Complete blockade of the left leg of the bundle of gis treatment with folk remedies. Blockade of the right and left legs of the His bundle: causes, symptoms and treatment

Incomplete blockade of the right bundle branch of His is a fairly common problem. It can be detected during electrocardiography. The problem arises under the influence of congenital or acquired pathologies and requires timely diagnosis. This will avoid worsening the condition.

The contraction of the muscles of the heart is provided by the conduction system. It consists of sinus and atrioventricular nodes, bundle of His and Purkinje fibers.

The bundle of His consists of the right and left legs. They provide the promotion of electrical signals to the tissues of the ventricles. If a blockade is diagnosed, this indicates that the signals do not pass through it completely or do not arrive at all.

In this case, excitation normally passes only along the left leg, which contributes to the depolarization of the ventricles.

If a partial blockade develops, then the electrical signal is not transmitted along one leg. This condition does not pose a danger to the life of the patient. The conduction of the heart in this situation slows down. Similar processes can be detected in people who do not have health problems. Therefore, the problem is often considered as a variant of the norm.

A great danger is the violation of the conduction of the impulse along the left leg, as this contributes to heart failure.

Pathology is most often diagnosed in men. Older women are more likely to suffer from blockade of the left leg.

Often the conduction of impulses slows down in childhood. If there are no pathologies of the heart, respiratory and circulatory systems, then this condition is not dangerous.

Although the disease most often proceeds without the slightest manifestations, it gradually disrupts the work of the ventricles.

Causes

Incomplete blockade of the right leg can occur under the influence of many diseases. Most scientists are inclined to think that such disorders are not associated with a hereditary predisposition. Although in the presence of pathologies of the heart and blood vessels in close relatives, the likelihood of their development increases significantly.

Violation of conduction on the right leg occurs in different cases:

with ischemic disorders in the heart;
as a result of tumor processes;
with anomalies in the development of the body;
with inflammatory processes in the endocardium or myocardium;
if one pulmonary artery is clogged;
with cardiosclerosis;
if a prolonged course of hypertension has led to an increase in the heart;
with pathologies in the respiratory system that led to the appearance of cor pulmonale;
after a heart attack;
under the influence of bad habits;
with constant emotional stress.

The electrical impulse is transmitted more slowly than it should if the person has taken large doses.

Incomplete blockade of the right leg of His occurs if the vagus nerve is in an overexcited state. This happens when a person is subjected to excessive physical activity.

Blockades also develop if surgical treatment of heart diseases was performed.

Symptoms

Most often, when the electrical signal does not completely pass through the right leg, the person does not notice any symptoms. Determine the problems in the process of the planned passage of electrocardiography.

Patients may feel signs of an underlying pathology that has impaired cardiac conduction. Wherein:

having difficulty breathing;
soreness periodically appears in the chest;
the rhythm of contractions of the heart is disturbed.

Therefore, such diseases should be treated in time.

But, if the signal is blocked completely:

When such violations appear, it should be urgently examined, as this can occur with dangerous chronic diseases.

Although with incomplete blockade, healthy people do not need specific therapy, since this condition is considered quite normal.

Establishing diagnosis

If diagnostic procedures are not carried out, then the appropriate treatment option cannot be selected. Complete or even partial disruption of the electrical signal progression leads to a decrease in the number of ventricular contractions. To confirm such changes, electrocardiography is performed and the blood is examined for hormones.

Incomplete blockade of the right leg of the His bundle on the ECG is manifested by a slow passage of an electrical signal. In this case, there is a tooth showing atrial contractions, but a tooth characteristic of ventricular contraction is absent. This disorder is characterized by the appearance of small notches on the S wave and changes appear on the right.

If a person suffers from partial obstruction, then the QRS complex has a normal duration, but sometimes reaches 1.1 seconds.

To identify pathological conditions that can disrupt the progress of the impulse, the patient must additionally undergo procedures in the form of:

Various pathologies of the heart muscle often put the patient in a state of slight bewilderment, since the doctor does not explain the etiology and consequences of a particular condition. Incomplete blockade of the right bundle branch of His is a fairly common conclusion in an ECG. Especially in children who have no symptoms and signs of pathology. What causes can lead to this pathology and in which case treatment is required - you can find out from this article. What is an incomplete blockade of the right leg of the bundle of His in the understanding of cardiology - a pathology associated with a violation of the autonomic function of the central nervous system, which under certain circumstances does not pose a threat to the health and life of the patient. But how this could be dangerous in the future development of the blockade is a separate question. To understand the essence of the issue, one should delve into the anatomy of the heart and its innervation system.

What is the bundle of His and its legs

What is the system of innervation and what role does it play in ensuring the smooth operation of organs and systems, there is no need to tell, everything is clear and without long explanations. If the nerve impulse does not pass, then the inevitable failure of the function occurs. In medicine, the bundle of His is a small area of the myocardium in which non-typical forms of myocytes are located. It is divided into a trunk and two legs: right and left, responsible for the innervation of the anterior and posterior parts of the heart muscle. The trunk of the bundle of His is located in the upper parts of the heart, between the two ventricles, and its legs descend to the atria in the form of Purkinje fibers. They are responsible for the innervation of muscle tissue, stimulate the contractility of myocytes. By and large, this is the coordinator of the synchronous work of the atria and ventricles. At the moment of atrial contraction, the impulse is transmitted to the ventricles.

Incomplete blockade of the right leg of the bundle of His is more common in children and people who have stepped over the age limit of 50 years. Runs without symptoms or signs. Treatment is required only in case of serious damage to the conductive fiber and the occurrence of persistent forms of arrhythmia of the heart rhythm.

Types and causes of blockade of the legs of the bundle of His

Types of pathology are divided according to the localization of pathological changes. It can be single-beam, two-beam or three-beam blockade. The patient's condition with single-beam blockade of the right or left leg of the bundle of His remains normal. With the defeat of the 2nd and 3rd bundles, various clinical symptoms may appear. According to the nature of functional disorders, the following types are distinguished:

complete and incomplete blockade of the nerve impulse;
permanent progressive or remission;
intermittent disturbance with periods of improvement and deterioration of the state of the nervous conduction system;
the transitional form is characterized by the fact that the manifestation of the pathology is not recorded at every ECG reading;
alternating blockade of the legs of the bundle of His differs in that pathological changes can appear alternately on the left and right legs.

The reasons for the incomplete blockade of the right and left bundle of His can be hidden behind a number of pathological disorders, including those affecting the central nervous system. The most common risk factors are:

coronary heart disease in patients over the age of 40;
alcoholic and toxic cardiomyopathy;
diseases of the metabolic system and a decrease in the blood level of certain trace elements (potassium, magnesium);
the presence of scar tissue at the location of the bundle of His (after myocardial infarction, rheumatism, systemic lupus erythematosus, myocarditis);
acquired and congenital heart defects in the form of stenosis and prolapse, coartation and defects;
hypertrophy of the tissues of the heart muscle against the background of hypertension without compensating it with the help of pharmacological preparations;
thromboembolism of the coronary and pulmonary blood vessels;
bronchial asthma with concomitant respiratory failure;
chronic bronchitis and emphysema;
pulmonary heart.

