What is the right leg of the heart. Treatment of blockade of the right leg of the bundle of His. Alternative treatment of ischemia of the heart

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The blockade of the signal passing through the branches of the pedicle coming from the left branch of the bundle of His is a symptom, it is caused by heart disease, which is manifested by a complete violation of the passage of the impulse in the nerve conduction system in the heart.

The His bundle is capable of generating impulses with a frequency of 25-40 myocardial beats per minute. The His bundle departs from the level 2 automatism node, which is the atrioventricular node, which lies in the right atrium.

From the common trunk, the legs of His depart to the corresponding ventricles of the heart. With a complete or partial blockade of His, coming from the conduction paths of the bundle of the right leg, the right ventricle is blocked.

Who is this article for?

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

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

Signs of different types of blockade of the bundles of His or blocking in the atrioventricular node are found in the QRS complex when registering the conduction of excitation on the ECG in pathologies of the heart. The purpose of determining conductivity is to assess the state of the myocardium.

Causes of complete blockade of the left leg of the bundle of His

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

* ischemia;
* atherosclerosis;
* hypertensive crisis;
* defects of the aorta.

The causes of LBBB on the ECG may be a violation of the conduction or blockade of the atrioventricular node, heart pathology.

Less commonly, blockade of impulse conduction is caused by:

* myocarditis;
* myocardial dystrophy;
* arterial thromboembolism;
* poisoning with glycosides;
* taking antiarrhythmics, diuretics;
* Hyperkalemia.

Severe prognosis with two-beam blockade, when the impulse from the atrioventricular node to both legs of His is disturbed, as well as with coarctation of the aorta. This congenital disease is detected in children by ECG, and treatment methods entirely depend on the data of the instrumental examination and the condition of the child.

Diseases that create a risk of blockade of two legs of His, or even a three-bundle block in the case of a violation in the right bundle, develop with some bacterial infections.

The bacteria cause infective endocarditis. This is such a lesion of the heart bag, in which chills, fever, valve damage appear, which in 30% of cases can lead to death.

Endocarditis is caused by staphylococci, streptococci, enterococci, and the colonization of the heart bag is provoked pathogenic microflora angina, which has already been mentioned more than once on the blog pages.

Symptoms of a complete blockade of the left leg of the bundle of His

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

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

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

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

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

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

The blockage separates the beats of the atria and ventricles.

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

Such dissociation in work leads to the appearance of rhythm disturbance. There is a complete blockade with symptoms:

* atrial fibrillation;
* asystole;
* ventricular bradycardia.

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

* atrial beat frequency up to 300 - 600 pulses per second;
* shortness of breath;
* feeling of disruption of the myocardium;
* fainting;
* fear;
* plentiful urination;
* after;
* dizziness;
* Pulsating veins in the neck.

Symptoms of ventricular bradycardia are manifested:

* slowing and weakness of the pulse;
* sticky sweat;
* flies in sight;
* weakness.

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

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

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

No less dangerous is sudden cardiac arrest asystole. The state of systole corresponds to the ejection of blood. And asystole, respectively, is the lack of blood supply to the general circulation.

Asystole, which looks like a straight line on the ECG, is responsible for 5% of all cases of cardiac arrest. The symptoms of asystole serve as precursors to cardiac arrest. Their appearance should be treated especially carefully, and immediately call "emergency help".

Asystole is expressed:

* stupefaction of consciousness;
* motor activity;
* convulsions;
* wheezing.

Diagnostics of the complete blockade of the left leg of the bundle of His

Diagnose using:

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

Detect disturbances in impulse conduction or complete absence transmission of excitation is possible with the help of electrocardiography.

Signs of blockade of the posterior His leg on the ECG are the following symptoms:

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

Signs of anterior His blockage are:

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

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

A similar mode of transmission is manifested by a delay in the contraction of the left ventricle. On the ECG, blocking manifests itself:

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

With a three-beam block, blocking of the AV node is noted.

Treatment of complete blockade of the left leg of the bundle of His

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

Outpatient treatment is sufficient even with a complete loss of conduction in the left side of the branch of the bundle of His, due to blockade of the signal along the leg, caused by taking certain medications.

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

* Captopres;
* Mildronate;
* Riboxin;
* Trimetazidine.

If a complete blockade is caused by severe pathologies of the heart, then the patient must be hospitalized. These pathologies include:

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

AT similar situations no specific treatment has been developed. Therapy eliminates the underlying disease, avoiding complete blockade of the atrioventricular node.

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

Nutrition with complete blockade of the left leg of the bundle of His

The diet should be built based on the main risk factors:

* atherosclerosis;
* hypertension;
* Hyperkalemia.

And the rules of nutrition when blocking the excitation wave following the trunk of the bundle of His are in the prevention of these conditions.

The patient needs to achieve steady state:

* reduce the intake of cholesterol;
* exclude all alcohol;
* provide the body with useful nutrients, but do not overdo it with potassium;
* drinking regimen;
* Refusal of products that increase pressure.

Prohibited in hypertension:

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

Separately about drinking. If at the same time full conductivity is disturbed on the left side along both branches of the leg and a two-beam blockade is possible, then the enhanced drinking regimen will create an extra load.

Complications with complete blockade of the left leg of the bundle of His

Blockages create the risk of disease:

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

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

Thus, the prognosis of survival worsens with extensive infarction, when conduction disturbance is combined with extensive damage.

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

When there is a violation of the conduction of cardiac nerve impulses, the prognosis is very serious and largely depends on the myocardium. Survival increases with a satisfactory state of the myocardium, its normal value.

Prevention of complete blockade of the left leg of the bundle of His. Physical exercises with complete blockade of the left leg of the bundle of His

Prevention is considered:

* observance of the sleep regimen;
* proper nutrition;
* walks, moderate loads under the supervision of a doctor;
* no stress, overwork;
* Regular examination by a cardiologist.

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

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

If blockade of the His leg is found on the left side, high-impact training should be stopped for a while and undergo comprehensive treatment.

The video will complete the story, which shows how the impulse goes along the right and left parts of the legs emanating from the bundle of His, how the heart stops working with a three-bundle complete blockade.

Health to everyone!

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

The reasons

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

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

Kinds

The blockade can be localized in different parts of the organ, on which its classification and treatment depend.

