disorder develops, including:

• dyspnea;
• heartache;
• severe fatigue;
• disruptions in the functioning of the heart.

However, the blockade itself is also asymptomatic in this case, and is diagnosed exclusively by ultrasound of the chest or during an ECG or listening.

Complete blockage of the left bundle branch can be identified by other symptoms, including:

• dizziness;
• cardiopalmus;
• chest pain.

A characteristic feature of the blockade is that it is not permanent, so it can occur suddenly, but often disappears over time. For example, in the tachycaemic form of the disease, the disorder is eliminated when the heart rate normalizes.

With a three-bundle blockade, complete or incomplete isolation along the path of passage is also formed nerve impulse. With incomplete blockade, impulses conducted to the ventricles along intact fibers are blocked.

With a complete three-fascicle blockade, the impulses do not pass through at all. At the same time, in the cardiac ventricles appears ectopic focus excitement. The work of the atria and ventricles is completely disconnected, and the heart rate per minute slows down to 20-40. This indicator is significantly lower than normal, which indicates that a full ejection of blood into the aorta is impossible.

This type of blockade is accompanied by fainting caused by difficulty in blood circulation in the brain and concomitant oxygen starvation of the organ. There may also be sensations of disruption in the functioning of the heart and dizziness. In such cases, the risk of sudden death increases.

Development forecasts

If the blockade occurs in isolated form, the prognosis is usually favorable. Isolation only in very rare cases develops into an atrioventricular form. This can only happen if the blockade is formed against the background of a very serious disease or disorder. There are also high chances of cure with a single-bundle block and in the absence of pathological processes in the heart and lungs.

The prognosis for cure worsens in the presence of arterial hypertension or ischemia. However, acute infarction most often does not have a significant effect on the development of the blockade. The likelihood of death increases in the presence of a large transmural infarction.

An unfavorable prognosis for complete blockade is given if myocardial infarction is present. In this case, 40-50 patients out of 100 die. Also, low chances of cure are observed with a three-bundle block, since this increases the risk of asystole.

Causes

The causes of blockade of the right leg of the heart are usually multiple congenital anomalies:

• unformed segment of the right bundle;
• pulmonary stenosis;
• defect of the septum inside the heart.

Complete blockade of the right bundle branch is formed due to certain diseases. Their list is quite extensive:

• hypertension;
• cardiomyopathy;
• acute form of heart attack;
• ischemic disease;
• blunt chest injuries;
• heart surgery;
• dystrophic changes in muscle fibers;
• hyperkalemia;
• intoxication with cardiac drugs;
• changes in the functionality and structure of the myocardium.

Treatment of right heart branch block

There are no specific signs of bundle branch block, and the disorder is usually diagnosed incidentally during routine examinations. In this regard, it is possible to identify disorders only by the presence of concomitant heart diseases. Accordingly, treatment for blockage of the right leg of the heart begins with eliminating the negative impact of these diseases on the body.

There are 4 main diseases against which a blockage in the His bundle develops:

• ischemic disease;
• arterial hypertension;
• chronic intoxication;
• right ventricular infarction.

Before directly eliminating the consequences that arise due to blocking of the bundle branch, the primary disease that provoked the development of the pathology should be cured.

The very fact of the presence of blockage of the legs of the heart indicates the presence of significant disorders in the organ. They are localized in the muscles of the right ventricle or in the septum between the ventricles.

Medicines

Certain medications are used to treat the effects of right bundle branch block, including the following: Enalapril; Mildronate; Riboxin; Trimetazidine. The specific type of drug is selected by the doctor individually in each case, taking into account the indicators obtained from the research results. As part of additional therapy, the patient is prescribed medications for arrhythmia. If there is a persistent increase in blood pressure, the doctor prescribes medications to the patient to eliminate this symptom.

Surgery

Surgery may be required if the blockage of the heart stem is caused by a congenital heart defect.

Upon completion of the full course of treatment or after surgery, the patient should continue to be monitored by general practitioners and cardiologists. Specialists will monitor all changes. If such a need arises, they will adjust the treatment methods in time.

Consequences

However, everything Negative consequences in most cases, they develop due to the fact that the patient ignores the doctor’s recommendations. Therefore, in order to save yourself from various risks, you need to undergo timely medical examination and appear for examination by your doctor.

It is especially important to consult a doctor for those patients who are this moment treat the cardiovascular system. When the first dangerous symptoms It is important to go to the hospital immediately, without delaying the examination until later. The consequences may be irreversible.

Bundle branch block (BNBB) is a disorder of intracardiac conduction caused by damage to the His bundle. Diagnosis of pathology is carried out during instrumental research by taking an electrocardiogram. The disease manifests itself as abnormalities heart rate, dizziness, development of syncope.

What is a bundle branch block?

Bundle branch block - partial/ complete violation passage of an electrical impulse through the conduction system of the heart. In cardiological practice, it is not distinguished as an independent disease, but is considered as a sign of an existing heart disease. Found in 0.6% of the population, much more often in men. The frequency of diagnosis increases with age.

Reference! The ICD-10 code depends on the area of ​​damage.

Causes of bundle branch block

There are quite a lot of factors that provoke the development of the condition.

The causes of RBBB (right bundle branch block) are:

• hypertonic disease;
• pathological enlargement of the right heart;
• cardiac ischemia;
• sarcoidosis;

Causes of LBBB (left bundle branch block):

• heart attack;
• myocarditis;
• endocarditis;
• cardiosclerosis;
• calcinosis.

Important! The provoking factor of double-bundle blockades is narrowing/absolute closure of the aorta and other aortic defects.

In addition to the previously discussed reasons, the following can provoke RBBB:

• cardiopathologies - rheumatism, heart failure, etc.;
• changes in electrolyte levels;
• long-term use, in particular;
• influence of toxic components;
• diseases of endocrine origin, for example, high content blood sugar;
• a constant lack of oxygen in the body, caused, in particular, by asthma.

Characteristics and symptoms of each type of RBBB

Each variety has its own typical symptoms and clinical picture.

Right bundle branch block (RBBB)

The causes of focal RBBB are directly dependent on the existing form of conduction disturbance. The background for the primary blockade is:

• taking antiarrhythmics of classes 1A and 1C;
• electrolyte balance deviations;
• injury to the chest area;
• formation of blood clots in the lumen of the pulmonary artery;
• myocarditis, etc.

Important! RBBB is a typical complication accompanying the post-infarction state. Especially if the changes affected the right ventricle of the heart or back wall.

RBBB accompanies the following diseases:

• valve system defects;
• organic damage to myocardial cells.

In approximately 20% of all diagnosed cases, it is not possible to identify the true cause of the condition.

Left bundle branch block (LBBB)

A characteristic of complete blockade of LBP is the absence of propagation of excitation to the point of divergence of the leg. The occurrence of a two-bundle blockade cannot be ruled out; both branches are excluded from the process.

RBBB (incomplete block of the right bundle branch) accompanies slow impulse conduction. Excitation of the myocardial cells of the left ventricle occurs due to impulses passing through the right branch of the His bundle.

Symptoms of blockade of the anterior branch of the left bundle branch (ALBBB)

The state of blockade of PVLNP in most cases occurs unnoticed by the patient. Diagnosed accidentally during a cardiogram. ECG signs are a shift of the QRS electrical axis to the left and the appearance of pronounced R (up) and S (down) waves.

Very rarely the condition is accompanied by the development of arrhythmia, but is considered as characteristic clinical symptom she shouldn't.

Block of the posterior branch of the left bundle branch (LPBLB)

In case of complete blockade of the zone, it does not participate in excitation processes. Any characteristic features are missing.

Double-bundle BNPG

In the two-fascicle form, the posteroinferior zone of the left ventricular myocardium is first excited. Then the spread to the anterolateral sections and further, to the myocardial tissue of the right ventricle is recorded.

The pathology is clearly visible on the ECG and is expressed in the expansion of the QRS complex and some other changes.

Important! Diagnosis of combined blockade indicates serious changes in the myocardium.

Three-bundle BNPG

In the incomplete form, the transmission of the exciting impulse occurs along a less damaged branch and is accompanied by the development of the first/second degree.

With complete blockade, the passage of excitatory impulses along the atrium-ventricle path is completely stopped. This is expressed in the disunity of rhythms. Ventricular contraction occurs in an idioventricular arrhythmic mode, which also acts as asystole.

Symptoms of bundle branch block

Most cases of blockade are completely asymptomatic. In particular, this applies to incomplete single-bundle blockade. The condition is diagnosed completely by accident during a planned cardiac cardiogram.

But clinical symptoms complete blockade of the right leg is recorded in the patient even when signs of organic heart damage are not detected. Signs of pathology are:

• changes in the functioning of the heart muscle;
• development of dizziness;
• syncope and presyncope;
• exercise intolerance;
• increased fatigue, general weakness;
• pain in the heart area and a feeling of interruptions in its work.

It is possible that a clinical picture may develop that reflects the underlying pathology. This may be a cardiological profile, or diseases of other organs and systems.