In children with the appearance on the ECG of signs of incomplete blockade of the legs of the bundle of His, an extended examination is required to exclude intrauterine malformations. This may be an abnormal chord in the cavity of the left ventricle, valve prolapse, or an oval atrial septal defect of the open type.

In the absence of the above organic pathologies, incomplete blockade of the right leg of the His bundle refers to the variants of the norm and is associated exclusively with the peculiarity of the functioning of the autonomic nervous system. However, constant dispensary observation is required to exclude the option of progression of pathological changes. Incomplete block of the left leg of the bundle of His is never a variant of the physiological norm and requires adequate treatment in view of the danger of this condition.

Primary signs and classic symptoms of incomplete bundle branch block

Primary signs of incomplete blockade of the right leg of the bundle of His may not appear and the patient feels completely healthy. Severe clinical symptoms may occur with complete blockade of the left bundle branch block and require urgent medical attention. In most cases, there are manifestations of the disease that provokes the development of this pathology - these are:

shortness of breath on exertion and at rest;
sensation of palpitations and violations of its rhythm;
muscle weakness and fatigue;
and dizziness;
heart rhythm disturbances;
pain, feeling of heaviness in the chest.

The diagnosis is based on the result of an ECG, in controversial cases Holter monitoring is indicated. Confirmation of the diagnosis is carried out using ultrasound and computed tomography.

If symptoms suddenly appear, an ambulance should be called immediately, as this may indicate the development of ischemia in the posterior wall of the myocardium (infarction). The danger to the life of the patient is a three-beam partial and complete blockade of the legs of the bundle of His, it may be accompanied by the development of Morgagni-Adams-Stokes attacks. During such attacks, the blood supply to the cerebral structures is disrupted, the patient suddenly loses consciousness, he has a sharp decrease in heart rate. The chance of death is very high. This condition is associated with a complete lack of synchronization of the work of the atria and ventricles. Against this background, a pathological focus of nervous excitation occurs in the tissues of the myocardium. It can provoke an attack of atrial fibrillation and ventricular paroxysm. Bradycardia appears with a heart rate of less than 40 beats per minute.

Diagnosis is based on ECG results. If for the first time a blockade of the left leg of the His bundle is detected, then the patient is urgently sent to a specialized hospital with the possibility of resuscitation. Additional examinations are carried out to identify the disease leading to the blockade. Adequate supportive treatment with the help of pharmacological drugs is prescribed. With incomplete blockade of the right leg of the bundle of His, treatment is often not required, but the patient is recommended to have an ECG performed regularly (at least 2 times a year).

On the ECG, the blockade of the bundle branch of His can manifest itself in the following variations;

in V1 and V2 of the right leads, pathological Rsr complexes appear, and in leads V5 and V6, the QRS complex due to the wide S wave is more than 0.12 s.
V5,V6, I with deformed complexes without a Q wave and splitting of the apex of R indicates blockade of the left leg;
with a total lesion of three legs, pronounced signs of antrioventricular blockade appear.

Patients are assigned a set of diagnostic examinations:

a biochemical detailed blood test reveals an imbalance of trace elements, elevated cholesterol levels;
ultrasound reveals the expansion of the heart muscle, conduction disturbance;
daily monitoring will tell about the form of the blockade;
transesophageal cardiography is used in controversial situations.

Possibilities of treatment of bundle branch blockade in modern conditions

In modern conditions, with a high level of development of cardiology, the condition is quite successfully treated. But the main measures are aimed at eliminating the pathogenic factor (the underlying disease). The possibilities of treating bundle branch blockade depend on the general condition of the patient, the factor preceding the development of the pathology, the presence of concomitant diseases of the cardiovascular and respiratory systems.

Treatment of incomplete blockade of the right leg of the bundle of His is usually not carried out, the condition of the patients does not suffer, it is possible to independently restore the violation of the conduction of the nerve impulse. In the case of a two-beam blockade, the following pharmacological preparations can be used:

vitamin complexes (nicotinic acid and B vitamins);
improving blood supply to the heart muscle ("Mexidol", "Carnitine", "Preductal");
restoring the function of nerve conduction (motherwort, valerian, "Afoobazol");
antiplatelet agents to reduce the risk of blood clots (aspirin, chimes, cardiomagnyl);
statins to normalize blood cholesterol levels;
cardiac glycosides and nitrates;
drugs that normalize blood pressure levels.

It is recommended to constantly take potassium and magnesium preparations, vitamin complexes, antiarrhythmic drugs if indicated. In infectious processes, the appointment of broad-spectrum antibiotics is indicated.

In severe cases, emergency surgery is indicated to install a pacemaker. An artificial pacemaker increases the patient's life expectancy to the physiological norm and significantly improves his quality of life.

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Complete blockade of the right leg of the heart is a rare pathological process in the human body. It is not a separate disease, but becomes an auxiliary symptom that is detected during the removal of electrocardiography. Although the symptom is a danger to health, there are no complaints from the patient about feeling unwell.

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

measles;
flu;
chickenpox;
angina;
scarlet fever.

During the examination of the patient, the doctor reveals residual manifestations of disorders in the activity of the heart muscle, which were not diagnosed in time. However, these myocardial changes, which appeared in childhood, no longer require treatment in adulthood.
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On the other hand, it is very important to diagnose pathological changes in the functioning of the heart muscle in childhood in order to avoid complications in adulthood. Therefore, pediatricians are required to be attentive to patients and take heart problems seriously.

Functions of the cardiac bundle of His

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

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

The bundle of His has a special structure in which two legs stand out - left and right. Nerve impulses pass through them, rushing to one of the heart ventricles. If the nerve conduction of the impulse is disturbed, they speak of a pathology, which doctors call the blockade of the legs of the bundle of His.

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

Depending on the localization of the violation, blockade of one leg is distinguished - right or left, as well as both at the same time. Very often in childhood blockades are formed for no apparent reason.

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

If there is a complete blockage of the right leg of the heart, then in this case the nerve impulse is conducted through individual muscle fibers, starting from the left ventricle and the left side of the septum between the ventricles.

Symptoms

Incomplete blockade of the right leg of the heart of an isolated type is in no way associated with current disorders of the internal organs and diseases. In this regard, the pathology proceeds without pronounced signs and is therefore difficult to diagnose. Violation is detected most often by chance during a routine inspection.

With complete blockage of the right leg of the heart, there are signs of primary diseases against which this disorder develops, including:

dyspnea;
heartache;
severe fatigue;
malfunctions of the heart.

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

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

dizziness;
cardiopalmus;
chest pain.

A characteristic feature of the blockade is that it does not have a permanent character, so it can occur suddenly, but often disappears over time. For example, with a tachycardia form of the disease, the violation is eliminated when the heart rate returns to normal.

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

With a complete three-beam blockade, the impulses do not pass at all. In this case, an ectopic focus of excitation appears in the cardiac ventricles. The work of the atria and ventricles is completely disconnected, and the frequency of heart beats per minute slows down to 20-40. This indicator is significantly below the norm, which indicates that a full release of blood into the aorta is impossible.

