Disruption of intraventricular conduction – what is a local violation of intraventricular

It is possible to suspect a violation of intraventricular conduction in a child and an adult when the following problems are detected:

  • palpitations become more frequent – tachycardia detected;
  • heart rate skips beats;
  • cardiac muscle contraction chaotic;
  • heart pains like angina pectoris;
  • shortness of breath, fainting, dizziness – poor blood supply to the brain.

If such symptoms bother you, you should immediately contact a specialist and sign up for a check, where the diagnosis can be refuted or confirmed, depending on what the cardiac ECG shows and other tests.

In order to accurately determine the violation of patency at the first stage, doctors use an electrocardiograph. If rhythmic inconsistencies are detected, Holter monitoring is performed – a specialized kind of ECG. The third stage will be the study of the locality of pathology with the help of the electro-Hiss beam.

Some medical tests that determine local violation of intraventricular conduction, suggest tests with physical exertion. Thanks to them, it is possible to establish an accurate picture of the course of the disease and find out what kind of heart block accompanies pathology. On how competently carried out the diagnosis will depend on the treatment.

It is very important to make timely preventive measures to strengthen the vascular system, even if you have not found a violation of intraventricular conduction. What does this give? First reduces the risk of disease. It is better to prevent any disturbance in the body than to fight it. The main measures to be followed by people at any age:

  1. Walking in the fresh air is a guarantee of a good blood supply to all vital organs, including the heart. Fresh air oxygenates tissues and cells.
  2. A balanced diet enriched with potassium and vitamins. In general, eating healthy food adds strength, energy and health.
  3. Compliance with the daily regimen – if you get enough sleep, eat at the same time, you feel much better, and the risk of disease becomes much lower.
  4. Non-intensive physical activity, which is very important – daily. Easy jogging, gymnastics, exercises, yoga.
  5. The use of power sports, especially bodybuilding, is undesirable; it rather negatively affects the heart vessels.
  6. No matter how trite, less stress and worries. Constant emotional stress is detrimental to the heart muscle.
  7. Annual vacation at sea. If there is such an opportunity, then it should definitely be used. A two-week trip to pure, salty, mineral-enriched water restores both the physical and psychological state of a person. If you can’t go to the sea, you just need to arrange your own outdoor recreation. A trip to the forest will be a worthy alternative to the sea breeze.
  8. Timely examination at a medical facility. It is better not to ignore even the slightest discomfort when it comes to the health of the heart muscle.

No wonder the heart muscle is called the motor. It regulates most of the processes and supplies the vital organs with blood. The heart should be treated with special trepidation. While it beats and does not bother, we sometimes do not attach due importance to its little motor. But everyone knows if health problems happen, including a violation of intraventricular conduction, which is just out of balance. Therefore, it would be better not to run your health.

The conduction system of the heart ensures the timely transmission of nerve impulses from the main node to the atrium, and then to the ventricles. In order for this process to occur correctly, important cells are located in the inner part of the interventricular septum, which connect into a kind of branch.

Such a zone of the main organ is called by doctors, as the legs or bundles of His. Tissues in the lower part of the two ventricles and the upper part of the heart are called Purkinje fibers. Violation of the intraventricular conduction of the heart provokes the appearance of various deviations in the activity of the organ, which can be very dangerous.

Therefore, it is important to know everything about the pathology and be able to prevent its complications in time.

Violation of intraventricular conduction of the heart: what is it? This disease can affect people of any age, especially often pathology is observed in children in adolescence, which is the result of hormonal changes in the body.

Any conduction disorder inside the ventricles in the heart system can disrupt the transmission of the nerve signal, slow it down or change it. Doctors call such pathologies heart block.

There are statistics of such ailments, which show that more often a failure is detected in the signal transmission in the area of ​​the left leg of the bundle of His, and sometimes there are cases of damage to the right leg of this department. For adults, especially the elderly, the risk of such a pathology is very high.

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Classification

Types of cardiac conduction disorders in the ventricular part can be very diverse. There are types that pose the greatest danger, while others are considered light.

  1. Depending on how many beams the violation has occurred, there are mono-, bi- or trifascicular varieties of the disease.
  2. The focal form in the transcript is defined as a lesion that is not visible in all leads.
  3. Arborization form, its location – these are Purkinje fibers.
  4. Transient disturbances manifest themselves in the form of alternating normal conductivity with abnormal.
  5. Persistent forms are diagnosed with a constant disorder of this indicator.
  6. Complete or incomplete. In the case of a complete type of disease, patency of the intraventricular region is not fixed at all. When the conduct is incomplete, the signal arrives in an altered form.
  7. Alternating types of the disease are characterized by the fact that they diagnose one or the other form of pathology.

To determine the type of such a disease, it is necessary to undergo a cardiogram, only with this method you can correctly evaluate the clinical picture. The interpretation of this examination shows all the nuances of the disease.

Causes

The provoking factors that cause this ailment can be divided into several categories. Depending on what influenced the development of such a pathology, treatment is prescribed and the outcome is predicted.

  • nonspecific conduction disorders inside the ventricular cavity;
  • organic damage to the heart;
  • medicinal reasons;
  • functional abnormalities.

The non-specific nature of the disease suggests that various notches or damage in the form of splitting can be observed in the ventricular zone.

With organic causes of the disease, a significant change in the entire intracardiac system is observed, as a result of which some diseases arise.

In addition, this factor may indicate the presence of a congenital heart defect or a previously performed surgical intervention on an organ, which is why the disease appeared.

If a conduction disorder developed under the influence of such therapy, then it will be difficult to get rid of such a deviation, and it will have to be treated for a long time.

The functional causes of the onset of the disease cause a destructive process in the area of ​​the entire conductive system of the organ, a shift in the work of the entire cardiac department is diagnosed.