Severe symptoms accompany the following complex cardiac pathologies:

• heart failure;

They are accompanied by the development different forms heart blockades with lesions of the ventricular myocardium.

Right bundle branch block in children

The child has pathological condition can be formed during intrauterine development, i.e. during a woman’s pregnancy. But it can also be acquired against the background of a previous disease of the cardiovascular system.

The reasons can be:

• insufficient blood supply - the resulting oxygen starvation can cause the development of myocardial ischemia;
• death of the His bundle - a state of hypoxia can provoke the death of myocardial cells and their replacement with non-functional scar tissue;
• heart failure;
• pathologies of the heart muscle caused by its organic damage;
• abnormal structure of the heart - intrauterine development disorders;
• inflammation of myocardial tissue;
• heart surgery;
• autoimmune pathology - can provoke disruptions in the functioning of the myocardium;
• a pathological increase in blood pressure - in childhood can cause changes in the structure of the heart, in particular, provoke the development of LVH (), which is accompanied by a violation of its functionality.

Reasons congenital blockade speakers:

• multifocal damage to connective tissues in a pregnant woman;
• insulin-dependent form of diabetes;
• abnormal development of the right bundle branch;
• disturbance in the structure of the partitions in the heart cavity.

The condition may develop as a result closed injury hearts. It could be:

• a blow to the chest during a fall or push;
• incorrectly executed medical manipulations during surgery on the heart muscle.

The primary symptoms are:

• loss of consciousness and presyncope;
• attacks of dizziness;
• periodic development of bronchospasm;
• fatigue and unexplained weakness;
• heart attack;
• oxygen starvation of brain cells;
• general development lag;
• enlargement of the left ventricle and atrium;
• angina attacks;
• heart defects.

Diagnostics

Diagnosis of pathology in patients in adulthood and childhood is based on instrumental tests and analyses. This:

• general and biochemical blood test;
• examination of the patient's urine;
• establishing hormonal status - helps in determining the causes of the disease that are not associated with impaired functionality of the heart and blood vessels;
• taking an electrocardiogram - helps to obtain a description of the existing deviations and determine the form of the blockade;
• Holter (24-hour) monitoring - helps to identify existing conduction disorders;
• taking an ECG after stimulating the myocardium with an electrical impulse;
• EchoCG - used to determine the root cause of the block.

Interpretation of the results obtained is within the competence of the specialized specialist and helps him select the necessary treatment.

Treatment for bundle branch block

There is no specific treatment for the pathology. Since RBBB is only a symptom, doctors treat the underlying disease that caused the blockade to develop.

If the condition was provoked hypertension, angina pectoris or heart failure, then the treatment protocol prescribes the patient to take the following medications:

• products from the nitrate group;
• cardiac glycosides;
• medications that stabilize blood pressure.

It is recommended to treat the condition by installing a pacemaker when AV block develops.

In the case of an asymptomatic course, the patient is prescribed clinical observation.

Lifestyle with bundle block

If the patient’s well-being is not overshadowed by the development of clinical manifestations of a pathological cardiac condition, he can live as usual, without limiting physical activity. There are no other contraindications.

When identifying two- and three-fascicular blockades, the following recommendations must be observed:

• limitation of physical and psycho-emotional stress;
• frequent rest;
• proper nutrition;
• quitting smoking and alcohol.

If a pacemaker is installed, the patient must carry a pacemaker card with him. In addition, during a conversation on cell phone The tube should be applied not to the left, but to the right ear.

A control ECG is taken once a year. The procedure can be performed more often if the attending physician sees a need for it.

Complications

Complications of any type of blockade can include:

• ventricular fibrillation - cardiac arrhythmia, characterized by asynchronous contraction of the ventricles;
• full .

A complete blockade of the leg of His can provoke the following complications of the underlying disease:

• development of heart failure - the inability of an organ to provide adequate blood supply to the body;
• blocking the lumen of the vessel with detached particles of the thrombus.

Prevention of the formation of pathology comes down to timely elimination of diseases, systematic visits medical institution, compliance with all prescribed recommendations. This is especially important for people with diagnosed diseases of the heart and vascular system

Forecast

As a result, it should be noted that His bundle block is only a symptomatic sign of cardiac pathology, but not a disease. It is detected during a cardiogram or based on a patient interview.

The general prognosis of the condition largely depends on the root cause, i.e., the disease that acted as a provoking factor for this disorder.

• With a single-bundle right-sided blockade in the absence of cardiac and pulmonary complications, the prognosis is good.
• Complete blockade of the left leg in combination with necrotization of myocardial cells receives bad prognoses from doctors. Mortality in acute period reaches 50%.
• Three-bundle blocks also have poor prognosis for outcome. There is a high probability of asystole formation and subsequent death of the patient.

Bundle branch block is a pathological cardiac condition that requires medical supervision. That is why, if unpleasant symptoms develop, it is recommended to obtain medical advice.

Hello, dear readers of the blog site!

Blockade of the signal passing through the branches of the leg coming from the left branch of the His bundle is a symptom, its cause is heart disease, which is manifested by a complete disruption of the passage of impulses in the nerve conduction system in the heart.

The His bundle (His) is capable of producing impulses at a frequency of 25–40 myocardial beats per minute. The His bundle originates from the level 2 automaticity node, which is the atrioventricular node located in the right atrium.

From common trunk His legs extend to the corresponding ventricles of the heart. With complete or partial blockade of His, coming from the conduction pathways of the right bundle branch, the right ventricle is blocked.

Who is this article for?

Blockade of two or only the anterior/posterior parts of the His leg is recorded on the ECG in 0.6% of the adult population, and with age this figure increases and 2% after 60 years.

The blockade can be detected even in healthy people, considered a variant of the norm. In this case, the impulse propagates with a slowdown, as it goes through the right leg of His and Purkinje fibers, into which His bundles normally break up.

Signs of different types of blockade of the His bundles or blockage in the atrioventricular node are detected in the QRS complex when recording excitation on an ECG for heart pathologies. The purpose of determining conductivity is to assess the condition of the myocardium.

Causes of complete blockade of the left bundle branch

The causes of complete prolapse along the left leg, i.e. blockade in the His bundle, are:

* ischemia;
* atherosclerosis;
* hypertensive crisis;
* aortic defects.

The causes of LBBB on the ECG may be conduction disturbance or blockage of the atrioventricular node, or heart pathology.

Less commonly, impulse conduction blockade is caused by:

* myocarditis;
* myocardial dystrophy;
* arterial thromboembolism;
* glycoside poisoning;
* taking antiarrhythmics, diuretics;
* hyperkalemia.

Difficult prognosis for double-bundle blockades, when the impulse from the atrioventricular node to both legs of His is disrupted, as well as for coarctation of the aorta. This congenital disease is detected in children by ECG, and treatment methods depend entirely on the data. instrumental examination and the condition of the child.

Diseases that create the risk of double-branch block or even triple-bundle block in the case of a disorder in the right bundle develop with certain bacterial infections.

Bacteria cause infective endocarditis. This is a lesion of the heart sac in which chills, fever, and valve damage appear, which in 30% of cases can lead to death.

Endocarditis is caused by staphylococci, streptococci, enterococci, and the colonization of the cardiac sac by pathogenic microflora is provoked by sore throats, which have already been described more than once on the blog pages.

Symptoms of complete blockade of the left bundle branch

The entire clinic corresponds to the disease that caused the distortion excitation impulse.

Signs of blockade are revealed only when diagnosed by changes in the ECG. LBBB on the ECG is manifested by widening of the QRS segment.

The left bundle branch of His divides into two branches that go to the interventricular septum. If both branches are blocked, then they speak of a complete blockade.

If one of the branches is capable of transmitting an impulse, then the blockade will be incomplete, and conduction is partially preserved.

In this case, the impulse is transmitted along the smallest Purkinje fibers, into which the stalk diverges.

The most dangerous is a three-bundle block in the His bundle in the left leg, when there is excitation along the anterior branch. The same can be said about the signal on the rear branch.

The blockage separates the beating of the atria and ventricles.

Atrial beats in this case are set by the sinus node, which generates impulses with a frequency of 60 beats per second. And the rhythm of ventricular contraction is set by the center of level 3 automaticity, which creates impulses with a frequency of about 30 beats per second.

Such separation in work leads to rhythm disturbances. A complete blockade of symptoms appears:

* atrial fibrillation;
* asystole;
* ventricular bradycardia.

Atrial fibrillation is characteristic of severe blockade of the atrioventricular node, accompanied by symptoms:

* atrial beating frequency up to 300 – 600 impulses per second;
* shortness of breath;
* feeling of interruptions in myocardial function;
* fainting;
* fear;
* copious urination;
* Then;
* dizziness;
* pulsating veins in the neck.

Symptoms of ventricular bradycardia appear:

* slow and weak pulse;
* sticky sweat;
* flies in the field of view;
* weakness.

With signs of ventricular bradycardia, the prognosis for life is as unfavorable as with atrial fibrillation.