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

Development forecasts

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

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

An unfavorable prognosis with complete blockade is taken out if myocardial infarction is present. In this case, 40-50 patients out of 100 die. Also, a low chance of cure is observed with a three-beam block, as this increases the risk of asystole.

Causes

The reasons for the formation of the blockade of the right leg of the heart are usually multiple congenital anomalies:

unformed segment of the right bundle;
pulmonary stenosis;
septal defect within the heart.

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

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

Treatment of blockade of the right leg of the heart

When blocking the legs of the bundle of His, there are no specific signs, and disorders are usually diagnosed by chance during routine examinations. In this regard, it is possible to identify violations only by the presence of concomitant heart diseases. Accordingly, the treatment of blockage of the right leg of the heart begins with the elimination of the negative impact of these diseases on the body.

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

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

Before the immediate elimination of the consequences that arise due to the blocking of the pedicle of the bundle of His, the primary disease that provoked the development of the pathology should be cured.

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

Medicines

Certain medications are used to treat the effects of right bundle branch block, including the following:

Enalapril;
Mildronate;
Riboxin;
Trimetazidine.

The specific type of drug is selected by the doctor in each case individually, taking into account the indicators obtained from the research results.

As part of additional therapy, the patient is prescribed drugs for arrhythmias.

If there is a persistent increase in blood pressure, the doctor prescribes medication to the patient to eliminate this symptom.

Surgery

Surgery may be required when the blockage of the heart pedicle was caused by some kind of congenital heart defect.

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

Consequences

However, all the negative consequences in most cases develop due to the fact that the patient ignores the doctor's recommendations. Therefore, in order to save yourself from various risks, it is necessary to undergo a medical examination in a timely manner and appear for an examination with your doctor.

It is especially important to consult a doctor for those patients who are currently treating the cardiovascular system. When the first dangerous symptoms appear, it is important to immediately go to the hospital, without postponing the examination for later. The consequences may be irreversible.

For example, the blockade of the legs of the bundle of His is associated with the pathology of the conduction of electrical signals through the myocardium of the heart, or rather, through the section of the conduction system responsible for the contraction of the ventricles. The result of the development of pathology is a violation of the sequence, strength, speed of excitation, 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 leg of His, or rather the legs of the bundle of His, is an element of the cardiac conduction system that is responsible for conducting excitation impulses in the ventricles. The legs of the heart (bundle of His) are three - left, right front 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. Between the branches of the legs of the bundle of His there is a network of anastomoses. The entire bundle of His consists of atypical muscle fibers. The end of the legs in the region of the right and left ventricle breaks up into the smallest elements of the conduction system - the Purkinje fibers.

The main function of the bundle of His is the transmission of 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 a partial or complete violation of the conduction of an 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, while they are diagnosed in 6 people out of 1000 of the population. With age, the incidence of the disease increases, and after 55 years of blockade, it occurs already in 20 out of 1000 people, more often in men.

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

Incomplete blockade of the bundle of His (slowing down the transmission of impulses).
Complete blockade of the bundle of His (complete cessation of impulse transmission).

In addition, the following types of blockades are distinguished:

Single-beam - covers the right leg, or is a blockade of the posterior or anterior branch of the left leg.
Two-beam - affects both branches of the left leg or includes a blockade of the right leg, coupled with a lesion of one branch of the left leg.
Three-beam - the right and left legs are blocked.

According to the type of development of BNPG, 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 localization, that is, appear in the region of different legs).

Causes of the blockade of the legs of the bundle of His

Signs of pathology can appear in children from birth, in which case they can be triggered by congenital diseases:

defect of the interventricular and interatrial septum;
underdevelopment of the segment of the right leg of the bundle of His;
stenosis of the mouth of the pulmonary artery;
coarctation of the aorta;
other heart defects that cause an overload of the right ventricle.

In childhood, incomplete single-beam blockades can be recognized as a variant of the norm if they are not accompanied by organic damage to the heart. So, in many babies, an incomplete blockade of the right bundle of His bundle is detected, combined with small anomalies of the heart - an additional chord, mitral valve prolapse, etc. The blockade of the left leg is more often provoked by acquired diseases and is often also recognized as a variant of the norm.

Among the cardiac causes that can cause BBB, doctors call 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;
tumors of the heart, metastatic lesions of the heart;
chest trauma;
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 blockade of the legs of the bundle of His, including transient ones:

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

In the absence of obvious reasons, after the diagnosis, an idiopathic blockade of the legs of the bundle of His can be established.

Symptoms of manifestation

Many clinical cases of BBB occur without any manifestations. Incomplete single-beam blockades almost never show themselves as symptoms, therefore they are detected only by ECG during a routine examination. But with a complete blockade of the right leg, symptoms, as a rule, are observed in a person even in the absence of organic heart damage. These include:

various changes when listening to heart sounds;
dizziness;
pre-fainting states and fainting;
feeling of lack of air;
dyspnea;
decrease in working capacity;
poor exercise tolerance;
fatigue and weakness;
sometimes - pain in the heart;
feeling of interruption in the work of the heart.

In addition, the appearance of a clinical picture corresponding to the underlying disease, both cardiological and covering other organs and systems, is possible. 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 ventricular myocardial damage.

Danger and Consequences

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

stroke - acute ischemia of a part of the brain against the background of a cessation of blood circulation in it;
chronic heart failure - dysfunction of the heart, leading to malfunctions of the whole organism;
aggravation of the course of the underlying heart disease;
the appearance of thrombosis and thromboembolism due to blood clotting.

Complete BNPH is dangerous - with age, if left untreated, it can lead to the development of severe types of arrhythmias - paroxysmal ventricular tachycardia, ventricular fibrillation, which ends in cardiac arrest (the probability of death is highest with three-beam blockade).

PE, an ischemic stroke, can also lead to death. On average, mortality in the development of blockade against the background of a heart attack is 50% in the first days of pathology. Only an early start of examination and treatment, the fulfillment of all doctor's prescriptions, the elimination or correction of major diseases of the heart and blood vessels can prevent such consequences.

Diagnosis of pathology

Even a therapist, when listening to the heart, can note a change in rhythm, a violation of heart rate. This should prompt a further, more detailed examination to look for 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 BBB (below are the most common options for blockades):

Blockade of the anterior branch of the left NPG. There is a high R wave, a deep S wave, and a deviation of the QRS vector up to the left.
Blockade of the posterior branch of the left NPG. The QRS vector is directed up, 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.
Blockade of the right NPG. There is a high wide R wave, a broadened S wave, the amplitude is increased. The ventricular QRS complex takes the form of qRS or rSR, widens to 0.12 sec. and more. In addition to acquired causes (anterior myocardial infarction, coronary artery disease), this variant of the development of the disease is characteristic of congenital heart defects and other diseases.
Blockade of the left NPG. EOS deviates to the left, or is located horizontally. The QRS is shaped like an extended R wave with a serrated or flattened apex. The width of the ventricular QRS complex is greater than or equal to 0.12 seconds. The condition is characteristic of arterial hypertension, acute myocardial infarction (less often), aortic heart disease.
Two-beam blockade (blockade of the right leg and left anterior branch). The QRS complex is expanded over 0.12 sec., the negative T segment, and the RS-T segment is shifted down, the EOS deviates to the left. This change is most characteristic for IHD and other myocardial pathologies.