Diseases causing a violation of the conductive features:

  1. arterial hypertension;
  2. myocardial infarction, extending to the area of ​​the side or front wall;
  3. incomplete fusion of the septum between the atria;
  4. myocardial dystrophy with the presence of metabolic disorders;
  5. focal type cardiosclerosis;
  6. cardiomyopathy with hypertrophic lesions;
  7. myocarditis;
  8. myocardial infarction of the posterior phrenic form;
  9. calcification of the idiopathic system.

Such a diagnosis is very dangerous for a child, as it can lead to cardiac arrest if conduction is completely blocked. The reasons that provoke such a disorder in infants and older children are many.

It is necessary to identify the disease in a timely manner in order to begin treatment at an early stage of the development of the disease and prevent serious consequences. Regular examination of the baby will help to quickly diagnose the disease.

Since signs of pathology may be completely absent or local in nature, one needs to hope only for the actions of doctors.

Causes of the disease in children:

  • Severe oxygen deficiency to nourish the heart muscle.
  • Prematurity of the child.
  • Injuries resulting from labor.
  • Circulatory disturbance in the arteries that feed the whole heart, atrial zone, ventricles and other parts of the organ.
  • Incomplete closing of the oval window.
  • The effect of certain drugs.
  • Cardiomyopathy
  • Surgical interventions in the region of the main organ.
  • Pathologies of the nervous system.
  • Endocrine diseases.
  • Infectious endocarditis.
  • Rheumatic lesions.
  • Poisoning the body.
  • Psychogenic disorders.

An important role is played by the timely registration of a pregnant woman, so that as a result of all diagnostic measures, doctors can identify any deviation in the development of the fetal heart. When the baby’s pathologies are recorded at an early stage of gestation, doctors have ways to start therapy before the onset of labor, than to improve the prognosis of the baby’s life.

Manifestations

Often the symptoms of this disease are absent in a person completely before the appearance of serious malfunctions in the work of the body. Typically, conduction disorders within the ventricles of the heart are detected as a result of diagnosis, and the patient learns about the disease for the first time. If any ailment of this type occurs, you should immediately consult a doctor to detect pathology at an early stage.

  1. weakness, loss of strength and fatigue appears from time to time;
  2. weak pulse;
  3. shortness of breath that accompanies the patient all the time;
  4. sensation of palpitations;
  5. dizziness;
  6. a sharp change in the emotional background;
  7. sharply occurring states of anxiety or anxiety;
  8. memory impairment, up to failures;
  9. a person may suddenly fall when walking, out of the blue;
  10. fainting;
  11. pain in the heart.

How is the diagnosis made?

What is this pathology?

The non-specific nature of the disease suggests that various notches or damage in the form of splitting can be observed in the ventricular zone. With organic causes of the disease, a significant change in the entire intracardiac system is observed, as a result of which some diseases arise. In addition, this factor may indicate the presence of a congenital heart defect or a previously performed surgical intervention on an organ, which is why the disease appeared.

Medicinal effects on heart function can be very dangerous. As a result of taking certain medications, the rhythm of the organ can change. If a conduction disorder developed under the influence of such therapy, then it will be difficult to get rid of such a deviation, and it will have to be treated for a long time. The functional causes of the onset of the disease cause a destructive process in the area of ​​the entire conductive system of the organ, a shift in the work of the entire heart department is diagnosed.

Such a diagnosis is very dangerous for a child, as it can lead to cardiac arrest if conduction is completely blocked. The reasons that provoke such a disorder in infants and older children are many. It is necessary to identify the disease in a timely manner in order to begin treatment at an early stage of the development of the disease and prevent serious consequences.

The term “violation of the intraventricular conduction of the heart” means that one to three bundles of the system malfunction. Cardiac blockades appear – barriers that interfere with the normal passage of nerve impulses of the main muscle of the body. For example, the processes of the heart slow down, the rhythm becomes less frequent, in special cases a complete stop may occur.

The main characteristic that tells us about the presence of a violation is the appearance of a heart block (complete or partial). In the first case, the nerve impulse is completely absent and the contractile work ceases. With partial blockade, slow activity is observed, the frequency of the pulse decreases.

There is a fairly large list of causes of the development of the disease.

Among them, the most common can be distinguished:

  • violation of the conductivity of the right leg of the bundle of His;
  • after birth, the oval window in children remains unclosed;
  • complete blocking of all beam legs;
  • previous diseases of myocardial infarction, cardiosclerosis or high blood pressure;
  • impaired functioning of certain parts of the cardiac system;
  • congenital heart disease in children or acquired (in adults);
  • violation of the dosage of taking medications.

To prescribe an effective course of treatment, it is necessary to determine as accurately as possible the true cause that provoked the violation of ventricular conduction.

All possible causes of failure can be divided into two large groups: cardiac – caused by pathology of the heart and non-cardiac – provoked by other disorders.

  • heart defects;
  • myocardial infarction;
  • myocarditis;
  • cardiac ischemia;
  • cardiomyopathy;
  • coronary arteriosclerosis;
  • the consequences of surgical interventions (for example, due to valve prosthetics, radiofrequency catheter ablation).
  • vascular dystonia;
  • endocrine problems: hypothyroidism, diabetes mellitus;
  • disorders of the respiratory system with tissue hypoxia – bronchospasm, chronic inflammation;
  • irrational medication;
  • arterial hypertension;
  • alcohol poisoning;
  • taking drugs;
  • pregnancy.

Failure of the signal does not always indicate pathology. For example, a partial violation of conductivity along the right leg of the bundle of His is considered a variant of the norm, characteristic of individual young people.

Violation of the conductive function of the myocardium can be permanent and transient. Temporary “malfunctions” are detected against the background of physical activity (for example, in training and competitions). If after rest the situation normalizes, there is no cause for concern. But if the problem persists, and changes are visible on the ECG, you need to be examined by a specialist.

Types of impaired conductivity

Most blockade of the His bundle is found only on the ECG without any symptoms or against the background of the main manifestations of the disease that caused this deviation. With poor circulation, weakness, dizziness, and fainting appear. They are associated with low discharge of blood into the arterial network due to non-synchronous contraction of muscle fibers.

