Hist bundle block treatment. Right and left bundle branch block: causes, symptoms and treatment

It happens that the patient, upon receiving a transcript of the cardiogram, learns from the doctor that he has a blockade. right leg His bundle. Sometimes the diagnosis concerns young children, but more often it concerns men over 45 years of age. What does it mean similar pathology whether it is a disease and whether it should always be treated are the most common questions that require detailed consideration.

The human heart is a blood pump that supplies biological fluid all cells of the body. Blood circulation is carried out thanks to the rhythmic alternating contraction of the chambers of the heart - the atria and ventricles. The contractile function is provided by the local conduction system, which serves to pass the cardiac electrical impulse along a given route - from one chamber to another.

The conduction system includes:

sinus node - located in the upper part of the right atrium;
atrioventricular node - connected to the sinus node, based at the bottom of the right atrium;
His bundle - the central part of the heart, consisting of atypical nerve fibers, connected to the atrioventricular node; has two legs - right (single-branch) and left (formed from the front and rear branches);
Purkinje fibers are filaments that extend from the legs and communicate with the myocardium of the left and right ventricles.

The task of the system is to excite the muscular layer of the ventricles with the help of electrical impulses originating in the right atrium. Complete cessation or partial disruption of the conduction of nerve fibers leads to a malfunction of the heart and is called bundle branch block (ICD-10 code - I45.0).

According to the classification, depending on the number and combination of blocked branches, one-, two- and three-bundle RBBB are distinguished. Most common is a single-bundle blockade of the right leg of the PG: it can be complete or incomplete (RBBB), permanent or transient. In the second case, a failure may be recorded and then disappear during the same ECG session, or it may not be recorded during every cardiographic examination.

Features of incomplete blockade of the right bundle branch

With this type of blocking, the excitation vector partially passes along the right leg, and the main mission of its implementation takes on left leg. In essence, RBBB is a focal (intraventricular) blockade that does not lead to severe consequences for good health. The impulses follow a circular path without interfering with the work of the heart pump. Considering the above, partial (incomplete) blockade of the right bundle branch is considered either a natural condition or a companion to one of the cardiac pathologies. The final conclusion and possible treatment depend on the causes, symptoms and diagnostic results.

What causes the disorder

Factors contributing to the deterioration of the conduction of cardiac impulses by nerve bundles are divided into several groups.

Cardiac reasons:

Important: The cause of partial blockade of the right leg of the PG can be secondary myocardial diseases (myocardiopathy, cardiodystrophy) caused by anemia, obesity, thyrotoxicosis, alcoholism, diabetes mellitus, syphilis, neoplasms.

Medicinal reasons:

overdose of cardiac glycosides;
taking diuretics;
uncontrolled treatment for arrhythmia.

Electrolyte imbalance – changes in the ratio of elements that make up salts (sodium, potassium, magnesium).
Toxicosis – smoking, drinking alcohol.
Dysfunction of the autonomic nervous system.
Malfunctions of the hormonal system.
Chest bruises.

Signs

With partial right single-fascicle blockade, clinical manifestations are usually not recorded, and conduction disturbances are detected only during hardware examinations. If the patient complains of shortness of breath, heaviness in the heart, arrhythmia, bradycardia, weakness, then this is most likely caused by the disease that provokes the blockade. Sometimes RBBB is combined with increased heart rate, even in the absence of serious cardiac pathology. It happens that tachycardia is caused by dysfunction of the thyroid gland, so you need to consult an endocrinologist and monitor the condition of the heart (periodically do an ECG).

Complete right bundle branch block

This condition indicates the cessation of transmission of rhythmic self-excitation from the right atrium to the ventricles. The peculiarity of PBPNP is that the right ventricle contracts not due to impulses transmitted by the right leg, but due to those coming from the left ventricle.

Causes

As well as partial disruption of conductivity, its absolute loss can be caused by congenital and acquired cardiac pathologies. These include:

birth defects hearts;
heart attack, cardiosclerosis, ischemia;
inflammation of the walls of the heart muscle;
hypertrophy of the right ventricle or atrium;
anomalous anastomosis separating the left and right atrium;
myocardial dystrophy of various etiologies.

Diseases that lead to enlargement of the right chambers of the heart often act as provocateurs of complete blockade: bronchial asthma, prolonged pneumonia, Chronical bronchitis, emphysema, blockage pulmonary arteries. Sometimes PBPNP appears suddenly – due to stress.

Symptoms

Complete blockade of PNPG is characterized by the following clinical signs:

arrhythmia;
shortness of breath even with slight exertion;
a feeling of “movement” in the head;
pre-fainting;
fatigue, loss of strength, drowsiness.

The symptoms are caused by profound structural changes occurring in the myocardium of the left ventricle under the influence of underlying diseases - heart attack, severe anemia, thyrotoxicosis. Over time, the relationship between the atria and ventricles is completely disrupted, bradycardia is noted (heart rate is only 20-45 beats per minute), causing a decrease in blood ejection into the aorta. Disturbances in cerebral blood supply during PBPBB often lead to loss of consciousness, which can provoke sudden death.

Features of blockade in children

Typically, RBBB is detected in a newborn child together with congenital heart defects or minor cardiac anomalies. Incomplete blockade in a baby is assumed (and its presence is checked) for the following cardiac pathologies:

underdevelopment of the heart muscle - for example, an extra septum in the left ventricle;
defects of the septa between the chambers of the heart;
valve defects;
defects associated with increased loads on the right side of the heart.

In children and adolescents, single-bundle incomplete RBBB is sometimes even considered normal - provided that they are not associated with damage to the structures of the main organ.

Diagnostics

The presence of the disease can be assumed by the results of listening to the heart with a phonendoscope (auscultation). The patient does not physically feel signs of pathology, and the doctor hears the splitting of heart sounds. Further examination to make a diagnosis consists of several stages.

In addition to the main types of research, the doctor may prescribe additional:

general and biochemical blood tests;
general clinical urine analysis;
Transesophageal ECG is one of the most error-free methods for studying right leg block.

To clarify the diagnosis, an MRI (magnetic resonance imaging) or multislice CT (computed tomography) of the heart may be prescribed.

Right bundle branch block on ECG

The duration of depolarization increases - accordingly, the gastric QRS complex expands on the ECG. It exceeds the normative 90 ms (due to the fact that the impulse has to “bypass” the blocked bundle branch) and becomes bifurcated.

When interpreting the electrocardiogram, the blockade can be determined by the following signs:

QRS duration is 90 - 120 ms (with complete blockade or more);
in the case of RBBB, the QRS section on the ECG in leads V1-V2 has the shape RsR’ - it seems that these are rabbit ears (and the left is higher than the right);
the trough of the S wave becomes wider and deeper in the left leads – I, AVL, V5-V6.

Sometimes other deviations from the norm are noticeable:

the first R wave is not prominent - the entire QRS complex is an extended R wave;
since the direction of repolarization changes, downward ST depression occurs, while T becomes negative in V1-V2 (as with right ventricular overload)

Treatment of complete and incomplete blockade of PNPG

If such a pathology is not combined with dysfunction of the heart or other internal organs that negatively affect its condition, medical intervention is not required. In the presence of provoking diseases, complex therapy for PNPG blockade using the following drugs is recommended:

Unfavorable and dangerous consequences underlying diseases should be treated with appropriate groups of medications. If in the background bronchopulmonary pathologies“pulmonary heart” syndrome has arisen (its right sections have expanded), the doctor prescribes glucocorticosteroids (Spiriva beclazon, Berotec), inhaled adrenergic agonists. For inflammatory processes in the membranes of the heart, antibiotics and NSAIDs (Diclofenac, Nimesil) are prescribed. The development of heart failure requires the use of diuretics (Chlorthalidone, Indapamide) and cardiac glycosides - Celanide, Strophanthin, Ditoxin.

If conservative methods are ineffective, installation of a pacemaker or surgery blockades

Important: A patient with an installed pacemaker should not come within 20 cm of operating electrical and wave devices. This applies to TV, laptop, mobile phone, hair dryer.