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

Blood and urine tests to assess electrolyte balance, hormone levels, indicators of autoimmune processes, etc.
24-hour ECG monitoring to detect non-permanent atrial conduction disturbances, arrhythmias, assess the severity of blockades, search for night or exercise blockades.
Ultrasound of the heart to establish cardiac causes of heart block, especially organic heart disease.
EFI to clarify the data on the disease, when ECG or Holter monitoring does not allow an unambiguous diagnosis.

Methods of treatment

Incomplete single-beam blockades usually do not require any treatment. If there are no cardiac reasons for such disorders, then they are unlikely to progress or be aggravated by other pathologies. Such BNPs almost never turn into complete blockades and are not life threatening. Occasionally, especially against the background of hypertension, progression of the blockade of the right leg and AV blockade of the second or third degree is possible. At the beginning of such processes, the doctor always prescribes preventive drug therapy.

Similarly, you should act with more serious types of blockades. Of the drugs, a complex of therapy is selected, which is carried out in courses. It is also necessary to treat the underlying disease. In general, medical treatment of blockades may include the following drugs:

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

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

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

Combine equally valerian root, rose hips, dandelion roots, calamus roots, 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.
Combine pharmacy 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 dilution 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 the disease, the following measures are important:

more rest, sleep;
eliminate stress and overwork;
observe the regime of work and rest;
eat only healthy food, consume more vegetable fiber;
give up cigarettes, alcohol;
take all drugs only in recommended doses and under the supervision of a doctor;
early treatment of all heart diseases.

Are you one of the millions with heart disease?

Have all your attempts to cure hypertension failed?

And have you already thought about drastic measures? It is understandable, because a strong heart is an indicator of health and a reason for pride. In addition, this is at least the longevity of a person. And the fact that a person who is protected from cardiovascular diseases looks younger is an axiom that does not require proof.

The presented materials are general information and cannot replace the advice of a doctor.

Left heart block

In order to understand what a blockade of the left ventricle of the heart is, you need to know how a healthy human heart works, as well as how its conducting system is organized.

Our heart is made up of ventricles and atria, which contract in turn to supply blood to the entire body. The heart works under the influence of electrical impulses that are produced by its certain structures.

The sinus node is the dominant impulse-generating structure. After an impulse leaves this node, it is conducted to the atria, which are reduced because of this. After it reaches the atrioventricular node. This node is located between the ventricles and atria and is a kind of gate for the eclectic impulse between these two structures. For a fraction of a second, the impulse is delayed in the atrioventricular node. This is necessary so that the blood has time to move from the atria to the ventricles. Then this impulse is carried out along the trunk of the His release, reaching the ventricles, thereby forcing them to contract and pour blood into the general channel.

So, in simple terms, the blockade of the left ventricle of the His bundle is a conduction disorder in which the electrical impulse stops or slows down.

Blockade of the left ventricle of the heart appears on the background of ischemic or hypertension disease or a number of other cardiovascular diseases.

Classification

The blockade of impulse conduction can occur anywhere in the pedicle, and it can be complete or incomplete. And since the left leg is divided into the back and front, various classification options follow:

The consequences of a complete blockade of the left leg of the bundle of His

The heart is a unique organ that governs itself, i.e. has automatism, but, of course, taking into account the needs of the body and not without interference in the work of the nervous and endocrine systems. This organ is not just a muscle bag, which is a pump for pumping blood, the heart is much more complicated than it might seem.

The structure of the heart and the resulting causes of blockades

In addition to muscles, four cavities, valves, its own coronary vessels, it has a conducting system and two of its centers (pacemaker). From the main center (the pacemaker of the first order), electrical impulses enter the second, and then along the left and right legs of the His bundle they spread to the entire myocardium, which then contracts (and pushes blood out of the heart).

Naturally, if there is a blockade, in this case, a complete blockade of the left leg of the bundle of His. therefore, the impulse cannot spread further, and this leads to a violation of the rhythm and, in general, the work of the whole heart. The reason for this may be myocardial infarction, it should be assumed first of all if the blockade occurred for the first time. Other causes: cardiosclerosis, cardiodystrophy, hypertension, cardiomyopathy, myocarditis, etc.

Consequences of the blockade

Complete blockade of the left leg of the bundle of His leads to a violation of the conduction of an electrical impulse to the left ventricle. But even despite the complete blockade, the impulse still passes, but along bypass routes (anastomoses), and with a delay.

What is the danger of a complete blockade of the left leg of the bundle of His?

Even a complete blockade of the bundle branch can be asymptomatic, and at first does not pose a serious danger to life. However, over time, the condition worsens, ventricular arrhythmia develops, more often one of its types is ventricular paroxysmal tachycardia. It is she who ultimately leads to ventricular fibrillation: a chaotic contraction of the muscle fibers of the myocardium, which is incompatible with life and inevitably leads to death.

Treatment

There is no specific treatment for blockade. With this pathology, treatment is aimed at eliminating the underlying disease, which caused the blockade. As a rule, cardiac glycosides, nitrates, drugs that lower blood pressure are prescribed. If the heart rhythm is not restored, then they resort to surgical intervention: the installation of a pacemaker.

Rehabilitation for cardiac arrhythmias

In addition to the drug therapy of the underlying disease causing the blockade, treatment should include additional non-pharmacological methods related more to rehabilitation measures. In general, this tactic is suitable for other causes of left ventricular block. For example, physical therapy. Physical exercises tone not only the whole body, but have a particularly fruitful effect on the cardiovascular system, increasing the supply of oxygen and generally reducing the mechanical load on the heart. Simply put, by moving, we help the heart to disperse the blood. Of course strength exercises are not suitable here. Choice: walking and jogging. But in physical therapy it is very important, especially in case of heart disease, that the load be dosed and adequate to the capabilities of the heart. Otherwise, you can get a negative effect.

Left ventricular block

The heart muscle has special properties compared to other organs of the human body. One of these properties is the conductivity of impulses that occur in special structures of the heart tissue. Sometimes it happens that the impulse is not transmitted by the cells of the heart. Such conditions are called blockades.

The blockade of the left ventricle of the heart or, as it is called in medical practice, the blockade of the left leg of the bundle of His in most cases is only a complication of the disease. Accordingly, if there is a lesion of the right leg of the bundle of His, a blockade of the right ventricle of the heart occurs. Diseases that can lead to blockade occur both in young (heart defects) and in old age (arterial hypertension, ischemic heart conditions, etc.).

For reference

Recently, left ventricular block has been used as a term that has a broader concept than "left leg block". This is due to the mechanism of momentum transfer. The fact is that the left leg of the bundle of His is divided into two legs: anterior and posterior. Sometimes the block occurs at the point of division into the anterior and posterior branches, in such cases, diagnosis by setting the level of the lesion is difficult. As a result, we decided to introduce a broader concept.