Blockade PNPG

The right ventricle is excited by signals coming from the left heart. This is manifested by an expanded S, high, wide R, the ventricular complex acquires a qRS configuration, it is elongated to 0,11 seconds.

Blockade of the LDL

With a complete defeat, there is no movement of signals along the trunk or two branches at once. The excitation spreads to the left ventricle from the right through Purkinje cells. The electrical axis is deflected to the left, the QRS is wide and deformed.

The front part of the leg is responsible for the contraction of the anterolateral wall. With blockade, impulses approach from the back wall in the direction from the top of the heart to the base. When the rear branch is blocked, the excitation waves go in the opposite direction. It is characterized by an increase in ventricular complexes on the electrocardiogram.

It is possible to suspect a violation of conduction on PNPG and the front part of LDL by expanded QRS, S notch, negative T, displacement of the axis of the heart to the left. If the right leg and the back branch of the left are affected, then on the ECG there are signs of a blockade of PNPG and a deviation of the axis to the right. This combination is often found with common injuries (extensive heart attack, myocarditis).

If all three branches are blocked, then the waves pass along the less broken, atrioventricular blockade joins. With a complete stop of the atrial signals, they function in a normal rhythm, and the ventricles contract with their own (idioventricular) frequency. On the ECG, different durations of PQ intervals are noted. Often, a complete three-beam blockade leads to atrial fibrillation or stopping contractions.

If the results of standard ECG recordings were not convincing enough, then the transesophageal method or Holter monitoring, rhythmocardiography can be used. To detect the cause of conduction blockade, patients are prescribed ultrasound of the heart, MRI, MSCT, positron emission tomography.

With sinoauricular blockade, a whole heartbeat occurs. Then there is a pause. Patients sometimes feel:

  • “Freezing” or short-term cardiac arrest;
  • sharp reinforced “hit”.

Such isolated symptoms rarely lead to a doctor. More often detected after infection with targeted interrogation. An ECG study allows you to confirm the complicating factor of the disease, suspect myocarditis.

For a patient taking digitalis preparations, an ECG picture indicates the onset of the negative effects of an overdose and the urgent need to discontinue the drug.

Sinoauricular block may occur at night, then you should think about the participation of an increased tone of the vagus nerve. The same mechanism acts on the heart in case of eye injury (stroke), compression of the carotid arteries.

Atrial conduction disturbance is observed with mitral stenosis with hypertrophy of the right atrium.

Atrioventricular blockade rarely occurs as a random occurrence. If characteristic signs are detected on the ECG, the patient should be carefully examined, since the areas of incomplete conduction disturbance eventually turn into a complete differentiation of atrial and ventricular contractions.

This can cause serious consequences without treatment, which are manifested in a decrease in blood supply to the internal organs and the brain.

The atrioventricular view is characterized by the presence of a deep and widespread lesion.

  • post-infectious or septic myocarditis;
  • cicatricial changes in the myocardium with diffuse cardiosclerosis, myocardial infarction;
  • severe atherosclerotic lesion of the coronary vessels.

There are 3 degrees of such violations. If after treatment the changes on the ECG disappear, then we can retrospectively talk about incomplete damage to the pathways or the first degree and their restoration.

The second and third degrees are distinguished by persistence and constancy. Long-term pathology leads to an interruption in the connections between the atria and ventricles. Clinical manifestations depend on the frequency of independent ventricular contractions.

If the frequency of heartbeats is in the range of 40-50 per minute, dizziness appears in patients, short-term fainting is possible.

An extreme degree of disturbance of atrioventricular conduction is considered to be the development of Morgagni-Edems-Stokes syndrome. In this case, the frequency of ventricular systoles decreases to 25–20 per minute. The condition can be life-threatening because it causes hypoxia of brain cells.

Causes of conduction disturbance may be:

  • general diseases accompanied by a change in metabolism (endocrine pathology, systemic collagenoses);
  • local damage to the conduction system by areas of ischemia, inflammation, cardiosclerosis, myocardial distension with hypertrophy of individual sites.

After scarring of the necrosis zone, myofibrils and conducting cells are gradually replaced in areas of cardiosclerosis

Inflammatory reaction (myocarditis) is most often found with:

  • acute infectious diseases of a viral and bacterial nature (influenza, acute respiratory viral infections, diphtheria in children, rheumatic attacks after tonsillitis);
  • autoallergic processes on the background of vasculitis with the involvement of coronary vessels;
  • productive granulomatous inflammation.

The area of ​​ischemia caused by insufficient blood supply to the conducting fibers depends on thrombosis in both the right and left branches of the coronary arteries. Sometimes by the type of intraventricular blockade they judge the possible localization of a heart attack.

Pathology is observed in acute heart attack, chronic coronary insufficiency.

Heart defects cause deformation of the heart chambers, overstretching and hypertrophy. Therefore, a violation of conduction in children with congenital changes in the structure of the chambers and valve apparatus is not uncommon.

The development of left ventricular hypertrophy with hypertension, cardiomyopathy also leads to interruption of the ventricular impulse propagation paths. In these cases, the degree of blockade indicates the severity of the lesion.

Depending on the physiological conditions that have arisen, types of impulse conduction disturbance are distinguished:

  • creating an obstacle in the area between normal myocardial tissue and the altered area;
  • conservation of propagation at slow speed in the pathology zone;
  • impulse involvement in the affected area with subsequent blockade;
  • the possibility of passing in only one direction, interrupting the return flow.

One of the rhythm pathologies due to the latter option is paroxysmal tachycardia, in which impulses pass only from the ventricles to the atria through an additional Kent bundle.

The disturbed and expanded form of the ventricular complex indicates extrasystole or altered conduction

Failure of intraventricular conduction does not have specific symptoms. Often this condition remains unrecognized for a long time. The patient does not complain about anything, and the problem is identified by chance – during a medical examination, undergoing a medical examination before starting work or study, military service, before the operation, etc.

