What is an incomplete blockade of the right leg of the bundle of His on an ECG

A bundle of His (GH) is called a cluster of cells of the conduction system of the heart, located under the atrioventricular node and interventricular septum. PG consists of the right and left legs. Legs of GHGs are elements that are responsible for the transmission of electrical excitation to the heart ventricles. They, in turn, are divided into branches and are located on both sides of the interventricular septum. In the ventricular myocardium, the legs are separated into conducting bundles of cardiac myocytes (Purkinje fibers).

Danger of blockade

The poor conductivity of the His bundle is a dangerous pathology that affects the functional work of the heart muscle. Incomplete blockade of the right leg of the PG leads to partial impairment of the transmission of pulses on the right. The danger to life is a complete blockade of the right leg, in which the transmission of excitation to the heart is completely stopped.

In clinical practice, blockade of the right leg of PG is uncharacteristic for young people (no more than 0,1%). This disease develops with age and often affects the cardiovascular system of men.

The first wave of excitation, which sets the basic rhythm of the heart, is generated by the sinus node located at the apex of the right atrium. The impulse passes through the myocardium of the atria, causing it to contract, as well as along the three inter-nodal tracts to the atrioventricular node. It is localized in the interatrial septum and is responsible for the spread of excitation through the ventricles.

An electric pulse from the AV node reaches the myocardium through the fibers of the His bundle. Its trunk breaks up at the very beginning of the interventricular septum into two legs – the right and left, extending to the corresponding sections of the ventricular myocardium. The left leg in the thickness of the heart muscle is divided into anterior and posterior branches. The bundle of His ends with numerous branches – Purkinje fibers that penetrate the muscle wall of the ventricles.

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

Types of blockade

The level of damage is determined by the department of the beam, in which the excitation from the AV node ceases to be carried out. The following types of blockade of the bundle of His are distinguished:

  • single-beam – violation of the propagation of an electrical impulse along the right leg or one of the branches (back or front) of the left leg;
  • two-beam – excitation from the main trunk of the bundle of His does not reach both branches of the left leg or to one of the branches and the right leg;
  • three-beam – a single lesion of both legs.

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

  • constant – ECG signs of conduction disturbance in the beam are constantly displayed;
  • intermittent – a blockade appears and disappears during the recording of a cardiogram;
  • transient – changes are not recorded at every ECG recording;
  • alternating – during ECG recording, different types of blockade replace each other.

Violation of conductivity in the fibers of the bundle of His can occur both for cardiac and extracardiac reasons. Diseases of the cardiovascular system in which this syndrome can occur are:

  • Heart defects: stenosis or aortic valve insufficiency, mitral insufficiency, defects of the atrial or interventricular septa;
  • Chronic forms of cardiac ischemia, especially in combination with arterial hypertension;
  • Acute myocardial infarction;
  • Inflammation of the muscle membrane of the heart (myocarditis) of various origins;
  • Rheumatic heart disease;
  • Cardiomyopathies of any genesis.

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

  • Diseases of the respiratory system, accompanied by severe obstruction of the lungs: pulmonary emphysema, chronic obstructive pulmonary disease, bronchiectasis, severe bronchial asthma. They lead to the development of a “pulmonary” heart – myocardial hypertrophy.
  • Pulmonary embolism (pulmonary embolism).
  • Alcoholic and drug intoxication, leading to extensive myocardial damage.
  • Diseases of the thyro />

If the impulse passes through the left front branch of the PG, the excitation does not reach the anterolateral wall of the left ventricle. Blockade of the anterior branch of the left bundle branch block occurs when:

  • anterior or anterolateral acute myocardial infarction;
  • pronounced expansion of the walls of the LV due to hypertension, valvular defects of the heart apparatus;
  • myocarditis of rheumatic and infectious origin;
  • cardiomyopathies.

It is less common than damage to the anterior branch. An electrical impulse does not extend to the posterior LV. Blockade of the posterior branch of LDL occurs when:

  • posterior diaphragmatic acute myocardial infarction;
  • Tela;
  • atherosclerotic cardiosclerosis;
  • cardiomyopathies of various origins.

