Hist bundle block symptoms. Bundle branch block (right and left): incomplete and complete, what is shown on the ECG, reasons, dangerous or not? Causes of the disease

Sometimes a patient, having received an ECG report from a doctor, may hear that he has a His bundle block. This may raise some questions for the patient, especially if we are talking about a small child, since blockade sometimes occurs in children. What is it - a disease or syndrome, is there a threat to life and health, what should be done in such a situation, we will consider in this article.

The figure shows nervously - muscular system hearts

So, the bundle of His is a part of the heart muscle, which consists of atypical muscle fibers and includes a trunk and two legs - the left (its anterior and posterior branches) and the right. The trunk is located in the upper part of the septum between the ventricles, and the legs are directed to the right and left ventricles, respectively, breaking up into tiny Purkinje fibers in the thickness of the heart muscle. The function of these structures is to transmit electrical impulses arising in the right atrium to the ventricular myocardium, causing them to contract in a rhythm corresponding to the rhythm of the atria. If impulse conduction is partially or completely impaired, bundle branch block develops. This is one of the types of conduction disorders, most often occurring without clinical manifestations and characterized by a complete or partial block in the path of impulses in the ventricles of the heart. It occurs in 6 people out of a thousand, and after 55 years - in 2 people out of a hundred, more often in males.

The following types of blockade are distinguished:

Single-bundle - blockade of the right leg; blockade of the anterior or posterior branch of the left leg;
- two-bundle - blockade of both branches of the left leg; blockade of the right leg with one branch of the left leg;
- three-bundle - blockade of the right and left legs.

Each of these types of blockade can be complete or incomplete. Also, the blockade can be permanent, intermittent (appearing and disappearing during the recording of one ECG), transient (not recorded on every electrocardiogram), or alternating (change of blockades of different legs during the recording of one ECG).

Causes of bundle branch block

Diseases such as:

- congenital and acquired heart defects - stenosis of the aortic and mitral valves, pulmonary artery stenosis, stenosis and coarctation of the aortic mouth, aortic valve insufficiency, atrial septal defect
- cardiomyopathy, myocardial dystrophy of various origins - endocrine (thyrotoxicosis, diabetes mellitus), metabolic (anemia), nutritional (alcoholism, obesity), autoimmune (systemic lupus erythematosus, rheumatoid arthritis)
- cardiac ischemia
- cardiosclerosis as an outcome of many cardiac diseases, leads to the replacement of part of the muscle fibers with scar tissue, including atypical muscle fibers
- myocarditis of viral or bacterial origin
- heart damage due to rheumatism - endocarditis, myocarditis
- myocardial infarction
- long-term arterial hypertension, leading to myocardial hypertrophy
- intoxication with cardiac glycosides
- pulmonary embolism
- chronic lung diseases (chronic obstructive bronchitis, pulmonary emphysema, severe bronchial asthma), leading to the formation of cor pulmonale - stagnation of blood in the right atrium and ventricle with their hypertrophy and expansion

In young children and teenagers incomplete single-fascicle right blockade may accompany minor anomalies in the development of the heart (additional chord in the left ventricle, patent foramen ovale, mitral valve prolapse), and in the absence of organic damage to the heart it is considered a variant of the norm.

Single- or double-bundle left blockade is almost always associated with acquired rather than congenital heart diseases and cannot be regarded as a normal variant.

Symptoms of bundle branch block

Right single-fascicle blockade, as a rule, does not manifest itself in any way and is detected by chance during a routine ECG. The presence of complaints such as shortness of breath, pain in the heart area, sensations of interruptions in the work of the heart, increased fatigue, may be due to the underlying disease that caused the blockade.

With anterior or posterior left hemiblock(one of the branches) clinical manifestations are also minimal and are caused by the underlying disease.

Complete left blockade may manifest itself as a feeling of palpitations, dizziness, pain in the heart area. It can be caused by massive changes in the cardiac muscle of the left ventricle, for example, acute myocardial infarction.

Three-bundle blockade caused by a complete or incomplete block in the path of the impulse. Incomplete blockade is characterized by a delay in impulses arriving at the ventricles and conducted along several intact fibers, and a complete blockade is characterized by the absence of impulses to the ventricles and the appearance in them of an ectopic (located in the wrong place) focus of excitation, in which case there is a complete separation of the atria and ventricles, which contract in their own rhythm with a frequency of 20–40 beats per minute. This contraction frequency is significantly lower than normal and cannot ensure adequate ejection of blood into the aorta. Clinically, it is manifested by frequent dizziness, a feeling of interruptions in the work of the heart and a tendency to faint due to a sharp decrease in cerebral blood flow (Morgagni-Edams-Stokes attacks). May lead to life-threatening complications or cause sudden cardiac death.

Diagnostics

This conduction disorder can be detected by standard electrocardiography. The doctor’s further tactics depend on the type of blockade detected.

If incomplete right blockade and in the absence of cardiac diseases, the doctor may regard this as a variant of the physiological norm and not prescribe additional examination methods.

Double-bundle blocks require a more detailed examination of the patient. If a complete left block is detected on an ECG for the first time in life, then immediate hospitalization is required, even if the patient does not complain, since this condition is caused by extensive processes in the myocardium. It is better to find out the duration of these processes (chronic cardiosclerosis or acute myocardial infarction, especially its painless form) in a hospital under the supervision of doctors. In addition, the manifestations of such a blockade on the ECG mask the ECG - criteria for myocardial infarction, so the doctor simply will not be able to confirm or refute a heart attack using only a cardiogram. Long-term complete left blockade in the absence of worsening of the underlying disease does not require hospital observation.

Three-bundle block is an indication for emergency hospitalization for more full examination and addressing the issue of cardiac surgery.

Signs of blockade on the ECG are:

Right leg block. In the right leads (V 1, V2) M-shaped complexes of the Rsr or rSR type, in the left leads (V5, V6) the S wave is wide, jagged, the QRS complex is more than 0.12 s

Left leg block. In the left leads (V5, V6, I) there are widened deformed ventricular complexes without a Q wave with a split apex of the R wave, in the right leads (V1, V2, III) there are deformed complexes with a split apex of the S wave, the width of the complex is more than 0.12 s

Three-fascicular block - signs of right and left blockades, signs of atrioventricular block of I, II, III degrees.

Among the additional examination methods in the clinic or in the cardiology department, the patient may be prescribed routine diagnostic methods - general blood tests, urine tests, biochemical blood tests, as well as:

• Daily ECG monitoring is indicated to detect transient blockade during the day.
• Transesophageal electrocardiography helps diagnose rhythm disturbances when a conventional ECG is uninformative
• Echocadiography diagnoses organic pathology of the heart, evaluates ejection fraction and myocardial contractility.
• MSCT of the heart (multispiral CT scan) or cardiac MRI (magnetic resonance imaging) may be indicated in controversial and diagnostically unclear cases to identify heart disease.

Treatment for bundle branch block

There is no specific drug treatment for this conduction disorder. Patients with right bundle branch block in the absence of an underlying disease do not require treatment. For patients with single- or double-fascicular blockade, the following groups of drugs can be prescribed for the treatment of the underlying disease:

Vitamins – thiamine (vitamin B1) with lipoic acid, riboflavin (vitamin B2), niacin (vitamin PP)
- antioxidants – ubiquinone, carnitine, mexidol, preductal
- sedatives of plant origin (St. John's wort, motherwort, valerian, sage)
- antihypertensive drugs for the treatment of arterial hypertension – ACE inhibitors(perindopril, lisinopril), angiotensinogen II receptor antagonists (losartan, valsartan), beta blockers (bisoprolol, atenolol), calcium channel antagonists (amlodipine, verapamil). The last two groups should be prescribed with caution, as they reduce the heart rate
- ananginal drugs for the treatment of coronary heart disease - short- and long-acting nitrates (nitroglycerin, isoket, cardiquet, monocinque)
- antiplatelet agents to prevent thrombus formation in the heart and blood vessels - aspirin, cardiomagnyl, thrombo Ass
- lipid-lowering drugs to normalize cholesterol levels - statins (rosuvastatin, atorvastatin, simvastatin)
- diuretics and cardiac glycosides in the development of chronic heart failure - indapamide, diuver, lasix; strophanthin, digoxin
- drugs for the treatment of diseases bronchopulmonary system, which caused the development of “pulmonary” heart - inhaled adrenergic agonists and glucocorticosteroids (Berotec, Berodual, Spiriva, Beclazone)
- antibiotics, non-steroidal anti-inflammatory drugs for inflammation of the membranes of the heart - penicillin; nimesulide, diclofenac

In addition to medication, it is used surgical method blockade treatment, which involves installing a pacemaker (pacemaker) in the patient. Complete right blockade, especially in combination with left hemiblockade (blockade of one branch of the left leg), and complete left blockade, developed in the acute period of myocardial infarction (10 - 14 days), are an indication for temporary cardiac pacing by introducing an electrode through the central vein into the right ventricle Three-fascicle blockade with complete atrioventricular block, a rare rhythm of ventricular contractions and with Morgagni-Edams-Stokes attacks (attacks of loss of consciousness) is an indication for permanent cardiac pacing (implantation of an artificial pacemaker or cardioverter-defibrillator).

Lifestyle with bundle block

A patient with right leg block without clinical manifestations and without heart disease can lead a healthy lifestyle with usual physical activity. If you have an underlying disease that has caused a two-fascicle or three-fascicle blockade, you need to limit stress and stress, get more rest, eat right, get rid of bad habits.

When installing a pacemaker, the patient should always carry the pacemaker owner’s card with him and avoid close contact with electrical appliances and a mobile phone on the implantation area. For example, do not lean against the TV, talk on the phone with it pressed to your ear on the opposite side, and place a hair dryer or electric razor no closer than 10 cm from the implantation area.

The patient should visit the doctor once a year for an ECG, or more often if prescribed by the attending physician. When installing an pacemaker, the first visit to a cardiac surgeon and arrhythmologist after discharge will take place after three months, then after six months, then twice a year.

Complications

Complications include paroxysmal ventricular tachycardia, ventricular fibrillation, asystole (cessation of cardiac activity - sudden cardiac death). Complications of the underlying disease in a patient with a blockade may include acute and chronic heart failure, thromboembolic complications (pulmonary embolism, stroke).

Prevention of the development of complications is a timely examination, regular visits to the doctor and compliance with all his instructions, especially for patients with heart and vascular diseases.

Forecast

To summarize everything that has been written, we can say that His bundle block is not a disease, but a symptom of heart disease, which is either detected on an ECG or manifested clinically. To know what consequences this or that type of blockade may have, it is necessary to take into account that the prognosis depends on the disease that led to the development of the block.

With a single-fascicle right block and the absence of cardiac or pulmonary pathology, the prognosis is favorable. With the development of complete blockade of the left leg against the background of myocardial infarction, the prognosis is unfavorable, since mortality reaches 40–50% in the acute period of a heart attack. The prognosis of three-bundle block is also unfavorable, as the likelihood of developing asystole increases.

General practitioner Sazykina O.Yu.

Heart treatment with egg yolks

For various cardiovascular diseases, you should use this folk remedy. Take 20 boiled eggs that have been cooked for 10 minutes, separate the yolks and place in a plate. Add one cup of olive oil and place in the oven for 20 minutes. Then mix everything properly - and that’s it. The product should be stored in the refrigerator and taken one teaspoon before meals. Well traditional heart treatment is 10 days. After a week of break the course is repeated

A decoction of a plant such as Eleven angustifolia will help you cope with problems of the heart and blood vessels. Especially if you have heart pain. To prepare the medicine, grind 50 grams of oleaster fruit in a coffee grinder and pour half a liter of boiling water. Boil the mixture for 15 minutes, then cool, strain, and squeeze out the remainder. It is recommended to take half a glass of the decoction 4 times a day.

For those who suffer from heart pain

If you often experience pain in the heart area, then the following folk remedy for treating heart disease will help you. For a week, eat 400 grams of squash caviar, 7 walnuts, 200 grams of raisins and 4 tablespoons of honey every day. These products will restore the functions of the heart, and your health will begin to return.

Olive oil helps remove cholesterol from the body. It will also restore the functioning of the entire gastrointestinal tract and give your skin youth. Moreover carcinogens, which are formed during frying, are not formed in olive oil even in the case of repeated frying - provided, of course, that the olive oil is 100%.

Heart treatment with salad

One man suffered a heart attack. I constantly felt severe pain in my heart. The doctor forbade him from lifting weights or doing any physical exercise or stress at all. I was constantly in the hospital. In one newspaper he read that the heart can be cured with carrot and beet juice in a ratio of ten to three. A mixture of these two juices should be drunk at a rate of six hundred grams per day, but it is still better to drink about one to four liters of this juice. But since such treatment is expensive, the man found another way out of the situation.

He prepared a salad from beets and carrots in a ratio of one to two: he made seven hundred grams of salad, poured it into a glass jar, enough for two days. To it he added two tablespoons sunflower oil. And now every time before a meal a man eats such a salad. But since the salad is stored in the refrigerator, it must be reheated over low heat to medium temperature before eating. You need to eat it without bread. And with this folk treatment, the man helped his heart and cured his arrhythmia.

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How to strengthen your heart

Prepare two compositions. For the first, take half a kilogram of May honey and half a liter of vodka. Mix these two components and heat over medium heat until a milky film forms, then let the mixture sit.

In order to prepare the second composition, take 1 liter of water, which was previously settled for 24 hours, and boil it. Pour this boiling water over a mixture of the herbs marsh cudweed, motherwort, knotweed, chamomile, and crushed valerian root - you need to take them one spoon at a time.

It is necessary to infuse the product for thirty minutes, then strain through several layers of gauze and mix with the first composition.

Infuse the medicine for seven days. In the first week of treatment, drink one teaspoon twice a day, in the second week - one tablespoon twice a day, and so on until the end of treatment. And after you run out of medicine, take a break for ten days, and then prepare another portion of this composition.

The total course of treatment lasts a year. This method helps eliminate heart pain due to angina, arrhythmia, ischemia and hypertension.

"Heart" balm

I present to your attention traditional method of heart treatment. which I myself invented is a balm for the heart, helps with all heart troubles! To prepare it you will need a number of alcohol tinctures. You should mix 10 ml of tincture of arnica, lily of the valley, foxglove, and also add 20 ml of tincture of hawthorn flowers and leaves. This infusion should be drunk 30 drops 2-3 times a day half an hour before meals.

Heart block

Heart block is a pathological process associated with the impulse conducting system of the heart. Heart block is a very common phenomenon, since the substrate for its occurrence is heart disease. Heart blocks can develop in the womb and be acquired, permanent or transient. Some heart blocks may not manifest themselves and may be “masked” under other diseases.

Complete heart block is characterized by the cessation of excitation from overlying pacemakers.

Incomplete heart block occurs when the conduction of impulses through the conduction system slows down. When complete heart block occurs, asystole does not occur, since the underlying node takes over the functions of the pacemaker. As a result, the number of heart contractions decreases, and cardiac arrest does not occur. However, such compensatory work is often insufficient, which can lead to heart failure.

Heart block causes

In order to understand the cause of heart block, it is necessary to understand the structure of the conduction system. The most important formation that produces the impulse is the sinus node. It is located in the upper part of the right atrium, between the areas where the vena cava enters the atrium. The sinus node contains two types of cells: P cells, which have the ability to produce impulses, and T cells, located on the periphery of the sinus node and performing the function of conducting impulses. Normally, the frequency of impulse formation by the sinus node is 60-80 per minute.

From the sinus node, the impulse is distributed to the atria along several paths. The anterior tract, or Bachmann's tract, conducts excitation to the anterior wall of the right ventricle and in the atrial septum is divided into a branch that moves to the atrioventricular node and a branch that moves to the left atrium. Middle way, or Wenckebach's tract, runs along the interatrial septum. The Torrel tract, respectively the posterior tract, runs along the lower edge of the septum between the atria to the atrioventricular node with fibers spreading to the wall of the right atrium. Normal impulse propagation occurs along the Bachmann and Wenckebach paths, since they are the shortest.

The next “destination” in the movement of excitation is the atrioventricular node, or the Aschoff-Tawar node. Its location is in the lower part of the right atrium to the right of the atrial septum. The main task of this formation is to filter out impulses that come from the atrium. After all, not every impulse from the atrium is formed in the sinus node. Their formation can also occur in some areas of the atrium. And also the atrioventricular node does not allow all impulses to pass through during sinus tachycardia with a frequency of more than 200 per minute. The atrioventricular node itself, together with the His bundle, can generate excitation with a frequency of 40-60 per minute.

The bundle of His originates from the atrioventricular node (AV node). It is composed of two parts: the initial section, which does not come into contact with contractile myocardium, and the branching section, which is involved in further conduction of excitations to the ventricles.

The right and left bundle branches are directed towards the ventricles. Left leg The heart forms two branches - anterior and posterior. There are automatism fibers in the legs of the heart, which are also capable of generating excitation at a frequency of 15-40 per minute.

Purkinje fibers are the terminal branches of the cardiac conduction system. They penetrate the entire ventricular myocardium.

Heart block can result from conduction disturbances.

All heart blocks are divided into:

1. sinoauricular block;

2. blockade inside the atria;

3. atrioventricular block;

4. ventricular block;

5. blockade of the legs of the heart (branch legs).