I think when the pulse accelerates and the heart works in such a way that it creates myocardial infarction, everyone understands the danger and does everything to help the victim.

But people encounter a rare pulse, i.e., bradycardia, less often, and do not consider this condition threatening. However, if the heart rate is less than 40 per minute, then the patient must be shown to a doctor.

No less dangerous sudden stops heart asystole. The state of systole corresponds to the ejection of blood. And asystole, accordingly, is the lack of blood supply to the general circulation.

Asystole, which appears as a straight line on the ECG, causes 5% of all cases of cardiac arrest. Symptoms of asystole serve as precursors to cardiac arrest. Their appearance should be treated with particular care, and “emergency help” should be called immediately.

Asystole is expressed:

* clouding of consciousness;
* physical activity;
* cramps;
*wheezing.

Diagnosis of complete block of the left bundle branch

Diagnose using:

* electroocardiogram;
* transesophageal ECG;
* Holter monitoring;
* rhythmocardiography;
* tomography;
* MRI;
* echocardiography.

Impairments in impulse conduction or the complete absence of excitation transmission can be detected using electrocardiography.

Signs of His posterior leg block on the ECG include the following symptoms:

* the cardiac axis deviates to the right;
* the QRS segment lengthens slightly.

Signs of anterior His blockage are:

* deviation of the cardiac axis by 30 degrees in left side;
* prolongation of QRS complexes > 0.02 seconds.

With complete blockade, the impulse is transmitted along the right side, then reaches interventricular septum. Excitation is transmitted through the finest Purkinje fibers to the left ventricle, triggering its contraction.

This method of transmission is manifested by a delay in contraction of the left ventricle. Blocking appears on the ECG:

* the axis of the heart is horizontal or tilts to the left;
* QRS > 0.12 s;
* the RST segment is located below the straight line on the graph;
* T wave is large, above the isoline.

With a three-fascicular block, blockage of the AV node is noted.

Treatment of complete left bundle branch block

Blockages can be caused by medications or high blood pressure. Hospitalization in such a case is not necessary. Of course, an examination is necessary, but in the absence of a threat, if the disorder is caused by hypertension, you can be treated on an outpatient basis.

Outpatient treatment is also sufficient for complete loss of conduction in the left part of the His bundle branch, due to blockade of the signal along the leg, caused by taking certain medications.

To eliminate the cause of the blockade caused by hypertension, the patient is given:

* Kaptopres;
* Mildronate;
* Riboxin;
* Trimetazidine.

If a complete blockade is caused by severe heart pathologies, then the patient necessarily requires hospitalization. Such pathologies include:

* hypertensive crisis;
* heart attack;
* coronary acute syndrome;
* TELA;
* heart injury.

In such situations special treatment not developed. Therapy eliminates the underlying disease, avoiding complete blockade of the atrioventricular node.

Use cardiac glycosides with caution. It is noted that the use of cardiac glycosides provokes the occurrence of atrial fibrillation.

Nutrition for complete left bundle branch block

The diet should be based on the main risk factors:

* atherosclerosis;
* hypertension;
* hyperkalemia.

And the rules of nutrition when blocking the wave of excitation that follows the trunk of the His bundle are to prevent the listed conditions.

To achieve a stable condition, the patient needs:

* reduce cholesterol intake;
* exclude all alcohol;
* provide the body with useful nutrients, but do not overdo it with potassium;
* drinking regime;
* refusal of foods that increase blood pressure.

Prohibited for hypertension:

* smoked meats;
* pickled products;
* spices;
* starchy dishes;
* strong coffee;
* salt.

Separately about drinking. If complete conduction on the left side along both branches of the leg is simultaneously impaired and a two-bundle blockade is possible, then an increased drinking regimen will create an extra load.

Complications with complete block of the left bundle branch

Blockages create the risk of diseases:

* heart failure;
* thrombosis causing stroke, heart attack;
* cardiac death.

There is no consensus in medicine regarding the level of danger of incomplete and complete blockades in the left branches of the pedicle extending from the His bundle. There are opinions that the survival of patients with such diagnoses is influenced by the degree of myocardial damage and the cause of the pathology that caused the conduction disturbance.

Thus, the survival prognosis worsens with extensive infarction, when conduction disturbances are combined with extensive damage.

The likelihood of complications with this disease is also influenced by the reasons for which the state of blockade developed. If the disorder is asymptomatic and its cause is not related to heart damage, then for such patients the prognosis is generally favorable, and the consequences will be associated with restrictions physical activity, diet.

When there is a disturbance in the conduction of cardiac nerve impulses, the prognosis is very serious and largely depends on the myocardium. Survival increases when the myocardium is in satisfactory condition and is of normal size.

Prevention of complete blockade of the left bundle branch. Physical exercises for complete block of the left bundle branch

Prevention is considered:

* adherence to sleep patterns;
* proper nutrition;
* walks, moderate loads under the supervision of a doctor;
* no stress, overwork;
* regular examination by a cardiologist.

Sports activities with incomplete His bundle blockade should be approached with caution. In athletes, myocardial hypertrophy, caused by increased loads, can itself cause a prolongation of the impulse conduction interval in the left part of the myocardium.

The left ventricle of athletes becomes massive, and areas of ischemia are found in it. Overtraining of the myocardium leads to a compensatory decrease in heart rate.

If a blockage of the His leg is detected on the left side, training associated with high physical activity should be stopped for a while and comprehensive treatment should be completed.

The story will be completed by a video showing how the impulse travels along the right and left parts of the legs emanating from the bundle of His, and how the heart stops during a three-bundle complete block.

Health to everyone!

Complete right bundle branch block, what is it? This condition is a diagnostic sign of certain diseases of the cardiovascular system. Pathology is detected during an ECG. The presence of RBBB does not always contribute to the deterioration of the general condition of the body.

The causes of pathological changes in the heart muscle are previous infectious diseases - tonsillitis, scarlet fever, chicken pox. Treatment of disorders that arose in childhood is not required in adulthood. The examination reveals only residual effects of myocardial dysfunction that was not detected in time.

Tissues receive oxygen and nutrients through the blood, which is circulated by the heart muscle. Its rhythmic contractions occur autonomously. Transmission of signals that stimulate contractile activity, is carried out through a conducting system called the bundle of His.

It is located in the tissues of the septum that separates the left ventricle from the right. The system consists of two legs through which impulses are transmitted to the heart walls. A nerve conduction disorder is called a bundle branch block. The disease can have varying degrees of severity. When its form is incomplete, the conduction of impulses slows down, but does not stop. Complete blockade is characterized by the cessation of signals entering the tissues of the left or right ventricle.

The lesion may affect the entire beam or half of it. It all depends on the speed of development of the disorder and the place of its occurrence. In children, RBBB may appear for no apparent reason. It does not contribute to the deterioration of the general condition and is physiological.

Complete blockade differs in that the excitation of the interventricular septum and signal transmission are carried out using the fibers of the muscle tissue of the left ventricle.

How does this pathology manifest itself?

Isolated right bundle branch block is not associated with other pathological processes in the body, so this form of the disease does not have pronounced symptoms. As a rule, it is detected during a routine medical examination. With secondary blockade of PNPG, signs of the underlying disease come to the fore. There are no typical manifestations of bundle branch conduction disorder.

Pathological changes in the heart muscle can be detected using a chest ultrasound or ECG. In some cases, the blockade occurs periodically. Meet and arrhythmic forms pathologies that occur when heart rhythm is disrupted. After the heart rate normalizes, the signs of blockade disappear.

The isolated form of the disease has a favorable prognosis. It extremely rarely turns into atrioventricular. However, a similar development of pathology is observed when it occurs against the background of congenital heart defects. Blockade that develops with arterial hypertension or coronary artery disease has a less favorable prognosis.

The disruption of His bundle conduction that accompanies the development of acute infarction does not affect the course of the underlying disease. The risk of death increases significantly when a large transmural infarction occurs. The main danger of the blockade is the possibility of influencing the ECG results, which is why the underlying disease is often detected untimely.

What is a bundle block and what causes it? The development of this pathology is facilitated by congenital defects, the most common of which are: ventricular septal defects, underdevelopment of the right bundle branch, pulmonary stenosis.

Acquired forms of pathology develop against the background of acute and chronic diseases: arterial hypertension, acute infarction, chest injuries, coronary artery disease. The blockage may be a complication of surgical intervention in the heart muscle, dystrophic changes in muscle fibers, impaired myocardial function, intoxication of the body with potassium ions, long-term use of cardiac drugs.

Methods of treating pathology

This disorder can be diagnosed in the presence of heart disease. For this reason, treatment begins only after the complications caused by them are identified and eliminated. Termination of conduction of the right bundle branch does not have typical manifestations; its idiopathic forms are found extremely rarely.

The main diseases leading to the development of blockade are: ischemia, arterial hypertension, chronic intoxication of the body, myocardial infarction. It is with their elimination that treatment must begin. Violation of the processes of excitation transmission indicates the presence of serious pathologies localized in muscle tissue right ventricle and interventricular septum.