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

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

Atrioventricular block I and II degree

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

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

Atrioventricular block III degree

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

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

Incomplete heart block

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

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

Heart block in children

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

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

Diagnostics

Diagnosis of heart block early stage can be a successful step towards recovery. Therefore, it is recommended to seek help when the minimum symptoms are disturbing, and not when it is already taking away. Ambulance. The danger of the disease depends on each specific case. And if, with an incomplete patient, the patient can continue a normal lifestyle, then full forms can result in serious complications, up to death.

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

Treatment

Treatment of blockades is divided into several important steps. First, this timely diagnosis, then - the establishment of the nature and causes. Further, most of the actions should be aimed at eliminating the cause (if it is acquired). In some cases (incomplete blockade), only observation is carried out. Only then proceed to the direct treatment of blockades, which, depending on the severity, can be medical or surgical.

In the treatment of medicines, drugs such as Orciprenaline sulfate, Isoprenarine hydrochloride, Atropine are most often prescribed. The severe condition of the patient and the ineffectiveness of medications can be a signal for temporary or permanent pacing. Implantation of a pacemaker is carried out mainly in patients aged 60-70 years.

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Causes of heart block

Blockades of the 1st degree and incomplete blockade of His, which are not clinically manifested, may be a variant of the norm or occur in athletes, in individuals with vegetative vascular dystonia, as well as in children, adolescents and young people with mitral valve prolapse, open oval window and other minor anomalies in the development of the heart.

Blockades of the II and III degrees, complete intraventricular blockades, three-beam blockade (of both the right and both branches of the left leg of His) almost always occur with organic damage to the heart tissues. Diseases that cause inflammatory or cicatricial processes in the myocardium include:

Heart block symptoms

Blockades of the 1st degree, incomplete single-beam blockade of the legs of His, intra-atrial blockade, as a rule, do not manifest themselves clinically and can only be detected by ECG during a routine examination.

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

Symptoms of a rhythm disorder:

- weakness, fatigue, reducing the ability to perform the previous physical work,
- a feeling of interruptions in the work of the heart - a feeling of fading or cardiac arrest, discomfort behind the sternum,
- dizziness, flies flickering before the eyes, sudden general weakness feeling faint, tinnitus,
- Morgagni-Edems-Stokes attacks (MES attacks) - sudden sharp pallor, cold clammy sweat, rare threadlike pulse, loss of consciousness, convulsions due to brain hypoxia are possible. As a rule, after how many seconds or two to three minutes consciousness is restored, but if this did not happen, and there is no breathing and heartbeat, then asystole (stop) of the heart and clinical death developed,
- complete left blockade of the His bundle, which developed suddenly for the first time in life, can lead to the development of acute left ventricular failure with pulmonary edema, which is characterized by suffocation, cough with sputum similar to foam, blue skin of the lips, face, fingers, shock.

Symptoms of the underlying disease - chest pain during exercise or at rest during coronary disease heart, shortness of breath, coldness of the hands and feet, cyanosis (bluish coloration) of the fingers, nose, ears or the entire face and extremities with heart defects, headaches of the occipital localization with nausea and vomiting with hypertension, heat or a prolonged increase in temperature not higher than 37.5º C with infections, damage to the joints and skin with systemic diseases and many others.

Diagnosis of heart block

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

— standard ECG — basic informative method, confirming the presence of blockade. However, not always a single electrocardiogram can "catch" signs of blockade, especially in the case of transient heart blocks.

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

Signs of intra-atrial blockade are splitting and expansion of more than 0.11 from the P wave, and the associated prolongation of the PQ interval. Sometimes an additional negative P wave appears (with complete dissociation of the right and left atria and their contractions in a separate rhythm).

Signs of atrioventricular blockade of the 1st degree - a constant lengthening of the PQ interval for more than 0.20 s, II degree of the Mobitz type 1 type - with each subsequent contraction, the PQ interval lengthens more and more until one cardiac P-QRS complex falls out, then the whole cycle repeats again. Mobitz type II degree blockade 2 - the duration of the PQ interval in each contraction is equally extended by more than 0.20 s, and the ventricular QRS complexes fall out randomly, without a clear periodicity, and can be deformed. Blockade II degree type 3 - there is no every second or two or more P-QRS complexes in a row. Blockade of the III degree - complete dissociation of the rhythm of the atria and ventricles - atrial contraction rate - 70 - 80 per minute, ventricles - 40 - 50 per minute or less. Atrial P waves are not associated with ventricular QRS complexes and may be superimposed, before or after them.

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

Complete left blockade of the bundle of His

— daily monitoring ECG is informative for transient blockades, as it allows you to analyze heart rate and conduction throughout the day, including at night.
- ECG with exercise is used to determine exercise tolerance, allows you to set the functional class of coronary heart disease and chronic heart failure.
- echocardiography, chest x-ray, cardiac MRI, coronary angiography are used to search for the underlying disease that led to conduction disturbances.

Treatment of heart block

Blockade therapy begins with the treatment of the underlying disease. Blockades of the I degree, which are not manifested clinically, do not require treatment.

In case of an overdose of drugs that slow down the rhythm, a complete abolition of these drugs is carried out. In case of heart blockade, beta-blockers (propranolol, bisoprolol, atenolol, anaprilin, tenoric, obzidan, egilok, etc.), cardiac glycosides (strophanthin, corglicon, digoxin), antiarrhythmic drugs (aymalin, cordaron, verapamil, diltiazem, quinidine) are contraindicated.

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

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

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

First aid for heart block

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

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

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

Lifestyle with heart block

Lifestyle is reduced to the correction of nutrition with an increase in the diet of proteins, vegetable fats and complex carbohydrates and with the restriction of animal fats and simple carbohydrates, reducing significant physical activity, proper organization daily routine with sufficient rest time.

A child with congenital or acquired heart block will not be able to lead a normal life for children of his age, as he will be prohibited from doing physical education, attending sports clubs and sections, and any significant loads. A young man with a blockade of the II degree and above, most likely, will not be fit to serve in the army. The issue of carrying a pregnancy for women is decided strictly individually with the participation of a cardiologist, a cardiac surgeon, an obstetrician-gynecologist and other specialists in a consultation.

It is mandatory to contact the attending physician in a timely manner with an increase in unpleasant symptoms and a significant deterioration in well-being. A patient with a blockade must be responsible for his disease and understand that a high-degree blockade can end fatally at any time. In order to prevent this from happening, you should be attentive to your health, listen to the advice of doctors and strictly follow their diagnostic and therapeutic appointments.