Heart block is often caused by functional and organic lesions. Organic lesions are myocardial infarction followed by focal or diffuse cardiosclerosis, cardiomyopathy. myocarditis, systemic myocardial lesions involving the conduction system of the heart, amyloidosis, sarcoidosis. tumors, neuromuscular diseases, thyrotoxicosis. diabetes.

Heart blocks can occur due to infectious diseases, intoxication, overdose of cardiac glycosides, novocainamide, quinidine.

Sometimes heart block can be congenital. For example, third-degree atrioventricular block occurs in 1 in 25,000 newborns.

Right heart block

Heart block can be performed as a right bundle branch block. It is manifested by slow impulses or the absence of excitation in the area of ​​influence of the right leg. Most often, all heart blockades occur in patients with various heart defects, cardiosclerosis, myocardial infarction, and hypertension. myocarditis.

Heart block may be accompanied by the development of paroxysmal ventricular tachycardia, myocardial infarction. Often observed in males after 40 years of age.

Blockades of the right leg of the heart are characterized by certain electrocardiography readings. Such a lesion is very rare and occurs in 0.15-0.2% of all blockades. 50% of cases of right heart block in young patients are not associated with heart disease.

The clinical picture of blockade of the right leg of the heart, if it develops without a total block of the His bundle, does not manifest itself symptomatically. The patient's complaints arise against the background of the underlying disease. Diagnosis is carried out using standard electrocardiographic studies and Holter monitoring.

Left heart block

Blockade of the left leg of the heart can be total or partial. Complete blockade of the left bundle branch occurs in 0.5-2%, and after 50 years - 9% of cases of heart block. Blockade of the anterior branch of the left leg of the heart accounts for 1-4.5% of cases, the posterior branch - 0.1%. One of the branches of the left leg may be involved in pathological processes, or there may be a total blockade.

Blockades of the left leg can be combined with blocks of the right leg, forming a complete block of the ventricles. Often, blockade of the left bundle branch is accompanied by myocardial infarction, which aggravates the hemodynamic disorders of the underlying disease. The symptoms correspond to the main pathology. The patient complains of pressing chest pain, which does not stop after taking nitrates. The patient is accompanied by feelings of fear of death, weakness, and sticky cold drops of sweat appear. During hospitalization, signs of a heart attack are determined.

Ventricular heart block

Ventricular heart block refers to blockade of the atrioventricular junction. Atrioventricular heart block can be of three degrees.

Complete heart block corresponds to third degree atrioventricular block. I degree blockade is observed in 0.45-2% of people, and over 60 years of age - in 4.5-14.4%, after 70 years - in 40% of people. Most often, third degree ventricular block occurs against the background of myocardial infarction in the area of ​​the atrioventricular junction. All AV blocks are divided into those that occurred before birth and acquired. According to their course, they are divided into acute, transient, and chronic. According to the severity of impulse conduction disorders, they are divided into AV blockade of the first degree, second degree, divided into Mobitz I, Mobitz II, high degree, and third degree. The clinical picture of AV blocks can be different: they can be asymptomatic, there are random findings on the ECG, fainting conditions develop, coronary and heart failure are aggravated, and there are sensations of pauses and interruptions in the heart.

Heart block treatment

All antiarrhythmic drugs are divided into several classes. The first class includes drugs that block sodium channels.

Class IA includes the drugs Quinidine, Novocainamide, Ritmilen.

Class IB drugs have a lidocaine-like effect: Lidocaine, Difenin.

Class IC drugs cause a sharp blockade of sodium channels, these include Ritmonorm, Enkainid, Gilurythmal.

II class antiarrhythmic drugs includes beta blockers: Propranolol, Nadolol, Bisoprolol, Esmolol, Atenolol.

Class III drugs are drugs that block potassium channels: Amiodarone, Nibentan, Sotalol.

Class IV antiarrhythmic drugs are medications that have an inhibitory effect on the conduction system of the heart. These are the drugs Verapamil and Diltiazem. But not all of these drugs are capable of stopping an attack of heart block, and sometimes even provoke this attack of impulse conduction disturbance.

Not every type of heart block requires treatment or hospitalization. Sinoatrial heart block is manifested by disturbances in the conduction of impulses from the sinus node to the atrium. The patient feels an interruption in the functioning of the heart, and bradycardia occurs.

Treatment for sinoatrial heart block is the same as for sinus bradycardia. Depending on the degree of heart block, it is prescribed drug treatment. With incomplete sinoatrial blocks (I-II degrees), the patient complains of freezing, heart failure, tinnitus and headaches. Stage III heart block. or complete heart block requires emergency treatment, since the bradycardia that has developed in this case is insufficient for the blood supply to all organs and tissues. For incomplete heart block, Atropine 0.1% solution is used in a dose of 1.0 ml intravenously. The total dose of this drug should not exceed 0.04 mg per kg. Alupent 0.05% solution in a dose of 1 ml intravenously when diluted in saline at a rate of 8 drops per minute.

If complete heart block or third degree sinoatrial block has developed, then more aggressive therapy is prescribed: Dopamine at a dose of 5-10 mcg per kg per minute. when diluted in a 5% glucose solution, the rate of administration is 10-20 drops per minute. The administration of Dopamine should be carried out in conjunction with ECG monitoring, as tachycardia may develop, including ventricular fibrillation. Instead of Dopamine, you can use Adrenaline, the concentration of which is 0.1%, diluted 1 mg in 250 ml of 5% glucose solution, with an injection rate of 10-20 drops per minute. If there is no effect from drug therapy, it is necessary to carry out electrical cardiac stimulation. Subsequently, they resort to installing an artificial pacemaker.

First degree AV block without clinical manifestations does not require treatment. Sometimes such heart block occurs in elite athletes.

Second-degree AV block Mobitz type I does not require drug treatment if there are no clinical symptoms. If there is a hemodynamic disorder, then Atropine 0.1% solution is prescribed in a dose of 1 ml. If Atropine is ineffective, cardiac stimulation is performed against its background.

If heart block occurs against the background of myocardial infarction, then the levels of adenosine in the tissues exceed, which is excreted by adenosine antagonists - Adenophylline, or Euphyllin. Advanced second-degree blockade requires monitoring the patient and taking conduction-improving agents.

With complete heart block, cardiac pacing is used for the following indications: acute heart failure, manifested by pulmonary edema, arterial hypotension, arrhythmogenic collapse; the appearance or worsening of myocardial ischemia; attacks of fainting, especially at rest; development of blockade during resuscitation; blockade as a consequence of an acute illness. In other cases, pharmacotherapy is used. Some medications can stop heart block, while others can cause an increase in ventricular rate. But the purpose of these drugs is the same - maintaining stable hemodynamics.

Before taking medications, drugs that slow down conduction should be discontinued. These include beta blockers, cardiac glycosides, potassium supplements, and calcium channel blockers.

The next step in treatment is the prescription of anticholinergics: Atropine at a concentration of 0.1% at a dosage of 1 ml intravenously, but not more than 0.04 mg/kg. Adrenergic agonists, or adrenaline receptor stimulants, are not as effective for heart block. They increase myocardial oxygen consumption and contribute to the development of more serious arrhythmias. Their use is justified only in the absence of the possibility of cardiac stimulation. Dopamine at a dose of 5-20 mcg per kg per minute. administered intravenously at a rate of 10-15 drops per minute. Adrenaline – 0.1% – 1 ml intravenously. But drugs like Dopamine and Adrenaline are a therapy of despair. Therefore, it is recommended to use other drugs: Ephedrine in a dose of 1 ml of a 5% solution intravenously and intramuscularly, or Alupent in a dose of 1 ml of a 0.05% solution dissolved in 200 ml saline solution, with an injection rate of 8 drops per minute. It is possible to administer Isoproterinol 0.5% and 1% at a dose of 1 ml per 250 ml of glucose at a rate of 20 drops per minute.

A potassium-sparing diuretic is not contraindicated in AV blockade. Hypothiazide at a dosage of 100 mg once a day for 3-5 days. Sodium bicarbonate is administered intravenously in a dose of 100 ml of a 4% solution. Soda must be administered slowly over 30 minutes, as ventricular fibrillation may occur.

If a prolonged fainting attack occurs, abrupt 2-3 blows with a clenched fist are performed on the supracardiac region and indirect cardiac massage, followed by electrical cardiac stimulation. In case of constant occurrence of fainting attacks, permanent pacemakers are used.

Surgery is the main treatment for AV block. One should take into account the fact that blockades of higher localization are permanent, and heart blockades in the lower parts of the conduction system are prone to progression. Indications for installation of a permanent pacemaker are divided into classes. The first class includes the following conditions: AV block of the third degree or rapidly progressive blockade of the second degree of any level, if it is combined with symptomatic bradycardia, arrhythmias, asystole for 3 seconds, with episodes of heart rate less than 40 beats per minute. Also, the first class of indications includes the condition after catheter ablation of the AV node, with neuromuscular diseases involving the AV junction, AV block with bradycardia.

Class IIa includes asymptomatic stage III heart block. regardless of the location of occurrence, with an average heart rate of more than 40 per minute while awake, especially when the boundaries of the heart expand and the function of the left ventricle is unstable. This class includes asymptomatic second-degree AV block of the Mobitz type II and I, as well as severe blockades of the first and second degrees.

Class IIb includes first-degree AV block in patients with poor left ventricular function and symptoms of hemodynamic insufficiency, neuromuscular diseases with any grade of AV block.

In patients who have suffered a myocardial infarction, a pacemaker is implanted in case of persistent blockade of the 2nd - 3rd degree. With the manifestation of AV block II - III degree. in the acute period of myocardial infarction, the introduction of a temporary pacemaker is indicated. Due to the fact that repeated conduction failure may occur, the installation of a permanent pacemaker should be delayed.

Treatment of conduction disorders in the legs of the heart begins with determining the indications for hospitalization. With the necessary selection of antiarrhythmic therapy and planned cardiac pacing, the patient should be hospitalized as planned. Treatment begins with the correction of electrolyte disturbances. Cardiac glycosides, beta-blockers, calcium channel blockers, quinidine, novocainamide, rhythmylene, rhythmonorm should be avoided.

Drug therapy consists of prescribing Belloid 1 tablet 3-4 times a day. c. It has an atropine-like effect and relieves bradycardia. Glaucoma is a contraindication. Theophylline in a dose of 0.1 g 2-3 r. c. Used to improve heart tone. Allapinin at a dose of 25 mg every 8 hours before meals. In most patients, when a blockade occurs, panic attacks appear, which should be stopped with Clonazepam in tablet form, 5 mg 2-3 times. per day within 3-5 days. Before taking medications, you should consult a doctor, as there are side effects.

Surgical treatment involves implantation of a pacemaker for blockade of two and three bundles. Also, an indication for a permanent stimulator is myocardial infarction due to heart block.

When treating disorders of the conduction system of the heart, you can use folk remedies. They will create a favorable background for therapy. One of the useful plants for this is considered to be rose hips. When brewing 5 tbsp. l. its fruits in ½ liter of water. Mash the boiled fruits with honey and pour into the resulting broth. If you drink ¼ cup of this decoction before meals, your condition will improve.

Horsetail may also have beneficial effects on the cardiovascular system. You need to brew it in a glass of water in the amount of two teaspoons. Use 1 tbsp. spoon every 2 hours.

A decoction of valerian roots, one tbsp. spoon every time before eating. It has a calming effect, which is important for diseases of the cardiovascular system.

Motherwort, yarrow, and cornflower have a good effect on impulse conduction.

An important role in the treatment of heart blocks also plays the restoration of a normal daily routine, adequate sleep, the right image life, restoration of normal levels of cholesterol and fats in the blood. When these indicators are normalized, the atherosclerotic process regresses. In 70% of the smoking population, the risk of atherosclerotic lesions is higher than in non-smokers. To prevent the cardiosclerotic process, it is necessary to begin treatment of myocarditis, chronic infections, and rheumatic fever in time.

How to treat heart disease with folk remedies

Cardiac extrasystole treatment with folk remedies

Extrasystole of the heart is a fairly common disease among the population that does not require any treatment. The cause of the disease is stress, overwork, or the effects of caffeine, alcohol and tobacco.

You can normalize your heart rate and improve your well-being with the help of traditional treatment for extrasystole hearts. Traditional medicine is also good because it does not give side effects.

To combat the disease, try this recipe: take a tablespoon of lemon balm herb, pour it with 2.5 glasses of water and let it brew. Take half a glass three times a day.

A mixture of black radish juice and honey in a 1:1 ratio also helps against extrasystole. You need to take this remedy one tablespoon three times a day.

Traditional treatment of cardiac ischemia

To restore normal blood circulation, take this decoction: mix chamomile, hawthorn and motherwort flowers in equal proportions. Fifty grams of the mixture pour half a liter of boiling water. Take this folk remedy for the treatment of cardiac ischemia up to four times a day before meals.

Heather is suitable for treating coronary heart disease using traditional medicine. For 50 grams of dry grass, take half a liter of water. Boil the mixture over low heat for 20 minutes. Afterwards, let it brew in a warm place for about a day. This product is added in 50 ml doses. in tea and drink three times a day.

Traditional treatment of heart disease

For the treatment of heart disease according to traditional medicine recipes, the following remedy is suitable: take a teaspoon of dry mint leaves, pour 300 ml of them. boiling water, infuse and take a glass on an empty stomach three times a day. This product can be used for quite a long time.

Rosemary is a good folk remedy for treating heart disease. It is infused in dry red wine and taken orally. The course of treatment is 1.5-2 months.

Beetroot juice mixed with honey in a 2:1 ratio has healing properties. This remedy helps not only with heart defects, it is recommended as a general tonic for the whole body.

Traditional treatment of cardiac tachycardia

For tachycardia, mix 10 grams of horsetail and hawthorn flowers, add 20 grams of motherwort herb. Pour two tablespoons of the dry mixture, pour two glasses of water over it and place on water bath for 15 minutes. Leave for an hour and take a quarter of a glass 3-4 times a day for two weeks.

A good folk remedy for the treatment of heart tachycardia is considered to be a mixture of valerian, hops, lemon balm and dill seeds. You need to take 2 teaspoons of each component and pour 300 ml. boiling water, infuse and take a glass three times a day. Before meals.

Mix ten grams of dried hawthorn fruits with a teaspoon of dry celandine herb, pour a glass of boiling water and boil for 5 minutes. Take this traditional medicine recipe before meals, for a month, a third of a glass.

Rheumatism of the heart treatment with folk remedies

For rheumatism of the heart, cut three large onions and boil them in a liter of water for about 15 minutes. Take a glass of this decoction twice a day in the morning and with a fan. This remedy can be taken for a long time and for the prevention of disease.

Brew a tablespoon of fresh or frozen raspberries with a glass of boiling water and drink this tea hot at night.

For folk treatment of heart rheumatism, it is useful to take a bath with an infusion of black currant leaves or a decoction of pine buds. It is also useful to drink lemon or cranberry juice, previously mixed with linden or buckwheat honey.

Alternative treatment for heart block treatment

If you have heart block, it is important to follow a diet. Consume more milk and dairy products, as well as products of plant origin. The consumption of alcoholic beverages, coffee, and strong tea is strictly prohibited. You should also stop smoking.

Pour three tablespoons of dried blood-red hawthorn flowers into half a liter of boiling water and leave for 30 minutes. Take this folk remedy to treat heart block three times a day.

Pour fresh lily of the valley flowers with vodka in a ratio of 1:3 and leave in a cool and dark place for 10 days. Then the product can be taken 15 drops in the morning and evening.

Each of us knows how to treat colds, but when it comes to the heart, we panic. Many, risking their health, self-medicate, which is absolutely forbidden to do for any ailment. The first thing you need to do is consult a doctor to prescribe an examination, and only then, after determining the diagnosis, treatment can be prescribed.

From year to year, more and more people are diagnosed with... There are several varieties of it, but without proper treatment and prevention, related problems and diseases arise. The development of the pathology is quite rapid, and even if you feel well and do not notice any changes, this is temporary, so if you have been diagnosed with this disease, listen to the recommendations of the cardiologist.

Let's understand what blockade of the left bundle branch is, the probable symptoms, how it is diagnosed and what preventive measures are used.

What are “Blockade” and “Bundle of His”

Left bundle branch block

The bundle of His (PH) is a cluster of cells of the cardiac conduction system about 20 mm long, which is located under the atrioventricular or atrioventricular (AV) node and the interventricular septum, and is divided into the left and right legs.

In turn, the right leg and the left, which are divided into two more branches connected by a network of anastomoses, descend down on both sides of the interventricular septum. The legs are divided in the ventricular myocardium into thin bundles of cardiac conductive myocytes (Purkinje fibers).

Rhythmic impulses can only be generated by special cells of the pacemaker (pacemaker) and the conduction system of the heart. This pacemaker is the sinoatrial or sinoatrial (SA) node, which is located in the wall of the right atrium.

Excitation from the SA node spreads through the atria, and then through the conduction system the impulses are transmitted to the atrioventricular node. The His bundle transmits excitation from the atrioventricular node to the ventricles.