Possible signs of pathology:

  • a feeling of “fading” in the chest;
  • interruptions in the work of the heart – the appearance of extraordinary contractions;
  • slow pulse;
  • dyspnea;
  • feeling short of breath;
  • dizziness;
  • anxiety, anxiety.

As the process progresses, Morgagni-Adams-Stokes syndrome (MAS) develops. At the beginning of the attack, the patient turns pale and faints. After improvement, redness of the skin persists. Such episodes last 1–2 minutes and are caused by insufficient blood supply to the brain amid a sharp decrease in cardiac output. Neurological complications are usually not observed.

  • weakness;
  • cold sweat;
  • dizziness;
  • fainting conditions;
  • disability;
  • pain in the heart;
  • slow pulse, which is very poorly audible.

Often, such symptoms can simultaneously indicate both myocardial infarction and a violation of intraventricular conduction. To make a more accurate diagnosis, it is necessary to use special examination methods.

Incorrect operation of these structures leads to a condition such as a violation of intraventricular conduction of the heart, the treatment of which consists in the treatment of the main pathology. Most often, such pathologies do not pose a serious danger, however, they can complicate other heart diseases.

To understand exactly how such pathological conditions develop, you need to know what exactly the conductive system consists of, which is responsible for transmitting impulses through the ventricles. So, the leading role in this process belongs to the so-called bundle of His, consisting of two structural parts:

  • Left leg. It is represented by the anterior and posterior branches, each of which is responsible for its wall in the left ventricle. Their branches form a system of Purkinje fibers.
  • Right foot. It is represented by one bundle branching in the lower parts of the right ventricle.

For the occurrence of excitation in the ventricles, an impulse from the pacemaker passes through the interventricular septum and then the simultaneous excitation of both ventricles occurs. For this to happen, the pulse needs approximately 0,12 seconds.

In the event that blockages are noted on one of the paths, not only the path along which the impulse passes, but also the time during which the ventricles are excited, changes.

According to the generally accepted classification, all blocks of the impulse to the ventricles are divided as follows:

  1. One, two, or three-beam. This is determined by how many beams are involved in the incorrect conduct of pulses.
  2. Local. Violation of the conduction is not observed in all leads during ECG examination.
  3. Carryover. Improper impulse conduction alternates with normal.
  4. Arborization. Impulse blockade occurs in Purkinje fibers. More precisely, in their lower sections.
  5. Complete blockades.
  6. Incomplete blockades.
  7. Alternating blockades. When conducting research, one or the other option is revealed.

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Types of heart block

Depending on how difficult the impulse passage through the legs of His is, a complete and incomplete blockade of the legs of the bundle of His is isolated. If the changes are permanent, the blockade is called a stand. If the blockade appears under the influence of certain factors, they speak of a transient blockade. There is also a classification that distinguishes conduction disturbances depending on the number of beams involved. In Latin, the sheaf is spelled “fasciculus”, therefore the synonym for sheaf is the adjective “fasciculus”.

Single beam (monofascicular) – one beam is partially or completely blocked. This can be a blockade of the right leg of the bundle of His, anterior or posterior branch of the left leg.

Two-kidney (bifascicular) – two beams are involved in the process. It can be the left leg, so it consists of two bundles: the front and rear branches; the right leg and the front or rear branch of the left leg.

Three-beam (trifascicular) – completely blocked the left leg and partially right leg, complete blockade of the right leg and incomplete blockade of the front and rear branches of the left leg.

According to the localization of the process, these types of blockade are distinguished:

  1. Single beam – signal delay is recorded only in one of the beam branches. Accordingly, a blockage of the right ventricle or a violation in the work of the left is detected.
  2. Two-beam – two branches do not function – both left legs or one left and right.
  3. Three-beam – pulse delay is noted in all three branches.

Clinical case

Patient M., 65 years old, was admitted to the therapeutic department. At the time of examination, he complains of shortness of breath during physical exertion, frequent bouts of dizziness, general weakness. Repeatedly there were a loss of consciousness.

During the survey, it was possible to find out that such symptoms disturb her for more than a year. Over 14 months, marked weakness, headaches, dizziness were noted. For six months, there were loss of consciousness – about once a week. In the last month, fainting occurs almost daily. The patient faints for one minute, then general weakness is noted.

Upon further examination, changes were detected on the ECG. Ultrasound, dopplerography, left ventricular failure, valvular stenosis. Diagnosis: Coronary heart disease; rhythm disturbance as a two-beam blockade and MAC attacks; heart failure I tbsp.

The patient was given a pacemaker, her condition improved, and she was discharged.

The nature of the violations distinguishes:

  • Incomplete blockade. Impulse conduction is slow, but it is preserved. Excitation of the myocardium occurs due to intact branches. This condition happens in healthy people, but it can also indicate pathology. Changes are usually detected by chance on an ECG. There are no complaints in patients, sometimes there is general weakness, increased fatigue.
  • Complete blockade. Impulses do not reach the lower parts of the ventricles. High probability of cardiac arrest on the background of bradycardia. This condition is accompanied by clear clinical symptoms.

According to the type of violations, there are:

  • Focal changes – observed in separate parts of the myocardium closer to Purkinje fibers, the impulse partially passes through the ventricles.
  • Arborization changes – signal transmission is stored in all parts of the conducting system, except its end sections.

Clinic Syndrome

More often, before the onset of an attack, patients experience prodromal symptoms:

  • note anxiety, excitement;
  • increase in dizziness;
  • noise in the head;
  • numbness of the arms and legs appears.

These signs are also called a mild form, if the further development of symptoms stops.

Further, the manifestations are aggravated:

  • loss of consciousness;
  • a sudden fall of a walking person is possible;
  • the complexion of the skin changes – from redness to pallor with a bluish tinge;
  • respiratory movements become rare and deep;
  • dilated pupils;
  • on the arms and carotid arteries it is impossible to determine the pulsation.