The question is often asked: does incomplete blockade of the right leg of the PG allow for sports training? You can play sports only in the absence of cardiac or pulmonary diseases, which provoked deterioration of conductivity. If such pathologies exist, physical activity should be reduced. Restrictions apply to strength sports: kettlebell lifting, weightlifting, powerlifting, arm wrestling, power yoga. The intensity of the load and types of exercises should be selected by a specialist with a medical education.

Consequences and prognosis

If a patient is accidentally diagnosed with a right bundle branch block during an ECG, how serious is the health threat, is it dangerous? If a person is young and has no symptoms of organic damage to the heart muscle, the prognosis is favorable. According to modern research According to studies carried out in the field of cardiology, isolated RBBB does not develop into complete atrioventricular block and never leads to death.

If cardiac conduction is blocked due to the development of coronary artery disease or worsening hypertension, the prognosis worsens - the risk of death almost triples. Death is possible as a result of the following severe complications:

ventricular fibrillation - a cardinal disturbance of heart rhythm;
ventricular tachycardia;
heart failure;
thromboembolism - blockage of arteries;
stroke;
cardiomegaly - pathological growth of the heart muscle.

For example, blockade of the bundle branches is associated with a pathology of 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 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:

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

In addition, they highlight the following types blockades:

Single-bundle - covers the right leg, or represents a blockade of the posterior or anterior branch of the left leg.
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.
Three-bundle - the right and left legs are blocked.

According to the type of development of BBBB 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:

interventricular defect 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-fascicle blockades can be considered a variant of the norm 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, prolapse mitral valve 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 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 disruptions in the functioning of the entire 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-fascicle blockade).

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):

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.
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.
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.
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 defects hearts.
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:

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

Treatment methods

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. Generally, drug treatment blockade may include the following drugs:

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

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.
Connect pharmacies alcohol tinctures 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.

Are you one of the millions who have heart disease?

Have all your attempts to cure hypertension been unsuccessful?

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

The materials presented are general information and cannot replace medical advice.

Left heart block

In order to understand what left ventricular block is, you need to know how a healthy human heart works, as well as how its conduction system is organized.

Our heart consists of ventricles and atria, which contract in turn to provide blood circulation to the entire body. The heart works under the influence of electrical impulses that are produced by its specific structures.

The sinus node is the dominant impulse-generating structure. After the impulse leaves this node, it is carried out to the atria, which contract because of this. Then it reaches the atrioventricular node. This node is located between the ventricles and atria and is a kind of gateway for the eclectic impulse between these two structures. The impulse is delayed for a fraction of a second 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, reaching the ventricles, thereby forcing them to contract and pour blood into the general channel.

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

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

Classification

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

Consequences of complete blockade of the left bundle branch

The heart is a unique organ that governs itself, i.e. possesses automaticity, 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 sac, which is a pump for pumping blood; the heart is much more complex than it might seem.

The structure of the heart and the resulting causes of blockades

In addition to the muscles, four cavities, valves, and its own coronary vessels, it has a conduction system and its two centers (pacemaker). From the main center (the pacemaker of the first order), electrical impulses enter the second, and then along the left and right branches 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 bundle branch. therefore, the impulse cannot spread further, and this leads to disruption of the rhythm and, in general, the work of the entire 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, cardiac dystrophy, hypertension, cardiomyopathy, myocarditis, etc.

Consequences of the blockade

Complete blockade of the left bundle branch leads to disruption of the conduction of electrical impulses 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 complete blockade of the left bundle branch?

Even a complete bundle branch block may be asymptomatic and may not initially pose a serious threat to life. However, over time, the condition worsens, ventricular arrhythmia develops, more often one of its types is ventricular paroxysmal tachycardia. It is this that ultimately leads to ventricular fibrillation: random contraction of myocardial muscle fibers, 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, and blood pressure-lowering drugs are prescribed. If the heart rhythm does not recover, then they resort to surgery: installing a pacemaker.

Rehabilitation for cardiac arrhythmia

In addition to drug therapy for the underlying disease causing the blockade, treatment should include additional non-drug methods that relate more rehabilitation measures. In general, this tactic is suitable for other causes of left ventricular block. For example, physical therapy. Physical exercise They tone not only the entire body, but have a particularly beneficial 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 accelerate blood. Of course, strength exercises are not suitable here. Choices: Walking or jogging. But in physical therapy It is very important, especially in case of heart disease, that the load is dosed and adequate to the capabilities of the heart. Otherwise, you may 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 arise in special structures of the cardiac tissue. Sometimes it happens that the impulse is not transmitted by the heart cells. Such conditions are called blockades.

Block of the left ventricle of the heart or, as it is called in medical practice, block of the left bundle branch in most cases is only a complication of the disease. Accordingly, if there is damage to the right bundle branch, 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

IN Lately Left ventricular block is used as a term that has a broader concept than “left bundle branch block.” This is due to the mechanism of impulse transmission. The fact is that the left bundle branch is divided into two legs: anterior and posterior. Sometimes the block occurs at the site of division into the anterior and posterior branches; in such cases, diagnosis by establishing the level of the lesion is difficult. As a result, they decided to introduce a more extensive concept.

Types of blockades

In addition, blockade of the left ventricle can be complete or incomplete. An incomplete blockade does not pose any danger to life. The symptoms that are observed with it are weakness, slow pulse (bradycardia). If an 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 hypertrophy of the left ventricle, 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 diagnosing “blockade...” is an electrocardiogram, which may look different in the same cases, although it was done on the same device.

Things are very serious with complete blockade of the left bundle branch (left ventricular block). First, I would like to tell you what happens normally: the left ventricle is “responsible” for releasing oxygenated blood into the aorta. If the left ventricle fails, the release of oxygenated blood is delayed or stopped, which leads to oxygen starvation of all organs and systems (primarily the brain). Clinically, this is manifested by breathing disorders (shortness of breath), dizziness, drowsiness, a decrease in heart rate to 25 beats/min and, in the end, acute heart failure, which can result in death if timely and correct medical care is not provided.

Diagnosing a complete blockade with an experienced doctor does not pose any particular difficulties. Everything will be visible on the ECG. Provided there is no other pathology.

Dangerous conditions

Complete blockade and myocardial infarction or complete blockade and unstable angina are very common. It is much more difficult to treat complete blockades. To date no special recommendations on this occasion. The main thing is to stop the acute condition, and then prevent recurrences, so to speak, carry out prevention. Also read about the consequences of a complete block of the left bundle branch.

This condition can be cured in different ways, including the use of an electric defibrillator. Then, when the condition has stabilized, drug therapy is carried out, drugs that improve the quality of life (beta blockers, etc.), and antiarrhythmic drugs are prescribed.

Prevention

It is advised to follow a diet (blockades often occur due to obesity). All this is for older people who have, so to speak, “acquired” diseases. For people with defects, the most optimal treatment method 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, I am his guardian. He takes haloperidol 3 times, cyclodol 2 times, aminazine 100 mg at night and phenazepam 2 mg at night. On the ECG, complete blockade of the left bundle branch and incomplete blockade of the right bundle branch indicate: possible overload of the right ventricle. I walk with him on the street, his weight is 84 kg, his height is 167 cm. His “heart” is not complaining. There are “voices” in your head. In September, after September 14, an MSE examination was scheduled for the purpose of rehabilitation for the underlying disease (paranoid schizophrenia, continuous progressive course).

The therapist prescribed asparkam. It's 08.10. Born 1973. Need a cardiologist?

Of course I need it. I have a complete blockade of my left leg. A pacemaker was installed. I'm 26 and have had a stimulant since I was 17 years old.

I have a complete blockade of the left bundle branch. IT IS POSSIBLE TO DO SURGERY FOR UTERUS PROPRESSION. AND I WANT TO KNOW THE RECTUM. AND HOW TO CONTINUE TO LIVE

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

Absolutely each of us knows that thanks to the work of the heart, the entire body 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 early stages, the edge of the main pathology and can be identified using an ECG. But if you notice one of the signs indicated in the article, do not put off visiting a cardiologist, because this can lead to more serious complications. What is an incomplete block of the left bundle branch, how does it manifest itself, diagnostic methods and treatment methods, we will consider below.

What is a blockade?

The bundles of His are modified elements of cardiac tissue that are part of the conduction system of the heart. Exciting 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 branch(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 ones - to the muscles of the left. This ensures synchronous contraction of the right and left parts of the heart. With an incomplete blockade, the passage of nerve impulses becomes difficult, with a complete blockade, their complete cessation occurs.