In the conduction system of the heart there is a sinus impulse that is formed during cardiac activity in the node of the same name. In the event that there is a blockade of the left bundle branch in the body, interference is created that forms a kind of obstacle to the normal passage of the impulse.

The most common phenomenon is disturbances along the entire path of the impulse. In this case, violations can be divided into several groups, depending on the location of the problem:

• sinus impulse block;
• atrioventricular block;
• failure of intraventricular conduction.

In addition, the ventricular conduction system is conventionally divided in thematic classification into right and left legs. The right leg is one wide bundle that branches mainly in the thickness of the muscles.

In turn, the left leg is divided by specialists into several more branches: the anterior and, accordingly, the posterior. During normal functioning of the cardiovascular system, the sinus impulse always excites the interventricular septum first.

If there is a blockade of the left bundle branch, both the path and the time of excitation of the ventricles radically change.

It is not possible to diagnose the problem yourself. The only way out is to consult a doctor, who will probably oblige the patient to do an ECG. Then, based on the data obtained, the patient will be prescribed high-quality and effective treatment, thanks to which the disease will recede.

Characteristics of the disease

A complete blockade can affect both legs at once, or simply reach their branch, interfering with the conduction of the impulse. As a rule, it travels along the right leg in the usual way, exerting a stimulating effect on both the entire right ventricle and the septum.

The activation wave slows down and spreads to the left ventricle along the contractile fiber. Because of this, the total activation time of both increases.

The consequences of the blockade are quite serious, as they lead to disturbances in the left ventricle, preventing the normal conduction of electrical impulses. It will, of course, pass, but not just with a delay, but also through anastomosis (that is, a bypass route).

The danger of the pathology lies in its practically asymptomatic course, and in the initial stages it is generally considered not to seriously threaten health. The aggravation occurs against the background of the rapid development of arrhythmia in the ventricles. At this stage, paroxysmal ventricular tachycardia is already beginning to appear.

Treatment must be carried out necessarily, since the pathology gradually worsens and ventricular fibrillation develops. Such a diagnosis means that the myocardial fibers begin to contract individually and quickly, which seriously increases the load on the muscle.

Important! Contact your doctor promptly as soon as you notice even the slightest problems in your heart. Many people mistakenly think this is a sign of stress or fatigue, but it is often a signal of much more serious problems!

In many cases, under stress, stress or other negative situations, this can even lead to death. If there is a block of the anterior branch of the left leg, then the passage of the impulse will be disrupted in the area of ​​the anterolateral surface of the left ventricle.

The right ventricle is not involved in the process, since the right bundle branch is responsible for it. According to statistics, this pathology can be diagnosed in 3 out of 4 elderly people, that is, 75%. Conduction disorders are often the most important sign of cardiovascular diseases.

With blockade of the anterior branch of the left bundle branch, the symptoms are nonspecific or completely absent. In rare cases, arrhythmia is observed. As for the pathology of the posterior branch, the conduction of excitation in the posterior and lower portion of the left ventricle is disrupted.

You can often find a condition where there is a blockade of the left and right legs at the same time. This indicates pronounced changes in the heart muscle.

Classification

LBBB can be caused by damage at various levels:

• lesion of the left leg in the trunk of the His bundle;
• damage to the main trunk of the left leg before its branching;
• simultaneous damage to the anterior and posterior branches of the left leg after their separation from the main trunk of the left leg;
• damage to the left half of the interventricular septum involving both branches of the left leg;
• the presence of pronounced diffuse changes in the myocardium of the peripheral branches of the anterior and posterior branches of the left leg.

Despite the above options, as a result, with LBBB, excitation cannot pass in the usual way along the left leg to the myocardium of the left ventricle - excitation is carried out in an unusual way, which causes a slowdown in the passage of excitation through the ventricles, as evidenced by the broadening of the QRS complex and a change in the direction of repolarization in the left ventricle:

• in the left precordial leads the QRS complex is represented by a wide tooth RV5, V6 with a notch;
• in the right chest leads, a QRS complex of type rS, QS with a wide and deep tooth SV1, V2 is recorded.

A particularly inquisitive reader who wants to understand in more detail the electrophysical processes occurring during blockade of the heart muscle can do this independently by analogy with the reasoning given on the page “Myocardial excitation”, but it should be borne in mind that with blockade of the left bundle branch:

1. Excitation stage 1:
2. Excitation stage 2:
3. Excitation stage 3:
4. The repolarization process begins in the right ventricle and spreads from the epicardium to the endocardium (the vector is directed towards the V1 electrode).

The table on the right shows the ECG (12 leads) of two patients: a healthy person and a patient diagnosed with “sinus rhythm with left bundle branch block” (bases: wide QRS complexes - 0.14 s, jagged wave RV6, inversion of TI, aVL, V6). ECG tape speed is 25 mm/s (1 horizontal cell = 0.04 s).

Anatomical aspects

To understand what blockade of the anterior and posterior branches of the left bundle branch is, you need to know about the conduction system and its main properties.

The main functions of myocardial cells are the ability to excite, conduct nerve impulses and contract. This ensures normal blood flow and oxygen supply to tissues and organs. These processes are closely interconnected.

Correct contraction of the heart is ensured by the continuous flow of nerve impulses through various structures. It goes from top to bottom. This is ensured through the conduction system, most of which is represented by the trunk of His.

It is located in the thickness of the interventricular septum. Consists of two legs - left and right. The first has branches into the anterior and posterior. They go to the corresponding walls of the ventricles. The branches of the left bundle branch terminate in the myocardium with Purkinje fibers. These structures carry the path of the nerve impulse.

Blockades of the left bundle branch and its branches are called slowdown or absence of excitation along one or two branches. The consequence is a disrupted sequence of the nerve impulse path. Excitation will first cover the interventricular septum. Then the unchanged right bundle branch (RBB) will reach the ventricle.

This is normal. The blocked ventricle on the left is the last to be excited due to impulses from Purkinje fibers and the undisturbed branch of the His bundle. This is reflected in the electrocardiogram accordingly.

Signs, symptoms and causes of manifestation

Signs of blockade depend on the form of pathology and concomitant diseases in the patient. Right blockade with a unilateral nature often occurs without visible symptoms, is discovered accidentally during a routine ECG.

Sometimes the patient experiences a pain syndrome that spreads to the area of ​​the heart, shoulder blades, collarbones, rapid heart rate, shortness of breath, loss of performance, which is explained by the underlying pathology that provoked the blockade.

When the left bundle (anterior or left branch) is blocked, the patient notices dizziness, periodic heart pain, the pain syndrome is often temporary and intensifies with physical activity.

Patients experience rapid heartbeat and shortness of breath. Symptoms of the pathology include fatigue, loss of performance, and depression. Three-bundle blocks are divided into complete and incomplete.

The first option is accompanied by a complete block of the passage of cardiac impulses. Due to the impossibility of conducting impulses through this section, separation of contractions of the atria and ventricles occurs. The rhythm of contractions is from 20 to 40 beats/min.

The result of this is the risk of blood escaping into the aorta. Symptoms of the pathology are pronounced:

• frequent dizziness;
• fainting;
• interruptions heart rate;
• chronic fatigue, depression;
• chest pain;
• headache.

Sometimes in the background severe violations sudden cardiac arrest is diagnosed. Partial blockade is diagnosed in patients whose electrical impulses travel through intact heart fibers. Here the signs are mild, complications are less common.

There are 8 groups of causes of cardiac conduction disturbances.

1. Cardiac (heart) causes:

• coronary heart disease (insufficient blood supply and oxygen starvation) and myocardial infarction (death of a section of the heart muscle from oxygen starvation with its further replacement by scar tissue);
• heart failure (a condition in which the heart does not fully perform its function of pumping blood);
• cardiomyopathies (heart diseases manifested by damage to the heart muscle);
• congenital (arising in utero) and acquired heart defects (serious abnormalities in the structure of the heart);
• myocarditis (inflammation of the heart muscle);
• surgical interventions and heart injuries;
• inflammatory diseases of the heart muscle (myocarditis);
• heart damage due to autoimmune diseases (conditions in which the immune system has a damaging effect on the body’s own tissues);
• arterial hypertension (persistent increase in blood pressure, accompanied by changes in the structure and functioning of the heart due to increased load on it).

Medicinal (medicinal) causes - prolonged or uncontrolled use of certain medications, such as:

• diuretics (medicines that increase the production and excretion of urine).
• antiarrhythmic drugs (drugs that can cause rhythm disturbances).
• cardiac glycosides (drugs that improve heart function by reducing the load on it).

Electrolyte disturbances (changes in the proportions of the ratio of electrolytes (salt elements) in the body - potassium, sodium, magnesium). Toxic (poisonous) effects:

• smoking,
• alcohol.

Imbalance (impaired functioning) of the autonomic nervous system (the part of the nervous system responsible for the functions of the body necessary to maintain its vital functions). Hormonal disorders (diseases of the adrenal glands, thyroid gland, diabetes mellitus - damage to the pancreas in which a violation occurs hormonal regulation exchange of glucose - blood sugar). Chronic hypoxia (insufficient oxygen supply) in various lung diseases ( chronic bronchitis, bronchial asthma). Idiopathic blockades - occurring for no apparent reason (detectable during examination).

I and II degree block of the left bundle branch

Second degree block resembles right ventricular block. It is usually transient, occurring before the development of a fixed blockade. If conduction in the ventricle is normal, then a negative T wave is relatively common, even in the absence of heart disease.

This explains the frequent persistence of a positive T wave in complexes with left ventricular blockade. Although second-degree left ventricular block is not usually associated with exercise-induced myocardial ischemia, left ventricular block has recently been described in association with myocardial ischemia. This type of block can be proximal or peripheral.

With the proximal type, the impulse slowly moves along the branching of the left bundle (less often along the left bundle branch), but the deceleration is less than 0.06 s. Subsequently, part of the left septum depolarizes abnormally along the transseptal pathway, while the rest of the left ventricle depolarizes normally, albeit with a delay.

The QRS loop shows that the smoothness is not medial and therefore both the loop and the QRS complex, although they have different durations, never exceed 0.12 s. The initial abnormal depolarization leads to the disappearance of the q wave in the left precordial leads and in lead I.

The less the transseptal depolarization is disturbed, the less the repolarization opposes the QRS complex. As a result, the T wave, although it can be negative, is more often negative-positive or even completely positive in the leads related to the left ventricle.

At lower degrees of blockade of the left ventricle ECG almost always remains normal, because in this case the likelihood of any violation of transseptal depolarization is small and the T wave is positive in leads I, aVL, V5 and V6.

It is confirmed only by the disappearance of the first vector, which is compensated by the simultaneously recorded right forces: this is confirmed by the presence of a QS wave in lead V1 and a single R wave in leads V6 and I. In lead V1 there may be an r wave arising in the right part of the septum or the wall of the right ventricle .

The possibility of septal infarction (the T wave is usually negative in leads V1-V2), septal fibrosis, emphysema, and dextrarotation (the latter two often have a 5 wave in lead V6) should also be considered.

It was already mentioned above why - + or a positive T wave can sometimes occur with complete blockade of the left ventricle. If the conduction slowdown in the left ventricle occurs at the level of the peripheral parts and is less than 0.06 s, then this gives a similar ECG picture.

If the midseptum is not depolarizing as slowly, the QRS complex will be slightly wider, but with a q wave in leads I and V6. Intracavitary ECG reveals a prolonged HV interval, a V-ADV of zero, and a widened QRS with mild left ventricular block, but less severe than with complete left ventricular block.

Incomplete LBBB

With incomplete blockade of the left leg, excitation may occur, but somewhat slowly. With incomplete RBBB, the QRS complex is shaped like a left bundle branch block, but the QRS width is less than 0.12 s:

• In chest leads V1, V2, the QRS complex has the form rS, QS.
• The STV1,V2 segment can be located on the isoline or above it, the TV1,V2 tooth is usually positive.
• In the chest leads V5, V6, an ECG is recorded that looks like an R wave (qV5, V6 is absent).
• The STV5,V6 segment can be located on the isoline or below it, the TV5,V6 tooth can be of any shape.

ECG for LBBB

The left leg in its structure has anterior and posterior branches that feed on blood from various arterial vessels. As a rule, a violation of the passage of an impulse in this department is not accompanied by a sharp expansion of the QRS complexes, as in the case of damage to the right leg, but it gives a clear picture of the deviation of the electrical cardiac axis in the frontal plane.

Visual signs of complete (affecting both branches) blockade of the left leg on the ECG include:

• There may be a prolongation of the ventricular complex beyond 0.120 seconds.
• The presence of deep long S waves in leads V4-V6.
• The presence of long and deformed R waves in leads I, aVL and V5-V6.
• Absence of Q on graphs I, V5-V6.

The blockade of the anterior branch of the left bundle branch of His looks like this:

• A pronounced deviation of the heart axis to the left side (from -30 to -90 degrees).
• Small R waves in combination with deep S waves in II, III and aVF.
• Small Q waves in I and aVL.

Blockade of the posterior branch of the left leg of His looks like:

• A pronounced deviation of the heart axis to the right side (from +120 to +180 degrees).
• Ventricular complex of normal duration.
• Small Q waves in combination with high-amplitude R waves in II, III and aVF.
• Small R waves in I and aVL.

In the ECG conclusion, following the nature of the rhythm, they indicate the location of the electrical axis of the heart, give a description of the blockade of the left leg (complete, incomplete), mention the lengthening of the electrical systole of the ventricles, and give a general description of the ECG.

If there is simultaneously hypertrophy of the right or left ventricle, then its description is usually given before the general characteristics of the ECG. LBBB is observed with pronounced changes in the myocardium of an inflammatory or sclerotic nature:

1. Occurs with left ventricular hypertrophy;
2. Circulatory failure;
3. With cardiosclerosis;
4. Myocardial infarction;
5. For symptomatic renal hypertension;
6. For myocarditis, rheumatism;
7. For aortic heart defects;
8. For heart damage in patients with diphtheria, uremia;
9. For congenital heart defects.

U healthy people LBBB usually does not occur.

Left bundle branch block - diagnosis

Diagnosis of this conduction disorder is based on the results of instrumental research. Electrocardiography is of greatest importance. Other varieties can also be used: daily monitoring, rhythmocardiography.

In order to determine organic pathology, it is recommended to perform MRI, positron emission tomography, and echocardiography. With pathology of the anterior branch of the left leg, the following changes can be seen on the cardiogram: the appearance of a Q wave in standard lead I and aVL.

The most characteristic sign is a high R wave in these same leads and a deep S wave in lead III and aVR. Prolongation of the QRS complex is often noted. The posterior branch block is characterized by the presence of a Q wave in lead III and an R wave in lead I and aVL. In addition, deep S is observed in leads I, aVL and VI.

A distinctive feature of the blockade of the posterior branch of the left leg is a change in the electrical axis of the heart. It deviates to the right or has a vertical position.

Detection of lesions of the His trunk occurs only when performing an ECG in 12 standard leads. The changes are caused by a disturbed excitation pathway. Each type of blockade has its own distinctive features.

Signs of complete blockade of LBP on the cardiogram are:

1. M-shaped QRS complexes in leads I, aVL, V5, V6.
2. Deviation of the electrical axis of the heart to the right.
3. Increase in the QRS complex by more than 0.12 s.
4. Changes in leads V1, V2, III, aVF.

Blockade of the anterior branch of the left bundle branch on the ECG is accompanied by certain signs:

1. Change in the direction of the electrical axis of the heart (position sharply to the left).
2. There is no expansion of the ventricular complex.

If BZVLNPG occurs, then the following changes are recorded:

1. The electrical axis of the heart is deviated to the right.
2. QRS complex normal sizes, no deformation is observed.

These signs of blockade are indicated by the doctor when deciphering the cardiogram, which allows for a faster diagnosis. Finally, the width of the complexes, the average value of the heart rate and all detected changes are entered. Ultrasound of the heart with blockade of the left anterior and posterior branches is of secondary importance.

It allows you to determine the underlying disease that caused conduction disorders. Diagnosing myocardial infarction is considered a difficult task when a complete block of the left leg is registered, since it “hides” the cardiographic criteria.

Holter study - 24-hour ECG monitoring shows a constant, periodic type of complete or incomplete blockade. In the second case, you can find out the cause of its occurrence.

During the examination, the patient keeps a diary where he records his daily manipulations. BPVLNPH is often recorded during physical and emotional stress. The Holter study is important for identifying various arrhythmias against the background of changes in conductivity.

Treatment and prevention

Treatment of such a deviation as complete blockade of the NPH involves treatment of the factors and diseases that caused it, because only this becomes the main cause of the development of the problem.

Depending on the type of disease that provoked a complete blockade, apply different drugs, but among them the most often used are nitrates, cardiac glucosides, as well as medications that lower blood pressure.

They use different methods to restore the heart rhythm, and if none of them help, the doctor may recommend surgery. In this case, a pacemaker is installed, which will regulate the functioning of the heart.

Non-drug methods are always combined with drug therapy, since in this case there is a higher chance of getting a positive reaction to certain techniques. Some techniques are more suitable for the rehabilitation period, but are also widely used during the period when intensive treatment is carried out.

This includes:

• unloading in nutrition (that is, removing heavy foods);
• compliance with the regime;
• load dosing;
• physiotherapy.