For the treatment of hypertensive forms of blockade are used antihypertensive drugs, venotonics, cardiac glycosides. Constant monitoring of blood pressure and adherence to a special diet are necessary. Alcohol, fatty and fried foods should be excluded from the diet.

The amount of salt consumed should be reduced to 3 g per day. Medicines should be taken only as prescribed by a doctor. In case of heart rhythm disturbances, antiarrhythmic drugs are used. Ischemic disease and myocardial infarction require longer and more complex treatment.

If the blockade of the right bundle branch is caused by congenital defects, surgical treatment is indicated. After completing a course of drug therapy or surgery, the patient should be under constant supervision of a cardiologist.

The effectiveness of treatment is assessed through regular ECG; if necessary, one or another drug is replaced or excluded from the therapeutic regimen.

More and more people are suffering from heart problems. Excessive physical and emotional stress, chronic diseases, bad habits - all this cannot but affect the functioning of the cardiovascular system. One of the dangerous pathologies of the organ is heart block - a disease that occurs either independently or against the background of other diseases. So, a condition in which the transmission of impulses through the heart muscle slows down or stops is called heart block. What kind of disease is this, what are the reasons for its development, symptoms, signs, how to protect yourself from it?

Causes

Pathology can occur on its own or as a result or complication of other diseases. In the first case, hereditary predisposition plays a role. If a person has someone in their family who suffers from heart problems, then they have a much higher chance of being affected by a condition called heart block. Not everyone knows that this is a serious risk, and in many cases patients are not even aware of possible problems in the cardiovascular system, continuing to lead their usual lifestyle. Congenital pathologies are another factor that contributes to the development of heart problems in a person.

Heart block can also develop against the background of diseases such as myocarditis, angina pectoris, cardiosclerosis, myocardial infarction, thickening of the heart muscle, etc. Another reason is an overdose of drugs or wrong technique medicines. It follows from this that you should always follow the doctor’s recommendations or carefully re-read the instructions for use.

Kinds

The blockade can be localized in different parts organ, which determines its classification and treatment.

With atrial (sinotrial) blockades at the level of the atrial muscle, the conduction of the nerve impulse slows down. If the atrium is left, then this condition is also called left blockade hearts, if right, then right. This pathology is very easily confused with bradycardia - a slow heart rate. Sometimes a healthy person may experience this type blockades A severe degree is accompanied by convulsions and fainting.

Atrioventricular or atrioventricular blockades develop due to disturbances in the conduction of impulses on the way from the atria to the ventricles. Ventricular heart block is a condition in which conduction in the His bundle is disrupted. The disease can be triggered by problems such as cardiomyopathy, coronary heart disease, infective endocarditis, myocarditis, and myocardial infarction. Another condition is heart branch block. Another common name for the disease is bundle branch disease. If only a blockade of the right leg of the heart (or left) is detected, then it does not pose a danger to life. It is much worse when the patient has a blockade of both legs, then immediate hospitalization and adequate treatment are required.

Atrioventricular block I and II degrees

If a patient is diagnosed with atrioventricular heart block (an electrocardiogram will clearly show what this is), then the condition and prognosis depend on the degree, of which there are three. In the first degree, slow conduction of impulses is noted. The most common causes of development are electrolyte disturbances, acute myocardial infarction, myocarditis, increased tone vagus nerve, overdose of cardiac drugs. Ignoring the disease can lead to an increase in the degree or progression of the blockade.

The second degree is characterized by not all impulses entering the ventricles. Clinical signs conditions: chest pain, dizziness, hypoperfusion, bradycardia, low blood pressure, irregular pulse. Exercise can provoke the development of the disease professional sports, acute myocarditis, valve surgery, heart defects, vagotonia.

Atrioventricular block of the 3rd degree

Third degree block, or complete block, is a condition in which the impulse is not carried out at all. Contractions of the ventricles and atria occur independently of each other. The patient may experience the following symptoms: chest pain, nausea, vomiting, shortness of breath, weakness, dizziness, sweating, disturbances of consciousness, and sudden death may occur.

The causes of acquired blockade are metabolic disorders, acute rheumatic fever, myocarditis, myocardial infarction, complications after surgery, drug overdose.

Incomplete heart block

This disease often occurs in young people and is even considered a normal variant. The only danger posed by incomplete heart block is that this condition can develop into a complete one. In most cases, the development of the disease is associated with organic heart disorders: cardiomyopathy, aortic valve dysfunction, hypertensive heart disease, and damage to the coronary arteries. Diagnosis of incomplete blockade is carried out using an electrocardiogram.

Sometimes patients are diagnosed with “incomplete blockade of the right leg of the heart” (bundle of His). This disease can be congenital or acquired, and is associated with a partial disruption of the passage of an electrical impulse along the right leg of His. It proceeds benignly, does not require special treatment and extremely rarely can turn into a complete blockade. Incomplete blockade of the heart ventricle is also not dangerous, but monitoring is necessary to prevent progression.

Heart block in children

When conductor cells of the second and third types, responsible for transmitting impulses to contractile myocardium through the entire conduction system, function poorly, and children develop heart block. By localization it can be ventricular block (left and right heart block), atrioventricular or sinoatrial block, by completeness - complete and incomplete, in relation to the His bundle - transverse or longitudinal.

Heart problems in a child can be congenital or acquired. If a heart pathology of any nature is detected in children, it is necessary to immediately contact a doctor (pediatrician, cardiologist) and begin treatment. The occurrence of heart block in childhood will deprive the child of the opportunity to lead a normal life, he will be constantly haunted by symptoms, and life expectancy will be significantly reduced. Therefore, it is important to prevent the development of complications of heart disease, monitor the child’s health, and fight for his life by any means.

Diagnostics

Diagnosis of heart block early stage can be a successful step on the path to recovery. Therefore, it is recommended to seek help when minimal signs are alarming, and not when it is already taking away ambulance. The danger of the disease depends on each specific case. And if with incomplete the patient can continue his normal lifestyle, then complete forms can result in severe complications, even death.

Pathology can be diagnosed based on the results of an electrocardiogram, which at the time of the study allows one to assess the condition of the organ. But it is worth considering the fact that the occurrence of blockades can be periodic. Transient blockades are examined using a treadmill test, Holter monitoring, and echocardiography can also be prescribed to confirm the diagnosis.

Treatment

Treatment of blockades is divided into several important steps. Firstly, this timely diagnosis, then - establishing the nature and cause. Next, most actions should be aimed at eliminating the cause (if it is acquired). In some cases (incomplete blockade), only observation is carried out. Only then do they begin direct treatment of the blockades, which, depending on the severity, can be medicinal or surgical.

When treating with medications, drugs such as Orciprenaline sulfate, Isoprenarine hydrochloride, and Atropine are most often prescribed. The patient's serious condition and the ineffectiveness of medications may be a signal for temporary or permanent cardiac pacing. Pacemaker implantation is carried out mainly in patients aged 60-70 years.

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Causes of heart block

First degree blockades and incomplete blockade of His, which do not manifest themselves clinically, may be a variant of the norm or occur in athletes, in persons with vegetative vascular dystonia, as well as in children, adolescents and young adults with prolapse mitral valve, open oval window and other minor anomalies of heart development.

Blockades of the 2nd and 3rd degrees, complete intraventricular blocks, three-bundle block (of both the right and both branches of the left leg of His) almost always occur with organic damage to the heart tissue. Diseases that cause inflammatory or scarring processes in the myocardium include:

Symptoms of heart block

First-degree blockades, incomplete single-bundle block of His legs, intraatrial blockade, as a rule, do not manifest themselves clinically and can only be detected by ECG during a routine examination.

Complete blockades are manifested by symptoms of arrhythmia and signs of the underlying disease. These clinical manifestations may occur suddenly, against the background wellness, or can exist for a long time, with periods of deterioration, to which the patient has adapted and “learned” not to pay attention to them. However, if you notice some of these symptoms, you should consult a doctor for examination, because some symptoms may be a sign of impending dangerous conditions.

Symptoms of rhythm disturbance:

- weakness, increased fatigue, decreased ability to perform previous physical work,
- a feeling of interruptions in the work of the heart - a feeling of fading or cardiac arrest, discomfort in the chest,
- dizziness, flickering of spots before the eyes, sudden general weakness with a feeling of lightheadedness, tinnitus,
- Morgagni-Edens-Stokes attacks (MES attacks) - sudden sharp pallor, cold sticky sweat, thread-like rare pulse, loss of consciousness, possible convulsions due to cerebral hypoxia. As a rule, after a few seconds or two to three minutes consciousness is restored, but if this does not happen, and breathing and heartbeat are absent, it means that cardiac asystole (stop) and clinical death have developed,
- complete left His bundle blockade, which developed suddenly for the first time in life, can lead to the development of acute left ventricular failure with pulmonary edema, which is characterized by suffocation, coughing with foam-like sputum, blue discoloration of the skin of the lips, face, fingers, and shock.