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

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

Symptoms

The clinical picture with conduction disorders along the left leg of the bundle of His varies depending on the level of damage.

In the absence of an impulse passing along one of the branches (front or back), there may be no symptoms at all or there will be complaints about the manifestations of the underlying disease that caused the blockade.

Often, one- and two-beam blockades are detected only during an ECG. Their occurrence does not affect the quality of life and the health of the patient.

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Complete blockade of the common trunk of LDL is manifested by a feeling of palpitations, pain behind the sternum, radiating to the neck, epigastrium, left arm. But the symptoms of diseases leading to an extensive defeat of the cardiac conduction system (myocardial infarction, myocarditis, arterial hypertension, heart defects) come to the fore.

With a complete or partial violation of the impulse along all branches of the bundle of His (three-beam blockade), clinical manifestations are more pronounced. The main symptoms of the syndrome are:

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  • sensations of increased heartbeat;
  • bouts of dizziness;
  • frequent fainting due to cerebral ischemia (Morgagni-Adams-Stokes syndrome);
  • nausea;
  • pain in the heart.

The onset of symptoms of BLNPG cannot be ignored. It can lead to dangerous cardiac arrhythmias, up to ventricular fibrillation and asystole – sudden cardiac death.

Diagnostics

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

Ultrasound of the heart (ECHO-KG), Doppler examination of coronary vessels, blood pressure monitoring, transesophageal ECG, determination of biochemical markers of myocardial damage are additional diagnostic methods for BLNPG, which determine the main cause of the syndrome.

To detect ECG signs of various blockages of LDL, attention is paid to changes in the ventricular complex (Q, R, S teeth) in the left leads and the position of the electrical axis of the heart.

Symptoms of BLNPG on an ECG

With blockade of the left posterior branch, the ventricular complex is deformed. In the first standard and AVL leads, it takes the form r S – a low-amplitude R wave passes into a deep S in the absence of a Q wave.

In the third standard and AVF leads, the S wave is absent in the complex, and a shallow Q is replaced by a high-amplitude R (complex q R). The highest R is recorded in lead III, i.e.

the electrical axis of the heart is shifted to the right.

Violation of conduction along the left front branch is reflected in the cardiogram with the following changes:

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

With complete blockade, tooth deformations are more pronounced than with incomplete. In the same leads, the R wave takes the shape of the letter M, and S becomes like a “goat leg”. The ventricular complex lasts more than 0,12 s. Sometimes a deviation of the EOS to the left is recorded on the cardiogram.

Treatment

Single-beam or incomplete double-beam BLNPG do not need treatment. They do not lead to serious complications. Finding its ECG signs in a child before adolescence can be considered a normal option with the exception of organic myocardial damage.

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

  • Injections of B vitamins (thiamine, riboflavin) and nicotinic ac ) is an antiplatelet agent for the prevention of blood clots.
  • Penicillin antibiotics for the treatment of infectious lesions of the membranes of the heart.
  • Preparations for the elimination of chronic obstruction of the lungs: inhalation of steroid hormones and beta-blockers (Berotek, Berodual, Budesonide).

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Types of blockade

Blockade of the legs of GHGs differ in localization, degree of damage, and the time of development and course of the pathology.

Depending on the location of the violation of nerve conduction in the heart, three types of blockades are distinguished:

  1. Single beam – a nerve impulse is difficult in the right leg or in one of the branches of the left leg (front or back).
  2. Two-beam – a nerve impulse does not pass through two legs (the right leg with one of the left or both left).
  3. Three-beam – all three branches are affected.

During the course of the disease, permanent, transient and intermittent blockades are distinguished. Permanent blockade is a persistent violation of the conduction of nerve impulses in the heart. Transient manifests itself periodically. Intermittent may occur and disappear within a few minutes, for example, during an ECG recording. Sometimes during one ECG recording a blockade is observed in one or the other leg of the bundle of His. This kind of heart block is called alternating.

Depending on the degree of damage to nerve conduction, complete and incomplete blockade are distinguished.