In the latter case, classes are initially carried out with an instructor, since the task of the loads is to provoke normal work system of veins and blood vessels, get more oxygen, but reduce the load on the heart muscle itself.

Attention! Be sure to consult with a specialist so that he can choose the optimal level of training for you. All loads must be not just dosed, but also adequate, suitable for the condition and function of the heart. Otherwise, they have a deeply negative effect.

The pathology of the left leg is only a sign of the underlying disease. There is no specific treatment for this condition. Therapy should be aimed at treating the underlying disease (coronary artery disease, hypertension, myocarditis).

If the blockade is complicated by heart failure, angina pectoris, hypertension, then treatment should include taking cardiac glycosides, nitroglycerin, and antihypertensive drugs.

IN Lately A drug such as Transfer Factor Cardio has been successfully used. This is an immune remedy that enhances the effect of other medications, stimulates the immune system, and has the property of immune memory.

It is important that a branch block can lead to complete atrioventricular block, which worsens the prognosis for life. Left leg block can cause sudden cardiac death.

The average survival rate is 2.5 to 5 years. Thus, the pathology of the conduction system of the heart is very dangerous and, if left untreated, can lead to the death of the patient.

Any LBP blockade detected for the first time requires hospitalization in a specialized department. The changes do not require special treatment, but careful diagnosis is necessary.

It is worth noting that the first occurrence of complete LBBB, accompanied by pain in the heart area, is regarded as an emergency pathology.

Such patients are hospitalized in the intensive care unit or intensive care unit. Treatment in these cases is similar to that for acute myocardial infarction!

In other cases, patient management is reduced to treatment of the underlying disease and prevention of its complications. Knowing what LBP blockade is, you can understand that it does not pose a serious health hazard. However, it always requires a thorough examination of the patient to identify cardiac pathology and select rational treatment.

LBBB can have unpredictable and sometimes even very dangerous consequences for the cardiovascular system, which will take a long and painful time to get rid of. It would be much more reasonable to start treatment on time or, if there is a tendency to problems, to take preventive measures.

The main task that the attending physician sets for himself is to find and eradicate the root cause of LBP, which provoked the disorders. If the patient suffers from heart failure or other disorders, most often he has to take glycosides, antiarrhythmic and antihypertensive drugs.

If there is a congenital defect, only surgical intervention can cause improvement. Of course, if the patient's condition is satisfactory, we can limit ourselves to maintenance therapy. However, the doctor can make an appropriate decision only during the examination.

Incomplete block of the anterior branch of the left bundle branch suggests slow motion of the impulse, which can only be identified by ECG. After the diagnosis is made, a treatment regimen is prescribed, which never contains glycosides. It is thanks to them that the blockade has every chance of developing into its full form.

To ensure that unpleasant symptoms do not in any way disturb a person’s peace, patients are strongly advised to reconsider their lifestyle, eliminating bad habits and introducing physical activity.

Such simple rules are relevant for absolutely any disease. If you follow them, signs of health problems will not knock on your door for a long time! Treatment should be carried out only after consultation with a cardiologist.

Treatment with traditional methods

Treatment consists, first of all, of competent treatment of the underlying disease. If the patient does not have serious abnormalities, we can recommend taking herbs that normalize heart rate and conduction of nerve impulses. These home remedies have been tested for generations and proven to be effective.

1. Ramson (bear onion)
2. Jaundice spreading
3. Common hazel
4. Caustic sedum
5. Marsh dry grass
6. Herbal infusions

• Raspberry fruits – 20g;
• Birch leaves – 10g;
• Leonurus cordial herb – 10g;
• Herb or dill seeds – 10g;
• Periwinkle leaves – 20g.

Brew a tablespoon of this mixture with 0.5 liters of boiling water in a thermos, close the lid and leave for at least an hour. Every time 15 minutes before meals, drink half a glass of this drink. The course of treatment is from one month to a year (depending on the patient’s condition).

In an ancient French herbal medicine reference book we found the following recipe:

• Sage herb – 50g;
• Dill seeds – 50g;
• Medicinal cap herb – 50g;
• White mistletoe – 30g;
• Fragrant rue herb – 10g;
• St. John's wort herb – 10g.

Combine all ingredients. Take a liter of water for 2 tablespoons of the mixture, bring the mixture to a boil, and immediately remove from the heat. Let the drug brew for half an hour, then strain it and drink a glass 4 times a day. In severe cases of heart failure, the dosage is halved.

The following collection provides an excellent therapeutic effect:

• Blood red hawthorn flowers – 30g;
• Small periwinkle leaves – 30g;
• Melissa leaves – 10g;
• Spring adonis herb – 10g;
• Lavender flowers - 10g.

Take a heaping tablespoon of this mixture, pour a glass of cold water and leave for half an hour. Then put the medicine on the fire, boil for 5 minutes and cool. Drink the resulting medicine in small portions throughout the day. The course of treatment must last at least 2 months for you to feel a stable effect.

Forecasting

The prognosis for patients who did not experience any symptoms throughout the entire period during which treatment was carried out is considered quite favorable. If there was any disease that accompanied the complete blockade or caused its development, then the doctor should take into account these factors when making a prognosis.

However, it should also be taken into account that complete blockade of the PNH itself significantly increases the risk of not only the development of very serious complications in the future, but also sudden death.

If the defect gradually progresses, or hypertension, AB blockade, heart failure or cardiomegaly develops, the unfavorable prognosis will be significant.

In patients with partial blockade, the course of the pathology is favorable, especially in those who do not have symptoms or other cardiac pathologies. Patients should take into account that the prognosis depends on the underlying pathology of the heart or blood vessels, as well as on how attentive they are to their health.

Source: “iserdce.ru, diabet-gipertonia.ru, 1poserdcu.ru, lookmedbook.ru, medicalplanet.su, okardio.com, vseoserdce.ru, oserdce.com, serdec.ru.”

Blockade of the heart muscle is a condition characterized by a pathological change in the rhythm of heart contractions (arrhythmia) due to a disruption in the passage of impulses through the heart.

Mechanism of blockade:

1. The heart muscle works under the influence of electrical impulses generated in the sinus node (a plexus of nerve cells) and sent to the conduction system (this is a collection of nodes, bundles and nerve branches, they transmit impulses from one part of the heart to others).
2. The sinus node is located in the right atrium, at the confluence of the greater and lesser vena cava.
3. In a healthy person, the number of impulses generated is 60–90 per minute
4. An impulse may encounter some kind of obstacle while passing through a conducting system. These may be congenital characteristics of the body or acquired changes (scar tissue).
5. For certain reasons, the muscle cells of the heart can become inflamed or degenerate into connective tissue. This becomes a kind of block that impedes the progress of the impulse.
6. In this case, the passage of the electrical impulse to the underlying parts of the heart may be delayed or may not pass at all.
7. This pathology is called “heart block”. It can be complete if the impulse does not pass at all, and incomplete if its passage is delayed and not every impulse passes.

Heart block can be classified according to different parameters:

• All information on the site is for informational purposes only and is NOT a guide to action!
• Can give you an ACCURATE DIAGNOSIS only DOCTOR!
• We kindly ask you NOT to self-medicate, but make an appointment with a specialist!
• Health to you and your loved ones!

First degree of pathology

First-degree atrioventricular block involves slowing the conduction of impulses from the atria to the ventricles.

During normal heart operation, the pulse interval is 0.18 seconds. For 1st degree blockade – from 0.3 seconds.

This pathology does not manifest itself with any pronounced symptoms. It is detected during an ECG for another reason or during a routine examination. Treatment for early stage heart block is not required.

When diagnosing this disease, it is necessary to keep in mind that it can progress and enter a more severe stage.

It is recommended to use drugs intended to reduce heart rate with caution. Therefore, patients need to warn doctors who will subsequently treat them about the presence of this diagnosis.

A first degree block is sometimes normal. It also occurs in professional athletes, in children and adolescents diagnosed with mitral valve prolapse and other minor cardiac anomalies.

Structure of the heart

Second degree

This stage is characterized by the fact that not all electrical impulses are carried out, but only every second or third. The conductive fibers are damaged, but not completely.

The causes of 2nd (and often 3rd) degree blockade are almost always organic lesions of the heart, followed by the formation of connective tissue.

These are the following diseases:

Incomplete heart block

in the absence of other pathologies, it is not treated, but the patient’s condition must be monitored using an ECG.

Symptoms of ventricular block in humans are listed in another article.

Symptoms of 2nd degree blockade:

• chest pain;
• dizziness;
• bradycardia (decreased heart rate);
• low blood pressure.

Treatment of complete third degree heart block

Complete blockade is defined as a condition in which the electrical impulse does not pass through at all. The ventricles and atria contract without synchronization relative to each other.

Symptoms:

• chest pain;
• reduction of heart rate to 40 beats per minute or less;
• dyspnea;
• nausea and vomiting;
• weakness;
• dizziness;
• confusion of consciousness.

Treatment of complete heart block is carried out by two methods: conservative or surgical. Surgery (implantation of a pacemaker) is indicated when drug treatment is ineffective or the patient’s condition sharply worsens.

Electrical stimulation

In critical cases, when the patient's condition sharply worsens, a temporary pacemaker is used. A similar manipulation is carried out before implantation of a permanent device or to stabilize geodynamics under the influence of transient factors (overdose medicines or during a severe attack of ischemia). Mechanism of temporary cardiac stimulation: a catheter with an electrode is inserted into the patient’s vein, which is placed in the upper part of the right ventricle; the electrode is connected to an external generator. It is not advisable to use this method of influencing the heart for more than 48 hours. Otherwise, there is a high risk of thromboembolism.

Implantation of an artificial pacemaker

The second stage of treatment by artificially stimulating cardiac impulses is surgery for implantation of a permanent pacemaker. In most cases, a pacemaker is used for life. But sometimes it happens that when the disease that caused the blockade is cured, the heart rate is completely restored. In progress surgical intervention The electrodes are inserted through the lumen of the subclavian vein into the desired area of ​​the heart muscle. An electrical pulse generator (pacemaker) is placed subcutaneously, just below the collarbone. It consists of a battery and an electronic chip. These devices are housed in one housing. It is usually made of titanium alloy. The microcircuit is responsible for sending electrical impulses and synchronizing them. If stimulation of the activity of the ventricle and atrium is necessary, then 2 electrodes are inserted into the corresponding zones and a two-chamber stimulator is used. The pacemaker runs on lithium batteries. Their service life is about 10 years.

Folk remedies

It is necessary to realize that treatment with traditional medicine methods is an auxiliary effect, and not the main one.

The main condition in the treatment of heart muscle blockades is that a doctor must diagnose the disease, and he must prescribe a complex of treatment. And after this, you can agree with the doctor on the use of folk remedies.

First of all, after diagnosing heart block, you need to:

• eliminate nicotine and alcohol from consumption;
• reduce the amount of strong tea and coffee you drink;
• reduce salt intake;
• adhere to the principles of a healthy balanced diet, i.e. exclude fried, fatty, smoked foods, increase the amount of fruits and vegetables in your menu;
• avoid physical and emotional stress;
• lead a measured lifestyle, with a competent alternation of work and rest.

Over the centuries, traditional medicine recipes have been improved and accumulated to help normalize heart function.

How to treat with folk remedies? Let's look at several effective recipes:

Peppermint infusion	Finely chop the leaves, brew a large spoon of the resulting raw material with 250 ml of boiling water. The infusion should “simmer” for at least an hour. Strain and drink throughout the day.
Valerian root decoction	Brew 2 small spoons of dry raw materials with half a glass of boiling water and cook for about 10 minutes. Drink: 1 large spoon before meals (3 times a day).
Decoction of hawthorn flowers	A tablespoon of flowers is brewed with hot water (1 glass) and heated in a water bath for about 20 minutes. Strain, add boiling water to 200 ml and drink half a glass chilled before meals.
Calendula infusion	2 tbsp. spoons of flowers are poured with half a liter of hot water. Simmer for about 60 minutes. Drink half a glass 4 times a day.

First aid

Heart block, especially 3rd degree, is a very serious and dangerous disease.

After all, the absence of oxygen (delivered by the bloodstream) even for 30 seconds can cause oxygen starvation of the brain and body tissues. It is necessary to know first aid techniques and be able to provide it.

What can be done if a patient develops pronounced symptoms (weakness, paleness, cold sweat, loss of consciousness, rare pulse):

• call an ambulance;
• place the patient on a flat, hard surface;
• give an isadrin tablet (if the person is conscious);
• in case of loss of consciousness, give him artificial respiration;
• if there is no heartbeat, perform an indirect cardiac massage;
• Upon arrival of the ambulance, doctors will carry out resuscitation, hospitalization and decide on the use of a pacemaker.

From this article you will learn: what it is – bundle block, its types, causes, symptoms and characteristic ECG signs. Methods of diagnosis and treatment.

• Types of pathology
• Causes
• Characteristics and symptoms of each type of pathology
• Diagnostics
• Elimination methods
• Forecast

Bundle branch block (abbreviated as BBBB) is a problem with the conduction of excitation impulses along special fibers called the bundle branches.

BNPG is characterized by incomplete or complete blocking in one or simultaneously in two branches. The latter is a complete block of the bundle branch, the first is partial.

This conduction disorder is intermittent or permanent. The bundle of His consists of the left and right bundle branches. The first is divided into 2 branches: posterior and anterior. Impulses pass through them to the ventricles, after which the latter contract. Any blocking of excitation impulses leads to the development various kinds arrhythmias.

RBBB is not a separate independent disease, but a consequence and electrocardiological manifestation of the underlying cardiac pathology. In patients with age, the detection rate of this disorder increases.

On average, BBBB, according to ECG data, is detected in approximately 0.6% of patients, more often in men. Among people after retirement age, the frequency of diagnosis of pathology increases to 1–2%.

Impact on physical well-being, normal life in a person depends on the type and degree of RBBB, the age of the patient, the characteristics of the underlying cardiac disease and the correctness of the therapy. When the right bundle branch block is insufficiently complete, there are generally no symptoms observed. Incomplete blockade of the right bundle branch is detected only on an ECG during a routine examination. And with a complete block of the left bundle branch, or three-bundle branch, a person is bothered by pain in the projection of the heart, rapid pulse, dizziness, and shortness of breath.

A cardiologist deals with such disorders. His consultation is necessary if RBBB is detected.

Types of pathology

According to the structure	Single-beam	Problems with conduction along one fiber, for example, blockade of the anterior branch of the left bundle branch or the right bundle branch separately.
	Double-beam	The defect is in one branch and leg or in both.
	Three-beam	Both legs are not functioning properly.
Regarding the degree of electrical conductivity disturbance	Full	With heart block 3 tbsp. impulses do not reach the ventricles at all, as a result, the contraction of the latter is reduced to 20–40 beats per minute.
	Incomplete	Problems with the passage of impulses through only one leg. Myocardial contraction occurs in full due to the intact leg, but occurs with a delay. There is an incomplete blockade of the right bundle branch of 1st stage. or left. For incomplete RBBB, 2 tbsp. impulses partially reach the ventricles.
According to the nature of the flow	Permanent (irreversible)	Persistent violations do not go away under any circumstances.
	Intermittent	Conduction changes may vary during the ECG recording or may not always be detected.
	Alternating	Alternating blockades of different legs or branches.

There are many causes of RBBB.

Aortic stenosis or other aortic defects, as well as coarctation of the aorta (narrowing of the aortic lumen or its complete occlusion) are a common cause of the development of double-bundle blocks.

The causes of RBBB are divided into 7 groups.

Characteristics and symptoms of each type of RBBB

There are no independent symptoms specific to RBBB, but certain changes are recorded by the cardiogram.

Right bundle branch block (RBBB)

Conduction through the fibers is slowed down when incomplete. Single-fascicle right hemiblock most often does not produce any symptoms; it is detected on an ECG during medical examination or during an examination for some kind of heart disease. If incomplete RBBB is found in a practically healthy person, then it is considered a physiological norm.

Electrocardiography can be used to diagnose bundle branch block.

With complete RBBB there is no conduction along this leg. Contraction of the right ventricle and the corresponding half of the interventricular septum is carried out along fibers from the left ventricle. Increased heart rate and pain in the heart are manifestations of the underlying disease.

Left bundle branch block (LBBB)

With a complete block of the left bundle branch, the ECG shows typical changes with a shift of the EOS (electronic axis of the heart) to the left. The leg is not functioning. This may be a consequence of a heart attack or massive serious disorders in the muscle of the left ventricle. The patient is worried about pain in the heart, palpitations, weakness, dizziness. Incomplete left bundle branch block is not as serious. There are no or minimal symptoms.

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

Electrocardiological signs: the S wave is deepened, the R wave is enlarged, the QRS complex is deviated upward and to the left. There are often no clinical symptoms or they relate to the underlying heart disease.

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

During complete BZVLNPG, impulses do not pass through the fibers of this branch. Conductivity compensation is carried out thanks to the anterior branch. The ECG shows similar changes as with LBP, only the QRS is deviated to the right and down.

When any of the branches are blocked, clinical signs are often absent or minimal and are caused by the underlying heart disease.

Double-bundle BNPG

This is a combination, for example, of RBBB and one of the left branches. Depending on which branch or leg is affected, the ECG records the corresponding changes. Possible cardialgia (heart pain), shortness of breath, palpitations.