Types of blockades

In addition, left ventricular block may be complete or incomplete. Incomplete blockade does not pose any danger to life. Symptoms that are observed with it are weakness, slow pulse (bradycardia). If incomplete blockade is detected on the ECG, the signs of which will be a deviation of the electrical axis of the heart to the left and left ventricular hypertrophy, the main thing is to exclude myocardial infarction, which is very often “masked” in the lines of the cardiogram with incomplete blockade of the left ventricle.

Symptoms and ECG

The main tool in the diagnosis of "blockade ..." is an electrocardiogram, which may look different in the same cases, although it is made on the same device.

Things are very serious with a complete blockade of the left leg of the bundle of His (left ventricular blockade). First, I would like to tell you what happens normally: the left ventricle is “responsible” for the release of oxygenated blood into the aorta. With the failure of the left ventricle, there is a delay or cessation of the release of oxygenated blood, which leads to oxygen starvation of all organs and systems (primarily the brain). Clinically, this is manifested by respiratory disorders (dyspnea), dizziness, drowsiness, a decrease in the rhythm rate to 25 beats / min and, in the end, access to acute heart failure, which can result in death if timely and proper medical care is not provided.

Diagnosis of a complete blockade, from an experienced doctor, does not cause any particular difficulties. Everything will be visible on the ECG. Provided that there is no other pathology.

Dangerous states

Complete block and myocardial infarction or complete block and unstable angina are very common. Much more difficult and with the treatment of complete blockades. To date, there are no specific recommendations in this regard. The main thing is to stop the acute condition, and then prevent recurrences, so to speak, to carry out prevention. Also read about the consequences of a complete blockade of the left bundle branch block.

This condition is stopped in different ways, reaching, in the flesh, to the use of an electric defibrillator. Then, when the condition stabilizes, drug therapy is carried out, drugs that improve the quality of life (beta-blockers, etc.), antiarrhythmic drugs are prescribed.

Prevention

It is advised to follow a diet (often blockades occur against the background of obesity). All this is for the elderly, who, so to speak, have “acquired” diseases. For persons with defects, the most optimal treatment is heart surgery to eliminate the defect. Another direction in treatment is the installation of a pacemaker. In modern conditions, the approach to all patients is individual.

My son has schizophrenia and I am his guardian. He takes haloperidol 3 times, cyclodol 2 times, chlorpromazine 100 mg at night and phenazepam 2 mg at night. On the ECG, a complete blockade of the left leg of the His bundle and an incomplete blockade of the right leg of the His bundle, they write: an overload of the right ventricle is possible. I walk with him on the street, his weight is 84 kg, height is 167 cm. He does not complain about his “heart”. There are "voices" in the head. In September, after September 14, an MSE examination was scheduled for the purpose of rehabilitation for the underlying disease (paranoid schizophrenia, continuously progressive course).

The therapist prescribed asparkam. He is 08.10. 1973 of birth. Need a cardiologist?

Of course I need it. I have a complete blockade of the left leg. They installed a pacemaker. I've had a 26 stimulator since I was 17.

I have a complete blockade of the left leg of the bundle of His. IT IS POSSIBLE TO DO AN OPERATION ON THE UTERINE PROLOSSION. AND THE RECTAL I WANT TO KNOW. AND HOW TO LIVE FURTHER

Incomplete blockade of the left leg of the bundle of His: causes, symptoms and treatment

Absolutely each of us knows that thanks to the work of the heart, the whole organism functions. And when it fails, irreversible health processes begin, especially with late diagnosis and improper treatment.

The danger of this disease lies in the absence of symptoms in the early stages, the edge of the underlying pathology, and it can be detected using an ECG. But if you notice one of the signs indicated in the article, do not postpone a visit to a cardiologist, because this can lead to more serious complications. What is an incomplete blockade of the left leg of the His bundle, how it manifests itself, diagnostic methods and methods of treatment, we will consider with you below.

What is a blockade?

His bundles are altered elements of cardiac tissue that are part of the conduction system of the heart. Excitatory impulses pass through them from the sinus node to the heart muscle. Normally, the main generator of nerve impulses in the heart is the sinus node, from which the trunk goes to the atrioventricular node and is divided into the right and left branches (legs), the so-called bundles of His.

The elements of the right bundle of His, respectively, go to the muscles of the right ventricle, and the left - to the muscles of the left. This ensures synchronous contraction of the right and left parts of the heart. With incomplete blockade, there is a difficulty in the passage of nerve impulses, with complete - their complete cessation.

This leads to a violation of the contractile function of the heart. Groups of causes causing blockades (detailed causes will be discussed below):

Cardiac, that is, pathologies from the side of the heart.
Drug group of causes (or drug) - as a result of taking certain medications.
A group that includes changes in the electrolyte composition of the blood (potassium, sodium, magnesium, phosphorus).
A group that combines toxic factors that lead to poisoning of the body and cause conduction blockade in the heart.
A group of autonomic disorders (of the autonomic nervous system), it is responsible for controlling the rhythm of the heart.
Hormonal causes (diseases of the endocrine organs).
A group of causes that cause oxygen starvation of the heart muscle.
Idiopathic causes that are not determined by examination of the patient.

Types of blockades

If the electrical discharges of the upper chambers are not transmitted, as they should, to the lower chambers, then a blockade of the legs of the His bundle occurs. This is reflected in the cardiogram.

As a rule, all blockades are divided into 3 main varieties:

Single-beam - it can affect the right leg, as well as one of the branches of the left process.
Two-bud - this variety immediately affects both left-sided branches or the right and one of the branches of the left.
Three-beam - the most serious pathology, in which 3 branches suffer at once.

In turn, LBBB can occur in several scenarios:

blockade occurs in a certain part of the trunk up to the branching border;
the stem part is completely affected before it branches;
the blockade affects the process on both sides after branching;
both peripheral parts of the left process are blocked;
scattered changes in the middle muscle layer of the heart.

Incomplete blockade of the left leg of the bundle of His - characteristic

Under incomplete blockade is meant a violation of the conduction of an electrical signal along one of the branches of the left leg. To determine which part suffers, the electrographic deviation of the total vector of the electrodynamic force of the heart is evaluated at the position of the recording electrodes on the right upper and left lower extremities.

If there is a pronounced deviation of the total vector of the electrodynamic force of the heart to the left, then a blockade of the anterior branch is diagnosed, and if a pronounced rightogram is observed, then this indicates a lesion of the posterior branch.

Incomplete LBBB usually does not cause serious clinical abnormalities and no abnormalities are observed when listening to the patient. And if an incomplete blockade of the right leg is found, then the condition can be regarded as corresponding to the physiological norm and an additional examination in this case is completely optional.

The blockade of the left leg of the bundle of His (or LBBB) is a pathology, which may be based on damage to the heart apparatus at different levels. For example, the left leg in the trunk of the bundle of His may be affected. Or the main trunk of the left leg before branching.

The anterior and posterior branches of the leg can be affected at one moment after the end of the place of their release from the body of the main trunk. The left good half of the septum between the ventricles is also damaged, along with this, both branches of the pedicle are involved in the process.