Complications of heart block

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

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

Forecast

The prognosis for blockades of the 1st degree in the absence of organic heart disease is favorable.
For complete blockades, the prognosis is determined by the nature of the underlying disease, the degree of dysfunction of the heart and the stage of chronic heart failure. The frequency and number of MES attacks are not predictors of mortality, that is, they do not affect the prognosis - in some patients, attacks may occur frequently, while in others, a single attack in a lifetime can be fatal.

Prognosis for patients in acute period myocardial infarction, complicated by the development of a complete left or right blockade of the His bundle, is extremely unfavorable.

Therapist Sazykina O.Yu.

www.medicalj.ru

What are they?

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

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

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

• 1 degree. Occurs when there is a slowdown (elongation) of the signal entering the lower sections of the conductive system of the natural pump. Its occurrence can only be confirmed by an ECG, since the path of the impulse is disrupted, thereby showing dysfunction in the system.
• 1 degree. For the 2nd degree of heart block, a subsequent increase in conduction along the atrioventricular node is characteristic. It has three types of advancement violations (Mobitz).

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

  • Mobitz II notes complete prolapse complexes of the ventricle, but the intervals of the cardiac impulse remain unchanged.
  • Mobitz III atrioventricular blockade is an obstruction of the electrical impulse and further pathology of its occurrence, followed by loss of the excitation reflex. In this case, the electrocardiogram will show a marked increase in ventricular contraction.
• 3 degree. In the case of grade 3, it is clearly noticeable complete cessation signal transactions at the atrioventricular node. They lose synchronization with each other, and their random contraction begins.

Types of disease

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

• sinoatrial;
• interatrial;
• atrioventricular;
• blockade in the legs of the gypsum bundle;
• intraventricular;
• syndrome of early excitation of the ventricles.

Sinoatrial heart block is a direct disruption of the impulse transaction in the compartment of the sinus node, resulting in dysfunction of conduction to the atrium from the sinoatrial node. This phenomenon is followed by a complete loss of contractions along the conduction system of the heart. This fact can be observed during auscultation of cardiac activity. In the presence of an irregular fallout.

Interatrial blockade is manifested in violation of the passage of signals through the transactional system of the atrium. This is followed by a violation of the rhythm of contractions, and subsequently there is an elongation of the P wave before the QRS complex and its subsequent expansion.

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

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

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

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

Intraventricular blockade is localized from below under the atrioventricular node: in the ventricular bundle, in the left, right leg. The excited impulse, which tends to the ventricles, with this blockade of the heart either arrives belatedly or does not arrive at all.

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

Causes contributing to heart block

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

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

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

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

Also blockade occurs after surgical intervention, treatment of heart defects, other problems.

Infections transferred in childhood may also precede the appearance of changes in the heart system, in particular to complete heart block or a defect in the right bundle of His bundle. Not so often, an overdose of antiarrhythmic drugs, B-blockers, cardiac glycosides is quite capable of leading to impaired patency along the right leg of the His bundle. In particular, it is precisely the defect of the right bundle of His bundle that leads to blockade in the right heart ventricle.

Diagnosis of the disease

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

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

The ECG shows variable waves, which symbolize a very slowly advancing impulse to the ventricle from the atrium. Regarding an incomplete block in the right leg of His, the ECG will show changes in the form of serrations on the S wave in the leads of the chest compartments.

Symptoms of the disease

At the first stage of the onset of heart block obvious symptoms generally absent. The possibility of identifying this stage is presented only by means of an ECG.

During the second stage or different localizations of the disease, there is dizziness, some darkening in the eyes with sudden movement, other. During physical activity, there is shortness of breath, tingling in the temples.

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

With complete heart block, the impulse that contracts the ventricles may not come at all. In such a case, it is possible fatal outcome. We strongly recommend when the following symptoms consult a doctor with the task of conducting an ECG and detecting blockade in the early stages, which will greatly facilitate treatment.

In general, the symptoms are as follows:

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

Treatment of pathologies

First of all, the course of treatment directly depends on the severity of the course and the degree of heart block. If the disease stems from any symptoms, by and large, no special treatment is needed.

The installation of a pacemaker is needed in those circumstances when heart block is severe or detected in the third stage and is not caused by drug intervention or diseases.

In the event of a blockage due to the use therapeutic drugs need to be replaced or discontinued altogether. In such a situation, you can not do without medical advice.

The introduction of a pacemaker is the main solution for complete heart block. It is a small device, the size of which does not exceed a matchbox, which is implanted near the collarbone on the left front.

It affects the heartbeat, generates electrical transactions that lead to heart contraction. The pacemaker either sends signals without interruption, or only if its rhythm slows down. It is installed preferably under local anesthesia. The wound after the operation heals after about six weeks.

Predictions and Complications

With incomplete blockades, a favorable prognosis comes as a consequence successful treatment and all the frivolity of the course of the disease. Complete blockade of the third degree often leads to disability.

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

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

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

A complication can be called the fact of an increase in the chance of myocardial infarction. The likelihood of coronary disease, the presence of constant arrhythmia of heart contractions, anemia, and other things is also growing significantly. It should be remembered that the main and most dangerous, perhaps, the result of a complete heart block can be fatal.

In conclusion, it must be said that heart block is very versatile and its consequences can be different meaning depending on the degree. With a minor disease, that is, the first degree, it is possible to diagnose the blockade only with the help of an ECG. But the earlier this pathology is detected, the more significantly the possibility of increasing the degree decreases.

Complete heart block can be fatal. So, if you have symptoms similar to those mentioned above, we strongly recommend that you contact a cardiologist.

Important! In no case do not allow unauthorized intervention, that is, self-treatment.

With common sense, almost any disease can be cured. And heart block is on that list. Thanks for reading, take care. All the best!

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What is a heart block?

Let's start with the fact that the normal functioning of the heart is facilitated by electrical impulses generated in the sinoatrial node. From it, they are distributed through the atria, the contractions of which contribute to the transmission of the impulse further, through the atrioventricular node to the atrioventricular His bundle. From it, it is distributed over the sections through smaller branches. With a decrease in the automatism of the sinus node the passage of the impulse slows down, there is an increase (lengthening) of the interval between atrioventricular beats.

Sometimes the impulse does not pass through the conductor system at all. In this case, there is no contraction of the atria or ventricles. There is a long pause (atrial asystole), which is called the Wenckebach period. When it occurs, conductivity is restored again, due to ectopic rhythm, which was called "saving". And the next atrioventricular interval has already normal length. Symptoms with incomplete (partial) heart block are almost completely absent, since it does not interfere with the blood supply to the brain. Most often partial heart block is accompanied by mild dizziness and slight malaise.