Three-bundle BNPG

When incomplete, the impulses pass along the least affected branch, and atrioventricular block of either 1st or 2nd degree develops. When complete, the conduction of electrical impulses is completely blocked. The rhythm of contraction of the ventricles and atria becomes uncoupled, and 3rd degree AV block develops. and atrial fibrillation.

Due to a decrease in heart beats to 40 per minute. and less, and also due to insufficient release of blood into the aorta, the patient suffers from frequent dizziness and even fainting, freezing and (or) heart failure. This condition is fraught with sudden death caused by cardiac arrest.

Diagnostics

A similar conduction disorder is detected when deciphering a regular electrocardiogram. The doctor's further actions depend on the type of blockade detected. If a young person is diagnosed with incomplete RBBB on an electrocardiogram in the absence of cardiac problems, then this is often considered normal and does not require medication.

Hospitalization for incomplete LBBB is not necessary. The examination can be done on an outpatient basis. In case of complete blockade of the left bundle branch, further examination is mandatory, as well as consultation with a cardiologist, and possibly a rheumatologist or cardiac surgeon.

To identify irreversible changes in the valve apparatus and heart muscle, echocardiography (ECHOCG), magnetic resonance or positron emission tomography (MRI or PET), and transesophageal electrocardiography (TEE) are prescribed.

Methods for diagnosing bundle branch block

With three-bundle BBBB, the patient is urgently hospitalized, and treatment and diagnostic measures are carried out in the hospital.

There is no specific therapy for this pathology. In case of RBBB, especially incomplete right one, and the absence of complaints, observation is limited. To normalize the heart rate during single- and double-fascicular blockade occurring against the background of hypertension, coronary artery disease, the patient is prescribed cardiac glycosides, nitrates, antianginal and diuretics, PAF inhibitors, and statins.

Based on the underlying disease, some patients, for example with rheumatism, are prescribed a course of antibiotics, glucocorticosteroids and long-term use of NSAIDs.

In case of atrioventricular block, the question of implanting a pacemaker is considered, because the heart cannot function fully on its own, the pulse is very rare, which can lead to serious consequences, even death.

In patients with partial blockade, the course of the pathology is favorable, especially in those who do not have symptoms or other cardiac pathologies. Patients should take into account that the prognosis depends on the underlying pathology of the heart or blood vessels, as well as on how attentive they are to their health. Strict adherence to the doctor’s recommendations, completion of treatment courses, and regular visits to a cardiologist to monitor the condition can stop the progression of the disease.

The prognosis is unfavorable with complete left hemiblock and three-fascicular block. The first, in the acute period of a heart attack, ends in death in 40–50% of cases, the second is dangerous by the development of asystole, ventricular fibrillation, and sudden death from cardiac arrest.

Left bundle branch block - what is it and how does it manifest?

Surely each of us has felt severe discomfort from disturbances in heart rhythm, which can begin to develop for many objective reasons. Breathing problems, unpleasant heaviness in the heart area, physical malaise - these symptoms may indicate that there is an arrhythmia, which is easily detected during a full examination.

And blockade of the anterior branch of the left bundle branch, referring to the concept of “arrhythmias,” can be defined as one of the most common pathologies in the activity of the heart today. Severe symptoms, varied manifestations, which can be determined even without examination by a cardiologist. However, their appearance, even in small quantities, is already a serious reason for a visit to the clinic. A specialist will help you deal with malfunctions of the heart, establish the cause of cardiac pathology, and also develop the most effective method of treatment that will stabilize the condition and avoid probable complications, and sometimes even save the patient’s life.

Most often, this cardiac pathology occurs among the male half of the population, however, the frequency of diagnosing BPVLPH is insignificant against the general background of cardiac ailments: only 0.7% of their total number. Old age is the main age category of people who experience manifestations of this condition.

Complete blockade of the left bundle branch is relatively rare; it cannot be excluded if there is a feeling of muscle tightness and heaviness in the area where the heart muscle is located, if there is a feeling of irregular heart rhythm, uneven perception of reality, dizziness and possible loss of consciousness. If we give a general definition of this concept as blockade of the left leg of the heart and the His bundle, then this pathological condition can be classified as a pronounced decrease in the function of muscle tissue conduction. The transmitted impulse directed through the left part of the beam is felt weakly or not diagnosed at all.

General sensations suggest the presence of certain dysfunctions in the activity of the heart muscle, however, even incomplete blockade of the left bundle branch should be detected using instrumental examination. For example, ECG signs of the subject in question pathological condition will immediately detect: irregularities in the heart rhythm, relatively low intensity of the heart muscle.

It must be remembered that the condition of LBBB is not considered a separate and independent disease; Most often, this abnormal condition is a consequence or parallel manifestation of an existing lesion of the cardiac system. And in this difficult case, competent assistance from a specialist in the activity of the cardiac system will be even more necessary.

Types of disease

Depending on the type of damage to the cardiac region and the degree of detection of concomitant symptoms, several degrees of this pathology differ:

• only a single part of the leg is affected;
• the lesion is detected completely throughout the left part of the bundle;
• and the full form, when a doctor diagnoses a lack of conduction along the entire length of the left side;
• partial, in other words - incomplete. And in this embodiment, there is a slight delay in the process of work of both cardiac ventricles.

In addition to the listed varieties, blockade of the posterior branch of the left bundle branch can have three stages of its occurrence and subsequent manifestation. The first stage is characterized by some delay in the process of conducting the impulse, which is transmitted through the trunk leg to the atrium. At the second stage of development, a partial absence of conducted impulses in the atria can already be diagnosed. These first two stages should be considered incomplete blocking. The third stage is the most severe manifestation of blockade of the left bundle branch: here an absolute lack of tissue conduction is revealed, and as a result the ventricle exhibits independent contractions, regardless of the flow of nerve impulses through the left side.

As a result, the heart rate decreases significantly and can even reach less than 21-45 beats per minute (despite the fact that the normal number of heartbeats in a healthy person is 40-65 beats per minute).

Manifestations of left leg block and symptoms

Treatment of this pathological and life-threatening condition can be prescribed only after the necessary diagnostic measures have been carried out. However, the presence of subjective manifestations, which primarily include heaviness in the heart area, noticeable interruptions and changes in heart rate, accompanied by a deterioration in well-being up to loss of orientation, varying degrees of dizziness, allows one to timely identify the onset of a pathological process.

Signs of left leg block may appear as follows:

• a pronounced slowdown in the conduction of the transmitted impulse through the tissues of the left side, while the ventricle begins to exhibit contractions in a different mode;
• the process of excitation of the ventricle on the left is carried out during impulse conduction;
• the process of excitation takes place on the anterior part of the tissues of the left half.

However, the above manifestations of the pathological condition can only be detected by electrocardiographic methods: blockade of the left bundle branch on the ECG can be manifested by a change in the clear pattern of heart contractions, a significant lag in ventricular contraction. This method also allows us to identify the type of pathology, its stage and features of manifestation, which is important when treatment is prescribed. Also, a cardiogram is recommended when diagnosing any type of cardiac pathology, which is accompanied by a pronounced disruption of the heart rhythm and arrhythmia.

And in order to begin treatment of this pathology, it is necessary to identify probable reasons blockades Since LBP is not considered an independent disease, but a consequence or parallel pathological process, the reasons that caused it may lie in dysfunction of the heart and a deterioration in its general condition.

The main causes of pathology

Blockage of the tissue of one of the legs of the cardiac muscle of the His bundle, as well as its branches, can occur for several independent reasons, among which the following should be highlighted:

• stenosis;
• insufficiency of the tricuspid valve;
• defective structure of the interatrial septum;
• pulmonary heart;
• IHD and its varieties;
• myocarditis manifestations;
• myocardial infarction and its consequences.

Blockade of the right and left parts can be manifested when thromboembolism of the pulmonary arteries is activated, while the speed of ventricular contraction is markedly different from the speed of impulse arrival.

The disease can also develop according to certain etiological factors that explain the nature of this pathology and determine the rate of its development.

Etiological factors influencing the activation process

Significant changes in hormonal levels due to certain external influences are also additional reasons occurrence of left bundle branch block. The most common etiological factors that can largely influence the occurrence of the first signs of blockade include the following:

• poisoning of the patient’s body with a large amount of residues of drugs that were used in the treatment of concomitant heart diseases. These include various types of diuretics, symptoms and cardiac glycosides;
• abuse of bad habits that negatively affect the entire human cardiac system. This could be alcoholism, narcotic drugs, smoking;
• thyrotoxicosis;
• insufficient amounts of certain substances in the body. These are potassium and magnesium, which are responsible for electrolytic balance in the body. A significant amount of them, as well as some of their deficiency, affect the balance in the functioning of the cardiac system.

As a result of the above situations, the anterosuperior bundle loses its rhythm of work; ventricular contractions occur regardless of the receipt and conduction of impulses through the tissues of the leg.

Diagnostic methods

Electrocardiogram and emission tomography are considered to be the most effective - these research methods make it possible to make an accurate pre-diagnosis and identify the main causes of this cardiac pathology. Thanks to this diagnostic study it becomes possible to determine the most effective method therapeutic effects.

Therapeutic measures

Treatment of this condition is based on comparing the results of the cardiogram and ECG with normal heart rate indicators. Since bundle block is not recognized as an independent heart disease, this state usually accompanies a specific heart disease or several diseases. Therefore, treatment is necessarily directed primarily at eliminating the root causes of this condition. And the methods of treating primary cardiac damage are determined both by the disease itself and its degree of development, manifestations and general condition of the patient’s body.

The most effective methods of influence include the following:

• if the underlying cause of His bundle block is heart failure, broad-spectrum cardiac glycosides will often be prescribed, as well as nitroglycerin, antihypertensive drugs that primarily stabilize the heart and its rhythm;
• immune drugs aimed at stimulating the body's defenses and increasing the degree of its resistance to all kinds of diseases, including heart diseases. The most popular today is a broad-spectrum medicine called “Transfer Factor Cardio”: the absence of side effects, a rapid effect on the heart muscle and stimulation of the immune system are the main manifestations of taking the drug;
• Nitrates and antihypertensives are also commonly prescribed medications for this condition. They help stabilize the general condition, restore normal rhythm heartbeats.

However, it should be borne in mind that there is no universal therapy for His bundle tissue blocks; The main focus of the therapeutic effect in this case should be considered to be treatment of the underlying disease of the cardiac system with parallel maintenance of the patient’s condition. This pathology has an unpleasant likely consequence if basic treatment is insufficient: a blockade of this type can progress to a complete blockade of the heart and its atria, which has a poor prognosis for the patient and in this situation requires immediate special medical intervention.

What is the prognosis for this pathology of the cardiac system?

Features of the disease

The branch of His, or more precisely the branches of the bundle of His, is an element of the cardiac conduction system that is responsible for conducting excitation impulses in the region of the ventricles. There are three legs of the heart (bundle of His) - left, right anterior legs and one back. The last part of the bundle of His is thicker than the rest and is a continuation of the trunk of the bundle of His, and the left and right legs are its branches. There is a network of anastomoses between the branches of the bundle branches. The entire bundle of His consists of atypical muscle fibers. The end of the legs in the area of ​​the right and left ventricles breaks down into the smallest elements of the conduction system - Purkinje fibers.

The main function of the His bundle is to transmit impulses from the right atrium to the ventricles of the heart, which begin to contract in the rhythm of the atria. For any reason, children and adults may experience partial or complete violation conduction of the impulse at the level of one or two legs. In cardiology, such heart diseases are called bundle branch block (BBB). Pathologies often do not manifest themselves clinically, but are diagnosed in 6 people out of 1000 people. With age, the incidence of the disease increases, and after 55 years of age, blockades occur in 20 people out of 1000, more often in men.

The classification of the disease according to the degree of disruption of the conduction of excitation impulses into the ventricles is as follows:

1. Incomplete blockade of the His bundle (slowing of impulse transmission).
2. Complete blockade of the His bundle (complete cessation of impulse transmission).

In addition, they highlight the following types blockades:

1. Single-bundle - covers the right leg, or represents a blockade of the posterior or anterior branch of the left leg.
2. Double-bundle - affects both branches of the left leg or includes a blockade of the right leg coupled with damage to one branch of the left leg.
3. Three-bundle - the right and left legs are blocked.

According to the type of development of RBBB it can be:

• intermittent (appears and disappears during the recording of one ECG study);
• constant (always present on the ECG);
• transient (not recorded on all ECGs);
• alternating (can change location, that is, appear in the area of ​​different legs).

Signs of pathology can appear in children from birth, and in this case they can be provoked by congenital diseases:

• defect of the interventricular and interatrial septum;
• underdevelopment of a segment of the right bundle branch;
• stenosis of the pulmonary artery;
• coarctation of the aorta;
• other heart defects that cause overload of the right ventricle.

In childhood, incomplete single-bundle blockades can be considered a normal variant if they are not accompanied by organic heart damage. Thus, many children have incomplete blockade of the right bundle branch, combined with minor cardiac anomalies - additional chord, mitral valve prolapse, etc. Blockade of the left leg is more often provoked by acquired diseases and is often also considered a variant of the norm.

Among the cardiac causes that can cause RBBB, doctors name the following:

• acute and chronic heart failure;
• myocarditis of viral, bacterial origin;
• rheumatism of the heart;
• endocarditis;
• various cardiomyopathies;
• myocardial dystrophy of the heart;
• cardiosclerosis;
• heart tumors, metastatic heart lesions;
• chest injuries;
• surgical interventions on the heart, coronary vessels;
• autoimmune pathologies that affect the heart muscle;
• severe arterial hypertension or long-term hypertension;
• myocardial infarction.

There are other reasons that can lead to partial or complete blocks of the bundle branches, including transient ones:

• chronic diseases respiratory system accompanied by obstructive processes, for example, bronchial asthma, emphysema, cor pulmonale, chronic bronchitis;
• pulmonary embolism;
• progressive muscular dystrophy;
• hyperkalemia, as well as other electrolyte disturbances - disruptions in the balance of magnesium and sodium;
• overdose of certain drugs - cardiac glycosides, diuretics, antiarrhythmics, etc.;
• long history of smoking;
• alcoholism;
• dysfunction of the autonomic nervous system;
• diseases of the adrenal glands, thyroid gland;
• diabetes;
• severe anemia.

With absence obvious reasons After the diagnosis, an idiopathic bundle branch block can be established.

Symptoms of manifestation

Many clinical cases RBBB occurs without any symptoms. Incomplete single-fascicle blocks almost never show symptoms, so they are detected only by ECG during a routine examination. But with complete blockade of the right leg, symptoms are usually observed in a person even in the absence of organic heart damage. These include:

• various changes when listening to heart sounds;
• dizziness;
• presyncope and fainting;
• feeling of lack of air;
• dyspnea;
• decreased performance;
• poor exercise tolerance;
• fatigue and weakness;
• sometimes - pain in the heart area;
• feeling of interruptions in the work of the heart.

In addition, a clinical picture may appear that corresponds to the underlying disease - both cardiac and affecting other organs and systems. The most serious symptoms appear in acute cardiac pathologies - heart failure, myocardial infarction, which are most often accompanied by various heart blocks against the background of damage to the ventricular myocardium.

Danger and consequences

The prognosis for this disease is difficult to predict, since, in fact, it is a symptom of other pathologies. If the patient has an incomplete single-fascicular block without cardiac or pulmonary disease, the prognosis is good. With regard to the presence of organic heart lesions, the prognosis depends entirely on the underlying pathology. As for the danger of BBBB, then unpleasant consequences, as a rule, occur with complete blockades. They lead to progressive hemodynamic disorders, which can cause the following complications:

• stroke - acute ischemia of a part of the brain due to cessation of blood circulation in it;
• chronic heart failure - dysfunction of the heart, leading to disruptions in the functioning of the entire body;
• worsening of the underlying heart disease;
• the appearance of thrombosis and thromboembolism due to blood thickening.

PE can also lead to death, ischemic stroke. On average, mortality when blockade develops against the background of a heart attack is 50% in the first days of the pathology. Such consequences can only be prevented by an early start of examination and treatment, compliance with all doctor’s prescriptions, and getting rid of or correcting underlying diseases of the heart and blood vessels.

Diagnosis of pathology

Even a therapist, when listening to the heart, can note a change in rhythm, a disturbance in heart rate. This should be a reason to perform further, more detailed examination to find the cause and type of heart block. The main diagnostic method is an ECG, which can be used to draw a conclusion about the form of RBBB (the most common types of blockades are presented below):

1. Blockade of the anterior branch of the left LES. There is a high R wave, a deep S wave, and a deviation of the QRS vector up to the left.
2. Blockade of the posterior branch of the left LES. The QRS vector is directed upward, to the right and forward, there is a high R wave, a deep S wave. Both types of blockades can be accompanied by acute heart failure, myocardial infarction, which should not be forgotten when obtaining such examination results.
3. Blockade of the right LES. There is a tall, wide R wave, a widened S wave, and increased amplitude. The ventricular QRS complex takes the form qRS or rSR and widens to 0.12 seconds. and more. In addition to acquired causes (anterior myocardial infarction, ischemic heart disease), this variant of the development of the disease is characteristic of congenital heart defects and other diseases.
4. Blockade of the left LES. The EOS deviates to the left or is located horizontally. The QRS is shaped like a widened R wave with a jagged or flattened apex. The width of the ventricular QRS complex is greater than 0.12 seconds or equal to this indicator. The condition is typical for arterial hypertension, acute myocardial infarction (less commonly), aortic heart defects.
5. Double bundle block (blockade of the right leg and left anterior branch). The QRS complex is widened over 0.12 seconds, the T segment is negative, and the RS-T segment is shifted downward, the EOS is deviated to the left. This change is most typical for ischemic heart disease and other myocardial pathologies.