The circumstance may also lie in pronounced diffuse transformations of the myocardium in the peripheral branches of the posterior and anterior branches. With LBBB, the passage of excitation to the myocardium of the left ventricle along the left leg is difficult.

It is carried out by an unusual method, as a result of which the QRS complex is widened, and the direction of repolarization in the left ventricle changes. We will not consider this in detail, this is a task for hearty experts. Consider some of the features of this disease.

Damage to the leg can be the result of fibrous processes, which are associated with coronary sclerosis and less often with limited myocarditis (syphilitic, rheumatic, diphtheria, infectious). It is very rare, but not uncommon, that the blockade appears with a completely healthy heart.

Complete and incomplete blockade of the left leg of the bundle of His is not uncommon. If it comes to complete, excitation at first covers only the septum between the ventricles, and not the entire ventricle entirely. Incomplete blockade begins with violations of electrolyte metabolism, or an overdose of drugs, or various kinds of intoxication.

As a result, the normal conduction of the cardiac system is disturbed, and the full excitation of the left section does not occur. It is possible to diagnose this violation using a simple electrocardiogram; when deciphering, transformations will be visible.

If the blockade has spread to only one leg, then no, it is not life-threatening, despite the fact that there is certainly nothing good in this.

Many modern cardiologists are sure that this deviation has already ceased to be a deviation in those cases, at a time when it is not the result of other heart diseases. The complete blockage of both legs is terrible, in such cases it is required to implant a pacemaker.

Causes

The causes of pathology include:

Atherosclerotic cardiosclerosis - replacement of part of the heart muscle with connective tissue.
Aortic valve defects. Such a defect leads to the expansion and increase in the size of the left half of the heart, which disrupts the conduction of nerve impulses in this part of the heart.
Cardiomyopathy, myocardial dystrophy, bacterial endocarditis are diseases characterized by damage to the myocardium (heart muscle) and with it Purkinje fibers (the smallest cells in the conduction system of the heart).

Types of incomplete blockade of the left side of the bundle of His:

at the level of the left leg in the very trunk of the beam;
blockade occurring in the left leg until it is divided;
difficulty in conducting an impulse in both branches after their separation;
a variant when the spread of the lesion to half of the interventricular septum in its left part joins the previous type;
blockade at the level of the extreme, smallest branches of the branches of the left leg.

An important role in the occurrence of this disorder is played by drug intoxication of the body. In this case, poisoning with diuretics, cardiac glycosides, sympathomimetic drugs is observed.

Sometimes the development of blockade leads to excessive consumption of alcoholic beverages, smoking, and taking drugs. Also, the appearance of this disease may be the result of deviations in the electrolyte balance of the body.

The development of blockade of the His bundle leads to a deficiency of magnesium, a lack or an excessive amount of potassium. Also, the cause of the development of the blockade may be the appearance of thyrotoxicosis.

The causes of damage to the anterior and posterior branches of this part of the organ can differ significantly. So, the following factors most often lead to problems in the work of the anterior branch:

anterior infarction;
arterial hypertension;
aortic valve disease;
cardiosclerosis;
mitral insufficiency.

Also, the blockade of the anterior branch of the left leg may be the result of a violation of the integrity of the septum between the atria. It often leads to cardiomyopathy and calcium salt deposits.

Often the cause of the deviation lies in the inflammatory process that affects the heart muscle. Violation of the posterior branch develops under the influence of such factors:

atherosclerosis;
infarction, which differs in posterior localization;
deposition of calcium salts;
myocarditis.

In more rare cases, a two-beam blockade can be detected - in this case, both the anterior and posterior branches of the organ suffer.

Significant changes in the hormonal background, due to certain external influences, are also additional causes of the blockade of the left leg of the His bundle.

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, symptomatic and cardiac glycosides;
Abuse of bad habits that adversely affect the entire human heart system. It can be alcoholism, the use of narcotic drugs, smoking;
thyrotoxicosis;
Insufficient amount of certain substances in the body. These are potassium, magnesium, which are responsible for the electrolytic balance in the body. Their significant amount, as well as some of their lack, affect the balance in the work of the cardiac system.

As a result of the above situations, the anteroposterior bundle loses its rhythm of work, ventricular contractions pass regardless of the receipt and conduction of impulses through the tissues of the pedicle.

Anterior branch block

With the blockade of the anterior branch of the left leg of the bundle of His, uniform violations are determined regardless of the location of the lesion. This is due to the fact that the reaction of the excitable structure does not reach the upper sections of the anterior wall of the left lower chamber of the heart.

Therefore, using standard electrocardiography, it is impossible to accurately determine the place subject to blockade.

With BPVLNPG, excitation in the right lower cardiac chamber occurs in a standard way. In the lower left chamber, the reaction of the excitable structure propagates in stages.

First, it passes along the posterior branch of the left leg, and then spreads to the upper parts of the left-sided lower chamber.

This deviation can be detected against the background of a number of cardiac pathologies:

chronic myocardial damage, which is based on pathological processes in the system of coronary arteries, and this especially applies to the anterior wall of the left-sided lower chamber;
ischemic necrosis of the myocardium of the anterior wall of the left-sided lower chamber;
inflammation of the heart muscle;
significant thickening of the wall of the left ventricle;
pathological expansion of the left lower chamber of the heart, caused by insufficiency of the aortic valve;
primary isolated sclerosis and calcium deposition in the walls of the conducting system;
congenital heart defects.

According to statistics, LBBB appears over the age of 50 in 1.25% of male patients. And in most cases, this indicator is the only sign of a developing pathology in the muscular middle layer of the heart.

Posterior branch block

With the blockade of the posterior branch of the left leg of the bundle of His, serious conduction disturbances occur in the posterior branch, which can proceed with different indicators. The same deviations are noted on the ECG, which are difficult to differentiate using standard electrocardiography.

This condition develops in pathologies similar to those in BPVLNPG:

insufficiency of blood supply to the myocardium;
atherosclerosis of the coronary arteries;
necrosis of a portion of the myocardium affecting the left ventricle;
inflammation and other changes in the heart muscle caused by a variety of reasons;
deposition of calcium and degeneration of tissues into a solid connective tissue.

If we talk about the blockade of the anterior branch, then in electrocardiography this is a fairly well-studied section. And the defeat of the posterior branch gives non-specific signs, and this section is still under development. It is impossible to diagnose a lesion of the posterior branch only on the basis of the results of a standard cardiogram.

As a rule, for clarification, you need to resort to additional diagnostic methods. In any case, any of the above blockades is detected during a full examination and the specialist, if necessary, will prescribe additional studies before making an accurate diagnosis.

Symptoms

Single-beam blockade is asymptomatic, it is detected by an ECG. Such signs of a violation as constant fatigue, pain in the sternum, shortness of breath, in this case, are caused by a disease that caused a violation of electrical conductivity.

Signs of blockade of the left leg of the anterior or posterior branch are also not felt by the patient. The blockade of the left complete gives such symptoms as: dizziness, pain in the heart, strong heartbeat. The symptoms are caused by severe changes in the left ventricular muscle (myocardial infarction).