Severe course is characterized by the appearance of:

  • cramps in the form of twitching of facial facial muscles or sharp contractions of limbs, muscles on the back;
  • involuntary discharge of urine and feces.

Seizures with the described clinic affect up to 60% of patients with complete atrioventricular block

The frequency of their appearance varies significantly in different patients, depending on the effectiveness of treatment.

paroxysmal tachycardia or atrial fibrillation and flutter. Upon exit from tachycardia, the period of systole is within a few seconds, and then sinus bradycardia reappears. This pathological condition is associated with an organic lesion of the sinus node (damage to the P cells), it exhausts the patient, prolonged delay may lead to his death. Arrest-2-sinus syndrome is an indication for constant electrical stimulation – surgical intervention.

Clinical case

Patient M., 65 years old, was admitted to the therapeutic department. At the time of examination, he complains of shortness of breath during physical exertion, frequent bouts of dizziness, general weakness. Repeatedly there were a loss of consciousness.

During the survey, it was possible to find out that such symptoms disturb her for more than a year. Over 14 months, marked weakness, headaches, dizziness were noted. For six months, there were loss of consciousness – about once a week. In the last month, fainting occurs almost daily. The patient faints for one minute, then general weakness is noted.

Upon further examination, changes were detected on the ECG. Ultrasound, dopplerography, left ventricular failure, valvular stenosis. Diagnosis: Coronary heart disease; rhythm disturbance as a two-beam blockade and MAC attacks; heart failure I tbsp.

The patient was given a pacemaker, her condition improved, and she was discharged.

Anatomy

At the junction of the superior vena cava and the right atrium there is a group of cells that generates the initial electrical impulse of each normal heart beat – the sinus node (SU). The electrical impulse of these pacemaker cells spreads to neighboring cells, which leads to stimulation of the heart chambers in an ordered sequence.

Impulses propagate within the atrium to the atrioventricular junction (AB) through the preferred conduction of atrial interstitial tracts and non-specialized myocytes. AV delay time affects the heart rate and is modulated by autonomic tone and catecholamines circulating in the bloodstream to maximize cardiac performance at any time.

The atria are electrically isolated from the ventricles by the fibrous ring everywhere, except for the anterior septum. There is a bundle of His (continuation of the AV node), which enters the interventricular septum, where it bifurcates into left and right bundles.

What happens with blockade in the right leg of the bundle of His

The past few decades, the number of patients with the cardiac system has increased markedly.

Among a large list of diseases, the diagnosis of impaired intraventricular conduction of the heart occurs in 20% of patients.

Disorders of intraventricular conduction of the heart: what is it? Let’s try to find out the causes, features of the course of this pathological condition and treatment options.

Nerve impulse transmission is the primary function of the heart muscle. Nerve stimulation is gradually transmitted from the sinus node to the region of the ventricles and atria.

Interruption of transmission of nerve impulses is included in the concept of “blockade”. It can be organic or functional.

Blockade of the right bundle branch block

The essence of the blockade

By “intraventricular blockade” is meant a selective or absolute cessation of impulse delivery through the legs of His.

Delayed excitation reaches the contractile structures of one or both ventricles. Therefore, the processes of repolarization and depolarization of the ventricles occur intermittently. Pathological changes are displayed in the results of the ECG.

The blockade will depend on the localization of the pathological process:

  • One bundle – there is a delay in neural transmission in 1 bundle (left front, back or right leg);
  • Two beams – impulse transmission is broken in 2 beams (one-sided – left leg, two-sided – right leg with front or rear left);
  • Three beams – pulse delay is observed in 3 beams.

Ventricular blockade may be:

  • Full;
  • Incomplete (partial deceleration of the conductivity of the excitation).

Problematic intraventricular conduction is also divided into:

  • Focal – local pathological changes are not observed on all ECGs;
  • Arborization – problems with conductivity in the final sections of Purkinje fibers.

By the nature of the deviations of the blockade there are:

  • Persistent;
  • Transient (the transmission of pulses is then normal, then not);
  • Alternating (there is one kind of blockade, then another).

Types of blockade

Malfunctions in the work or structure of the heart, which often cause internal interventricular blockade:

  • Ischemic damage to the heart;
  • Excessive increase in heart muscle;
  • Obstruction from the left ventricle;
  • Myocarditis;
  • Constant high pressure;
  • Myocardial infarction;
  • Cardiosclerosis (local and general lesion).

Disorders of intraventricular conduction are observed with:

  • Drug intoxication;
  • Pulmonary embolism;
  • Thyrotoxicosis;
  • Nonspecific electrolyte imbalance;
  • Obstructive pathology of the lung tissue of a chronic nature.

The elements by which the data are assessed when examining the heart for an ECG depend on the type of blockade.

They will differ:

  • The axis vector of the heart muscle;
  • Ventricular shape;
  • Localization in the chest and normal leads;
  • Duration of intervals
  • The width of the cloves.

When interpreting the results, the doctor always compares the data of the last ECG with the data obtained earlier.

An example of an ECG with an incomplete three-beam blockade of the His system

Deviations in ventricular conduction are found in adult patients, more often in the elderly. The most common blockade that affects the left bundle (upper front leg).

Less often in practice, doctors are faced with problematic impulse conduction along the right leg of the His bundle. The back beam has difficulty transmitting excitation extremely rarely.

Statistics indicate that intraventricular blockade occurs in 2,4% of cases among all heart diseases diagnosed with ECG.

In a child, problematic intraventricular conduction indicates congenital malformations. Sometimes it is the result of genetic abnormalities. Local delays in the transmission of nerve impulses along the right leg are not a deviation, but a normal condition for children.

Fainting conditions are accompanied by blueness of the skin, lack of pulse, convulsions. There is a temporary asystole. It can be short or long. The latter threatens the life of the child.