After identifying these abnormalities in the ECG, the patient is recommended to perform other examinations that will help to detail the information and establish the correct diagnosis:

1. Blood and urine tests to assess electrolyte balance, hormone levels, indicators of autoimmune processes, etc.
2. Daily ECG monitoring to identify unstable atrial conduction disturbances, type of arrhythmias, assess the severity of blockades, search for nocturnal or stress blockades.
3. Ultrasound of the heart to determine the cardiac causes of heart block, especially organic heart lesions.
4. EFI to clarify data about the disease when ECG or Holter monitoring does not allow making an unambiguous diagnosis.

Treatment options

For incomplete single-bundle blocks, as a rule, no treatment is required. If there are no cardiac causes for such disorders, then they are unlikely to progress or be aggravated by other pathologies. Such RBBB almost never develop into complete blockades and do not threaten life. Occasionally, especially against the background of hypertension, progression of right leg block and second or third degree AV block is possible. When such processes begin, the doctor always prescribes preventive drug therapy.

The same should be done for more serious types of blockades. A set of medications is selected from the medications and is carried out in courses. Treatment of the underlying disease is also mandatory. In general, drug treatment for blockades may include the following drugs:

1. Vitamins in injections - thiamine, riboflavin, nicotinic acid and others.
2. Sedatives - motherwort, valerian.
3. Antioxidants - Mexidol, Preductal, Carnitine.
4. Drugs for high blood pressure from different groups (calcium channel blockers, ACE inhibitors, beta blockers, etc.) - Betaloc, Valsartan, Verapamil, Amlodipine.
5. Drugs against cardiac ischemia, mainly nitrates - Nitroglycerin, Cardiket.
6. Medicines for high cholesterol- Rosuvastin, Simvastatin.
7. Cardiac glycosides and diuretics for heart failure - Digoxin, Lasix.
8. Antiplatelet agents against thrombosis - Cardiomagnyl, Aspirin-Cardio.
9. Medicines against chronic obstruction lungs - Pulmicort, Berodual, Beclazon.

Currently, several types of surgical interventions have been developed, which are most often recommended for patients with complete blockade of one branch, or with two- or three-bundle blockades. The most commonly used technique is implantation of an electrical pacemaker, including a temporary one (for a heart attack and other acute conditions). For some types of conduction disorders, the method of radiofrequency catheter ablation helps. Some patients should also have a cardioverter-defibrillator installed, for example, with a three-fascicular block combined with a complete ventricular-atrial block.

In general, a person with blockades without manifestations can lead a normal life, but should immediately give up excessive physical activity, get more rest, and avoid prolonged stress. Nutrition must be correct, without an abundance of salt and animal fats and sugar. You should give up bad habits, especially smoking. After having a pacemaker installed, a person should initially visit a cardiologist once every three months, and then once every six months and a year. Some people use folk remedies against heart block. By agreement with the doctor, the following prescriptions from the section of alternative medicine are allowed:

1. Combine equal amounts of valerian root, rose hips, dandelion roots, calamus roots, and grind everything in a coffee grinder. Take a teaspoon of reset, pour 300 ml of boiling water. Drink 100 ml three times a day for 1 month.
2. Combine pharmaceutical alcohol tinctures of hawthorn (50 ml), valerian (30 ml), motherwort (40 ml), calendula (20 ml), peony (80 ml), mint (20 ml). Take 10 drops three times a day after diluting in water for a course of 1 month. With a strong decrease in pressure, the dose is reduced to 5-7 drops.

Preventive measures

To prevent illness, the following measures are important:

• rest more, get enough sleep;
• eliminate stress and overwork;
• observe the work and rest regime;
• eat only healthy foods, consume more plant fiber;
• give up cigarettes and alcohol;
• take all medications only in recommended doses and under the supervision of a physician;
• treat all heart diseases early.

Bundle branch block

Bundle branch block is a malfunction of cardiac activity caused by partial or complete absence impulse transmission along the conduction pathways of the atrioventricular bundle, provoking a delay in the excitation of the ventricular myocardium and accompanied by changes in the electrocardiographic pattern.

In the structure of cardiovascular diseases accompanied by cardiac disorders, blockade of the bundle branches accounts for up to 2.5% of cases, among which a large proportion are blocks of the anterior superior branch of the left bundle branch. The localization of this branch in the projection of the aortic valve annulus contributes to the development of blockade, due to constant exposure to increased pressure in the ventricular cavity, as well as pathology of the aortic valve.

In second place in terms of occurrence is blockade of the right bundle branch, which is not associated with any other cardiac pathology. Blockade of the posterior branch of the left bundle branch rarely occurs as an isolated pathology, due to the fact that it is supplied with blood from both the anterior and posterior descending coronary arteries. Recent scientific research refutes the three-bundle structure of the cardiac pathways, although this concept is still used in medicine today. practical purposes. According to this theory, all possible intraventricular blockades are divided according to the principle of localization:

1. Blockade in the projection of one beam:

* violation of the transmission of electrical impulses along the anterior branch of the left leg of the atrioventricular bundle;

* blocking impulse transmission along the posterior branch of the left leg of the atrioventricular bundle;

* dysfunction of conduction along the fibers of the right bundle branch.

2. Blockade of both bundles:

* combined blockade (anterior upper branch left bundle branch and right bundle branch);

* hemiblock (posterior lower branch of the left leg and right bundle branch).

3. Blockade of three bundles.

Causes of bundle branch block

A blockade in the conduction system of the atrioventricular bundle can occur both against the background of complete well-being in healthy people (blockade of the right bundle branch) and as a consequence of organic damage to the cardiac myocardium. In some cases, atrioventricular block is an accidental finding during ECG registration and becomes the reason for a targeted examination of the patient for the presence of cardiac pathology.

As a rule, a violation of the conduction of an electrical impulse is caused by the presence of a lesion in the cardiac muscle with an atypical structure (necrosis, sclerosis, myocardial defect), therefore, in most cases, persistent complete blockade of the bundle branches is a consequence organic pathology heart muscle.

Among the cardiac causes of bundle branch block, the leading positions in terms of frequency of occurrence are occupied by: hypertension with a tendency to crisis, acute coronary insufficiency and transmurral myocardial infarction. hypertrophic and dilated forms of cardiomyopathies, as well as the use of surgical methods for treating heart diseases.

The relationship between the occurrence of double-bundle blocks and the presence of aortic valve pathology in the patient (congenital aortic defects), as well as coarctation of the aortic arch, has been reliably proven.

Of no small importance in the occurrence of blockade is the state of electrolyte balance in the body. Thus, hyperkalemia and hypercalcemia with a combined decrease in sodium levels in the blood can provoke the development of any form of cardiac arrhythmia, including bundle branch block.

There is a separate type of blockade of the legs of the atrioventricular bundle of iatrogenic origin (the appearance of signs of blockade after the use of certain groups of drugs - antiarrhythmics, diuretics and cardiac glycosides).

The main pathogenetic mechanism for the development of disturbances in the conduction of impulses along the conduction pathways of the His bundle branches is the occurrence of focal organic damage as a result of compression due to edema, necrosis with subsequent sclerosis, changes in excitability and the duration of the refractory period, and a decrease in the level of potential on the membrane.

Blockades of the fibers of the conduction system of the His bundle are not accompanied by gross rhythm disturbances and unpleasant sensations in the patient, due to the fact that the legs of the atrioventricular bundle are pacemakers fourth order, that is, they are capable of generating no more than 30 impulses per minute, in contrast to the sinoatrial node, which generates up to 80 impulses within 1 minute. When one or another branch of the atrioventricular bundle is blocked, impulses begin to be generated and propagate along the pathways of Purkinje fibers at a slow frequency of up to 20 impulses per minute. These circumstances do not pose a threat to the patient’s life, however, the prolonged course of the disease provokes irreversible changes in the brain caused by impaired blood supply to the brain structures.

Symptoms of bundle branch block

According to the course of the disease, three forms of blockades are distinguished: persistent, transient (blockades with unchanged intraventricular conduction alternate) and alternating (ECG changes in blockade of one or the other leg are determined).

This form of cardiac arrhythmia belongs to the category of intraventricular blockades, and therefore is not accompanied by gross disturbances in rhythm and heart rate. Patients suffering from atrioventricular bundle branch block generally present with nonspecific complaints that do not allow a correct preliminary diagnosis to be made during the initial examination of the patient: dizziness and short-term disturbances of consciousness, a feeling of difficulty breathing, decreased performance and fatigue.

If a patient experiences a blockade of the left bundle branch, which develops against the background of cardiovascular pathology, patients present complaints characteristic of certain nosological forms (cardialgia or typical attacks angina pectoris, symptoms of heart failure). When percussion of the heart in such a situation, expansion of cardiac dullness is determined, and auscultatory signs of blockade are the splitting of the second sound at the apex of the heart, which depends on the respiratory phases.

A laboratory examination of blood and urine does not reveal any changes; only an examination of the hormonal status makes it possible to determine the extracardiac nature of the occurrence of bundle branch block.

A mandatory instrumental method for examining a patient with suspected intraventricular block is Holter ECG monitoring. This method allows not only to determine ECG changes characteristic of one or another form of bundle branch block, but also to record the clinical symptoms that occur in the patient at the time of the blockade attack. A prerequisite for correctly performed Holter monitoring is constant surveillance the patient with his own feelings and recording all changes and the time of their occurrence. Keeping such a diary in some cases allows you to determine the cause of the blockade, the elimination of which can prevent the development of cardiac arrhythmias.

In a situation where, when recording an ECG, it is not possible to identify reliable symptoms of blockade of the atrioventricular bundle, the patient is advised to undergo a transesophageal electrophysiological study, which allows assessing the condition of the conduction system of the heart.

Despite the absence of pronounced clinical symptoms, bundle branch blocks do not always have a favorable course and, in the situation of existing chronic heart pathology, can be fatal.

The consequences of bundle branch block occur with complete blockade and are characterized by the development of Morgagni-Adams-Stokes attacks. In order to prevent this condition, which is dangerous to the life and health of the patient, the patient is recommended to have a pacemaker implanted.

Right bundle branch block

In the overall structure of incidence of bundle branch block, right bundle branch block accounts for up to 4.5%, among which the majority of patients are elderly men suffering from coronary heart disease with episodes of acute coronary insufficiency.

Congenital etiological factors in the occurrence of blockade of the right leg of the atrioventricular bundle are anomalies in the development of the sheaths of the His bundle fibers, as well as a violation of the normal position of the vessels. Acquired risk factors are chronic heart diseases accompanied by organic myocardial pathology (ischemic heart disease, hypertensive heart disease with frequent crises, acute myocardial infarction and post-infarction cardiosclerosis).

Clinical manifestations of blockade of the right leg of the atrioventricular bundle are nonspecific and largely characterize the underlying cardiac pathology that provoked the development of the blockade. During the initial examination of the patient, the splitting of the second sound at all auscultation points, caused by asynchronous contraction of the ventricles and non-simultaneous closure of the aortic and pulmonary valves, indicates in favor of blockade of the right bundle branch. In addition to the splitting of the second tone, its intensification during inspiration is noted, since during this period there is a physiological slowdown in the closure of the pulmonary valve leaflets.

When determining treatment tactics for a patient with right branch block of the atrioventricular bundle, it should be based on the presence or absence of acute cardiac pathology. Thus, in case of a blockade that has developed against the background of an acute myocardial infarction, emergency hospitalization of the patient in a cardiology hospital is mandatory. If the blockade of the right bundle branch has developed in a completely healthy young man, then this condition does not require drug treatment, since it rarely provokes complications and has a favorable prognosis for the patient’s life.

In any situation, even with concomitant cardiac pathology, the prognosis for the life of a patient with a block of the right leg is more favorable than that of the left leg of the atrioventricular bundle, since this block almost never transforms into a complete atrioventricular block.

Left bundle branch block

The risk group for the disease of left bundle branch block are elderly women in the age group of 50-70 years, who have been suffering from hypertensive heart disease for a long time. IN at a young age in healthy people this form rhythm disturbances practically do not occur.

An objective examination of patients with left bundle branch block in 90% of cases is accompanied by auscultation of a prolongation of the first sound in combination with a split second sound, caused by uncoordinated contraction of the ventricles, uneven closure of the aortic and pulmonary valves, intensifying during exhalation.

Blockade of electrical impulse conduction along the anterior branch of the left leg of the atrioventricular bundle occurs and progresses in diseases accompanied by an increase in myocardial thickness in the projection of the left ventricle (pathology of the interventricular septum, myocardial infarction, myocarditis infectious origin, congenital and acquired aortic valve defects). As a result of this blockade, the impulse is not transmitted to the side wall, but spreads “from bottom to top.” Thus, excitement occurs first back wall of the left ventricle, and the lateral and anterior walls are excited with a delay.

Blockade of the left leg of the atrioventricular bundle is the main provocateur of the occurrence of complete atrioventricular block, ventricular tachycardia and ventricular fibrillation, which are fatal in 70% of cases, therefore this rhythm disturbance is considered unfavorable for the patient’s life.

Incomplete bundle branch block

In order to assess the mechanism of development of incomplete bundle branch block, the characteristics of the conduction system of the heart should be taken into account. The atrioventricular bundle is wide in size, so conduction disturbance may be observed only in some of the fibers belonging to the right or left bundle branch, and in such a situation, electrocardiography reveals signs of incomplete intraventricular block.

A characteristic difference between incomplete right bundle branch block and complete block is the splitting of the QRS complex in leads V1-2 in the absence of pronounced expansion of this ventricular complex.

The left leg of the atrioventricular bundle has two branches, and therefore, incomplete blockade of this leg means a violation of the movement of the electrical impulse along one of the branches. In order to determine which branch of the left bundle branch is blocked, it is necessary to evaluate the presence of a deviation of the electrical axis of the heart on the ECG in standard lead II (a pronounced leftogram indicates a blockade of the anterior branch, and a deviation of the electrical axis to the right indicates a blockade of the posterior branch).

Clinical manifestations of incomplete bundle branch block are minimal, and an objective examination of the patient does not reveal any auscultatory changes.

Complete bundle branch block

As a result of complete blockade of the right bundle branch, the normal course of systolic excitation of the ventricular myocardium is disrupted. Thus, excitation from the interventricular septum is transmitted only to the cardiac muscle of the left ventricle, and excitation is transmitted to the right ventricle with a delay, since impulse transmission in this case occurs along other pathways (Purkinje fibers).

Such abnormal excitation of the right ventricle is reflected electrocardiographically in the form of expansion of the ventricular complex in leads V1-2 with an unchanged size of the S wave, which reflects the state of excitation of the left ventricle. The delay in impulse transmission to the right ventricle is also reflected when recording an ECG in the form of negativity of the T wave in the right precordial leads.

The main distinguishing criterion for complete blockade of the right bundle branch is an increase in the summation ventricular QRS complex in standard lead II, the value of which is more than 0.12 s.

The pathogenesis of complete blockade of the left bundle branch is similar, that is, excitation from the interventricular septum reaches only the right ventricle, from which the electrical impulse is transmitted through the network of Purkinje fibers to the cardiac muscle of the left ventricle of the heart.

In this situation, all electrocardiographic changes are recorded in the left precordial leads (widening of the summation QRS complex in the second standard lead, discordant depression of the ST segment).

Bundle branch block on ECG

Very often, ECG diagnostics becomes the only effective method of instrumental examination, which makes it possible to draw a conclusion about the presence of bundle branch block already at the patient’s initial visit. There are both general signs changes in the ECG picture, and specific for each form of blockade. Mandatory conditions for deciphering electrocardiography registration are assessment of the width and shape of the QRS complex in all leads, as well as identification of the chest leads in which the QRS complex is split.

Signs of blockade of the superior branch of the left leg of the atrioventricular bundle are:

Criteria for deviation of the electrical axis to the left by at least 45%;

Widening of the QRS complex is about 0.9-0.11 s;

The presence of specific ventricular complexes of the qR, rS/r type in standard leads;

In the chest leads, the amplitude R decreases and the depth S increases.

The blockade of the posterior inferior branch of the left bundle branch is characterized by the following ECG signs of impulse conduction disturbance:

Increased amplitude of the R wave in lead III compared to lead II, which indicates sharp deviation electrical axis of the heart by more than 90%;

Slight expansion of the QRS complex (no more than 0.11 s);

The width of the Q wave in leads III and aVF is less than 0.04 s;

The presence of a deep S wave in leads I and aVL with the formation of the rS wave.