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

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

Video: heart block on the ECG

The video shows an intermittent (intermittent) blockade of either the right or the left leg of the bundle of His

Heart blockades - briefly about the varieties

From where the emerging obstacles are localized, causing violation patency of the impulse, the following types of blockade are distinguished.

Sinoatrial blockade

Sinoatrial (SA) block is usually caused by excessive excitation of the vagus nerve, or organic damage to the sinus node. It is characterized by a violation of conduction in the area between the atria and the sinoatrial node, accompanied by a loss of full cardiac contraction, which is detected by auscultation (listening). The nature of the fallout is irregular.

Sinoatrial blockades also develop under the influence of glycosides prescribed for the treatment of heart disease, potassium preparations and quinidine. It is also found in people in excellent health who do various types sports, at the time of increasing physical activity.
Partial (incomplete) blockade, associated with a decrease in the activity of the sinoatrial node, is asymptomatic. Treatment for this type of blockade is not required. With a significant decrease in the activity of the sinus node caused by increased excitability of the vagus nerve, a course of therapy with atropine administered subcutaneously is carried out, sympathomimetics can be used.

Intra-atrial block

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

Atrioventricular block

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

1 degree

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

2 degree

Blockade of the 2nd degree is characterized by a further increase in conduction disturbances in the atrioventricular node. This violation has three types (Mobitz).

3 degree

At 3 degrees of blockade, the transmission of impulses at the atrioventricular node stops completely. And they begin to shrink spontaneously, regardless of each other. Myocardial pathologies, drug intoxication and other factors lead to the development of a complete blockade.

Intraventricular block

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

Video: lesson on heart blocks

Etiology

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

Blockade of intraventricular localization

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

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

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

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

The development of blockade of the right ventricle in most cases is caused by diseases that lead to its overstrain and the formation of wall thickening. Anomalies of this type are often caused by intoxication of the body with medications prescribed to eliminate disorders in the work of the heart (beta-blockers, quinidine, etc.). Blockade of the pancreas very often develops in people whose heart is quite healthy. The anomalous patency of the impulse in this case lies in the fact that the septum and the left ventricle are first excited, and only then the impulse is transmitted to the right ventricle.

The conclusion from the above follows: the pathology of the passage of the excitation impulse on any of the branches of the branching of the His bundle is a partial blockade of one of the ventricles, on the side of which a pathological interruption of the branch has occurred. In this case, excitation to the blocked ventricle is transmitted by an abnormal "bypass" route: through the septum and the ventricle corresponding to the normally working branch.

It is possible to identify intraventricular blockades mainly by methods of electrocardiographic research. The cardiogram shows a deviation of the electrical axis to the left by an angle of up to 90 ° with a negative value in the left ventricular block caused by impaired conduction of the anterior segment. The deviation of the electrical axis to the right at an angle of up to 90 ° with a positive value indicates a blockade of the left rear area. The QRS complex remains unchanged. To clarify the diagnosis, Holter monitoring is carried out (taking readings for a day or more).

Video: a lesson on the blockade of the legs of the bundle of His

Why is heart block dangerous?

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

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

Diagnosis

With the loss of part of the contractions of the ventricles, their number decreases. This happens both with complete and partial blockade, including functional. To reveal the nature of its occurrence, the so-called test with atropine is used. The patient is given atropine. Incomplete blockade, the occurrence of which is not associated with pathological changes, then disappears in just half an hour.

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

Pathology treatment method

Treatment of heart block (antrioventricular) is prescribed depending on the type and cause of its occurrence. For first-degree atrioventricular block, a constant dispensary observation patient. Drug therapy is carried out in case of deterioration of his condition. If the blockade develops against the background of a heart disease (myocarditis or acute myocardial infarction), then the underlying disease is first eliminated. The method of treatment of the blockade of the 2nd and 3rd degree is chosen taking into account the localization of the conduction disturbance.

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

Under the influence of drugs nervus vagus it is not uncommon for complete heart block to become partial.

help yourself

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

Complete heart blocks

Let's consider how the complete intraventricular blockade, caused by pathological changes, looks like on the ECG. The amount of damage to each branch of the His's left leg is displayed by the deviation of the isoline in the direction of negative or positive values. It is located neutral (zero position) when excitation to the ventricles is transmitted to normal rhythm. If the pulse propagation is disturbed, a broadening is recorded QRS complex, which in some cases reaches more than 0.18 s.

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

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

With right ventricular blockade, the following occurs:

1. A low tooth is formed S greater width;
2. Prong R, on the contrary, narrow, but high;
3. QRS The complex is shaped like the letter M.
4. Secondary repolarization (early) is displayed in the chest leads on the right with a convex upward segment ST, which has a slight downward bias. At the same time, the tooth T- with inversion (inverted).

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

• The proximal type of block occurs when the ventricular pacemaker is located in the atrioventricular node. On the ECG, this type of blockade is noted by the usual (not widened) complex QRS, the frequency of contractions of the ventricles is quite high (up to 50 per minute).
• In the distal type, the ventricular pacemaker has a lower idioventricular location. It is the bundle of His with all the branches. It is called the automatic center of the third order. The electrocardiogram shows that the number of ventricular contractions is reduced, it does not exceed 30 per minute. This is indicated by the broadening of the complex QRS more than 0.12 s and layering on the ventricular QRS prong complex R. It may have a modified form (if an automatic impulse occurs below the starting point of the branching of the His bundle). The ventricular complex retains an unchanged shape if the starting point of localization of the automatic impulse is located in the bundle itself.

With atrioventricular blockade, simultaneous contraction of the ventricles and atria occurs. This gives an increased sound of the first tone, which is called "cannon". It is well heard when listening. The symptomatology of this type of blockade depends on the degree of circulatory disorders and the causes that cause it. If the frequency of ventricular contractions is high enough (not less than 36 per minute), and there are no concomitant diseases, then patients do not experience discomfort and discomfort. In some cases, when cerebral blood flow decreases, dizziness occurs, consciousness begins to get confused periodically.

With an increase in the duration of the interval between ventricular contractions, partial AV blockade can turn into complete blockade, causing an acute circulatory disorder in the brain. It is often accompanied by a slight eclipse of consciousness, heart pain. In more severe cases, attacks of MAC occur, accompanied by convulsions, for a short time the person loses consciousness. Prolonged ventricular arrest can cause instant death due to ventricular fibrillation.