Deviations of intraventricular conduction

With absolute blockade of the right leg, the impulses reach the right ventricle and the adjacent septum through the left ventricle and its septum. The latter are among the first to receive excitement, and then slowly transfer it to the right ventricle.

Absolute blockade occurs with excessive load on the right ventricle.

This is observed with:

  • Coronary heart disease (chronic) in combination with GB;
  • Congenital malformations of a particular heart structure;
  • Mitral valve stenosis;
  • Chronic lung tissue disease;
  • Myocardial conditions.

Partial blockade leads to:

  • Sclerotic, inflammatory disorders in the heart, electrolyte abnormalities;
  • The use of certain quinidine-based drugs, digitalis.

Coronary heart disease

The mechanism is associated with impaired conduction of excitation along the walls of the left ventricle (anterior, lateral). Initially, it is fixed in the left posterior branch, the septum of the ventricles, the lower part of the posterior wall. Further, the impulse, passing from the bottom up, reaches the left ventricle (its anterior lateral part).

This type of blockade occurs due to diseases of the left heart chamber:

  • Myocarditis;
  • Aortic defect;
  • Local cardiosclerosis.

Due to the fact that the problems of the two-beam blockade lie in the defeat of the right leg and the left front bundle, the features of the impulse transmission are as follows:

  • Initially, excitation comes in the left ventricle (posterior wall);
  • Then it reaches the anterior and lateral sections of the left ventricle;
  • At the end, an impulse appears in the right ventricle.

Such blockages are due to:

  • Heart defects;
  • Heart attacks;
  • Ventricular lesions of various origins.

Through a branch (left front) that is not affected by the pathological process, the excitation spreads to the walls of the left ventricle, then to its lower parts. At the very end, the impulse encompasses the right ventricle.

This blockade is characterized by the spread of a nerve impulse from the atria to the ventricles along a branch that is less affected by the pathological process. Symptoms of atrioventricular block are observed.

All types of blockades, except for the three-beam, have nonspecific symptoms. However, patients still feel unwell: their well-being is changing for the worse.

With a blockage of 3 bundles, 3 degrees of severity are distinguished:

  • 1 – excitement passes, but slowly;
  • 2 – part of the pulses is delayed, and the rest pass through areas only locally changed.
  • 3 – the passage of excitation through the ventricles is impossible.

The patient has:

  • Intolerance to physical exertion. They are accompanied by weakness throughout the body, shortness of breath, discomfort in the heart.
  • Fainting states.
  • Decrease in heart rate.

The complications of a three-beam blockade include:

  • Cardiogenic shock.
  • Specific seizures during which the patient faints, and after a couple of minutes comes to his senses. Often repeated attacks lead to memory impairment.
  • Sudden death due to cessation of cardiac activity.
  • Severe renal failure.

Features of treatment

Long-term intraventricular blockade does not need treatment. Pathological changes in intraventricular localization, revealed for the first time, require establishing the reasons for the appearance of the patient with hospitalization.

If the cause of intracardiac blockade lies in myocardial ischemia, then doctors prescribe drugs that:

  • Improve the blood supply to the heart muscle;
  • They will help to cope with the signs of atherosclerosis.

In this clinical situation, apply:

Myocardial infarction requires such actions by doctors:

  • Prescribing drugs that can limit the focal distribution of necrosis;
  • Carrying out manipulations to reduce the area of ​​ischemia;
  • Elimination of concomitant complications.

With the inflammatory origin of intraventricular conduction disorders, the following technique is recommended:

  • Antibacterial agents;
  • Hormonal drugs.

In chronic heart failure, doctors are prescribed in a small dosage:

The treatment of two-beam and three-beam blockades is carried out using the installation of a pacemaker. It can be of two types: temporary and permanent. The patient needs a temporary device when that blockade suddenly developed in several bundles at once.

Permanent pacemaker is installed according to indications:

  • When 2 bundles of one leg are affected. For him, characters have decreased heart rate, heart failure, symptoms of angina pectoris.
  • With the defeat of 2 legs and the presence of signs of atrioventricular block.
  • With blockade of pulses on the right and left leg (rear section).
  • With blockade of both legs, which is fixed for 3 weeks after a heart attack.
  • With fainting seizures.

Probable forecasts

Making a prognosis for intraventricular blockade is problematic. This pathological condition is not independent: it is closely associated with the underlying disease.

There are some statistics regarding blockades:

  • Problems with the conductivity of the left bundle increase the likelihood of death by 6 times.
  • Symptomatic worsening is noted with two-beam lesions of the ventricles.
  • If with the acute development of myocardial infarction the appearance of one or another blockade is observed, then death occurs in 50% of cases. The blockade in this situation indicates the spread of the site of necrosis.
  • The most difficult predicted case is a three-beam blockade. She has a high risk of asystole, and thus an increased risk of mortality.

In no case should blockade be considered as an independent disease separate from cardiogenic pathologies. Determining the type of blockade is necessary so that the doctor can choose the right treatment option.

Self-treatment or the use of folk remedies can aggravate the course of the disease and lead to serious complications, including death.

Today we will talk about a violation of intraventricular conduction, what is it to find out, consider the causes and treatment methods.

What is a violation of intraventricular conduction of the heart?

Pathological disturbances of one, two or all 3 of three bundles of an intraventricular conducting system are called by this term. These are the so-called mono-, bi- and trifashicular blockages, respectively.

Principles of treatment

  1. Changes in the cardiovascular system, not accompanied by organic deviations.
  2. Patient-borne diseases such as congenital malformations, ischemia, myocarditis, cardiomyopathy.
  3. The effect of the operation on the vessels of the heart.
  4. The negative impact of drugs, side effects.

When exacerbation of the situation, for example, the occurrence of myocardial infarction, promptly injected probe. At first, treatment is reduced to eliminating the cause of the disease, and only then begins work to alleviate the symptoms.