Symptoms of the underlying disease - chest pain with physical activity or at rest coronary disease heart disease, shortness of breath, coldness of the hands and feet, cyanosis (blue coloration) of the fingers, nose, ears or the entire face and limbs with heart defects, headaches of occipital localization with nausea and vomiting with hypertension, high temperature or prolonged increase in temperature not exceeding 37.5º With infections, damage to joints and skin in systemic diseases and many others.

Diagnosis of heart block

The doctor can think about a preliminary diagnosis even when clarifying the nature of the patient’s complaints. For further diagnostics they are used following methods:

- standard ECG - basic informative method, confirming the presence of a blockade. However, a single electrocardiogram cannot always “catch” the signs of a block, especially in the case of transient heart blocks.

Signs of sinoatrial block are periodic loss of P-QRS complexes due to the fact that not every impulse from the sinus node reaches the atria, and therefore the ventricles. An increase in the RR interval by two and sometimes more times.

Signs of intraatrial block are splitting and widening of the P wave by more than 0.11 s, and the associated prolongation of the PQ interval. Sometimes an additional negative P wave appears (with complete dissociation of the right and left atria and their contractions in a separate rhythm).

Signs of first degree atrioventricular block are a constant prolongation of the PQ interval by more than 0.20 s, second degree Mobitz type 1 - with each subsequent contraction the PQ interval lengthens more and more until one cardiac P-QRS complex falls out, then the whole cycle is repeated again. Second degree blockade of the Mobitz type 2 - the duration of the PQ interval in each contraction is equally prolonged by more than 0.20 s, and the ventricular QRS complexes fall out randomly, without clear periodicity and can be deformed. II degree blockade, type 3 – no every second or two or more P-QRS complexes in a row. Third degree blockade - complete separation of the rhythm of the atria and ventricles - the frequency of atrial contractions is 70 - 80 per minute, ventricular contractions - 40 - 50 per minute or less. Atrial P waves are not associated with ventricular QRS complexes, they can overlap, be before or after them.

Signs of intraventricular block: with incomplete blockades - the QRS complex is not widened, not deformed, changes in the R wave (widened and jagged) and S wave are observed in the left or right leads, according to the type of blockade (right or left leg); with complete blockades - widened deformed QRS complexes wider than 0.12 s, wide deep S wave in the corresponding leads (III, aVF, V 1.2 with right blockade, I, aVL, V 5, 6 with left blockade).

Complete left bundle branch block

— daily ECG monitoring is informative during transient blockades, as it allows you to analyze heart rhythm and conductivity throughout the day, including at night.
— ECG with stress is used to determine tolerance to physical activity, allows you to establish the functional class of coronary heart disease and chronic heart failure.
— echocardiography, chest radiography, MRI of the heart, coronary angiography are used to search for the underlying disease causing conduction disorders.

Treatment of heart block

Blockade therapy begins with treatment of the underlying disease. First degree blockades that do not manifest themselves clinically do not require treatment.

In case of an overdose of drugs that slow down the rhythm, these drugs are completely withdrawn. In case of heart blockades, beta blockers (propranolol, bisoprolol, atenolol, anaprilin, tenoric, obzidan, egilok, etc.), cardiac glycosides (strophanthin, korglykon, digoxin), antiarrhythmic drugs (ajmaline, cordarone, verapamil, diltiazem, quinidine) are contraindicated.

For functional blockades associated with vascular dystonia, minor cardiac anomalies, sports, sinoatrial blockades of the 1st - 2nd degree and intracardiac blockades, drugs are prescribed that improve metabolism in the heart muscle - ATP, riboxin, vitamins, antioxidants (ubiquinone, mexidol, actovegin) .

Complete atrioventricular block is treated with a course of isoprenaline and orciprenaline, after which the issue of implanting an artificial pacemaker is decided.

There are no specific drugs for the treatment of intraventricular block. In severe cases (complete right or left blockade against the background of acute myocardial infarction, two- and three-fascicle blockades, especially with attacks of MES), temporary or permanent pacing is used.

First aid for heart block

As first aid for a patient with attacks of MES, 1 - 2 tablets of isadrin under the tongue (5 - 10 mg), subcutaneous administration of atropine, intravenous administration of adrenaline, norepinephrine are indicated. In the absence of breathing and cardiac activity - indirect cardiac massage and artificial respiration before the ambulance arrives.

In the event of clinical death, the ambulance team performs cardioversion (restoration of rhythm) using an electrical discharge from a defibrillator and emergency hospitalization in the intensive care unit to further resolve the issue of implanting an artificial cardioverter - a defibrillator in the heart.

For the treatment of the underlying disease, non-steroidal anti-inflammatory drugs, glucocorticoids (prednisolone, hydrocortisone), penicillin antibiotics, diuretics (diuretics), antihypertensive drugs (enalapril, perindopril), aspirin to reduce thrombus formation in the bloodstream and on the walls of the heart, drugs that normalize cholesterol levels are used. in the blood (statins), etc.

Lifestyle with heart block

Lifestyle comes down to correcting nutrition with an increase in proteins, vegetable fats and complex carbohydrates in the diet and limiting animal fats and simple carbohydrates, reducing significant physical activity, proper organization of the daily routine with sufficient rest.

A child with congenital or acquired heart block will not be able to lead a normal lifestyle for children of his age, since he will be prohibited from physical education, attending sports clubs and sections, and any significant stress. A young man with a blockade of the second degree or higher will most likely not be fit for military service. The issue of pregnancy for women is decided strictly individually with the participation of a consultation of cardiologists, cardiac surgeons, obstetricians and gynecologists and other specialists.

It is mandatory to contact your doctor in a timely manner if there is an increase in unpleasant symptoms and a significant deterioration in health. A patient with a blockade must take a responsible attitude towards his illness and understand that a high-degree blockade can be fatal at any time. To prevent this from happening, you should be attentive to your health, listen to the advice of doctors and strictly follow their diagnostic and treatment prescriptions.

Complications of heart block

Complications include:
— progression of blockade, for example, 1st degree AV block often progresses to type 1 II degree blockade, rarely to complete AV blockade. In this regard, dynamic monitoring with ECG monitoring of the patient is important. Initially existing AV block of the second degree, type II, often progresses to complete block.
- complications of complete blockades - acute left ventricular failure with pulmonary edema, ventricular asystole and sudden death.
- progression of chronic heart failure.
- pulmonary embolism, myocardial infarction, ischemic stroke.

Prevention is competent drug treatment of the underlying disease, timely determination of indications for implantation of a pacemaker.

Forecast

The prognosis for first degree blockades in the absence of organic heart damage is favorable.
For complete blockades, the prognosis is determined by the nature of the underlying disease, the degree of cardiac dysfunction and the stage of chronic heart failure. The frequency and number of MES attacks are not predictors of mortality, that is, they do not affect the prognosis - in some patients, attacks can occur frequently, while in others, a single attack in a lifetime can be fatal.

The prognosis for patients in the acute period of myocardial infarction, complicated by the development of complete left or right His bundle block, is extremely unfavorable.

General practitioner Sazykina O.Yu.

www.medicalj.ru

What are they?

The difference in heart block into subtypes is characterized by the localization where they occur. Exist:

• Sinoatrial blockades. Which pass through the atrial muscle tissue;
• Atrioventricular. What are placed at the level of its connection;
• Intraventricular.

They are also classified according to severity and strength of appearance:

• 1st degree. Occurs when there is a slowdown (extension) of signal arrival in lower sections conductive system of the natural pump. Its occurrence can only be confirmed by an ECG, since the path of the impulse is disrupted, thereby showing dysfunction in the system.
• 1st degree. The 2nd degree of heart block is characterized by a subsequent increase in conductivity along the atrioventricular node. It has three types according to progression violation (Mobitz).

  Mobitz I is the first type, which shows an increase in intervals with the presence of Wenckebach periods, which represents the periodic disappearance of ventricular transactions.

  • Mobitz II notes complete loss of ventricular complexes, but cardiac impulse intervals remain unchanged.
  • Mobitz III atrioventricular block is an obstruction of the electrical impulse and further pathology of its occurrence with subsequent loss of the excitation reflex. In this case, the electrocardiogram will show a noticeable increase in ventricular contraction
• 3rd degree. In the case of grade 3, the complete cessation of signal transmission at the atrioventricular node is clearly noticeable. They lose sync with each other and random contractions begin.

Types of disease

In a holistic concept, the main types of heart block are determined, which depend on their level. Highlight:

• sinoatrial;
• interatrial;
• atrioventricular;
• blockade in the legs of the fasciculus;
• intraventricular;
• early ventricular excitation syndrome.

Sinoatrial heart block is direct violation impulse transactions in the sinus node compartment, which leads to dysfunction of conduction into the atrium from the sinoatrial node. This phenomenon is followed by a complete loss of contractions along the conduction system of the heart. This fact can be observed during auscultation of cardiac activity. There is irregularity of loss.