This leads to disruption contractile function hearts. Groups of reasons causing blockades (detailed reasons will be discussed below):

Cardiac, that is, pathologies of the heart.
Medicinal group of causes (or medicinal) - 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 blockades in the heart.
A group of autonomic disorders (autonomic nervous system), it is responsible for controlling the rhythm of the heart.
Hormonal causes (diseases of the endocrine organs).
A group of reasons that cause oxygen starvation of the heart muscle.
Idiopathic causes that are not determined during examination of the patient.

Types of blockades

If electrical discharges from the upper chambers are not transmitted as they should to the lower chambers, a bundle branch block occurs. This is reflected in the cardiogram.

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

Single-bundle - 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-bundle is the most serious pathology in which 3 branches are affected at once.

In turn, LBBB can occur in several scenarios:

the blockade occurs in a certain part of the trunk up to the branching boundary;
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 bundle branch - characteristics

By incomplete blockade we mean a violation of the conductivity of the electrical signal along one of the branches of the left leg. To determine which part is suffering, the electrographic deviation of the total vector of the electrodynamic force of the heart is assessed 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 right-branch is observed, then this indicates damage to the posterior branch.

As a rule, incomplete LBBB 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 detected, then the condition can be regarded as corresponding to the physiological norm and further examination is not necessary in this case.

Left bundle branch block (or LBBB) is a pathology that may be based on damage to the cardiac apparatus on different levels. For example, the left leg in the trunk of the His bundle may be affected. Or the main trunk of the left leg before branching.

The anterior and posterior branches of the peduncle can be affected at the same time at the end of the place where they are separated from the body of the main trunk. The left half of the septum between the ventricles is also damaged, and 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 becomes difficult.

It is carried out using an unusual method, as a result of which the QRS complex widens and the direction of repolarization in the left ventricle changes. We won’t look at this in detail; this is a task for heart experts. Let's look at some of the features of this disease.

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

Complete and incomplete blockade of the left bundle branch is not uncommon. If we are talking about complete excitation, the excitation first covers only the partition between the ventricles, and not the entire ventricle. Incomplete blockade begins with disturbances in electrolyte metabolism, or drug overdose, or various types of intoxication.

As a result, the normal conductivity of the cardiac system is disrupted, and full excitation of the left section does not occur. It is possible to diagnose this disorder using a simple electrocardiogram; when deciphered, 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 about it.

Many modern cardiologists are confident that this deviation has already ceased to be a deviation in those cases when it is not the result of other heart diseases. Complete blockage of both legs is scary; in such cases, a pacemaker must be implanted.

Causes

The causes of the pathology include:

Atherosclerotic cardiosclerosis is the replacement of part of the heart muscle with connective tissue.
Aortic valve defects. This defect leads to 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– 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 His bundle:

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

An important role in the emergence this violation drug intoxication of the body plays a role. In this case, poisoning with diuretics, cardiac glycosides, and sympathomimetic drugs is observed.

Sometimes the blockade develops due to excessive consumption of alcoholic beverages, smoking, narcotic substances. Also appearance of this disease may be a consequence of deviations in electrolyte balance body.

The development of His bundle block is caused by magnesium deficiency, deficiency or excessive amount of potassium. Also, the reason for the development of blockade may be the appearance of thyrotoxicosis.

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

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

Also, 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 is often caused by 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;
heart attack, which is characterized by posterior localization;
deposition of calcium salts;
myocarditis.

In more rare cases, a two-fascicle blockade may be detected - in this case, both the anterior and posterior branches of the organ are affected.

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 different kinds diuretics, symptoms and cardiac glycosides;
Abuse bad habits, which 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. Their significant amount, as well as some of their deficiencies, 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.

Anterior branch block

When blocking the anterior branch of the left bundle branch, uniform disturbances are determined regardless of the location of the lesion. This is explained by the fact that the reaction of the excitable structure does not reach the upper parts of the anterior wall of the left lower chamber of the heart.

Therefore, using standard electrocardiography it is impossible to accurately determine the location affected by the block.

With LPVPL, excitation in the right lower cardiac chamber occurs in a standard manner. In the lower left chamber, the reaction of the excitable structure spreads 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 coronary arteries and this especially applies to the front 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 enlargement of the left lower chamber of the heart caused by aortic valve insufficiency;
primary isolated sclerosis and calcium deposition in the walls of the conduction system;
congenital heart defects.

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

Posterior branch block

When the posterior branch of the left bundle branch is blocked, serious conduction disturbances occur in the posterior branch, which can occur with different indicators. The ECG shows identical abnormalities that are difficult to differentiate using standard electrocardiography.

This condition develops with pathologies similar to those with LPVPL:

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;
calcium deposition and tissue degeneration into hard connective tissue.

If we talk about blockade of the anterior branch, then in electrocardiography this is a fairly well studied section. But damage to the posterior branch does not give specific signs, and this section is still under development. It is impossible to diagnose damage to the posterior branch based solely on the results of a standard cardiogram.

As a rule, to clarify it is necessary 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 research before making an accurate diagnosis.

Symptoms

Single-fascicular block is asymptomatic and is detected by ECG. Signs of impairment such as constant fatigue, chest pain, shortness of breath, in this case are caused by a disease that causes electrical conduction disturbances.

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

Incomplete blockade of the left bundle branch of His, trifascicular, is characterized by the following symptoms:

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

Three-bundle incomplete blockade leads to sudden death.

Diagnosis of electron conduction disorders of the His bundle

A problem with electrical conductivity is shown by a cardiogram. Right incomplete blockade, in the absence of clinical symptoms and concomitant diseases, is considered normal and no additional examinations are performed.

ECG signs of double-fascicular blockade serve as a reason for hospitalization of the patient, as there is a risk of developing severe conditions. A three-bundle His bundle block detected on an ECG also requires immediate hospitalization followed by surgery.

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

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

Signs of conduction disturbance of the left leg:

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

Differences between three-bundle blockade:

all the signs of left and right;
ECG picture shows atrioventricular block.

Incomplete left bundle branch block on ECG

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 isolation 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.

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 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.

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

Excitation 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 (vector directed to electrode V6);
- 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 you to register a small rV1).
Excitation stage 2: this is the final excitation of the interventricular septum, flowing from right to left: further descent of the SV1 teeth (QSV1) and rise of RV6 are recorded.
Excitation stage 3:
- caused by excitation of the left ventricle, which follows an unusual path and proceeds slowly;
- further descent of teeth SV1 (QSV1) and further rise of RV6 are recorded, while on tooth RV6 a notch is usually observed located on the ascending knee (there are several options for explaining this phenomenon, such as;
- the presence of a short period of time between stages 2 and 3;
- the predominance of the vector of final excitation of the interventricular septum over the vector of initial excitation of the left ventricle;
- different interaction between the vector of the interventricular septum and the vector of the left ventricle). Due to the slow spread of excitation, a widening of the QRS complex is noted.
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 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 - to electrode V1 (registration of positive TV1, the ST segment in this lead is located above the isoline.

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.

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); they mention the prolongation of the electrical systole of the ventricles; 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.

Additional diagnostic procedures

Additional measures include:

Daily ECG monitoring is necessary to identify a transient form of the disease, manifested in different time days.
Electrocardiographic studies of the esophagus are necessary for the diagnosis of arrhythmias.
A cardiac echo is performed to identify organic pathologies in the structure of the heart and to assess the condition of the myocardium.
MRI is prescribed if controversial issues arise when making a diagnosis.

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 this state is based on a comparison of the results of the cardiogram and ECG with normal heart rate indicators. 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 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, cardiac glycosides will often be prescribed wide range actions, as well as nitroglycerin, antihypertensive drugs that stabilize the heart and its rhythm in the first place;
Immune drugs aimed at stimulating the body's defenses and increasing the degree of its resistance to all kinds of diseases, including heart problems.

The most popular today is a broad-spectrum medicine called “Transfer Factor Cardio”: the absence side effects, rapid effects 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 your general condition and restore normal heart rhythm.

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.

There is no special treatment for patients who experience cardiac conduction disorders. Patients who have been diagnosed with left bundle branch block are not indicated for drug therapy.