Drug therapy of complete blockade

Therapy of a complete blockade of any type is carried out on the basis of etiology and pathogenesis.

To radical ways include the implantation of a pacemaker. Indications for its use are:

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

Forecast

A favorable prognosis is given only with partial blockades. The development of a complete blockade of the third degree leads to complete disability, especially if it is complicated by heart failure or occurs against the background of myocardial infarction. The implantation of a pacemaker will allow to make more favorable prognosis. With their use in some patients, partial recovery is possible.

Features of localization of heart block

Bundle of His and its blockade

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

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

Sinoatrial heart block

A distinctive feature of sinoatrial block (SB) is that it can occur simultaneously with other types of cardiac arrhythmias and conduction pathologies. Sinoatrial blockade is sometimes caused by sinus node weakness. It can be permanent, transient or latent.

At the same time, three stages of its manifestation are distinguished.

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

Blockade interatrial

One of the small rare violations of the heart rhythm is interatrial blockade. Like all other species, it has three stages of flow.

1. The excitation impulse is delayed.
2. Periodic blocking of the exciting impulse coming to the left atrium.
3. Uncoupling of atrial activity or a complete violation of conduction.

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

Heart block in childhood

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

Congenital blockade can be caused by the following reasons:

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

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

But as it progresses, there is a gradual stretching of the heart chambers, a violation of hemodynamics with a slowdown in the overall blood flow. This leads to a deterioration in the supply of oxygen to the brain and myocardium. As a result of hypoxia in children, neuropsychiatric disorders. They are bad at remembering and assimilating educational material lag behind their peers in physical development. The child often has dizziness, weakness, slight fainting. Any stressful situation and an increase in physical activity can lead to fainting.

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

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

Blockade of the legs of the bundle of His (BNPG) is a violation of intracardiac conduction due to damage to the bundle of His. Diagnosis of pathology is carried out during instrumental research by taking an electrocardiogram. The disease manifests itself with heart rhythm disturbances, dizziness, and the development of syncope.

What is bundle branch block?

Blockade of the legs of the bundle of His is a partial / complete violation of the passage of an electrical impulse through the conduction system of the heart. In cardiology practice, it is not allocated in independent disease, and is considered as a sign of an existing heart disease. It is found in 0.6% of the population, much more often in men. The frequency of diagnosis increases with age.

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

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

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

The causes of RBBB (blockade of the right leg of the bundle of His) are:

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

Causes of LBBB (left bundle branch block):

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

Important! Narrowing/absolute closure of the aorta and other aortic malformations become the provoking factor of two-beam blockades.

In addition to the previously discussed reasons, BNPG can be provoked by:

• cardiopathology - rheumatism, heart failure, etc.;
• change in the level of electrolytes;
• prolonged intake, in particular;
• influence of toxic components;
• endocrine diseases such as high content blood sugar;
• a constant lack of oxygen in the body, caused, in particular, by asthma.

Characteristics and symptoms of each type of BBB

Each of the varieties has its own signs and clinic.

Right bundle branch block (abbreviated RBBB)

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

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

Important! RBBB is a typical complication that accompanies the postinfarction condition. Especially if the changes affected the right ventricle of the heart or the back wall.

RBBB accompanies the following diseases:

• valve system defects;
• organic lesions of myocardial cells.

Approximately 20% of all diagnosed cases to identify true reason state development fails.

Left bundle branch block (LBBB)

A characteristic of the complete blockade of LBB is the absence of the spread of excitation to the point of divergence of the stem. The occurrence of a two-beam blockade is not ruled out, both branches are excluded from the process.

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

Symptoms of the blockade of the anterior branch of the left leg of the bundle of His (BPVLNPG)

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

Very rarely, the condition is accompanied by the development of arrhythmia, but it should not be considered as a characteristic clinical symptom.

Blockade of the posterior branch of the left leg of the bundle of His (BZVLNPG)

In the case of a complete blockade of the zone of participation in the processes of excitation, it does not accept. Any characteristics missing.

Two-beam BNPG

With a two-beam form, excitation of the posterior-lower zone of the myocardium of the left ventricle occurs first. Then the spread to the anterolateral sections and further, to the tissue of the myocardium of the right ventricle is fixed.

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

Important! Diagnosis of combined blockade indicates major changes myocardium.

Tribundle BNPG

With an incomplete form, the transmission of the exciting impulse is carried out along a less damaged branch and is accompanied by the development of the first / second degree.

With a complete blockade, the passage of excitatory impulses along the path "atrium - ventricle" is completely stopped. This is expressed in the disunity of rhythms. The contraction of the ventricles takes place in the idioventricular arrhythmic mode, which acts as an asystole.

Symptoms of bundle branch block

Most blockade cases are completely asymptomatic. In particular, this applies to incomplete single-beam blockade. The condition is diagnosed quite by accident during the period of the planned removal of the cardiogram of the heart.

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

• changes in the work of the heart muscle;
• development of dizziness;
• syncope and before fainting;
• intolerance to physical activity;
• increased fatigue, general weakness;
• soreness in the region of the heart and a feeling of interruptions in its work.

The development of a clinical picture reflecting the underlying pathology is not excluded. This can be a cardiological profile, and diseases of other organs and systems.

Severe symptoms accompany such complex cardiopathologies:

• heart failure;

They are accompanied by the development of various forms of heart blockade with lesions of the ventricular myocardium.

Blockade of the right leg of the bundle of His in children

The child has pathological condition can be formed during fetal development, i.e. during a woman's pregnancy. But it can also be acquired against the background past illness of cardio-vascular system.

Causes can be:

• insufficient blood supply - the oxygen starvation caused by it can cause the development of myocardial ischemia;
• the death of the His bundle - the state of hypoxia can provoke the death of myocardial cells and their replacement with non-functional scar tissue;
• heart failure;
• pathologies of the heart muscle due to its organic damage;
• abnormal structure of the heart - violations of intrauterine development;
• inflammation of myocardial tissue;
• surgical operations on the heart;
• autoimmune pathology - capable of provoking malfunctions in the work of the myocardium;
• pathological increase in performance blood pressure- in childhood, it can cause changes in the structure of the heart, in particular, provoke the development of LVH (), which is accompanied by a violation of its functionality.