Interatrial block manifests itself in disruption of the passage of signals through the transactional system of the atrium. This is followed by a disturbance in the rhythm of contractions, and subsequently there is a lengthening of the P wave before the QRS complex and its subsequent widening.

Atrioventricular heart block is positioned at the level of the AV node or the trunk of the His bundle. This phenomenon calls for arrhythmia and the appearance of the third degree, deformation and subsequent expansion of the QRS complex.

Under the blockade of the His bundles, one can identify disharmony in the conduct of the transaction or a complete cessation of its expansion to the left, right leg in the His bundle, or by the branches of the left leg. According to the irradiation of this manifestation, differentiation is two-sided, constant or changeable, complete and incomplete. Its occurrence can be determined by physical examination, but diagnosis is usually carried out using an ECG.

Under blockades of the His bundles, there is a branching into such subtypes as: blockade of the left, otherwise - the right leg in the His bundle, three-bundle and two-bundle blockades.

Unlike the left one, the right leg in the His bundle does not have branches; it may be complete or incomplete; accordingly, the impulse will slow down or be absent. Thus, a defect in the right branch of the His bundle system results in a disruption and pathology in the subsequent coordinated work when conducting an outgoing impulse from the atrioventricular node straight to the right ventricle.

Intraventricular blockade is localized below the atrioventricular node: in the His bundle, in the left and right legs. With this heart block, the excited impulse that tends to the ventricles either arrives late or does not arrive at all.

The phenomenon of early excitation of the ventricles occurs in the presence of additional nerve fibers, during which the impulse itself from the atrium to the ventricles is replenished. The course of this syndrome may be insignificant for a person. The ECG shows an additional wave before the QRS complex.

Causes contributing to heart block

One of the foundations for the appearance of a disease can be a certain number of diseases, for example:

Further reasons that are important in the appearance of blockade may be drug intoxication or overdose of drugs such as verapamil, digitalis, digitalis, diphenhydramine or others aimed at treating arrhythmia.

Due to overexcitation of the vagus nerve, incomplete blockade can also occur in healthy people. The sources may be excessive loads or overwork, too intense training.

Heart blocks also show themselves in utero due to congenital pathology along with heart disease and other congenital diseases.

The blockade also occurs after surgery, treatment of heart defects, and other problems.

Infections suffered in childhood may also precede the appearance of changes in the cardiac system, in particular complete heart block or a defect in the right bundle branch. Not so often, an overdose of antiarrhythmic drugs, B-blockers, and cardiac glycosides can quite easily lead to obstruction of the right bundle branch. In particular, it is the defect of the right bundle branch that leads to blockade in the right cardiac ventricle.

Diagnosis of the disease

With various types of loss of area transactions in the contraction of the ventricles, their decrease occurs.

To diagnose the etiology of various heart blocks, a test with atropine is used, followed by its introduction into the human body. In case of incomplete heart block, which is not justified by any pathological reasons, it goes away in half an hour.

The ECG shows variable waves that symbolize a very slowly moving impulse towards the ventricle from the atrium. Regarding incomplete blockade in the right bundle branch, the ECG will show changes in the form of jagged S waves in the thoracic leads.

Symptoms of the disease

At the first stage of the onset of heart block obvious symptoms are absent at all. The possibility of identifying this stage is possible only through an ECG.

During the second stage or different localizations of the disease, dizziness, some darkening in the eyes with sudden movement, etc. occur. During physical activity, shortness of breath and tingling in the temples appear.

If the heart block is clearly expressed and goes away in the second or third stage, then there are painful sensations V chest area, sometimes fainting, symptoms of severe fatigue or heart failure. Increasingly, noticeable cramps are noticed, preferably on the left side of the body. This occurs due to a lack of oxygen in the brain.

With complete heart block, the impulse that contracts the ventricles may not arrive at all. In this case, death is possible. If the following symptoms appear, we strongly recommend that you consult a doctor with the task of conducting an ECG and identifying a blockade on early stages, which will greatly facilitate treatment.

In general, the symptoms are as follows:

• dizziness;
• dyspnea;
• chest pain;
• fainting;
• sudden convulsions due to lack of oxygen to the brain.

Treatment of pathologies

First of all, the course of treatment directly depends on the severity of the course and the degree of heart block. If this disease arises from any symptoms, by and large there is no need for special treatment.

Installation of a pacemaker is necessary in circumstances where heart block is severe or is identified at the third stage and is not caused by drug intervention or disease.

If a blockade occurs due to the use of therapeutic drugs, their replacement or complete cessation of use is necessary. In such a situation, you cannot do without medical advice.

The introduction of a pacemaker is the main solution for complete heart block. It is a small device, no larger than a matchbox, which is implanted near the collarbone on the left front.

It influences the heartbeat, generating electrical transactions that lead to contraction of the heart. The pacemaker either sends signals without interruption, or only when its rhythm slows down. It is installed preferably under local anesthesia. The wound heals after surgery in about six weeks.

Prognosis and complications

With incomplete blockades, a favorable prognosis follows successful treatment and all the frivolity of the course of the disease. A complete third-degree blockade often leads to disability.

With the use of pacemakers, the chances increase to indicate a favorable prognosis.

There is also the possibility that there is incomplete rehabilitation of working capacity.

In addition, in people who do not suffer from a lack of functional potential of the cardiovascular and respiratory system, the prognosis is very favorable.

A complication is the fact that the chance of myocardial infarction increases. The likelihood of coronary disease, the presence of constant arrhythmia of the heart, anemia, etc. also increases significantly. It should be remembered that the main and most dangerous, perhaps, result of complete heart block can be death.

In conclusion, it must be said that heart block is very versatile and its consequences can have different meanings depending on the degree. At minor illness, that is, the first degree, the blockade can only be diagnosed using an ECG. But the earlier this pathology is identified, the more significantly the possibility of increasing the degree decreases.

Complete heart block can result in death. So, if you experience symptoms similar to those mentioned above, we strongly recommend that you consult a cardiologist.

Important! Under no circumstances allow unauthorized intervention, that is, self-medication.

With common sense, almost any disease can be cured. And heart block is included in this list. Thanks for reading, stay safe. All the best!

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What is heart block?

Let's start with the fact that the normal functioning of the heart is facilitated by electrical impulses generated in the sinoatrial node. From it they are distributed throughout the atria, the contractions of which contribute to the transmission of the impulse further, through the atrioventricular node to the atrioventricular His bundle. From there it is distributed into areas through smaller branches. With a decrease in the automaticity of the sinus node the passage of the impulse slows down, the interval increases (lengthens) between atrial- ventricular contractions.

Sometimes the impulse does not travel through the conduction system at all. In this case, there is no contraction of the atria or ventricles. A long pause occurs (atrial asystole), which is called the Wenckebach period. When it occurs, conductivity is restored again, thanks to the ectopic rhythm, which is called the “rescuing” rhythm. And the next atrioventricular interval has already normal length. Symptoms with incomplete (partial) heart block are almost completely absent, since it does not disrupt the blood supply to the brain. More often partial heart block is accompanied by slight dizziness and slight malaise.

Complete heart block is characterized by the occurrence of bradysystole - a sharp decrease in the number of ventricular contractions (up to 30-40), when the number of atrial contractions remains normal. This almost always causes significant circulatory problems. Patients complain of shortness of breath, dizziness, and their vision suddenly becomes dark.

Sometimes a drop in cardiac activity (a sharp decrease in ventricular contractions to 15 per minute) causes cerebral ischemia. In this case, a Morgagni-Adams-Stokes (MAS) attack occurs: epileptiform convulsions develop, and the person loses consciousness for several minutes. Before it occurs, he begins to feel weak, a feeling of intense heat arises in his head, then he suddenly turns pale and loses consciousness. This condition is called instantaneous blockade. It develops when a violation sinus rhythm turns into ventricular automaticity. Repeated attacks of MAS often cause death.

Video: heart block on ECG

The video shows an intermittent (alternating) blockade of either the right or left bundle branch

Heart blockades - briefly about the types

The following types of blockade are distinguished depending on where the obstacles that arise that cause disruption of the impulse patency are localized.

Sinoatrial blockade

Sinoatrial (SA) block is usually caused by excessive stimulation of the vagus nerve, or organic lesion sinus node. It is characterized by conduction disturbances in the area between the atria and the sinoatrial node, accompanied by loss of complete cardiac contraction, which is detected by auscultation (listening). The nature of the loss is irregular.

Sinoatrial blockades also develop under the influence of glycosides prescribed for the treatment of heart disease, potassium supplements and quinidine. It also occurs in people in excellent health who engage in various sports when their physical activity increases.
Partial (incomplete) blockade, associated with a decrease in the activity of the sinoatrial node, is asymptomatic. No treatment is required for this type of blockage. If there is a significant decrease in the activity of the sinus node caused by increased excitability of the vagus nerve, a course of therapy with atropine administered subcutaneously is carried out, and sympathomimetics can be used.

Intraatrial block

When it occurs the patency of excitation is disrupted inside the atria.