Symptomatic treatment of the underlying pathology with one- and two-fascicle blockade includes the following medications:

Vitamins ( nicotinic acid, thiamine, riboflavin).
Sedatives (tincture of valerian, motherwort, sage).
Antioxidants (Preductal, Carnitine).
Antihypertensive drugs whose action is aimed at treating hypertension (beta-blockers, ACE inhibitors, calcium channel antagonists).
Antiplatelet agents that prevent blood clots (Aspirin, Cardiomagnyl).
Medicines used for treatment of ischemic heart disease(Isoket, Nitroglycerin).
Medicines that normalize blood cholesterol levels (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.)

Surgery for electrical conduction dysfunction involves installing a pacemaker in the patient. Complete blockade (right or left), resulting from an acute infarction, requires temporary stimulation of the myocardium using an electrode.

Three-fascicle 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 tolerates well normal conditions lives associated with stress.

Three-bundle and two-bundle blockade will require limited physical activity. Such patients should not work hard and be under stress. Diet and food composition are very important.

A diet for patients with electrical conduction disorders should restore proper hemodynamics of the peripheral nervous system and central nervous system, water and electrolyte balance, and reduce active oxidation of lipid peroxidation.

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

Seafood, mussels, seaweed, squid, are rich in beneficial microelements necessary for the functioning of the heart muscle.

Dishes are prepared without adding salt; it is recommended to add a little salt to the food when cooked.

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

long sleep;
active lifestyle;
lack of self-medication;
quitting smoking and alcohol;
balanced nutrition according to the regime;
elimination of stress and nervous shock;
regular diagnosis and treatment of heart diseases.

Page 25 of 37

10.4. Intraventricular conduction disorders

10.4.1. Right bundle branch block (RBBB)

Right bundle branch block (RBBB) occurs in 0.1-0.2% of cases in young people. With age, its frequency increases, reaching 0.3-0.24-4.5% in people over 40 years of age. RBBB occurs more often in men.

In acute myocardial infarction, RBBB appears in 2-3.7% of cases and mainly in anterior infarction, more often in transmural ones. Partial RBBB also occurs with posterior myocardial infarction.

Etiology. In young people, blockade of the right bundle branch is often (21-50% of cases) benign and not associated with cardiac pathology. In other cases, especially in older people,

RBBB is caused by hypertension (60% of cases), ischemic heart disease (although it more often causes blockade of the left bundle branch). Less commonly, the cause of RBBB may be a congenital anomaly - underdevelopment of the initial segment of the right bundle branch; congenital heart defects (atrial septal defect, less often ventricular septal defect, stenosis of the pulmonary artery); stretching of the right ventricle due to pulmonary embolism or obstructive chronic diseases lungs (then more often there is a partial blockade of the right bundle branch); Lev and Lenegre diseases; acute myocardial infarction; cardiomyopathy; blunt chest trauma; hyperkalemia, progressive muscular dystrophy; overdose of novocainamide, quinidine, less often cardiac glycosides; neoplasms of the heart; cardiac surgery, such as vertical ventriculotomy; syphilitic gumma.

Clinical picture.

Clinical signs of the organic disease causing RBBB may be detected. In addition, in 1/3 patients, some changes are detected during auscultation: splitting of the second tone, which occurs more often, and splitting of the first tone, which occurs less frequently (due to asynchronous contraction of the ventricles).

Diagnostic ECG criteria. Complete RBBB: duration of complex #R5>0.12 s; a high R or R' wave in lead Vi, sometimes in V2, 3 (a small p is usually recorded before the R wave. In the aVR lead there is often a deep Q wave and a wide, jagged R wave. In the I and left chest leads, various sizes are usually detected R wave and wide, jagged S wave); ST and T are deviated discordantly from the main direction of the QRS complex. When the electrical axis deviates to the left, the rR jagged R or qR shapes are recorded in lead Vj. When the electrical axis deviates to the right, a qR shape is observed in lead V1.

Partial RBBB: The morphology of the QRS complex is identical to complete RBBB, but its duration is 0.11 seconds. As the degree of blockade increases, the duration of the QRS complex increases and the R' deflexion in lead Vi becomes higher. More often (in 87% of cases) RBBB is constant, less often it is intermittent.

Treatment.

Right bundle branch block does not require special treatment. The appearance of RBBB in acute period myocardial infarction, prophylactic epdocardial stimulation is not

requires. If necessary, treat the underlying disease that caused RBBB.

Prognosis: Young people without organic heart disease have a relatively favorable prognosis. Most authors believe that isolated RBBB never turns into complete AV block, and even the joint finding of first-degree atrioventricular block has no prognostic value, since EFI in such cases, as a rule, only finds prolongation of the A-H interval, indicating worsening of the AV. conductivity at the AV junction. However, some authors point to the rare (1.8-6%) progression of RBBB to 2nd or 3rd degree AV block.

Associated RBBB on the background of hypertopic disease or ischemic heart disease worsens the prognosis, increasing mortality by almost 3 times. The prognosis is worsened by cardiomegaly, heart failure, and prolongation of the H-V interval. The prognosis for RBBB is always better than for left bundle branch block.

Against the background of acute myocardial infarction, the appearance of complete or partial BPIP does not, according to our data [Reingardene D. 1975], turn into complete AV block and does not worsen the outcome of the disease. Some authors [Doshchitsin V. L. 1979, etc.] with RBBB note an increase in mortality, but only with extensive transmural myocardial infarction with heart failure. RBBB does not affect the long-term prognosis of infarction, although there is an opposite opinion.

Incomplete right bundle branch block

Blockade of this level refers to disturbances at the level of conduction inside the ventricle of the heart, that is, it is an intraventricular block. Sometimes this can be found in apparently healthy young people, which should be considered as an option physiological norm. Considering that the blockade of one of their legs reflects a conduction disorder, it is necessary to examine the patient in order to identify the disease that led to the development of the disorder.

Causes of right bundle branch block

As a rule, the blockade develops against the background of heart disease. Conduction disorders inside the heart ventricle are often caused by necrotic, sclerotic, and inflammatory processes. In addition, the cause may be those pathological processes that lead to a state of overload of some parts, in particular the ventricle. Such diseases include heart defects (congenital, in which there is an excessive load on the right ventricle, defects of the septa between the atria and ventricles), mitral stenosis, coronary heart disease, acute conditions (heart attack), arterial hypertension and cardiosclerosis.

The causative factors for the development of an incomplete type of blockade are intoxication or overdose medicines(from the group of digitalis, adrenergic blockers), disturbances in electrolyte metabolism. Due to the development of the blockade, the conduction of impulses through the heart system slows down, which leads to the fact that physiological, full excitation of the right sections does not occur. The diagnosis of blockade separately at the level of the right leg can only be established on the basis of an electrocardiographic study. When deciphering the ECG, changes in the QRS complex are detected (expansion and jaggedness of its terminal part), while the duration of the complex itself is usually increased. In the chest leads, the R wave will be enlarged and jagged, the ST segment will be lowered.

Treatment of right bundle branch block

Therapeutic measures for incomplete blockade consist in treating the disease that is the cause of the blockade. That is, there is no specific therapy for the blockade itself; it is necessary to treat the underlying disease. For example, congenital defects in modern conditions can be operated on in a cardiac surgery clinic (if there are appropriate indications for this). If the patient suffers from heart failure, angina pectoris, hypertension, therapy is carried out with cardiac glycosides, antiarrhythmics, and antihypertensive drugs.

In some young people, this type of blockade is normal, so therapy is not prescribed. Can only recommend dynamic observation and examination by a cardiologist.

Depending on the identified underlying disease, the patient needs observation and treatment from a cardiologist or therapist. Observation involves assessing the dynamics of changes in the ECG and adjusting prescribed therapy based on clinical and laboratory examination.

Bundle branch block on ECG

Often in the electrocardiographic report you can find the term “bundle branch block”. The blockade can be complete or incomplete, affecting the right or left legs, or branches of the left leg. Let's figure out what it is.

What it is?

The electrical impulse that excites the heart travels from the sinus node through the atria to the atrioventricular node, which lies between the atria and ventricles. A pathway called the “bundle of His” begins from the atrioventricular node. This bundle splits into two smaller trunks - the right and left legs, which conduct excitation to the right and left ventricles. The left leg then divides into anterior and posterior branches. These branches further break up into many small branches that conduct electrical impulses to the muscle fibers of the heart.