The causes of congenital blockade are:

• multifocal lesion of connective tissues in a pregnant woman;
• insulin-dependent form of diabetes;
• abnormal development of the right leg of the bundle of His;
• violation in the structure of the partitions in the heart cavity.

The condition may develop as a result of blunt trauma to the heart. It could be:

• a blow to the chest during a fall or push;
• incorrectly performed medical manipulations during cardiac surgery.

Primary symptoms are:

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

Diagnostics

Diagnosis of pathology in patients in adulthood and childhood is based on instrumental tests and analyzes. It:

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

Deciphering the results obtained is within the competence of a specialized specialist and helps him choose the necessary treatment.

Treatment for blockade of the legs of the bundle of His

There is no specific treatment for the pathology. Since BNPH is only a symptom, doctors treat the underlying disease that caused the development of the blockade.

If the condition was provoked by hypertension, angina pectoris or heart failure, then the treatment protocol for the patient is to take the following drugs:

• funds from the group of nitrates;
• cardiac glycosides;
• drugs that stabilize blood pressure.

It is recommended to treat the condition by installing a pacemaker in the formation of AV blocks.

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

Lifestyle with blockade of the bundle of His

If the patient's well-being is not overshadowed by the development clinical manifestations pathological cardio condition, he can live in the usual mode, without limiting physical activity. There are no other contraindications.

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

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

If a pacemaker is installed, the patient must carry the EKS owner card with him. In addition, while talking on a cell phone, the handset should be applied not to the left, but to the right ear.

The control ECG is taken once a year. The procedure may be performed more frequently if the attending physician sees the need.

Complications

Complications of any of the types of blockade can be:

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

Complete blockade of the leg of His is capable of provoking such complications of the underlying disease:

• the development of heart failure - the inability of the body to provide adequate blood supply to the body;
• blockage of the lumen of the vessel by detached particles of a blood clot.

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

Forecast

As a result, it should be noted that the blockade of the His bundle is only a symptomatic sign of cardiac pathology, but not a disease at all. It is detected during the removal of a cardiogram or on the basis of a patient survey.

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

• With a single-beam right-sided blockade in the absence of cardiac and pulmonary complications, the prognosis is good.
• Complete blockade of the left leg in conjunction with necrotizing myocardial cells receives poor prognosis from physicians. Mortality in the acute period reaches 50%.
• Three-beam blockades also have unfavorable outcome predictions. There is a high probability of asystole formation and subsequent death of the patient.

The blockade of the legs of the bundle of His is a pathological cardiac condition that requires medical supervision. That is why, with the development of unpleasant symptoms, it is recommended to get medical advice.

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

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

Characteristics of the disease

Few have an idea what a bundle of His is. The bundle of His causes the ventricles to contract in atrial rhythm. In its composition:

• Left leg;
• right anterior leg;
• right rear leg.

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

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

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

The disease occurs in full and partial form.

The incomplete variant is characterized by delayed impulse transmission, if a complete blockade is diagnosed, the impulse is not completely conducted.

Violation of the patency of the pulse is usually caused by comorbidities or it is one of the symptoms of cardiac pathology.

The risk group includes people over 60 years old, most often, these are men. The older the person, the higher the risk of developing the disease.

Incomplete blockade of the right leg

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

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

If the cause of the pathological phenomena was the bundle of His, the blockade of the right leg of the bundle of His can be fixed on the electrocardiogram. Sometimes during an attack, the patient is worried about shortness of breath, dizziness appears.

Causes of incomplete right blockade

The blockade of PNG occurs due to different reasons. They can be congenital or acquired.

To congenital causes include:

• congenital heart defects;
• damage to the interatrial septum;
• violations of the interventricular septum;
• violation of cardiac conduction in childhood;
• stenosis of the pulmonary vessels;
• violations in the development of the right leg of His.

The acquired factors are:

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

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

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

Symptoms of incomplete right blockade

Blockade of the right leg of the heart is asymptomatic. Most often, the signs of blockade are mild. If there are bright symptoms, it means that the patient has concomitant diseases.

In this case, the following clinical manifestations are possible:

• heartache;
• dyspnea;
• violation of the heart rhythm;
• increased fatigue.

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

Diagnostics

Incomplete right heart block in most cases is regarded as a physiological norm. In special cases, the pathology requires special attention. Before determining the diagnosis, you will need to undergo a diagnostic examination.

It includes the following procedures:

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

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

Treatment of the right incomplete blockade

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

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

If no comorbidities are present, no medication is needed. It is desirable to engage in strengthening the body, reducing stress, both physical and emotional. Do not forget about regular walks in the fresh air.

Complete blockade of the right leg of His

Complete blockage of the right leg occurs when the electrical impulse ceases to be conducted to the right ventricle. The reason for its occurrence in most cases is an increase in the right ventricle, such a pathology is possible in the presence of heart disease, which complicates the course of the disease.

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

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

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

• heart attack;
• cardiac ischemia;
• hypertension;
• pathologies in the interventricular and interatrial septa;
• chronic lung diseases;
• congenital heart disease.

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

Treatment of complete blockade

Complete RBBB is diagnosed by ECG and ultrasound. You can also determine the disease by listening to the heart, since there is a violation of the rhythm of heart tones. Treatment of the disease is carried out only as directed by a doctor in the presence of a concomitant disease.

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

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

Vitamin therapy is necessary for both complete and partial blockade.

With their help, you can restore the conductivity of the pulse. Usually the complex of vitamins includes:

• thiamine;
• a nicotinic acid;
• riboflavin.

Antioxidants help restore tissues, these drugs help to release decay products.

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

Complications

In most cases, the blockade of the right leg of the bundle of His does not pose such a danger that occurs when the left leg is blocked. And yet, the disease can have consequences

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

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

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

If the conduction of an impulse along special muscle cells in the myocardium, called bundles of His, is disturbed, then a complete or partial blockade of the legs is diagnosed on the ECG. There are no symptoms or patients complain of dizziness, weakness and fainting. For treatment, it is necessary to eliminate the cause (heart attack, sclerosis, heart defects, hypertension), some patients need to install a pacemaker.

Read in this article

Bundle of His - what is it in the heart

The bundle of His in the heart is a section of the conduction system. Figuratively, it can be represented as a bundle of electrical wires that pass current. It first goes along the wall between the ventricles, then it is divided into 2 legs, and then the left one further diverges into the anterior, posterior. Gis fiber impulses are received from the atrioventricular junction and transmitted to small Purkinje cells branching in the walls of the ventricles.