Atrioventricular block

The cause of atrioventricular (AV) blockade is pathology of the passage of the impulse that excites the ventricles simultaneously through all three branches of the His bundle. They are divided according to degrees, which determine the severity of the disease.

1st degree

First degree heart block occurs when there is a delay in the passage of the electrical impulse through the atrioventricular region. It is detected only through an ECG. If cardiac activity is normal, the duration of the interval of impulse passage from the atria to the ventricles (P - Q) is 0.18 s. When a 1st degree blockade develops, the impulse conduction interval (P – Q) increases to 0.3 s and higher.

2nd degree

A 2nd degree block is characterized by a further increase in conduction disturbances in the atrioventricular node. This disorder has three types (Mobitz).

3rd degree

With the 3rd degree of blockade, the transmission of impulses in the atrioventricular node stops completely. And they begin to contract spontaneously, regardless of each other. Myocardial pathologies, drug intoxication and other factors lead to the development of complete blockade.

Intraventricular block

Intraventricular blockades (ventricular) are associated with the formation of pathology of the pathways located below the atrioventricular node: in the His bundle or one or more of its legs. With this type of blockade, the exciting impulse directed to the ventricles is delayed or not transmitted at all.

Video: Lesson on Heart Blocks

Etiology

• Basically, the causes of heart block lie in the progression of diseases, such as:
  1. myocarditis of thyrotoxic, diphtheria or autoimmune type;
  2. diffuse diseases connective tissue;
  3. heart defects and tumors;
  4. sarcodia and amyloidosis;
  5. myxedema;
  6. syphilis affecting the heart and myocardial defects caused by rheumatism;
  7. myocardial infarction or cardiosclerosis.
• No less common causes are drug poisoning caused by exceeding the dosage of certain drugs: quinidine (against arrhythmia), Corinfar, verapamil, digitalis and a number of others. Digitalis preparations are especially dangerous for heart blockades of any kind.
• Incomplete blockade often occurs in completely healthy people. Most often it is caused by overexcitation of the vagus nerve, which is caused by increased stress during training or physical work.
• There have been cases of congenital blockade that occurs as a result of pathology of intrauterine development. In this case, newborns are diagnosed with heart defects, etc.
• Blockade can also be caused by certain types of surgical interventions used to eliminate various heart defects and other anomalies.

Blockades of intraventricular localization

The most common is intraventricular heart block. It has several varieties, which are classified based on which branch of the His bundle the pathology arose. The mechanism by which the excitatory impulse is transmitted to the ventricles from the atria includes three branching segments. They are called the legs of His. First there is a branch to the RV (right ventricle). It is called the bundle branch (right). Next comes the left segment (leg), which is directed downward. Being a continuation of the main trunk, it is thicker than the others. Just below the segment branching to the pancreas, the left segment divides into posterior and anterior branches. Along the posterior branch, excitation is transmitted to the septum, and along the anterior branch - directly to the ventricle, located on the left side.

Damage to any branch of the His bundle contributes to the formation of a single-bundle block. If conduction is impaired in two branches, then we are talking about a two-bundle blockade. If the pathology develops in all three legs (complete bundle lesion), this means the occurrence of a complete three-bundle transverse block of the atrioventricular (distal) type.

Based on the location of the conduction pathology, there is a division into right ventricular and left ventricular blockades. If conduction pathology occurs along the anterior or posterior part of the left segment of the His bundle, a blockade of the left ventricle of the heart is formed.

1. Pathology of the conduction of the anterosuperior left leg mainly progresses with the development of diseases leading to thickening of the wall of the left ventricle (its hypertrophy). This may be myocarditis, anomalies of the interventricular septum, aortic heart disease, heart attack, etc. There is a violation of the patency of the excitation along the anterior section of its side wall. It is distributed abnormally, starting from the lower areas and gradually rising upward. That is, the septum between the ventricles is first excited, then the impulse is transmitted to the lower portion of the posterior wall. At the end of the period, along the anastomoses, the excitation reaches the anterior section of the lateral wall. The cardiogram shows that the QRS interval is wider than during the normal passage of the impulse by 0.02 s. The R wave is of greater height, and the S wave is of greater depth. At the same time, abnormal Q waves are formed.
2. When excitation completely ceases to be transmitted through the His bundle (along its left leg), a complete left ventricular block occurs. But along the segment on the right side the impulse passes in normal rhythm. And only after excitation occurs in the right part of the septum and RV, the impulse is sent to the left ventricle. Causes conduction disturbances of this type serious illnesses hearts, causing complications in the form of various defects of the myocardium and impulse-conducting system.
3. When the left ventricular block is incomplete, the passage of the electrical impulse to the branching slows down. It is brought to the LV transseptally, in a retrograde direction (from left to right) along the right branch of the His bundle, starting from the RV.

The development of blockade of the right ventricle in most cases is caused by diseases leading to its overstrain and the formation of wall thickening. Intoxication of the body often leads to anomalies of this type. medications prescribed to eliminate cardiac dysfunction (beta blockers, quinidine, etc.). RV block very often develops in people whose hearts are completely healthy. The anomaly in the patency of the impulse in this case lies in the fact that the septum and LV are first excited, and only then the impulse is transmitted to the RV.

From the above the following conclusion follows: The pathology of the passage of the excitation impulse at any of the branches of the His bundle is a partial blockade of one of the ventricles, on the side of which a pathological interruption of the branch occurred. Excitation to the blocked ventricle is transmitted in an abnormal “bypass” way: through the septum and the ventricle corresponding to the normally functioning branch.

Intraventricular blockades can be identified mainly by electrocardiographic examination. The cardiogram shows a deviation of the electrical axis to the left by an angle of up to 90° with a negative value in case of left ventricular block caused by conduction disturbances in the anterior segment. Deviation of the electrical axis to the right by an angle of up to 90° with a positive value indicates a blockade of the left posterior area. The QRS complex remains unchanged. To clarify the diagnosis, Holter monitoring is performed (taking readings for 24 hours or more).

Video: lesson on bundle branch blocks

Why is heart block dangerous?

The most dangerous is considered complete atrioventricular block., since it has serious consequences, manifested in the following:

1. The occurrence of chronic heart failure, accompanied by fainting and collapse. Over time, it will progress, causing exacerbations of cardiovascular diseases (in particular coronary artery disease), chronic kidney diseases, etc.
2. Against the background of a slow rhythm, ectopic arrhythmias develop, including ventricular tachycardia.
3. A common complication is bradycardia, leading to hypoxia (oxygen starvation) of the brain and attacks of MAS, frequent occurrence which in older people is the cause of dementia.
4. Sometimes an attack of MAS causes ventricular fibrillation, leading to sudden death. Therefore, it is important to provide emergency assistance in a timely manner: if necessary, perform a cardiac massage (indirect) or perform forced ventilation.
5. During heart attacks or post-infarction conditions, complete heart block can cause cardiogenic shock.

Diagnosis

When some of the ventricular contractions are lost, their number decreases. This happens both with complete and partial blockade, including functional blockade. To identify the nature of its occurrence, a so-called atropine test is used. The patient is given atropine. An incomplete blockade, the occurrence of which is not associated with pathological changes, then disappears literally after half an hour.

On the electrocardiogram, only the waves are modified, showing that the impulse exciting the contraction passes from the atrium to the ventricle very slowly. With partial second-degree heart block, the cardiogram shows that the impulse passes with a slowdown. The wave of atrial contraction is recorded, but there is no wave indicating ventricular contraction. Partial blockade of the right leg is recorded on the cardiogram by slight changes in the thoracic leads on the right side and the appearance of small notches on the S wave.

Pathology treatment method

Treatment for heart block (antrioventricular) is prescribed depending on the type and cause of its occurrence. For first-degree atrioventricular block, constant clinical monitoring of the patient is sufficient. Drug therapy is carried out if his condition worsens. If the blockade develops against the background of a heart disease (myocarditis or acute myocardial infarction), then the underlying disease is first eliminated. The treatment method for 2nd and 3rd degree blockade is selected taking into account the location of the conduction disorder.

• If the blockade is of the paroxysmal type, then treatment is carried out with sympathomimetic agents (isadrin) or subcutaneous administration of atropine.
• For distal blockade drug therapy does not give the desired effect. The only treatment is electrical stimulation of the heart. If the blockade is acute and occurs as a result of myocardial infarction, then temporary electrical stimulation is performed. In case of persistent blockade, electrical stimulation should be carried out continuously.
• In case of sudden complete blockade, if it is not possible to perform electrical stimulation, a tablet is placed under the patient’s tongue Isuprel or Euspirana(or half a tablet). For intravenous administration, these drugs are diluted in glucose solution (5%).
• Complete heart block that develops against the background of digitalis intoxication is eliminated by withdrawing glycosides. If the blockade, the rhythm of which does not exceed 40 beats per minute, persists even after discontinuation of glycosides, intravenous . In addition, intramuscular injections are given Unitola(up to four times a day). If necessary (for medical reasons), temporary electrical stimulation is performed.