Under various physiological and pathological conditions, conduction along these pathways is disrupted. Blockades of the bundle branches and their branches occur.

The blockade can be complete or incomplete. With incomplete blockade, conduction along the leg slows down. With a complete blockade, excitation occurs in an unusual way, “bypassing” the site of the blockade.

Sometimes blockades of two or three of the listed branches appear at once. They are called “two-bundle” and “three-bundle”, respectively, and occur in cases of serious heart disease.

Causes

Incomplete blockade of the right bundle branch can be recorded in healthy young people and is not a deviation from the norm. Incomplete blockades of the legs may appear with an increase in heart rate, which in some cases may be regarded by the doctor as a pathological sign.

Bundle branch blocks, both complete and incomplete, can be a sign of heart disease, in particular myocardial dystrophy, angina pectoris. myocardial infarction and scar changes after it, diffuse cardiosclerosis. hypertension, heart defects and others. Any pathological process in the heart muscle can also affect the conduction system, resulting in the development of this electrocardiographic sign.

Complete blockade of the right bundle branch is most often a sign of enlargement of the right ventricle with some heart defects, as well as with the formation of chronic pulmonary heart disease, so it is often found in chronic obstructive pulmonary disease, emphysema, and severe bronchial asthma.

Complete blockade of the left bundle branch most often appears against the background of coronary heart disease (angina pectoris, scar changes after suffered a heart attack myocardium). In this case, it is associated with a poorer prognosis for such patients, as it reflects severe damage to the heart muscle.

Symptoms

These electrocardiographic signs are not clinically apparent.

Diagnostics

The main diagnostic method is electrocardiography. Signs of a transient blockade can be seen during daily (Holter) electrocardiogram monitoring.

Treatment

The prognosis, ability to work, and the ability to perform physical activity are determined by the severity of the underlying disease.

Thanks to the contraction and relaxation of the heart muscles, our body receives all the necessary useful material. But in last years increasingly, many people, after going through another medical examination and ECG, they hear that they have a right bundle branch block.

Many people immediately panic, because they didn’t have a single symptom, and then immediately such a diagnosis. Remember, the most important thing in any situation is to remain calm, because unnecessary stressful situations negatively affect the functioning of the heart.

If you are faced with such a problem, then it should be interesting and useful for you to know about the features of right bundle branch block, what types there are, whether this condition is dangerous and what treatment a cardiologist can prescribe.

Bundle of His - what is it and why is it needed?

As you can see, arterial and venous blood in our heart does not mix, and the chambers of the heart contract strictly synchronously: first, ventricular systole occurs, and at this time the atria “rest”, filling with blood. The ventricles then fill with blood during diastole, which is ejected from the atria.

For normal contraction of the heart, the atria need to contract together, like the ventricles, in pairs. And there must be strict synchronicity between them. In the event that such a synchronous contraction does not occur, then various variants of the appearance of pathology of the electrical impulse, which are called blockades, are possible. These conditions can be life-threatening.

It is known that in the jejunum of the heart there is a special conducting system, in the form of special bundles nerve cells. They form nodes and bundles that help conduct impulses from the overlying parts of the heart to the underlying ones. There are patterns of impulse conduction, and there is a strict order.

One of these bundles is the His bundle, which is otherwise called the atrioventricular bundle. It passes through the thickness of the interventricular septum, and splits there into two legs - left and right.

As the name suggests, the right leg approaches the right ventricle, and the left leg approaches the myocardium of the left ventricle. These legs end with special Purkinje fibers, which branch into muscle tissue corresponding ventricles. The impulse is carried through the structures of the His bundle at different speeds, which average 1-3 meters per second, which is quite noticeable with a beam length of 15-18 mm.

In addition to arrhythmias, blockades of impulse transmission to the underlying parts of the heart can often be detected if, for some reason, there is a complete or incomplete blockage of impulse transmission along one of the legs of this bundle. Source: zdravlab.com

The bundle of His is a section of the conduction system of the heart, also called the atrioventricular bundle.

It consists of a trunk and two legs (left and right) and provides innervation between parts of the organ, transmitting impulses from the right atrium to both ventricles. Due to this, the latter contract according to the rhythm of the atria. If the conduction of a nerve impulse is disrupted for one reason or another, then we're talking about about such a diagnosis as bundle branch block.

The conduction system coordinates the contraction of the ventricles and atria, ensuring normal heart rhythm. If the conductivity is nerve fibers is disrupted, this causes a disruption in the activity of the heart. Incomplete blockade of the right bundle branch is more often detected in males over 45 years of age, and the risk of its development increases with age. The left bundle branch consists of two branches (posterior and anterior), and the right one only of one. There are three types of conduction block:

single-bundle, it involves the right leg or one of the branches of the left;
two-bundle, when the left bundle is completely affected or one of its branches and the right leg are affected;
three-bundle – affects both legs.

Each of these types of conduction failure can be complete or incomplete, permanent or periodic, that is, occurring at different intervals of time. The latter may appear and disappear on one ECG recording and may not even be recorded during every examination.

The following factors can disrupt impulse conduction in the atrioventricular bundles:

myocardial infarction;
lung diseases that cause the development of a “pulmonary” heart - blood stagnates in the right parts of the heart, these areas hypertrophy and expand (emphysema, bronchial asthma and others);
inflammatory lesions of the heart walls due to rheumatism or infection (endocarditis and myocarditis);
intoxication due to taking cardiac glycosides;
cardiosclerosis;
heart defects;
thromboembolism of one of the pulmonary arteries;
myocardial hypertrophy due to chronic hypertension;
cardiomyopathy and myocardial dystrophy of various etiologies (due to alcoholism, anemia, obesity, rheumatoid arthritis, diabetes, thyrotoxicosis).

The cause of incomplete blockade of the right bundle branch in childhood may be a congenital anomaly of the heart structure, for example, the presence of an additional septum in the left ventricle.

If there is no organic damage to the organ, then partial right blockade is considered as a physiological norm. Failure in the conduction of impulses in the left leg, caused by acquired pathologies of the heart, is not considered normal and requires therapeutic measures and constant monitoring patient. Source: "medknsltant.com"

The causes of focal right bundle branch block vary depending on the nature of this form of conduction disorder and the frequency of its occurrence. New-onset right bundle branch block, as well as a transient version of this pathology, usually develops as a result of:

Taking antiarrhythmics of classes 1A and 1C.
Electrolyte disturbances (hyperkalemia).
Chest injuries.
Pulmonary embolism.
Myocarditis.
Transient myocardial ischemia, and other conditions.

However, RBBB is also characteristic complication acute myocardial infarction, especially when it is localized in the right ventricle of the heart and in the posterior wall.

Permanent blockade of the right bundle branch in more than half of the cases is caused by coronary heart disease, valvular defects and other organic myocardial lesions. However, in 20% of patients the cause of conduction disturbance cannot be determined. Source: “ritm-serdce.ru”

Acquired factors of pedicle block:

Obstructive diseases of the respiratory system.
Chest injuries.
Neoplasms.
Cardiac muscle dystrophy (progressive type).
Excessive use of some medications(Corinfar, Quinidine, Digitalis, etc.)
Diseases affecting the myocardium of the heart (rheumatism, syphilis).
Excessive excess of potassium in the body - hyperkalemia.
Lack of thyroid hormones – myxidema.

Incomplete blockade of one of the His bundle branches may also have congenital factors, for example, pathologies of the interventricular or interatrial septum, narrowing of the pulmonary artery, or heart disease. It should be noted that incomplete blockade of the left leg is much more dangerous for health in the form various complications than pathology of the right leg. Source: "feedmed.ru"

Classification and types

According to the degree of impulse conduction disturbances caused, bundle branch block is divided into two types:

full;
incomplete.

There are other criteria for dividing pathology into types - according to anatomical structure(single-beam, two-beam, three-beam) and by the nature of the manifestation (transient and permanent). Also, the conduction of impulses may be impaired on the right or left bundle branch. This article will discuss the more common incomplete right bundle branch block (RBBB), also defined as intraventricular. Source: "serdceinfo.ru"

Types of pathology are divided according to the localization of pathological changes. This can be a single-bundle, double-bundle or three-bundle block. The patient's condition with single-bundle blockade of the right or left bundle branch remains normal.