What is bundle branch block

Conductive fibers consist of a trunk (located in the septum between the ventricles), right and left branches. The right one descends immediately to the right ventricle, and the left one is previously divided into 2 parts (anterior and posterior), and then passes to the left ventricle. In the future, the legs of the bundle of His in the heart muscle branch out, forming the Purkinje pathways.

The role of the branches of His is to perceive the contraction signal from the sinus and atrioventricular nodes and transmit it to all parts of the ventricular heart muscle. This causes them to contract in the correct rhythm.

If an obstacle occurs in the form of inflammation, necrosis, sclerosis in the myocardium, their work is blocked. If the area of ​​damage is insignificant, then there may be no symptoms; with a complete blockade, contractions occur less frequently than normal. This is due to the conduction of impulses along a roundabout path, which disrupts the synchrony of the work of the heart departments.

Reasons for the development of pathology

The right bundle branch of His (RBB) is damaged by overload and damage to the myocardium of the right ventricle in such cases:

• narrowing of the mitral orifice
• tricuspid valve insufficiency,
• pulmonary hypertension,
• hole in the septum between the atria,
• overdose of cardiac glycosides and beta-blockers.

Parts of the left branch of the His bundle (LBB) are blocked when the myocardium of the left ventricle changes:

• ischemia,
• dystrophic and dishormonal processes,
• hypertrophy in hypertension, aortic malformations, mitral insufficiency,
• bacterial and.

Symptoms in adults and children

Violation of signal conduction along the bundles of His does not have independent clinical signs, since it occurs secondarily against the background of an existing heart disease or large vessels. If the blockade is partial or only one branch, especially the right one, then the patient may not be aware of it, and such a deviation from the norm can only be detected on the ECG, more often with Holter monitoring.

With complete damage to all 3 branches (PNPG and 2 parts of the left), the volume of blood ejected from the ventricles decreases. In such cases, characteristic symptoms appear:

• dizziness;
• visual impairment;
• fainting spells of Morgagni-Adams-Stokes type;
• bradycardia;
• rhythm breaks,
• labored breathing;
• slowing down of contractions up to a complete stop of the heart.

Types of blockade of His

The legs of Gis can be blocked individually or all at once, also an isolated lesion occurs in one branch of the left leg, as well as their various combinations. There are periodic or permanent options, on one electrocardiogram, blockade of one, and then the other branch may be noted at first.

Right leg

The impulse for the right ventricle comes from the left and along the left side of the septum with complete blockage, its conduction slows down with incomplete blockage. The manifestations are minimal, can be found in a completely healthy person and do not give in further complications. If it occurs with cardiac pathology, then shortness of breath and fatigue are usually associated with the underlying disease.

Anterior branch of the LNPG

The conduction disorder affects the anterior and lateral sides of the left ventricle. Signals are sent to them along the back wall from bottom to top. Most often found in myocardial hypertrophy due to hypertension, congestion in heart defects and myocardiopathy, one of the causes is anterior wall infarction.

back branch

The electrical signal diverges along individual Purkinje fibers from the anterior sections of the left ventricle from top to bottom, reaching the posterior wall late. A heart attack or sclerosis, calcium deposits in the area of ​​conductive fibers lead to a similar condition.

Whole left leg

Partial blockades of one branch give minimal manifestations, but the complete blockade of LNPG is caused by massive heart attack or a pronounced inflammatory or dystrophic process that covers the myocardium of the left ventricle. Therefore, with this pathology, cardialgia, dizziness, and arrhythmia are noted.

Complete and incomplete blockade

With a partial blockade, the contraction wave passes with a slight delay, since it reaches the target quickly enough along numerous alternative paths. The rhythm is not disturbed or bradycardia develops, the severity of clinical manifestations depends on the cause that led to the blockade.

Complete blocking is characterized by:

• the impossibility of passing signals to the ventricles;
• the occurrence of foci of excitation in atypical places;
• departments of the heart are reduced in a chaotic rhythm, the pulse rate is from 20 to 40 per minute;
• insufficient release of blood into the arterial network.

Transient blockade of the right leg of the bundle of His

The blockade of the right and left legs of the bundle of His is possible in a permanent, as well as transient form. In the second case, it is also called intermittent. This means that it happens under provoking conditions. For example, it calls:

After the patient goes into a state of rest or the treatment of the underlying disease is successful, the blockade of the leg disappears. A daily cardiogram recording (Holter monitoring) helps to identify a transient slowdown in conduction, and a temporary blockade is often not visible on a regular ECG.

Transient blockade of the left leg of the bundle of His, right

Transient blockade of the left, right bundle of His is a synonym for transient, intermittent. Doctors use any of these terms when making a diagnosis to show that the blockage occurs only under the influence of a provoking factor. With the improvement of the course of the underlying disease, this symptom disappears. Intermittent blockades characterize initial changes heart, and persistent occur after a heart attack, severe inflammation.

Depending on how severely impaired signal patency, the blockade can be of several types:

• Transient complete blockade of the right leg of the His bundle, the left - the ventricles do not receive signals from the atrioventricular node, they work in their own rhythm (no more than 30-40 beats in 60 seconds).
• Partial blockage - not all electrical signals pass, so the frequency of contractions is below normal (50-60 / minute).
• Slow conduction - not all pulses can pass through the beam or the propagation is not synchronous. In this case, the pulse rate is within the normal range, but the ECG shows a prolapse of the ventricular complex.

Two-beam blockade of the legs of the bundle of His

The types of two-beam blockade of the legs of the bundle of His include inhibition of the passage of the signal along the right and one branch of the left. In any of these cases, the right ventricle receives an impulse from the healthy part of the left leg. This happens with a delay, which is reflected on the ECG in the form of an expanded ventricular complex, a deviation of the heart axis. Symptoms correspond to the underlying disease:

• angina,
• hypertension,
• heart attack,
• heart disease,
• cardiosclerosis,
• calcification.

Such a symptom means that there are violations of the structure and function of the heart muscle in both ventricles. This is regarded as an unfavorable sign, it happens with deep and extensive lesions of the myocardium.

Trifascicular blockade of the legs of the bundle of His

If there is a three-fascicular blockade of the branches of the bundle of His, then this means that both ventricles receive signals on the most intact of the three branches. They may contract more slowly than normal or at their own pace.