Under the influence of drugs on the vagus nerve, there are often cases when complete heart block turns into partial.

help yourself

With incomplete blockade of a specific drug treatment not required. But care must be taken to reduce the likelihood of its progression to more severe forms. And the symptoms that arise, such as dizziness and heaviness in the chest, also cannot be ignored. Therefore, it is recommended to reconsider your lifestyle and diet, refuse bad habits. If you experience discomfort caused by the blockade, do the following:

Complete heart blocks

Let's look at what a complete intraventricular block caused by pathological changes looks like on an ECG. The amount of damage to each branch of the left leg of His is indicated by the deviation of the isoline towards negative or positive values. It is located neutral (zero position), when excitation to the ventricles is transmitted to normal rhythm. When the passage of a pulse is disrupted, broadening is recorded QRS complex, which in some cases reaches more than 0.18 s.

With a significant increase in depolarization caused by conduction disturbances in the His bundle, early repolarization occurs. On the electrocardiogram this process is recorded as follows:

• Segment ST in the left parts of the chest is shifted below the isoline; prong T takes the form of a negative equilateral triangle.
• Segment ST in the right parts of the chest - above the isoline, tooth T with a positive value.

When the right ventricular block occurs, the following occurs:

1. A low tooth is formed S greater width;
2. Prong R, on the contrary, narrow, but tall;
3. QRS the complex is shaped like the letter M.
4. Secondary repolarization (early) is displayed in the chest leads on the right with a convex upward segment ST, which has a slight downward shift. In this case, the tooth T- with inversion (upside down).

Complete atrioventricular block, which occurs as a result of pathological changes in the myocardium or against the background of an overdose of certain types of drugs, can develop in a distal or proximal type.

• The proximal type of block occurs when the ventricular pacemaker is located in the atrioventricular node. On the ECG this type of blockade is marked by a normal (not widened) complex QRS, the frequency of ventricular contractions is quite high (up to 50 per minute).
• In the distal type, the ventricular pacemaker has a lower idioventricular location. It is the bundle of His with all its branches. It is called a third-order automatic center. The electrocardiogram shows that the number of ventricular contractions is reduced, it does not exceed 30 per minute. This is indicated by the broadening of the complex QRS more than 0.12 s and overlap with the ventricular QRS tooth complex R. It may have a changed shape (if the automatic impulse occurs below the point at which the His bundle begins to branch). The ventricular complex retains an unchanged shape if the initial point of localization of the automatic impulse is located in the bundle itself.

With atrioventricular block, simultaneous contraction of the ventricles and atria occurs. This gives raised sound the first tone, which was called “cannon”. It is clearly audible when listening. The symptoms of this type of blockade depend on the degree of circulatory disturbance and the causes that cause it. If the frequency of ventricular contractions is high enough (at least 36 per minute), and there are no accompanying illnesses, then patients do not experience discomfort or unpleasant sensations. In some cases, when cerebral blood flow decreases, dizziness occurs, and consciousness begins to periodically become confused.

As the duration of the interval between ventricular contractions increases, partial AV block may become complete, causing acute disorder blood circulation in the brain. It is often accompanied by a slight eclipse of consciousness and heart pain. In more severe cases, attacks of MAS occur, accompanied by convulsions, a short time the person loses consciousness. Prolonged ventricular arrest can cause instant death due to ventricular fibrillation.

Drug therapy for complete blockade

Therapy for complete blockade of any type is carried out based on etiology and pathogenesis.

Radical methods include implantation of a pacemaker. Indications for its use are:

• low ventricular rate;
• increased period of asystole (more than 3 s);
• occurrence of MAS attacks;
• complete blockade, complicated by persistent heart failure, angina pectoris and other diseases of the cardiovascular system.

Forecast

A favorable prognosis is given only with partial blockades. The development of a complete third-degree block leads to complete disability, especially if it is complicated by heart failure or occurs against the background of myocardial infarction. The implantation of a pacemaker will make it possible to make more favorable prognoses. When used, some patients may experience partial restoration of their ability to work.

Features of heart block localizations

His bundle and its blockade

His bundle block has distinctive features. It may be constant or appear periodically. Sometimes its occurrence is associated with a certain heart rate. But the most important thing is that this type of heart block does not get worse severe course. And although this blockade in itself does not pose a threat to human health, it can serve as a harbinger of more serious heart disease (in particular myocardial infarction). Therefore, it is necessary to periodically undergo a heart examination using an ECG.

May pose a threat to life pathological disorder conductivity, the location of which is the bundle branch. This is explained by the fact that she is a fourth-order pacemaker. It regenerates low-frequency pulses (no more than 30 per minute). It should be noted that the highest frequency impulse (up to 80 per minute) is formed in the sinoatrial node. The second-order atrioventricular node that follows it produces impulses with a decrease in frequency to 50 per minute. The His bundle (third-order pacemaker) generates impulses at a frequency of 40 per minute. Therefore, in the event of obstruction of the excitatory impulse along the pacemakers of all levels, they are automatically formed in the Purkinje fibers. But their frequency decreases to 20 per minute. And this leads to a significant decrease in the blood supply to the brain, causes its hypoxia and leads to pathological irreversible damage in his work.

Sinoatrial heart block

A distinctive feature of sinoatrial block (SB) is that it can occur simultaneously with other types of heart rhythm disturbances and conduction pathologies. Sinoatrial block is sometimes caused by a weak sinus node. It can be permanent, transient or have a latent form.

In this case, three stages of its manifestation are distinguished.

• At the first stage, the passage of the impulse through the sinoatrial region is delayed. It can only be detected by electrophysiological studies.
• At the second stage, two types of SB should be considered. With the development of the first type, a periodic blocking of one impulse occurs at the exit from the atria. Sometimes several impulses in a row are blocked at once, with Weckenbach periodicity. R-R interval, corresponding to a pause, extended. But its value is less than twice the R-R interval that precedes the pause. Gradually, the intervals that follow a long pause become shorter. It is detected during a standard ECG, on which the pulse frequency is displayed without change.
• The second type is characterized by a sudden disruption of impulse conduction, in which there are no Weckenbach periods. On the cardiogram, the pause is recorded as doubling, tripling, etc. pauses R-R.
• The third stage is a complete disruption of impulse conduction in the atria.

Interatrial block

One of the small rare heart rhythm disorders is interatrial block. Like all other types, it has three stages.

1. The impulse of excitation is delayed.
2. Periodic blocking of the excitatory impulse entering the left atrium.
3. Dissociation of atrial activity or complete conduction disturbance.

The third stage is characterized by the automaticity of the formation of impulses from two sources at once: the sinoatrial and gastroatrial node. This is due to the fact that due to the emerging pathology of the sinus node, the number of impulses formed in it sharply decreases. At the same time, an accelerated formation of the number of impulses in the AV node occurs. This leads to simultaneous contraction of the ventricles and atria, regardless of each other. This type of blockade has another name - “Pre-ventricular dissociation” or dissociation with interference. On the electrocardiogram it is recorded together with normal contractions. When listening, a more sonorous “gun” tone is heard from time to time.

Heart block in childhood

In childhood and adolescence, the same types of blockade are formed as in adults, differing only in the cause of occurrence: acquired (due to a disease) or congenital etiology. Acquired forms in children and adolescents are secondary, and develop as a complication after surgery to eliminate various cardiac pathologies, or against the background of diseases with an inflammatory or infectious etiology.

Congenital blockade can be caused by the following reasons:

• Diffuse damage to the mother's connective tissue.
• The presence of type II diabetes mellitus (insulin-dependent) in the mother. This syndrome is called Legerne disease.
• Not fully formed right leg of the His bundle.
• Anomaly in the development of the interatrial and interventricular septa.
• M.Lev disease

The most dangerous is the third degree of atrioventricular or complete transverse block caused by damage to all three legs of the His bundle. When they occur, the conduction of impulses to the ventricles from the atria is completely absent. It does not always have pronounced symptoms. Its only manifestation is bradycardia.

But as it progresses, there is a gradual stretching of the heart chambers, hemodynamic disturbances with a slowdown in overall blood flow. This leads to a deterioration in the supply of oxygen to the brain and myocardium. As a result of hypoxia, children experience neuropsychic disorders. They have trouble remembering and learning educational material, lag behind their peers in physical development. The child often experiences dizziness, weakness, and slight fainting. TO fainting states any stressful situation and increased physical activity.

In the treatment of complete blockade in children, anti-inflammatory and hormonal drugs, antioxidants, nootropics and vitamin complexes are used. Severe forms in which drug therapy turns out to be ineffective, it is recommended to eliminate it with cardiac pacing. Pacemakers are also used in the treatment congenital forms heart block accompanied by bradycardia. Emergency help in case of loss of consciousness (attack of MAS) consists of performing a closed (indirect) heart massage, administering atropine or adrenaline. Continuous monitoring of conductivity through an ECG is recommended.

Congenital heart blocks often cause the death of a child in the first year of life. In a newborn they are manifested by the following symptoms:

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