When 2 and 3 bundles are affected, various clinical symptoms may appear. Based on the nature of functional disorders, the following types are distinguished:

complete and incomplete blockade of the nerve impulse;
constant progressive or remission;
intermittent disorder with periods of improvement and deterioration in the state of the system nerve conduction;
the transient form is characterized by the fact that the manifestation of pathology is not recorded every time ECG parameters are taken;
Alternating bundle branch block is different in that pathological changes can appear alternately on the left and right legs.

The causes of incomplete blockade of the right and left bundle branches may 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 40 years of age;
alcoholic and toxic cardiomyopathy;
diseases of the metabolic system and a decrease in the level of certain microelements (potassium, magnesium) in the blood;
the presence of scar tissue at the location of the His bundle (after myocardial infarction, rheumatism, systemic lupus erythematosus, myocarditis);
acquired and congenital heart defects in the form of stenoses and prolapses, coartation and defects;
hypertrophy of cardiac muscle tissue against the background of hypertension without compensation with the help of pharmacological drugs;
thromboembolism of coronary and pulmonary blood vessels;
bronchial asthma with concomitant respiratory failure;
chronic bronchitis and emphysema;
pulmonary heart.

In children, when signs of incomplete bundle branch block appear on the ECG, an extensive 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 open atrial septal defect.

In the absence of the above organic pathologies, incomplete blockade of the right bundle branch is considered normal and is associated exclusively with the functioning of the autonomic nervous system. However, constant dispensary observation to exclude the possibility of progression pathological changes. Incomplete block of the left bundle branch is never a physiological norm and requires adequate treatment due to the danger of this condition. Source: "santebone.ru"

Cardiologists speak of incomplete blockade when there is a disruption in impulse transmission in one of the branches of His, while the remaining branches should function normally. With such a clinical picture, excitation is transmitted through physiologically healthy branches to the myocardium of both ventricles, but is characterized by some slowdown or shutdown of certain complexes of ventricular contractions.

There are two types of incomplete heart block:

First degree - when the transmission of excitation along the branches between the ventricles and atria slows down.
Second degree - occurs when not all impulses arrive from the atria to the ventricles.

If not a single impulse passes from the atria to the ventricles, we are talking about complete heart block (dangerous third degree). In the case of such a pathology, the ventricles begin to contract independently at a speed of 25-40 beats per minute, and this poses a danger to the patient’s cardiovascular system. Source: illness.docdoc.ru

Complete blockade of the right bundle branch is usually manifested by Wilson's block and indicates a clear disruption of the process of propagation of automatic rhythmic self-excitation through the muscular structures of the ventricles and is not so rare.

This blockade is characterized by the fact that the RV contracts not through the transmission of nerve impulses emanating from the right leg, but due to those spreading from the LV. However, similar ECG results can also give independent enlargement or other pathologies of the pancreas. The main signs of the pathological condition:

disturbance of pulse waves;
rapid and difficult breathing even with minimal exertion;
“illusion of movement” in the head;
state close to fainting;
loss of consciousness;
increased fatigue;
drowsiness;
prostration;
depression.

Complete blockade of PNPG on the ECG can be observed in the following conditions:

angina pectoris, heart attack, atherosclerotic cardiosclerosis;
inflammation of the heart muscle or enlargement of the pancreas;
pathological anastomosis between the right and left atrium;
enlargement and expansion of the right side of the heart;
myocardial dystrophy against the background of endocrine and autoimmune disorders.

Pathology can also be provoked by concomitant diseases that cause enlargement and strain on the heart chambers on the right. As a rule, these are various pulmonary pathological processes: bronchial asthma, emphysema, pulmonary embolism, prolonged pneumonia, chronic bronchitis. Rarely, RBBB can result from severe emotional stress or fear, even in healthy people.

When diagnosing this pathology, a full-fledged ECG report indicates the nature of heart contractions, the total magnitude of bioelectrical changes occurring in the heart muscle with each contraction, characterizes the blockade, and also mentions the prolongation of the QT interval.

However, to confirm the diagnosis, a cardiogram alone is often not enough, so additional diagnostic methods are resorted to. Source: "diametod.ru"

With right blockade, there are often no symptoms, and the disorder is detected incidentally during an ECG. If there are clinical manifestations, for example, pain in the heart, shortness of breath, arrhythmia, fatigue, then this is due to the presence of the disease. When the blockade affected only one of the branches in the left leg, then symptoms are also present only if there is a pathological cause.

With absence serious pathologies incomplete blockade of the right leg of His and tachycardia may be combined.

In many cases this is not dangerous, but if your heart rate is persistently elevated, it is recommended to have your thyroid examined and have regular ECGs to monitor your heart condition. Symptoms of complete blockade:

Worried about pain in the heart;
Feeling dizzy often;
You can feel your heartbeat.

These manifestations are caused by pronounced changes in the muscle layer of the left ventricle (myocardium), for example, with thyrotoxicosis, severe anemia, and heart attack. Due to complete disconnection between the ventricles and atria, the rhythm decreases to 20-45 beats per minute, which causes an insufficient volume of blood to be released into the aorta. In this case, not only interruptions in heart rhythm are observed, but also fainting due to impaired blood supply to the brain. This may cause sudden cardiac arrest. Source: medknsltant.com

The overwhelming number of young people who have a blockade of the right leg have absolutely no symptoms of the disease. These are strong and healthy people.

The presence of such an unexpected find does not in any way affect health or life expectancy. The situation is different in older patients. In older people, new blockade of the right bundle branch is associated with a number of diseases. These include organic damage to the heart muscle and all kinds of chronic diseases of the respiratory system.

In rare cases, blockade occurs due to the presence of systemic autoimmune diseases. In such cases, the disease that caused the pathology must be treated. The symptoms of such diseases are typical. This is shortness of breath, a feeling of heart failure, fatigue, pain and a feeling of discomfort in the heart area. Such manifestations are very serious and indicate dangerous chronic diseases that need to be treated. On the other hand, incomplete blockade of the right bundle branch against the background of full health. It can even be considered a variant of the norm.

If electrocardiographic methods reveal, in addition to the blockade of the right bundle branch, a blockade of the left bundle branch, it is worth undergoing additional examination. Bifascicular block does not occur in healthy people and cannot be regarded as a normal condition.

Blockade of the left leg occurs against the background of diseases, affecting the myocardium. On the other hand, right leg block occurs with myocardial disease in older people. So all people over 55 years of age who have cardiac conduction disorders should undergo additional medical examination.

It is not difficult to diagnose the presence of right bundle branch block in a person. It is enough to conduct an electrocardiographic study. See on feed characteristic features Blockades can be performed by any doctor, not necessarily a cardiologist. The ECG shows the type of blockade - complete or incomplete. Source: “cardioplanet.ru”

If you suspect a blockade, you should consult a doctor, otherwise serious complications may develop. The consequences include ventricular fibrillation, asystole and paroxysmal ventricular tachycardia.

If complete heart block is not treated, there is a high risk of developing heart failure. In this situation, the heart ceases to function fully. The result of this process is complete cardiac arrest.

TO possible complications This could also include a circulatory disorder in the cerebral cortex, or, in other words, a stroke. A complication of His bundle block may be blockage of blood vessels in the limbs by blood clots or internal organs. If an incomplete or complete blockade was provoked by an underlying disease, then there is a high probability of aggravation and worsening of its course.

Often, all complications develop in the absence of treatment or non-compliance with doctor’s recommendations. To avoid various risks, you should undergo regular medical examinations. If you consult a doctor in a timely manner, the prognosis is favorable.

The blockade responds well to treatment, but if it is accompanied pathological processes in the lungs or heart, this usually complicates the main treatment.