Incomplete blockade of the left leg of the bundle of His three-beam is characterized by the following features:

interruptions in the work of the heart;
constant fainting caused by oxygen starvation of the brain;
dizziness.

Three-beam incomplete blockade leads to a sudden lethal outcome.

Diagnosis of violation of the electronic conductivity of the bundle of His

A cardiogram shows a problem with electrical conductivity. The right incomplete blockade, in the absence of clinical symptoms and concomitant diseases, is considered the norm and additional examinations are not carried out.

ECG signs of a two-beam blockade serve as a reason for hospitalization of the patient, since there is a danger of developing serious conditions. The revealed blockade of the His bundle on the ECG, the three-beam also requires immediate hospitalization, followed by a surgical operation.

How to see the problem with the electrical conductivity of the bundle of His on the cardiogram. Signs of blockade of the right leg:

Rsr or rSR complexes in V 1, V2 (right leads).
Wide S wave in V5, V6 (left leads).
QRS complex greater than 0.11 s.

Signs of impaired conduction of the left leg:

left leads V5, V6, I do not have a Q wave;
ventricular complexes are deformed;
the top of the R wave is split;
right leads V1, V2, III are characterized by a deformed top of the S wave, the width of the complex is more than 0.11 s.

Differences of the three-beam blockade:

all signs of left and right;
drawing of the cardiogram shows an atrioventricular blockade.

Incomplete left bundle branch block on ECG

LBBB can be caused by damage at various levels:

The defeat of the left leg in the trunk of the bundle of His;
The defeat of the main trunk of the left leg before its branching;
Simultaneous defeat of the anterior and posterior branches of the left leg after their isolation from the main trunk of the left leg;
The defeat of the left half of the interventricular septum with the involvement of both branches of the left leg in the process;
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.

What causes a slowdown in the passage of excitation through the ventricles, as evidenced by the widening of the QRS complex and a change in the direction of repolarization in the left ventricle:

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

It should be borne in mind that with the blockade of the left leg of the bundle of His:

Arousal stage 1:
- the left ventricle and the left part of the interventricular septum are not excited;
- excitation along the right leg is transmitted in the usual way and causes excitation of the right half of the interventricular septum (the vector is directed to the V6 electrode);
- at the same time, excitation of the right ventricle begins (the vector is directed to the V1 electrode);
- excitation from the right half of the interventricular septum passes to the left and flows slowly;
- as a result, the total EMF vector is directed to the V6 electrode, since the total thickness of the interventricular septum significantly exceeds the mass of the right ventricle: the beginning of the RV6 wave and the QV1 or rSV1 wave are recorded (this is due to the fact that at the beginning of the electrical systole the vector of the right ventricle is close to the V1 electrode, which sometimes allows a small rV1 to be recorded).
Excitation stage 2: this is the final excitation of the interventricular septum, flowing from right to left: further descent of the SV1 waves (QSV1) and the rise of RV6 are recorded.
Arousal stage 3:
- due to excitation of the left ventricle, which goes in an unusual way and proceeds slowly;
- a further descent of the SV1 (QSV1) waves and a further rise of the RV6 are recorded, with a notch usually observed on the RV6 tooth, located on the ascending knee (there are several options for explaining this phenomenon, such as;
- the presence of a small time interval between stages 2 and 3;
- the predominance of the vector of the final excitation of the interventricular septum over the vector of the initial excitation of the left ventricle;
- different interaction of the interventricular septal vector and the left ventricular vector). Due to the slow propagation of excitation, a widening of the QRS complex is noted.
The process of repolarization begins in the right ventricle and spreads from the epicardium to the endocardium (the vector is directed to the V1 electrode).

The process of repolarization in the left ventricle is associated with delayed depolarization, and spreads from the endocardium to the epicardium. As a result, the repolarization vector of the left ventricle has the same direction as the right one - to the V1 electrode (registration of positive TV1, the ST segment in this lead is located above the isoline.

With incomplete blockade of the left leg, excitation can pass, but somewhat slowly. In 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 or above the isoline, the TV1,V2 wave 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 prong can be of any shape.

In the ECG conclusion, following the nature of the rhythm, the location of the electrical axis of the heart is indicated; give a description of the blockade of the left leg (complete, incomplete); mention the lengthening of the electrical systole of the ventricles; give a general description of the ECG. If at the same time there is hypertrophy of the right or left ventricle, then its description is usually given before the general characteristics of the ECG.

Additional diagnostic procedures

Additional measures include:

Daily ECG monitoring is necessary to detect a transient form of the disease that manifests itself at different times of the day.
Electrocardiographic studies of the esophagus are necessary for the diagnosis of arrhythmias.
A heart echo is performed to detect organic pathologies in the structure of the heart and to assess the state of the myocardium.
MRI is prescribed in case of controversial issues in the diagnosis.

The most effective is considered to be an electrocardiogram and emission tomography - these research methods make it possible to make an accurate pre-diagnosis, to identify the main causes of this cardiac pathology.

Thanks to such a diagnostic study, it becomes possible to determine the most effective method of therapeutic action.

Therapeutic measures

Treatment of this condition is based on comparing the results of the ECG and ECG with normal heart rate. Since bundle block is not recognized as an independent heart disease, this condition usually accompanies a specific heart disease or several diseases.

Therefore, treatment is necessarily directed first of all to the elimination of the root causes of this condition. And the methods of treatment of primary cardiac lesions are determined both by the disease itself and by its degree of development, manifestations and the general condition of the patient's body.

The following methods of influence can be attributed to the most effective:

With the root cause of the blockade of the His bundle of heart failure, broad-spectrum cardiac glycosides will often be prescribed, as well as nitroglycerin, antihypertensive drugs that stabilize the heart and its rhythm in the first place;
Immune preparations aimed at stimulating the body's defenses and increasing the degree of its resistance to various diseases, including heart disease.

The most popular today is a broad-spectrum drug called "Transfer Factor Cardio": the absence of side effects, a quick 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 drugs for this condition. They allow you to stabilize the general condition, restore the normal rhythm of heart contractions.

However, it should be borne in mind that there is no universal therapy for blockade of the tissues of the bundle of His; the main focus of the therapeutic effect in this case should be considered the treatment of the underlying disease of the cardiac system with parallel maintenance of the patient's condition.

This pathology has an unpleasant probable consequence if the main treatment is insufficient: a blockade of this type can go on 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.

There is no specific treatment for patients who have experienced cardiac conduction disorders. Patients in whom blockade of the left leg of the bundle of His was found, drug therapy is not indicated.

Symptomatic treatment of the underlying pathology with one-, two-beam blockade includes such medicines:

Vitamins (nicotinic acid, thiamine, riboflavin).
Sedatives (valerian tincture, motherwort, sage).
Antioxidants (Preductal, Carnitine).
Antihypertensive drugs, the action of which is aimed at the treatment of hypertension (beta-blockers, ACE inhibitors, calcium channel antagonists).
Antiplatelet agents that prevent the appearance of blood clots (Aspirin, Cardiomagnyl).
Medicines used to treat coronary artery disease (Izoket, Nitroglycerin).
Medicines that normalize the level of cholesterol in the blood (Simvastatin).
Tablets and injections for the treatment of pathologies that are the root cause of the appearance of "cor pulmonale".
Diuretics (indicated in patients with heart failure).
Non-hormonal agents and antibiotics for the treatment of inflammation of the myocardial membranes (Diclofenac, Penicillin, etc.)