Moderate conduction disturbances do not require treatment. Incomplete blocking in the right branch of the bundle of His is not dangerous. In this situation, we recommend that you be observed by a cardiologist, undergo annual medical examinations and an ECG. But this is if the patient has no other complaints or concomitant pathology. If abnormalities are detected, appropriate therapy is indicated.

Left ventricular blockade is more dangerous. Against its background, disturbances in blood flow and heart failure develop more often. We recommend taking cardiac glycosides, antiarrhythmic and other drugs. The treatment regimen is determined individually based on the severity of the condition, the age of the patient, and concomitant diseases.

It is important to know: specific treatment for intraventricular blockade has not been developed. The proposed drugs only increase the excitation of heart tissue, but do not eliminate the cause. It is necessary to treat the main pathology – the one that caused the malfunction of the conductive system. This is the only way to slow down the progression of the disease.

If drug therapy is ineffective or the patient is in serious condition, surgical treatment is suggested. The installation of a pacemaker – an instrument that imposes its own rhythm of the heart. The implanted device ensures uninterrupted myocardial activity.

Expert advice: when they put the pacemaker

The installation of a pacemaker is a surgical operation, and it is prescribed only according to indications. It makes no sense to carry out the procedure in the absence of obvious symptoms of pathology. If the patient feels well, the introduction of an artificial pacemaker is not indicated. The operation is not recommended if the identified symptoms are associated with reversible causes. It is necessary to cope with the underlying disease – and the heart muscle can again fully work.

Indications for installing a pacemaker:

  • bradycardia with a heart rate of less than 40 beats / min and rhythm disturbances in the presence of obvious symptoms;
  • complications that threaten the patient’s life;
  • MAC attacks;
  • persistent conduction disturbances after myocardial infarction.

The possibility of installing a pacemaker with a pulse of less than 40 beats / min in the absence of obvious clinical symptoms is discussed. The procedure is carried out at any age.

Prevention of cardiac conduction disorders has not yet been developed. Do not delay treatment, avoid risk factors. This will reduce the chances of developing a pathology. In order to identify the problem in time, regularly undergo preventive examinations at the therapist with an assessment of the ECG (as necessary).

As you know, a violation of intraventricular conduction is characterized by the presence of heart block. They, in turn, are divided into full and incomplete. With complete passage of the nerve impulse is absent, with incomplete – nerve impulses are carried out with less frequency.

In addition, this pathology is classified by lesion site. For example, there was a blockage of the right or left leg of the bundle of Giss. Also, blockades are divided into proximal and distal. Moreover, distal blockades are considered less favorable, therefore, with such a violation, increased attention from the attending physician is required.

Why does this pathology arise?

There are three main reasons that cause a violation of intraventricular conduction. These are organic, functional and medicinal reasons.

With functional – changes in the conductive system are observed. However, there is no pathology of CVS. The conductive system is regulated by the sympathetic and parasympathetic systems.

The first increases the conductivity of the pulse, and the second, on the contrary, slows down. Normally, they work harmoniously, complementing each other.

In case of imbalance, a functional shift occurs in the work of the entire cardiovascular system.

Violation of intraventricular conduction is detected during electrocardiography. In the case of transient disorders, a special ECG method is used – Holter monitoring.

– Increased, rapid heartbeat; – Periodically observed gaps in heart contraction; – The presence of interruptions in the work of the heart muscle; – Angina pectoris;

– The presence of shortness of breath, dizziness, fainting. These symptoms are associated with inadequate supply of blood to the brain.

In the presence of the described symptoms, as well as with any other abnormalities in cardiac activity, consult a cardiologist or arrhythmologist.

Treatment of an intraventricular conduction disorder

With intraventricular blockade, as well as with heart failure, cardiac glycosides are used for treatment. They are prescribed to all patients with this pathology. In cases where intraventricular blockade is observed simultaneously with atrioventricular blockade of I – II degree, these drugs are prescribed with extreme caution with regular electrocardiographic monitoring.

In acute bifascicular blockade in patients with myocardial infarction, a probe (right ventricle) is introduced for prophylactic purposes, since there is a high probability of complete triphascicular blockade and circulatory arrest.

It must be remembered that acute monofascicular blockade only in 12% of cases precedes the violation of atrioventricular conduction. Therefore, it is not advisable to perform cardiac catheterization for all such patients. The procedure is carried out only if there is a real threat of atrioventricular blockade.

Basically, treatment is aimed at eliminating the causes that caused this or that type of blockade. Next, symptomatic treatment of this disorder is performed.

Establishment of the cause and treatment

Treatment of intraventricular blockade in both adults and children begins with the establishment of the cause. If the identified causes are functional, then, as a rule, their elimination leads to a complete recovery of the patient.

If a disease was the cause of this kind of conduction disturbance, then the treatment is aimed at the underlying disease. Drugs are prescribed or adjusted for arterial hypertension (AH), coronary heart disease, etc.

Attention is also paid to the issues of a therapeutic diet.

In the case of ineffective drug treatment, severe clinical symptoms, the patient is implanted with a device that artificially stimulates the ventricular myocardium.

When making a diagnosis of a violation of intraventricular conduction of the heart, which indicates the passage of a full course of examination, it is necessary to proceed to eliminate the cause of the disease.

If the violation is not associated with the presence of a patient with any cardiovascular disease, specialists prescribe a course consisting of such drugs:

  • vitamins or complexes of minerals;
  • drugs whose action is aimed at regulating and stabilizing the process of blood supply to the heart (ATP or Preductal).

When diagnosing complete intraventricular obstruction, the treatment consists in the introduction of an artificial pacemaker, which will stimulate the heart rhythm with a set frequency. Otherwise, the patient may develop bradycardia of the heart with subsequent complications.

In the treatment of patients with a similar pathology, the appointment of drugs that stimulate the metabolic processes of the myocardium of the heart is extremely important. Among them are such as inosine, cocarboxylase, adenosine triphosphoric acid. The course of taking such drugs lasts 30 days.