Treatment of the blockade becomes more complicated if there is coronary artery disease or arterial hypertension. It has been proven that a heart attack does not affect the development of partial blockade. A transmural extensive infarction is considered dangerous; it can lead to death. Source: "vashflebolog.ru"

Additionally, in order to identify diseases that may cause cardiac conduction disturbances, the doctor may prescribe other examination methods:

general clinical blood and urine tests;
blood chemistry;
daily Holter monitoring of the electrocardiogram of the heart is prescribed in order to identify transient disturbances;
transesophageal electrocardiography is very precise method research, and therefore can be prescribed as an additional diagnostic method;
echocardiography is one of the most popular methods for studying the heart muscle; it shows organic cardiac pathology, the degree of myocardial contractility, and gives an accurate assessment of the cardiac ejection fraction;
if the diagnosis is unclear, it is possible to prescribe a multislice computed tomography (CT) or, if appropriate equipment is available, a magnetic resonance imaging (MRI) of the heart. Source: "cardioplanet.ru"

The only option in which one can suspect the presence of a blockade before electrocardiography is the usual auscultation of the heart, or listening to it with a phonendoscope. The doctor may suspect this by ear if there is a splitting of tones that is not felt by the patient.

The next stage is to conduct a normal, routine ECG, during which the special shape of the ventricular complexes in the first chest leads is determined, as well as a slight increase in the duration of the gastric QRS complex to 0.11 seconds. It is clear that this increase in time occurs due to the “circular path”, but the indirect following of the impulse along the blocked bundle branch.

Holter monitoring is also indicated, in which it is possible to identify functional or transient variants of the development of the blockade. This can happen, for example, due to an overdose of certain medications during treatment of diseases. If the blockade of the leg occurs against the background of a cardiac disease, then an intracardiac electrophysiological study is performed. Its main task is to determine whether there are indications for placement (implantation) of a permanent pacemaker. Source: "zdravlab.com"

Among the most common diseases associated with an increased risk of sudden cardiac death during sports activities in people under 35 years of age, the first place is occupied by hypertrophic cardiomyopathy(HCM), the prevalence of which in the general population is quite high and amounts to 1:500.

Followed by congenital anomalies coronary arteries, myocarditis, Marfan syndrome (with aortic dissection) and arrhythmogenic right ventricular dysplasia. The most detailed structure of sudden death in trained athletes was analyzed in a study by Maron B. et al., published in 2009 in the journal Circulation.

The authors showed that of 1866 athletes who died suddenly or experienced cardiac arrest between 1980 and 2006, 1049 cases (56%) were due to cardiovascular causes, of which 690 cases were confirmed at autopsy. Moreover, the average age of the victims was 18±5 years (from 8 to 39 years), 89% were men, 55% were representatives of the white race.

Most often, sudden death occurred during basketball (33%) and American football (25%), which together accounted for 58% of all cases. In 80% of cases, death occurred directly during or immediately after playing sports.

The most common cardiovascular diseases found at autopsy were HCM (36%) and congenital coronary artery anomalies (17%). Specifics of the adoption problem expert solution in relation to athletes who have reached high results, is that they form a special part of society both because of their outstanding sporting achievements and because of the interests of those groups in society that they represent, experiencing a certain amount of pressure from coaches, sponsors, sports federations and the media.

The recommendations presented cannot be applied to persons involved in physical education or active recreation, which do not require systematic intensive physical training. The presented recommendations are based on published international documents: recommendations for admission to competitions of highly qualified athletes with cardiovascular pathology European Society of Cardiology and American College of Cardiology.

It must be emphasized that the presented document is advisory in nature, and their application in real practice should be carried out taking into account the individual characteristics of each athlete. Source: "diagnoster.ru"

If partial blockade is normal, then no special treatment is performed. The patient undergoes regular electrocardiogram examinations and follows preventive measures. Source: "vashflebolog.ru"

Right bundle branch block in children

In children, this pathology can appear in fetal development, at the time of heart formation. Or after birth as a result of previous diseases of the cardiovascular system. The signs of this disease will be as follows:

poor blood supply and lack of oxygen will lead to cardiac ischemia;
His bundle death due to oxygen starvation will lead to myocardial infarction, scar tissue will form;
as a result of heart failure;
diseases resulting from myocardial damage; underdevelopment of the heart during the prenatal period;
inflammatory processes in the heart muscle; surgical intervention;
in the presence of an autoimmune disease, disturbances in the functioning of the heart may occur;
an increase in blood pressure, which results in high loads changes may occur in the structure and function of the heart.

Congenital blockade in children can occur as a result of:

diffuse damage to the connective tissue of the expectant mother;
If future mom suffers from diabetes mellitus (insulin dependent);
underdevelopment of the right bundle branch;
pathological development of cardiac septa.

This pathology can be a consequence of heart injury. This can happen as a result of incorrectly performed surgical operations, as a result of a blow to the chest during a fall or push, or in a traffic accident.

If there is an incomplete block of the bundle branches, then no special treatment is required. The only thing that needs to be done is to prevent the transition to more severe forms. Do not ignore emerging symptoms.

As soon as there is a pressing feeling in the chest, dizziness, it is necessary to put the child to bed. Do it with him breathing exercises: take a deep breath, as you exhale, hold your breath for a couple of seconds, and then exhale the remaining air. It is advisable to do this exercise several times. Don't put off visiting your doctor.

The doctor collects life history data (parental complaints, symptoms, what treatment was given, changes in the clinical picture, whether the mother was sick during pregnancy, whether there is a hereditary predisposition to the appearance of such pathological conditions). Examines the child: measures the heart rate, pulse, conducts auscultation of the chest organs, and uses percussion to establish the border of the heart. Appoints laboratory research. Next he carries out treatment.

During drug treatment, vitamins and restorative drugs are used, and a diet is prescribed. Symptomatic treatment is also carried out.

The doctor prescribes diuretics, anticholinergic drugs, sympathomimetics, and glucocorticosteroids. If drug treatment does not help positive result, then the possibility of surgical intervention is considered. During this operation, a pacemaker is installed.

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Is incomplete right bundle branch block a “technical” diagnosis or a disease?

This unusual name for the diagnosis is most likely attracted by the word “blockade”. In itself, this is, of course, alarming, but it doesn’t tell a non-specialist anything specific. In order to understand the meaning of this complex term, you need to remember such an unusual anatomical structure as the conduction system of the heart.

This formation is designed to correctly distribute the impulses that come from the sinus node down. The conduction system of the human heart is responsible for the correct and synchronous contraction of the atria and ventricles. It is clear that the heart is a pump that “drives blood in one direction.”

The general direction of the blood is:

From the left ventricle, blood is ejected into the aorta, the largest artery in the body;
then, through a system of branching arteries of a smaller caliber, the blood enters the capillaries, and the speed of its flow slows down;
gas exchange occurs in the capillaries, and the process of tissue respiration is realized: oxygen is given to the tissues and carbon dioxide is taken in;
then, through venous vessels of ever-increasing caliber, the blood enters the vena cava system, and ends up in the right atrium, which is the main “collector” of venous blood;
From the right atrium, blood is sent to the right ventricle, and from there to the lungs, to enrich venous blood with oxygen and transform it into scarlet, arterial blood.

Bundle of His - what is it and why is it needed?

For normal contraction of the heart, the atria need to contract together, like the ventricles, in pairs. And there must be strict synchronicity between them.

In the event that such a synchronous contraction does not occur, then various variants of the appearance of pathology of the electrical impulse, which are called blockades, are possible. These conditions can be life-threatening.

It is known that in the jejunum of the heart there is a special conduction system, in the form of special bundles of nerve cells. They form nodes and bundles that help conduct impulses from the overlying parts of the heart to the underlying ones. There are patterns of impulse conduction, and there is a strict order.

One of these bundles is the His bundle, which is otherwise called the atrioventricular bundle. It passes through the thickness of the interventricular septum, and splits there into two legs - left and right. As the name suggests, the right leg approaches the right ventricle, and the left leg approaches the myocardium of the left ventricle.

These legs end in special Purkinje fibers, which branch in the muscle tissue of the corresponding ventricles. The impulse is carried through the structures of the His bundle at different speeds, which average 1-3 meters per second, which is quite noticeable with a beam length of 15-18 mm.

In addition to arrhythmias, blockades of impulse transmission to the underlying parts of the heart can often be detected if, for some reason, there is a complete or incomplete blockage of impulse transmission along one of the legs of this bundle. What kind of pathology is this, and how does it manifest itself?

Incomplete right bundle branch block - what is it?