Complete blockade of the left bundle branch is characterized by more significant changes in ECG registration:

Sharp expansion of the QRS complex for more than 0.12 s;

Complete absence of S and Q waves in leads I, aVL and V6 with simultaneous expansion of the R wave with a jagged apex;

Formation of the rS and QS complex in leads III, aVF and V2;

Determination of oblique depression of the T wave and ST segment and the dominant R wave in leads I, aVL and V6 with discordant oblique elevation of the ST segment in leads V1-2.

The only difference between incomplete blockade and complete blockade is mild changes in the ST segment and a slight widening of the QRS complex.

Diagnostic electrocardiographic criteria for complete right bundle branch block are:

QRS complex widened to 0.12 s;

Registration in leads V1-2, aVF and III of the ventricular complex type rSR;

Widening of the S wave and its prevalence over the width of the R wave in leads aVL, I and V6;

Double-bundle blockades have their own characteristic electrocardiographic changes caused by impaired impulse conduction along each of the His bundles.

With a two-fascicle blockade of the anterior branch of the left leg and the right leg of the atrioventricular bundle, the following electrocardiographic signs are observed:

Sharp left-side deviation of the electrical axis;

Oblique depression of the ST segment in leads V1-2 with simultaneous negation of the T wave with the formation of a ventricular complex of the rSR type;

Increase in the depth of the S wave in leads II, III and aVF with the formation of the rS complex.

Localization of the blockade in the posteroinferior branch of the left leg and right leg is also accompanied by combined characteristic changes in ECG recording:

Sharp right-side deviation of the electrical axis;

Widening of the QRS complex by more than 0.12 s;

ST segment depression in leads V1-2 with simultaneous T wave negativity;

The depth of the S wave is greater than the depth of the R wave in leads aVL and I.

When deciphering the ECG registration, you should carefully evaluate the identified changes and compare them with those present in the patient clinical symptoms, since in some cases, double bundle branch block can simulate ECG signs of acute transmurral myocardial infarction.

Treatment of bundle branch block

Due to the fact that in most cases, blockade of the atrioventricular bundle branches is an accidental finding during electrocardiography and is not accompanied by gross organic damage to the heart muscle, specific drug and surgical treatment there is no such pathology.

People who have signs of blockade of one of the bundle branches, especially those occurring in intermittent form, are recommended to perform simple rules during an attack, thereby helping to eliminate an attack of partial intraventricular block:

It is necessary to completely eliminate physical activity during an attack, and, if possible, take a horizontal position for a few minutes;

It is recommended to perform simple breathing exercises with alternating deep inhalation and exhalation, as well as holding your breath during the “exhalation” phase. This exercise allows you to eliminate the signs of blockade after a few minutes.

As preventive measures to reduce the number of blockade attacks, as well as to prevent its transformation into a more life-threatening atrioventricular block, it is recommended to follow a certain number of rules regarding diet and diet:

Mandatory daily night sleep of at least eight hours;

Correction of eating behavior with the exclusion of foods containing cholesterol and daily use high fiber foods;

Annual visit to a cardiologist and undergoing control electrocardiographic and ultrasound examinations.

Etiopathogenetic therapy is used only in cases of reliably established background organic pathology of the cardiovascular system, which not only acts as a provocateur of blockade of impulse transmission along the His bundles, but also significantly affects the prognosis and outcome of the disease.

Pathologies such as acute coronary syndrome, transmurral myocardial infarction, pulmonary embolism and hypertensive crisis with accompanying signs of bundle branch block are justification for hospitalization in a hospital for high-quality diagnosis and the appointment of an adequate treatment regimen.

In a situation where bundle branch block occurs against the background of high blood pressure, it is recommended to use antihypertensive drugs of combined action to reduce the load on the myocardium (Captopres at a dose of 25 mg once and then switch to a maintenance dosage of 12.5 mg in the morning daily).

As a preventative measure for further organic damage to the myocardium, as well as for the purpose of improving the conduction function of the heart muscle, in patients with atrioventricular bundle branch block, it is advisable to use a course of medications that improve metabolic processes in the myocardium (Mildronate in a daily dose of 0.5 g, Riboxin 200 mg 3 times a day, Trimetazidine in a daily dose of 40 g), lasting at least 1.5 months.

Prescription of drug treatment is possible only if the occurrence of bundle branch block is excluded while taking medications (the so-called “medicinal form” of the block).

No less effective in this situation are considered traditional medicine that has a cardioprotective and calming effect (alcohol tincture of hawthorn fruits and lily of the valley flowers, 10 drops in the morning).

The surgical method of treating bundle branch block is used only in the case of a malignant progressive course with frequent attacks of Morgani-Adams-Stokes and the risk of complete atrioventricular block and involves the implantation of a pacemaker as an artificial heart rhythm generator.

Left bundle branch block

Cardiomyopathy

· Direct or indirect cardiac trauma (for example, being hit by a car or puncture of the heart with a needle)

Neoplasia (tumor)

Subvalvular aortic stenosis

Ischemic cardiomyopathy (eg, coronary arteriosclerosis, myocardial infarction, and myocardial hypertrophy that obstruct the coronary arteries)

ECG characteristics

QRS prolonged - dogs, > 0.08 sec, cats, > 0.06 sec

QRS wide and positive in leads I, II, III, and aVF

PATHOPHYSIOLOGY

· Because the left bundle branch is relatively thick and long, the lesions caused by the block are wide-ranging.

SUSCEPTIBILITY: Cats and dogs

History data

· Usually detected incidentally during an ECG study - does not cause hemodynamic abnormalities

· Signs are usually accompanied by an underlying pathological condition

General Clinical Study Data

Does not cause clinical signs or hemodynamic disturbances.

DIFFERENTIAL DIAGNOSIS

Enlarged left ventricle

· Neither left ventricular enlargement on chest x-ray nor cardiac ultrasound findings support the diagnosis of isolated left bundle branch block.

· Can also be confused with ventricular ectopic contractions, however the PR interval is usually constant and left bundle branch block does not cause a pulse deficit.

VISUALIZATION

· Echocardiography can detect structural heart disease; the absence of left heart enlargement supports the diagnosis of left bundle branch block.

· X-rays of the chest and abdomen may reveal masses or metastatic lesions in the lungs; Traumatic injuries may result in localized or diffuse pulmonary consolidation.

DIAGNOSTIC TESTS

· Electrocardiography (ECG)

· Long-term ambulatory monitoring (Holter) may reveal intermittent left bundle branch block.

PATHOLOGICAL CHANGES

Possible lesions or scratches on the endocardial surface of the fascicle pedicle; Applying a solution of Lugol iodine on the endocardial surface within 2 hours postmortem allows clear visualization of the conduction system.

TREATMENT, DEVELOPMENT AND PROGNOSIS

HOSPITAL CARE: Mostly not necessary

PHYSICAL ACTIVITY: Without restrictions, except in cases where treatment of the underlying causes of the pathological condition is required.

DIET: Does not require restrictions, except in cases where treatment of the underlying causes of the pathological condition is required.

TRAINING (INFORMING) OF THE CLIENT

· Blockade of the left bundle branch does not, in theory, cause hemodynamic abnormalities.

· The lesions causing the block may progress and lead to more severe arrhythmias or complete heart block.

MEDICATIONS OF CHOICE: are not needed, except in cases where treatment of the underlying causes of the pathological condition is required.

PATIENT MONITORING

Serial ECG may reveal recovery or progression to complete heart block.

POSSIBLE COMPLICATIONS

· Etiological lesions may progress and lead to more severe arrhythmias or complete heart block.

· First- or second-degree AV block may be indicative of right bundle branch involvement.

EXPECTED DEVELOPMENT AND FORECAST

Without hemodynamic disturbances

· Atrioventricular block, Complete (Third-Degree)

Left bundle branch block

Left bundle branch block(LBBB) is a partial or complete failure of electrical impulses from the atria to the ventricles through the left bundle branch. In early childhood, this disease is extremely rare (0.005%), under the age of 40 is also rare (0.03-0.13%), and in 90% of cases, blockade of the left bundle branch occurs after the age of 50. LBBB occurs most often in women.

The His bundle is a section of the heart muscle that is responsible for conducting electrical impulses from the right atrium to the ventricular myocardium. The bundle of His consists of a trunk that is located between the cardiac ventricles.

Three legs diverge towards the right and left ventricles. If for some reason the impulse transmission is disrupted, a block of the bundle branches occurs.

Characteristics of the disease

Few people have any idea what a bundle of His is. The bundle of His causes the ventricles to contract in rhythm with the atria. It contains:

• Left leg;
• right front leg;
• right hind leg.

At the end, the legs break up into small elements called Purkinje bundles.

Heart blockage may be asymptomatic. Blockades are divided into several types:

• single-beam;
• two-bundle;
• three-bundle.

The disease occurs in full and partial form.

The incomplete version is characterized by slow transmission of the impulse; if a complete blockade is diagnosed, the impulse is not completely transmitted.

Impaired impulse patency is usually caused by concomitant diseases or is one of the symptoms of cardiac pathology.

The risk group includes people over 60 years of age, most often men. The older a person is, the higher the risk of developing the disease.

Incomplete blockade of the right leg

With incomplete blocking, impulse conduction is disrupted in only one leg. The impulse is carried out in a slow rhythm.

Incomplete blockade of the right bundle branch is a partial failure in the conduction of electrical impulses to cardiac ventricle. The disease does not have pronounced symptoms, however, in some cases it is dangerous and complicates the course of the underlying disease.

If the cause of the pathological phenomena is the His bundle, the blockade of the right bundle branch can be recorded on an electrocardiogram. Sometimes during an attack the patient experiences shortness of breath and dizziness.

Causes of incomplete right blockade

PNH blockade occurs for various reasons. They can be congenital or acquired.

Congenital causes include:

• congenital heart defects;
• damage to the interatrial septum;
• violations of the interventricular septum;
• cardiac conduction disorders in childhood;
• pulmonary vascular stenosis;
• disturbances in the development of the right bundle branch of His.

Acquired factors are:

• pathologies in the myocardium;
• drug overdose;
• excess potassium in the blood;
• muscular dystrophy, progressive;
• closed sternum injury;
• neoplasms in the heart;
• obstructive pulmonary diseases.

Incomplete heart block does not pose a serious threat to human health. But only if there are no concomitant serious diseases. Partial blockade never develops into a complete form. The course of some diseases can provoke blockade, such diseases include:

• cardiac ischemia;
• myocardial infarction;
• rheumatism;
• cardiac muscle hypertrophy;
• bronchial asthma accompanied by respiratory failure;
• thromboembolism of coronary vessels;
• emphysema;
• Chronical bronchitis.

Symptoms of incomplete right blockade

Right heart branch block is asymptomatic. Most often, the signs of blockade are mild. If clear symptoms appear, this means that the patient has concomitant diseases.

In this case, the following clinical manifestations are possible:

• heartache;
• dyspnea;
• heart rhythm disturbance;
• increased fatigue.

If the pathologies listed above are absent, then the blockade is not classified as a separate disease and is considered a manifestation of the norm and is considered in this case as a feature of the function of the autonomic nervous system, which has transitory nature. In any case, regular monitoring by a doctor is required.

Diagnostics

Incomplete right heart block in most cases is regarded as physiological norm. In special cases, pathology requires special attention. Before a diagnosis can be made, a diagnostic test will be required.

It includes the following procedures:

• blood chemistry;
• clinical blood test;
• daily mounting of ECG;
• echocardiography;
• magnetic resonance imaging.

Only based on the results of the data obtained, the doctor will be able to make a final diagnosis.

Treatment of right incomplete blockade

If RBBB is accompanied by cardiac pathologies, then the course of treatment prescribed by the doctor is usually carried out in the following direction:

• strengthening the body with vitamins B1, B2, PP;
• taking sedatives;
• medications aimed at stabilizing blood pressure;
• blood thinners;
• drugs that lower blood cholesterol;
• in the presence of heart failure, take diuretics and glycosides.

If no accompanying pathologies not present, no medication needed. It is advisable to work on strengthening the body and reducing stress, both physical and emotional. Don't forget about regular walks in the fresh air.

Complete right bundle branch block

Complete blocking of the right leg occurs in cases where the electrical impulse ceases to be conducted to the right ventricle. The cause of its occurrence in most cases is an enlargement of the right ventricle; such a pathology is possible in the presence of a heart defect, which complicates the course of the disease.

Complete blockade is diagnosed on an ECG. The disease does not have characteristic symptoms, but in some cases the patient may complain of a slight deterioration in health.

Pathology may develop as a result of previous infectious diseases, such as influenza, sore throat, scarlet fever, measles. Such disorders can also occur in children. In this case, the disease requires attention from doctors.

P The cause of complete right blockade may be heart disease. These include:

• heart attack;
• cardiac ischemia;
• hypertension;
• pathologies in the interventricular and interatrial septa;
• chronic pulmonary diseases;
• Congenital heart defect.

Blockades of the right leg of His are not dangerous, but against their background ventricular arrhythmia and other heart diseases can develop. Therefore, it is necessary to undergo regular examinations and do an ECG annually.

Treatment of complete blockade

Complete RBBB is diagnosed using ECG and ultrasound results. The disease can also be determined by listening to the heart, since there is a disturbance in the rhythm of heart sounds. Treatment of the disease is carried out only as prescribed by a doctor in the presence of a concomitant disease.

The nature of therapy depends on the complexity of the concomitant disease. If a complete blockade has pronounced symptoms, doctors prescribe:

• complex of vitamins;
• antioxidants (preductal, ubiquinone);
• antianginal drug for coronary heart disease (nitroglycerin);
• antihypertensive drugs in the presence of hypertension (Losartan, Valsartan)
• mild sedatives for additional support;
• anticholinergic drugs;
• diuretics for heart failure;
• cardiac glycosides if there is heart failure.

Vitamin therapy is necessary for both complete and partial blockade.

With their help, it is possible to restore the conductivity of the impulse. Typically the vitamin complex includes:

• thiamine;
• a nicotinic acid;
• riboflavin.

Antioxidants help restore tissue; these drugs promote the release of breakdown products.

If a complete blockade is combined with a left-sided blockade, then the only salvation is the implantation of an electrical stimulator.

Complications

In most cases, right bundle branch block does not pose the same danger as left bundle branch block. And yet, the disease can have consequences

Ventricular tachycardia may develop as a complication. The disease is manifested by an acceleration of the heartbeat, which in some cases reaches 120 beats per minute. The disease can cause serious consequences.

There is also a risk of ventricular fibrillation. This serious disease, if left untreated, is fatal. Chronic heart failure can also develop as a complication.

To avoid serious consequences, it is necessary to undergo regular examination and treat existing diseases. It is important to adjust your diet and remove all foods that are harmful to heart health from the menu.

Heart blocks are serious diseases that cause disruption of the conduction of heart impulses. For example, bundle branch block is associated with a pathology in the conduction of electrical signals through the myocardium of the heart, or more precisely, through the part of the conduction system responsible for contraction of the ventricles. The result of the development of pathology is a violation of the sequence, strength, speed of excitation, and contraction of the heart. In severe cases, there may be no contraction of any part of the myocardium at all, which can have unpleasant and even fatal consequences.

Features of the disease

The branch of His, or rather the bundle branches, is an element of the cardiac conduction system that is responsible for conducting excitation impulses in the ventricles. There are three legs of the heart (bundle of His) - the left, right anterior legs and one back. The last part of the bundle of His is thicker than the rest and is a continuation of the trunk of the bundle of His, and the left and right legs are its branches. There is a network of anastomoses between the branches of the bundle branches. The entire bundle of His consists of atypical muscle fibers. The end of the legs in the area of ​​the right and left ventricles breaks up into the smallest elements of the conduction system - Purkinje fibers.

The main function of the His bundle is to transmit impulses from the right atrium to the ventricles of the heart, which begin to contract in the rhythm of the atria. For any reason, children and adults may experience partial or complete disruption of impulse conduction at the level of one or two legs. In cardiology, such heart diseases are called bundle branch block (BBB). Pathologies often do not manifest themselves clinically, but are diagnosed in 6 people out of 1000 people. With age, the incidence of the disease increases, and after 55 years of age, blockades occur in 20 people out of 1000, more often in men.

The classification of the disease according to the degree of disruption of the conduction of excitation impulses into the ventricles is as follows:

1. Incomplete blockade of the His bundle (slowing of impulse transmission).
2. Complete blockade of the His bundle (complete cessation of impulse transmission).

In addition, the following types of blockades are distinguished:

1. Single-bundle - covers the right leg, or represents a blockade of the posterior or anterior branch of the left leg.
2. Double-fascicular - affects both branches of the left leg or includes a blockade of the right leg coupled with damage to one branch of the left leg.
3. Three-bundle - the right and left legs are blocked.

According to the type of development of RBBB it can be:

• intermittent (appears and disappears during the recording of one ECG study);
• constant (always present on the ECG);
• transient (not recorded on all ECGs);
• alternating (can change location, that is, appear in the area of ​​different legs).

Causes of bundle branch block

Signs of pathology can appear in children from birth, and in this case they can be provoked by congenital diseases:

• defect of the interventricular and interatrial septum;
• underdevelopment of a segment of the right bundle branch;
• stenosis of the pulmonary artery;
• coarctation of the aorta;
• other heart defects that cause overload of the right ventricle.