Surgical intervention for dysfunctions of electrical conduction involves the installation of a pacemaker for the patient. Complete blockade (right or left), acting as a consequence of acute infarction, requires temporary stimulation of the myocardium using an electrode.

Three-beam blockade, accompanied by attacks of loss of consciousness and a rare rhythm of ventricular contraction, is considered the basis for constant electrical stimulation of the myocardium. The patient is implanted with a cardioverter.

A patient who is not bothered by cardiac symptoms and does not suffer from chronic diseases is well tolerated by normal conditions of life associated with stress.

Three-beam and two-beam blockade will require restriction of physical activity. Such patients should not work hard and be in a stressful state. Diet and food composition are very important.

The diet for patients with impaired electrical conductivity should restore the correct hemodynamics of the peripheral nervous system and central nervous system, water and electrolyte balance, and reduce the active oxidation of lipid peroxidation.

Patients should prefer vegetable oils and avoid heavy animal fats entirely. This choice allows you to quickly reduce the level of bad cholesterol in the blood.

Seafood, mussels, sea kale, squids are saturated with useful microelements necessary for the work of the heart muscle.

Dishes are prepared without the addition of salt, food is recommended to be slightly salted in finished form.

To prevent the development of blockades and other cardiovascular pathologies, it is recommended to follow the general rules:

prolonged sleep;
active lifestyle;
lack of self-treatment;
quitting smoking and alcohol;
balanced nutrition according to the regimen;
exclusion of stress and nervous shocks;
regular diagnosis and treatment of heart disease.

Heart blocks are serious diseases that cause a violation of the conduction of heart impulses. For example, the blockade of the legs of the bundle of His is associated with the pathology of the conduction of electrical signals through the myocardium of the heart, or rather, along the section of the conduction system responsible for the contraction of the ventricles. The result of the development of pathology is a violation of the sequence, strength, speed of excitation, 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 classification of the disease according to the degree of violation of the conduction of excitatory impulses into the ventricles is as follows:

Incomplete blockade of the bundle of His (slowing down the transmission of impulses).
Complete blockade of the bundle of His (complete cessation of impulse transmission).

In addition, the following types of blockades are distinguished:

Single-beam - covers the right leg, or is a blockade of the posterior or anterior branch of the left leg.
Two-beam - affects both branches of the left leg or includes a blockade of the right leg, coupled with the defeat of one branch of the left leg.
Three-beam - the right and left legs are blocked.

According to the type of development of BNPG, 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 localization, that is, appear in the region of different legs).

Causes of the blockade of the legs of the bundle of His

Signs of pathology can appear in children from birth, in which case they can be triggered by congenital diseases:

defect of the interventricular and interatrial septum;
underdevelopment of the segment of the right leg of the bundle of His;
stenosis of the mouth of the pulmonary artery;
coarctation of the aorta;
other heart defects that cause an overload of the right ventricle.

Among the cardiac causes that can cause BBB, doctors call the following:

acute and chronic heart failure;
myocarditis of viral, bacterial origin;
rheumatism of the heart;
endocarditis;
various cardiomyopathies;
cardiosclerosis;
tumors of the heart, metastatic lesions of the heart;
chest trauma;
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 blockade of the legs of the bundle of His, 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, sodium;
overdose of certain drugs - cardiac glycosides, diuretics, antiarrhythmics, etc.;
long smoking history;
alcoholism;
dysfunction of the autonomic nervous system;
diseases of the adrenal glands, thyroid gland;
diabetes;
severe anemia.

In the absence of obvious reasons, after the diagnosis, an idiopathic blockade of the legs of the bundle of His can be established.

Symptoms of manifestation

various changes when listening to heart sounds;
dizziness;
pre-fainting states and fainting;
feeling of lack of air;
dyspnea;
decrease in working capacity;
poor exercise tolerance;
fatigue and weakness;
sometimes - pain in the heart;
feeling of interruption in the work of the heart.

Danger and Consequences

stroke - acute ischemia of a part of the brain against the background of the cessation of blood circulation in it;
chronic heart failure - dysfunction of the heart, leading to malfunctions of the whole organism;
aggravation of the course of the underlying heart disease;
the appearance of thrombosis and thromboembolism due to blood clotting.

Diagnosis of pathology

Even a therapist, when listening to the heart, can note a change in rhythm, a violation of heart rate. This should prompt a further, more detailed examination to look for 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 BNPG (the most common options for blockades are presented below):

Blockade of the anterior branch of the left NPG. There is a high R wave, a deep S wave, and a deviation of the QRS vector up to the left.
Blockade of the posterior branch of the left NPG. The QRS vector is directed up, 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.
Blockade of the right NPG. There is a high wide R wave, a broadened S wave, the amplitude is increased. The ventricular QRS complex takes the form of qRS or rSR, widens to 0.12 sec. and more. In addition to acquired causes (anterior myocardial infarction, coronary artery disease), this variant of the development of the disease is characteristic of congenital heart defects and other diseases.
Blockade of the left NPG. EOS deviates to the left, or is located horizontally. The QRS is shaped like an extended R wave with a serrated or flattened apex. The width of the ventricular QRS complex is greater than or equal to 0.12 seconds. The condition is characteristic of arterial hypertension, acute myocardial infarction (less often), aortic heart disease.
Two-beam blockade (blockade of the right leg and left anterior branch). The QRS complex is expanded over 0.12 sec., the negative T segment, and the RS-T segment is shifted down, the EOS deviates to the left. This change is most characteristic for IHD and other myocardial pathologies.

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

Blood and urine tests to assess electrolyte balance, hormone levels, indicators of autoimmune processes, etc.
24-hour ECG monitoring to detect non-permanent atrial conduction disturbances, the type of arrhythmias, assess the severity of blockades, search for nocturnal or exercise blockades.
Ultrasound of the heart to establish cardiac causes of heart block, especially organic heart disease.
EFI to clarify the data on the disease, when ECG or Holter monitoring does not allow an unambiguous diagnosis.

Methods of treatment

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

In general, a person with blockades without manifestations can lead a normal life, but one should immediately abandon excessive physical exertion, have more rest, and exclude prolonged stress. Nutrition without fail must be correct, without an abundance of salt and animal fats, sugar. You should give up bad habits, especially smoking. After installing the pacemaker, a person should initially visit a cardiologist every three months, and then every six months and a year. Some use folk remedies for heart blockade. By agreement with the doctor, the following prescriptions from the alternative medicine section are allowed:

Combine equally valerian root, rose hips, dandelion roots, calamus roots, 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.
Combine pharmacy 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 dilution 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 the disease, the following measures are important:

more rest, sleep;
eliminate stress and overwork;
observe the regime of work and rest;
eat only healthy food, consume more vegetable fiber;
give up cigarettes, alcohol;
take all drugs only in recommended doses and under the supervision of a doctor;
early treatment of all heart diseases.