It is important to know that in addition to the His bundle, which is the main path of impulse conduction, in the myocardium there are also the Kent bundle, Mahaim fibers, and two “alternative tracts” - James and Berschenmanche. All these pathways can serve as additional conduction pathways, so when the His bundle is blocked, the heart still contracts, nothing bad happens.

Clinically, this is manifested by the presence of intraventricular block syndrome, or a slowdown or cessation of the electrical impulse to the myocardium of the right ventricle. This occurs when the conduction of the right leg is impaired.

If we are talking about incomplete blockade of the right leg, then this indicates that the impulse passes, but its conduction is slowed down. In the event that the impulse does not pass to the myocardium at all, then they speak of a complete blockade. In this case, the right ventricle is still excited and contracts, the person lives, and may not experience any unpleasant sensations.

It’s just that the excitation of the right ventricle begins in a “roundabout way.” In other words, the wave of depolarization comes through the left ventricle, and the left half (lying on the other side) of the interventricular septum.

Causes of blockade

It is known that various signs of incomplete blockade of the right bundle branch, determined by ECG, are found in completely healthy people, most often men, who do not present any complaints. The incidence of this pathology in the population is quite high - 1-2% of the total population.

If we talk about complete blockade of the right leg, then it occurs in conscripts on average in 0.2% of all cases, and at the age of over 40 years, this figure increases to 5%. This means that every 20th adult male has some form of conduction disorder.

As for diseases, complete blockade is caused by diseases in which overload of the right parts of the heart can occur. These include:

Chronic cor pulmonale (a condition in which blood circulation in the lungs is obstructed and the preload on the right side of the heart increases). This condition develops with lung diseases: pneumosclerosis, and many other diseases;
Coronary heart disease (IHD), or, especially when combined with arterial hypertension, or (hypertension);
In acute cases and, often with posterior diaphragmatic or apical localization of the necrosis zone;
Sometimes complete blockade occurs in completely healthy people, but this is rare. Much more often in healthy people an incomplete conduction disorder is detected.

If we talk about incomplete blockade, then exactly the same reasons and diseases lead to it, only occurring in a “milder” form. In old age, these are all kinds of myocarditis, cardiosclerosis, chronic myocardial ischemia.

One of the important reasons for the occurrence of incomplete conduction disorders is the development of myocardial hypertrophy. In this case, the slowdown in impulse conduction occurs because there is simply “a lot” of myocardium, and therefore it seems that the impulse passes slowly.

This situation can develop in people with sporty heart, as well as in persons with pulmonary hypertension, because it is in them that the myocardium of the right ventricle should be stronger.

In some cases, incomplete blocking of the impulses of the right leg develops with an overdose of cardiac glycosides and beta-blockers, during treatment with certain antiarrhythmic drugs, for example, quinidine, as well as with severe dehydration (intestinal infections).

How dangerous is incomplete right bundle branch block? The prognosis for this condition is not determined by this formulation of the diagnosis. As stated above, crucial has the degree of development of the underlying disease, as well as the presence of a risk of developing complete atrioventricular block (in which the atria and ventricles can each contract in their own rhythm, disorganized).

It is the latter fact that can lead to the development of ventricular arrhythmias.

It should be noted that the blockade, especially incomplete, does not automatically mean the presence of arrhythmia. Simply, in the presence of predisposing and unfavorable factors, this can happen, and then the blockade of the leg, albeit incomplete, can increase the risk of sudden cardiac death.

Thus, the probability of a complete atrioventricular block in individuals with partial conduction disorders of the bundle branches is 1% per year.

Of course, this figure takes into account conditions in which there is severe cardiac pathology. It is in the presence of AV block that treatment will be required, which may include installing a pacemaker.

How does the blockage manifest?

Incomplete blockade of the right bundle branch may not have any effect on the heart. All clinical guidelines say that if the blockade has not reached the three-bundle state, then it does not manifest itself in any way. That is, in order for any manifestations of the blockade itself to arise (provided that there is no organic disease), it is necessary for the following to immediately arise together:

left bundle branch block;
complete or incomplete atrioventricular block.

In the vast majority of cases, variants of incomplete conduction disturbance of only one leg (no matter right or left) are a phenomenon that can only be determined on an ECG, for example, during examination during a medical examination.

In the same case, if the patient’s MC has some kind of heart disease, then the entire clinic is determined by the main complaints, for example, with emphysema or post-infarction cardiosclerosis, and bundle branch block is a “small and minor” diagnosis that practically does not play its own role roles.

The only option in which one can suspect the presence of a blockade before electrocardiography is the usual auscultation of the heart, or listening to it with a phonendoscope. The doctor may suspect this by ear if there is a splitting of tones that is not felt by the patient.

The next stage is carrying out a normal, routine test, during which the special shape of the ventricular complexes in the first chest leads is determined, as well as a slight increase in the duration of the gastric QRS complex to 0.11 seconds. It is clear that this increase in time occurs due to the “circular path”, but the indirect following of the impulse along the blocked bundle branch.

If the blockade of the leg occurs against the background of a cardiac disease, then an intracardiac electrophysiological study is performed. Its main task is to determine whether there are indications for placement (implantation) of a permanent pacemaker.

Can you play sports and serve in the army?

In case of incomplete blockade of the right bundle branch, sports are not contraindicated. After all, cardiologists are concerned about those conditions that increase the risk of sudden cardiac death, as well as various undiagnosed valve defects, especially aortic stenosis, which, when the load on the heart increases, can lead to unpredictable complications.

Isolated and asymptomatic conduction disorders, especially in at a young age, do not lead to a significant increase in complications. IN as a last resort, you can perform Holter monitoring, which will be carried out against the background of sports training.

If the analysis of the results does not reveal progression of the volume of blockade, the appearance of arrhythmia, or signs of disorder of the atrioventricular connection, then there are contraindications to sporting events does not arise. All that remains is to undergo an ECG annually in order to know in a timely manner the state of affairs with intraventricular conduction.

Regarding service in the armed forces, then, as we remember, in the absence of an unambiguous interpretation, the entire emphasis is on “impaired function.” In this case, given the absence of pronounced organic damage and the asymptomatic course, such a young man will be drafted into the army in category B-4, that is, “fit with minor restrictions.”

This actually means that he is unsuitable for the elite units of the RF Armed Forces, that is, where it is more or less prestigious to serve. As a result, he will be sent somewhere to the infantry, or to the signal troops, where, naturally, no restrictions will be observed, since the “automatic” determination of the type of troops will already serve as a guarantee that such restrictions have already been made.

About the treatment of right bundle branch block

As you probably already guessed, you only need to treat those types of blockade that cause increased risk development of cardiac death, or pronounced desynchronization occurs in the work of the upper (atria) and lower (ventricles) parts of the heart. As a rule, in this case, we are talking about patients who have clinically significant and reliable signs of heart failure.

Such patients are usually hospitalized in the department of interventional cardiac surgery and arrhythmology, or in diagnostic department cardiology hospital. Hospitalization is needed in order to:

choose good drug therapy if a diagnosed arrhythmia is observed against the background of the blockade;
exclude acute myocardial infarction when acute blockade of the bundle branch occurs (this is always suspicious, but, however, then the left leg is affected, not the right);
conduct an electrophysiological intracardiac study;
implant a pacemaker, or perform cardiac synchronization.

To reassure young people and their parents, it is safe to say that a pacemaker is not installed “just like that.” For this there must be very strict indications, for example:

Alternating blockade of the legs (when a “walking” disorder occurs either in the left or right leg;
Atrioventricular block of the 3rd degree with the presence of fainting.
Leg blockade that occurred during acute myocardial infarction;
Severe heart failure of functional class 3 or 4, despite proper treatment.

Thus, it becomes clear that it is not the blockade of the right bundle branch that is being “treated” at all, but those conditions and diseases that it can aggravate or provoke.

In conclusion, it must be said that to avoid confusion and ambiguous interpretation, if there are signs of blockade during an ECG, it is advisable for the patient to undergo an ultrasound of the heart. Only then will it be possible to assess the thickness of the interventricular septum and draw a conclusion about the presence or absence of the right ventricle.

Only in this case will the diagnosis of blockade of any of the legs be valid diagnostic value, since it will be set taking into account the presence or absence of myocardial hypertrophy.