In childhood, incomplete single-bundle blockades can be considered a normal variant if they are not accompanied by organic heart damage. Thus, in many children, incomplete blockade of the right bundle branch is detected, combined with minor cardiac anomalies - additional chord, mitral valve prolapse, etc. Blockade of the left leg is more often provoked by acquired diseases and is often also considered a variant of the norm.

Among the cardiac causes that can cause RBBB, doctors name the following:

• acute and chronic heart failure;
• myocarditis of viral, bacterial origin;
• rheumatism of the heart;
• endocarditis;
• various cardiomyopathies;
• cardiosclerosis;
• heart tumors, metastatic heart lesions;
• chest injuries;
• surgical interventions on the heart, coronary vessels;
• autoimmune pathologies that affect the heart muscle;
• severe arterial hypertension or long-term hypertension;
• myocardial infarction.

There are other reasons that can lead to partial or complete blocks of the bundle branches, including transient ones:

• chronic diseases of the respiratory system, accompanied by obstructive processes, for example, bronchial asthma, emphysema, cor pulmonale, chronic bronchitis;
• pulmonary embolism;
• progressive muscular dystrophy;
• hyperkalemia, as well as other electrolyte disturbances - disruptions in the balance of magnesium and sodium;
• overdose of certain drugs - cardiac glycosides, diuretics, antiarrhythmics, etc.;
• long history of smoking;
• alcoholism;
• dysfunction of the autonomic nervous system;
• diseases of the adrenal glands, thyroid gland;
• diabetes;
• severe anemia.

In the absence of obvious causes, after the diagnosis, an idiopathic bundle branch block may be established.

Symptoms of manifestation

Many clinical cases of RBBB occur without any symptoms. Incomplete single-fascicle blocks almost never show symptoms, so they are detected only by ECG during a routine examination. But with complete blockade of the right leg, symptoms are usually observed in a person even in the absence of organic heart damage. These include:

• various changes when listening to heart sounds;
• dizziness;
• presyncope and fainting;
• feeling of lack of air;
• dyspnea;
• decreased performance;
• poor exercise tolerance;
• fatigue and weakness;
• sometimes - pain in the heart area;
• feeling of interruptions in the work of the heart.

In addition, a clinical picture may appear that corresponds to the underlying disease - both cardiac and affecting other organs and systems. The most serious symptoms appear in acute cardiac pathologies - heart failure, myocardial infarction, which are most often accompanied by various heart blocks against the background of damage to the ventricular myocardium.

Danger and consequences

The prognosis for this disease is difficult to predict, since, in fact, it is a symptom of other pathologies. If the patient has an incomplete single-fascicular block without cardiac or pulmonary disease, the prognosis is good. With regard to the presence of organic heart lesions, the prognosis depends entirely on the underlying pathology. As for the danger of BBBB, unpleasant consequences, as a rule, occur with complete blockades. They lead to progressive hemodynamic disorders, which can cause the following complications:

• stroke - acute ischemia of a part of the brain due to cessation of blood circulation in it;
• chronic heart failure - dysfunction of the heart, leading to malfunctions of the whole body;
• worsening of the underlying heart disease;
• the appearance of thrombosis and thromboembolism due to blood thickening.

Complete RBBB is dangerous - with age, if left untreated, it can lead to the development of severe types of arrhythmias - paroxysmal ventricular tachycardia, ventricular fibrillation, which end in cardiac arrest (the likelihood of death is highest with three-fascicular block).

Pulmonary embolism and ischemic stroke can also lead to death. On average, mortality when blockade develops against the background of a heart attack is 50% in the first days of the pathology. Such consequences can only be prevented by an early start of examination and treatment, compliance with all doctor’s prescriptions, and getting rid of or correcting underlying diseases of the heart and blood vessels.

Diagnosis of pathology

Even a therapist, when listening to the heart, can note a change in rhythm, a disturbance in heart rate. This should be a reason to perform further, more detailed examination to find the cause and type of heart block. The main diagnostic method is an ECG, which can be used to draw a conclusion about the form of RBBB (the most common types of blockades are presented below):

1. Blockade of the anterior branch of the left LES. There is a high R wave, a deep S wave, and a deviation of the QRS vector up to the left.
2. Blockade of the posterior branch of the left LES. The QRS vector is directed upward, to the right and forward, there is a high R wave, a deep S wave. Both types of blockades can be accompanied by acute heart failure, myocardial infarction, which should not be forgotten when obtaining such examination results.
3. Blockade of the right LES. There is a tall, wide R wave, a widened S wave, and increased amplitude. The ventricular QRS complex takes the form qRS or rSR and widens to 0.12 seconds. and more. In addition to acquired causes (anterior myocardial infarction, ischemic heart disease), this variant of the development of the disease is characteristic of congenital heart defects and other diseases.
4. Blockade of the left LES. The EOS deviates to the left or is located horizontally. The QRS is shaped like a widened R wave with a jagged or flattened apex. The width of the ventricular QRS complex is greater than 0.12 seconds or equal to this indicator. The condition is typical for arterial hypertension, acute myocardial infarction (less commonly), aortic heart defects.
5. Double bundle block (blockade of the right leg and left anterior branch). The QRS complex is widened over 0.12 seconds, the T segment is negative, and the RS-T segment is shifted downward, the EOS is deviated to the left. This change is most typical for ischemic heart disease and other myocardial pathologies.

After identifying these abnormalities in the ECG, the patient is recommended to perform other examinations that will help to detail the information and establish the correct diagnosis:

1. Blood and urine tests to assess electrolyte balance, hormone levels, indicators of autoimmune processes, etc.
2. Daily ECG monitoring to identify unstable atrial conduction disturbances, type of arrhythmias, assess the severity of blockades, search for nocturnal or stress blockades.
3. Ultrasound of the heart to determine the cardiac causes of heart block, especially organic heart lesions.
4. EFI to clarify data about the disease when ECG or Holter monitoring does not allow making an unambiguous diagnosis.

Treatment options

For incomplete single-bundle blocks, as a rule, no treatment is required. If there are no cardiac causes for such disorders, then they are unlikely to progress or be aggravated by other pathologies. Such RBBB almost never develop into complete blockades and do not threaten life. Occasionally, especially against the background of hypertension, progression of right leg block and second or third degree AV block is possible. When such processes begin, the doctor always prescribes preventive drug therapy.

The same should be done for more serious types of blockades. A set of medications is selected from the medications and is carried out in courses. Treatment of the underlying disease is also mandatory. In general, drug treatment for blockades may include the following drugs:

1. Vitamins in injections - thiamine, riboflavin, nicotinic acid and others.
2. Sedatives - motherwort, valerian.
3. Antioxidants - Mexidol, Preductal, Carnitine.
4. Drugs for high blood pressure from different groups (calcium channel blockers, ACE inhibitors, beta blockers, etc.) - Betaloc, Valsartan, Verapamil, Amlodipine.
5. Drugs against cardiac ischemia, mainly nitrates - Nitroglycerin, Cardiket.
6. Medicines for high cholesterol - Rosuvastin, Simvastatin.
7. Cardiac glycosides and diuretics for heart failure - Digoxin, Lasix.
8. Antiplatelet agents against thrombosis - Cardiomagnyl, Aspirin-Cardio.
9. Medicines against chronic pulmonary obstruction - Pulmicort, Berodual, Beclazon.

Currently, several types of surgical interventions have been developed, which are most often recommended for patients with complete blockade of one branch, or with two- or three-bundle blockades. The most commonly used technique is implantation of an electrical pacemaker, including a temporary one (for a heart attack and other acute conditions). For some types of conduction disorders, the method of radiofrequency catheter ablation helps. Some patients should also have a cardioverter-defibrillator installed, for example, with a three-fascicular block combined with a complete ventricular-atrial block.

In general, a person with blockades without manifestations can lead a normal life, but should immediately give up excessive physical activity, get more rest, and avoid prolonged stress. Nutrition must be correct, without an abundance of salt and animal fats and sugar. You should give up bad habits, especially smoking. After having a pacemaker installed, a person should initially visit a cardiologist once every three months, and then once every six months and a year. Some people use folk remedies against heart block. By agreement with the doctor, the following prescriptions from the section of alternative medicine are allowed:

1. Combine equal amounts of valerian root, rose hips, dandelion roots, calamus roots, and grind everything in a coffee grinder. Take a teaspoon of reset, pour 300 ml of boiling water. Drink 100 ml three times a day for 1 month.
2. Combine pharmaceutical alcohol tinctures of hawthorn (50 ml), valerian (30 ml), motherwort (40 ml), calendula (20 ml), peony (80 ml), mint (20 ml). Take 10 drops three times a day after diluting in water for a course of 1 month. With a strong decrease in pressure, the dose is reduced to 5-7 drops.

Preventive measures

To prevent illness, the following measures are important:

• rest more, get enough sleep;
• eliminate stress and overwork;
• observe the work and rest regime;
• eat only healthy foods, consume more plant fiber;
• give up cigarettes and alcohol;
• take all medications only in recommended doses and under the supervision of a physician;
• treat all heart diseases early.

When reading an electrocardiogram, patients often see the conclusion “left bundle branch block.” This diagnosis raises many questions and concerns. What is this cardiac structure? Why is its blockade dangerous and how to recognize its occurrence? In this article we will try in detail and as much as possible in simple language disassemble the syndrome of blockade of this heart element.

Myocardial contractions are carried out due to the conduction system of the heart. This is a collection of special cardiomyocytes in which excitation occurs and fibers through which impulses are carried to all structures of the heart.

The first wave of excitation, which sets the basic rhythm of the heart, is generated by the sinus node located at the apex of the right atrium. The impulse passes through the atrial myocardium, causing it to contract, as well as through the three internodal tracts to the atrioventricular node. It is localized in the interatrial septum and is responsible for the spread of excitation through the ventricles. The electrical impulse from the AV node reaches the myocardium along the fibers of the His bundle. Its trunk breaks up at the very beginning of the interventricular septum into two legs - right and left, extending to the corresponding parts of the ventricular myocardium. The left leg in the thickness of the cardiac muscles is divided into anterior and posterior branches. The bundle of His ends in numerous branches - Purkinje fibers, which penetrate the muscular wall of the ventricles.

Thus, the His bundle is a fragment of the conduction system of the heart, responsible for the propagation of electrical impulses and contraction of the ventricles. Impaired conduction along its trunk or individual branches is called a blockade. In the International Classification of Diseases, Tenth Revision, LBBB are in section I44 (ICD-10 code I44.4 – I44.7)

Types of blockades

The level of damage is determined by the section of the bundle in which excitation from the AV node ceases. The following types of His bundle block are distinguished:

Any of the 3 types of blockades can be complete (conduction is completely interrupted) or partial (conduction is slowed down). This is reflected in characteristic changes on the ECG. In addition, the following types of His bundle block are recorded on the cardiogram:

• constant – ECG signs of conduction disturbances in the beam are displayed constantly;
• intermittent - the blockade appears and disappears while recording the cardiogram;
• transient - changes are not recorded with every ECG recording;
• alternating – during ECG recording different types blockades replace each other.

Common causes of LBP blockades

Conduction disturbances in the His bundle fibers can occur due to both cardiac and noncardiac causes. Diseases of the cardiovascular system in which this syndrome may occur are:

Extracardiac causes of blockades are diseases in which secondary damage to the ventricular myocardium occurs (hypertrophy, dystrophic transformation). These include:

Block of the anterior branch of the left bundle branch

If the passage of the impulse through the left anterior branch of the PG is disrupted, the excitation does not reach the anterolateral wall of the left ventricle. Blockade of the anterior branch of the left bundle branch occurs when:

• anterior or anterolateral acute myocardial infarction;
• pronounced expansion of the walls of the left ventricle due to hypertension, heart valve defects;
• myocarditis of rheumatic and infectious origin;
• cardiomyopathy.

Block of the posterior branch of the left bundle branch

Less common than lesions of the anterior branch. The electrical impulse does not propagate to the posteroinferior portion of the LV. Blockade of the posterior branch of the LBP occurs when:

Incomplete left bundle branch block

It manifests itself as a slowdown in conduction along both branches of the LPN. In this case, the left ventricle is excited more slowly than the right. Causes:

• arterial hypertension;
• myocardial infarction;
• congenital and acquired aortic valve defects;
• cardiosclerosis.

Complete left bundle branch block

Conduction along the main trunk of the left bundle branch completely ceases. The excitation of the right ventricle and the right half of the interventricular septum is not changed, the left ventricle is excited after them by impulses passing through the contractile fibers. The reasons are the same as for incomplete blockade of the LN of the His bundle. In this case, damage to the muscular lining of the heart is more extensive.

Symptoms

The clinical picture of conduction disorders along the left bundle branch varies depending on the level of the lesion. If the impulse does not pass through one of the branches (anterior or posterior), there may be no symptoms at all, or complaints will be about manifestations of the underlying disease that caused the blockade. Often, single- and double-fascicular blockades are detected only during an ECG. Their occurrence does not affect the patient’s quality of life and health.

Complete blockade common trunk LBP is manifested by a feeling of palpitations, pain behind the sternum, radiating to the neck, epigastrium, left hand. But the symptoms of diseases that have led to extensive damage to the conduction system of the heart (myocardial infarction, myocarditis, arterial hypertension, heart defects) come to the fore.

With complete or partial disruption of impulse transmission along all branches of the His bundle (three-bundle block), the clinical manifestations are more pronounced. The main signs of the syndrome are:

The occurrence of LBBB symptoms cannot be ignored. It can lead to dangerous cardiac arrhythmias, including ventricular fibrillation and asystole - sudden cardiac death.

Diagnostics

The “gold standard” for diagnosing bundle block is electrocardiography. Often, signs of impaired conduction are recorded on the cardiogram even before clinical manifestations occur. To determine the type and dynamic monitoring of the manifestations of the blockade, daily ECG monitoring (Holter monitoring) is performed.

Ultrasound of the heart (ECHO-CG), Doppler study coronary vessels, blood pressure monitoring, transesophageal ECG, determination of biochemical markers of myocardial damage – additional methods diagnostics of LBBB, determining the main cause of the syndrome.

Signs of blockade on the ECG

To detect ECG signs of various LBP blockades, pay attention to changes in the ventricular complex (Q, R, S waves) in the left leads and the position of the electrical axis of the heart.

Signs of LBBB on ECG

When the left posterior branch is blocked, the ventricular complex is deformed. In the first standard and AVL leads, it takes the form of r S - the low-amplitude R wave turns into a deep S wave in the absence of the Q wave. In the third standard and AVF leads, there is no S wave in the complex, and the shallow Q is replaced by a high-amplitude R (q R complex). The highest R is recorded in lead III, i.e. the electrical axis of the heart is shifted to the right.

Conduction disturbances along the left anterior branch are reflected on the cardiogram by the following changes:

• q R complex in leads I, AVL;
• r S complex in leads II-III, AVF;
• deviation of the EOS to the left – high-amplitude R in the first standard lead.

With incomplete LBBB, the duration of the ventricular complex is extended to 0.1-0.11 s. Splitting of the R wave is recorded in the first standard, fifth-sixth chest and AVL leads. An extended, deep S can be found in the first and second chest leads, the third standard lead and the reinforced one from the left leg. The electrical axis is not displaced.

With complete blockade, the deformations of the teeth are more pronounced than with incomplete blockade. In the same leads, the R wave takes the shape of the letter M, and the S wave becomes like a “goat’s leg”. The ventricular complex lasts more than 0.12 s. Sometimes the EOS deviation to the left is recorded on the cardiogram.

Treatment

Single-bundle or incomplete double-bundle LBBB does not require treatment. They do not lead to serious complications. The presence of its ECG signs in a child before adolescence can be considered a normal variant if organic myocardial damage is excluded.

With a complete blockade, treatment of the underlying cause of the syndrome is required. The following types of medications are often prescribed:

Three-fascicle blockade, which turns into a conduction disorder of the AV node with the development of Morgagni-Adams-Stokes syndrome, requires surgical intervention. The patient is implanted with an artificial pacemaker for permanent cardiac pacing.

Folk remedies are ineffective for the development of LBBB. Herbal mixtures containing herbs with pronounced sedative effect(valerian, peppermint, motherwort, hawthorn). However, traditional medicine recipes can only be used as a complement to traditional therapy prescribed by a doctor.

Danger and complications

Detection of His bundle block – is it dangerous?

Partial disruption of conduction along individual branches of the LPNH does not cause any dangerous consequences in the absence of other pathologies of the cardiovascular system. She doesn't need to be treated. It is recommended to undergo an ECG annually for dynamic monitoring of heart function. The prognosis for life and health is favorable. Such cardiac conduction disorders are not a criterion for deferring military service or for not being allowed to perform work associated with active physical activity.

Complete block of the left bundle branch or three-bundle block is a life-threatening condition. If not properly treated, they can be fatal. Most frequent complications PBLBB are asystole (cessation of cardiac activity), ventricular fibrillation, attacks of paroxysmal tachycardia.

Prevention

Prevention of the development and progression of LBBB is similar to recommendations for the prevention of all cardiovascular diseases. Its main points are:

• Active lifestyle.
• Weight control.
• Quitting alcohol and smoking.
• Elimination of stress, rational work and rest regime.
• Use table salt in a daily dose of no more than 5 g/day.
• Regular passage preventive examinations and ECG.