If a patient is diagnosed with a violation of intraventricular conduction and atrioventricular block 1 or 2 degrees, one should be extremely careful and attentive to the appointment of any drugs.

This is due to the fact that by blocking an attack of one type of blockade, you can activate the reason for the development of another type of pathology. Such patients should be under the constant supervision of specialists and periodically undergo an electrocardiographic examination.

If there is a threat of developing an atrioventricular focal block, the patient is immediately hospitalized and a method such as catheterization is prescribed.

Take care of yourself and be healthy!

Therapy is prescribed based on the cause of the disease. Each provoking factor requires a separate approach to eliminate.

  1. If the violation of intraventricular conduction is caused by myocarditis, then the treatment will consist in the appointment of glucocorticosteroids, as well as antibiotics. These drugs help reduce the progression of this ailment.
  2. When this pathology is provoked by ischemia, the therapy is aimed only at this condition, and they do not affect the patency of the ventricles in any way.
  3. With such changes in the heart caused by the use of certain medications, doctors immediately cancel these medicines.
  4. If the conductivity is disturbed slightly, and does not affect the functioning of the main organ, then therapy is not required.
  5. When an ailment is accompanied by various types of arrhythmias, often the patient needs to install a pacemaker.

Therapeutic measures

To prescribe the treatment of blockades, it is necessary to determine their main cause. To differentiate organic lesions from the increased influence of the vagus nerve, in mild cases, an atropine test is performed.

Subcutaneous administration of a small dose of Atropine can remove the effect of the parasympathetic nervous system. If the ECG picture is restored during control, then the patient is recommended to use belladonna-based preparations (candles in the rectum, Zelenin drops inside, Bellaspon or Bellataminal tablets) inconstantly.

The detection of myocarditis, the effects of metabolic changes, hormonal disruptions, ischemia, hypertrophy allows the use of therapy according to the pathogenetic principle:

  • anti-inflammatory drugs (antibiotics, corticosteroids, cytostatics);
  • alkalizing agents;
  • β-blockers and calcium channel blockers;
  • antiplatelet agents and thrombolytics;
  • funds for lowering blood pressure;
  • prompt elimination of heart disease.

Theofedrine – an analogue of ephedrine, is contraindicated in hypertension

When a classic Morgagni-Edem-Stokes attack occurs, the patient needs emergency care, because cerebral circulation is at risk. There is no time to talk about the reasons anywhere in the discovery. An adult is able to:

  • lay the patient on a hard surface;
  • inflict intense fist on the sternum;
  • start conducting cardiopulmonary resuscitation events in the maximum accessible volume (only heart massage or in combination with artificial respiration);
  • ask others to call an ambulance.

Doctors in such cases quickly listen to the heart to make sure of weak rare strokes, measure blood pressure.

Against the background of continued indirect massage and breathing, funds stimulating cardiac activity (Adrenaline solution, Ephedrine) are administered intravenously through the Ambu bag.

Outpatients are recommended to take a maintenance dose of Isadrin, Alupent.

In case of frequent seizures, the issue of indications for the installation of a pacemaker is considered.

Detection of conduction abnormalities in a person with an acute or chronic disease is considered a complication. This symptom requires a review and continued treatment for a longer period.

It is equally important to control the temporary form of blockades. Especially if their cause remains unclear

The patient should undergo an ECG test at least twice a year.

Physiology

To understand the causes of rhythm disturbances, it is necessary to have an idea of ​​the normal physiology of the heart.

Electrophysiology

The passage of ions through the cell membrane of the myocyte is regulated through specific ion channels that cause cyclic depolarization and repolarization of the cell, called the action potential. The action potential of a working myocyte begins when the cell is depolarized from a diastolic – 90 mV transmembrane potential to 50 mV.

At this threshold potential, potential-dependent fast Na channels open, causing rapid depolarization by reducing the concentration gradient of Na ions. Fast Na channels are inactivated and Na influx ceases, but voltage-dependent ion channels are open, which allows Ca to enter through the slow Ca channels (depolarization) and K to escape through K channels (repolarization).

Firstly, these two processes are balanced and support a positive transmembrane potential, and also extend the plateau of the phase of the action potential. During this phase, the Ca entering the cell is responsible for the electromechanical conjugation and contraction of the myocyte. In the end, the influx of Ca ceases and efflux K is enhanced, causing rapid cell repolarization back to 90 mV. During depolarization, the cell is refractory to a subsequent depolarizing event.

There are 2 main types of cardiac cells:

  • Fast channel cells
  • Slow Canal Cells

Cells with fast canals (working atrial and ventricular myocytes, His-Purkinje system myocytes) have a high density of fast Na channels and their action potentials are characterized by a small or complete absence of spontaneous diastolic depolarization, a very fast initial depolarization rate and loss of refractoriness, coinciding with repolarization.

Cells with slow channels (CA and AV nodes) have a low density of fast Na channels and their action potentials are characterized by faster spontaneous diastolic depolarization, a slow initial depolarization rate and loss of refractoriness after repolarization (and therefore have a long refractory period and the impossibility of repeating pulses at high frequencies).

The CA node is the dominant automatic pacemaker in the normal heart. If the CA node does not produce pulses, cells with a slightly lower automatism (for example, the AV node) take on the role of automatic pacemakers. Sympathetic stimulation increases the frequency of activity of pacemaker cells, and parasympathetic stimulation decreases.

Normal rhythm

At rest, the frequency of the sinus rhythm of the heart in adults is usually from 60 to 100 beats / min. A lower frequency rhythm often occurs in young people. An increase in the rhythm frequency occurs with physical exertion, illness, or emotion. As a rule, a noticeable daily decrease in heart rate occurs before morning awakening. Absolutely regular (rigid) sinus rhythm is pathological and occurs in patients with autonomic denervation (for example, in diabetics).

The electrical activity of the heart is presented on an ECG, although the depolarization of the CA site, AV site, and His – Purkinje does not involve enough tissue to be detected.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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