In an incomplete version, this is manifested by dizziness, weakness and shortness of breath during physical exertion, pain in the heart is possible. With further progression, there are interruptions and sensations of tremors in the region of the heart, fainting.

When the passage of the signal completely stops, then there are bouts of loss of consciousness, blue skin with convulsive twitching of the muscles. Three-beam acute blockade of the bundle of His is the cause of cardiac arrest, with untimely assistance, it ends in the death of the patient.

ECG signs and other diagnostic methods

Most often, a conventional ECG is used, but if there are doubts about the diagnosis, then a transesophageal technique or daily monitoring is additionally prescribed. In order to establish the cause, an examination is carried out using echocardiography, CT and MRI.

Symptoms on the ECG depend on the type and combination of blocked branches:

• Blockade of PNPG - the right chest leads reveal Rsr, rSR complexes, they look like the letter M, in the left - S is wider than normal, QRS is more than 0.12 seconds.
• Blockade of LBBB - wide complexes with a serrated apex in the left leads, in the right leads - abnormal complexes, split S.

Blockade of the leg of His in the heart: symptoms in women

Incomplete or temporary blockade of one leg or branch of His in the heart does not show symptoms in women and men. If there is a complete cessation of the movement of impulses, then the rhythm slows down, and the release of blood from the heart decreases. This leads to malnutrition of the organs, but the brain and myocardium suffer the most. The manifestations are:

• darkening in the eyes;
• fainting state;
• rare, non-rhythmic pulse, interruptions;
• difficulty breathing;
• heart attacks.

Often, with a transient blockade at rest, the state is good, but with physical, emotional overstrain, the patient feels a lack of air, there is an attack of dizziness, fainting.

Blockade of the right leg of the bundle of His during pregnancy

If the blockade of the right leg of the bundle of His is detected during pregnancy in a woman who has never suffered from heart disease before, then this is the norm. AT young age this phenomenon does not cause circulatory disorders and disappears on its own.

Causes associated with cardiac pathology include:

• hypertonic disease,
• angina,
• heart disease.

All of them have characteristic symptoms and EchoCG, ECG and pressure measurements are enough to exclude them. In doubtful cases, Holter cardiogram monitoring, a blood test for rheumatic tests are prescribed.

What is dangerous blockade of the left leg of the bundle of His

The blockade of the left leg of the bundle of His is dangerous when combined with a complete blockade of the right. There is a dissociation of the rhythm of contractions of the chambers of the heart. Against this background, the volume of blood entering the bloodstream from the heart decreases, episodes of loss of consciousness are possible. In a severe case, a complex form of arrhythmia appears and there is even a cardiac arrest of various durations.

If one leg is affected, then the ventricle (right, left, respectively) will receive a bioelectric impulse with a delay, but the contraction will still occur. Therefore, the blockade of only the right (left) leg of the His bundle is not dangerous, but requires therapy for the condition that caused it. With an asymptomatic course, observation, regular annual examinations (ECG, blood tests) are sufficient.

Is the blockade of the left leg of the bundle of His treated?

The blockade of the left leg of the His bundle is treated, but for this it is necessary to identify and eliminate the disease that caused it, and there is no special therapy for blockade only. Since this condition is not a disease, but only a symptom of it, the main diagnosis in a patient is:

• valve defect;
• septal defect;
• cardiosclerosis postinfarction, postmyocarditis;
• calcification;
• cardiomyopathy (viral, diabetes, hormonal disorders, gout, allergic, toxic, alcoholic).

Therefore, drugs are used that are needed in each specific case - reducing pressure, dilating blood vessels, improving myocardial nutrition, anti-inflammatory.

Treatment of bundle branch block

The underlying disease is being treated, vitamins, Coenzyme Q, Thiotriazolin, Mildronate are prescribed to improve the blood supply to the myocardium. Pressure reduction is carried out with angiotensin-converting enzyme blockers (Lisinopril, Kapoten), beta-blockers and calcium antagonists are avoided, as they slow down conduction in the myocardium.

Indications for the installation of a pacemaker (artificial source of rhythm or cardioverter):

• blockade of 3 beams,
• complete block for signals from the atrium,
• the rhythm of contractions is below 40 per minute,
• bouts of loss of consciousness.

If the blockade of the legs occurred in the acute stage of a heart attack, there is a complete blockade of the LBB, PNPG with one branch of the left, then temporary cardiac stimulation is recommended. To do this, an electrode is inserted into the right ventricle through the central vein.

If there are no clinical manifestations, then patients are shown observation by a cardiologist and periodic monitoring of the ECG.

Watch the video about the blockade of the right leg of the bundle of His:

What is the dangerous condition

Complete blockage of electrical impulses increases the risk of cardiac arrest and can cause a sudden stop of contractions with a fatal outcome. Morgagni-Adams-Stokes attacks, which occur when the blood supply to the brain is interrupted, can also be life-threatening, especially if the patient is driving a vehicle or other complex mechanisms at that time.

Complications of the blockade of the legs of His include:

• attacks of tachycardia of ventricular origin,
• and ventricular flutter
• circulatory failure,
• thromboembolism.

Prognosis for the patient

If the blockade is detected by chance during an ECG examination, there are no signs of a blood supply deficiency internal organs the prognosis for these patients is good. This may be a variant of the structure of the heart, no treatment is required.

An unfavorable outcome of the blockade is observed in patients with extensive infarction, uncompensated defects, massive myocardial dystrophy. It should be noted that the blockade that frolics in such situations is a sign of the negative dynamics of the disease, it increases the risk of complications and death.

Lifestyle when a problem is identified

If the examination did not reveal abnormalities, and there are only ECG signs of blockade, then the patient is recommended to maintain physical activity in the same volumes as healthy people.

With the development of conduction disturbances in patients with a cardiological profile, the load is limited, but not completely canceled. Stress, overwork, excess animal fats in the diet, smoking and alcohol abuse have a negative effect on the course of the disease.

After installing a pacemaker, devices with an electromagnetic field, security detectors in supermarkets and airports, and high-voltage electrical lines should be avoided. When using a mobile phone, keep it on the right side.

The blockade of the legs of the bundle of His is not a separate disease, but a sign of a violation of the conduction of the contraction signal through the heart muscle. Partial blockades of PNPG and 1 branch of the left are asymptomatic. With a complete blockage of 3 branches or the occurrence of a similar disorder against a background of a heart attack, sudden stop hearts. Treatment of the underlying disease is prescribed, with fainting attacks, the installation of a pacemaker is indicated.

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