The ventricular myocardium does not receive electrical impulses and contracts independently, but the frequency of these contractions is very small. Significantly disturbed hemodynamics. This dangerous condition can lead to ventricular fibrillation and sudden cardiac arrest and death.

Incomplete

Part of the nerve impulses either does not reach the heart muscle, or is delayed on its way. The time during which the nerve wave travels along the leg increases.

Possible complications

With the occurrence of such a disease, it is necessary to know the danger of blocking the right leg of the bundle of His in order to prevent the occurrence of unpleasant consequences in a timely manner. Among the main complications, it is necessary to highlight such as:

  • acute disorders of cerebral circulation;
  • aggravation of the course of the main pathology;
  • thromboembolism with a thickening of blood.

The most dangerous consequence of the blockade of the right bundle branch block is sudden death. A similar complication can be with complete blockade.

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

If you do not start treatment for complete heart block, then the likelihood of developing heart failure is high. In this situation, the heart ceases to function fully. The result of this process is complete cardiac arrest. Possible complications include circulatory disturbances in the cerebral cortex, or, in other words, stroke. A complication of blockade of the bundle of His can be clogging of blood vessels in the limbs or internal organs with thrombi.

If an incomplete or complete blockade was provoked by the underlying disease, then the likelihood of exacerbation and worsening of its course is high.

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Often, all complications develop with a complete lack of treatment or non-compliance with the recommendations of a doctor. To avoid various risks, you should regularly undergo a medical examination.

With timely access to a doctor, the prognosis is favorable. The blockade responds well to treatment, but if it is accompanied by pathological processes in the lungs or heart, it usually complicates the main treatment.

The treatment of blockade is complicated if there is ischemic disease or arterial hypertension. It is proved that a heart attack does not affect the development of partial blockade. Transmural extensive heart attack is considered dangerous, it can lead to death.

Treatment

Adequate therapy for heart disease

Functional incomplete deceleration of conduction along the right leg of the bundle of His does not require any treatment, since it is a variant of the norm. Any deviations from the norm in the conductive system require, first of all, the identification and treatment of the cause that causes the blockade. Adequate therapy of heart diseases, normalization of the electrolyte balance in the body, relief of inflammatory processes, correction of valve disorders lead to the fact that ECG signs of the blockade of the right leg can decrease or disappear altogether.

If a pathology of the elements of the cardiac conduction system is suspected, it is necessary to consult a doctor: an arrhythmologist, cardiologist, and in some cases a cardiac surgeon. In the case of incomplete blockade of the branches of the bundle of His, the main treatment should be directed to the organ or system of organs that provoked the abnormal work of the vascular bed and caused the development of the blockade.

A general therapy regimen for blockade of the legs of the bundle of His does not exist. If impulse transmission impulses are caused by angina pectoris, hypertension or heart failure, then the basic treatment is based on the use of antihypertensive and antiarrhythmic drugs, as well as cardiac glycosides. For proximal blockade, treatment with sympathomimetic agents: isadrin or subcutaneous injections of atropine is considered the most effective.

With incomplete blockade, if the patient does not feel discomfort and can lead a normal lifestyle, only control diagnostics and restorative therapy are required.

In the case of genetic abnormalities or congenital malformations, treatment of blockades is performed surgically. The reasons for the operation are frequent fainting and life-threatening abnormalities of the heart. In modern cardiac surgery, to correct the work of the vascular branches of the cardiac conduction system, an pacemaker is installed – a device that generates contractions and provides a given heart rate.

With an incomplete blockadele leg of the Hisashirin bundle, the complex is more than normal, therefore, a slow pulse is characteristic of the disease. As a rule, such a blockade is diagnosed on an electrocardiogram. An experienced cardiologist can hear a split tone at the apex during auscultation. Partial impaired impulse transmission in the branches of the bundle of His contribute to the development of chronic heart failure. So that the blockade does not develop into a complete one, with this diagnosis, cardiac glycosides are contraindicated.

Blockade of the distal type is difficult to drug treatment. The most effective means are electrical stimulation of the heart. For acute blockages that were triggered by myocardial infarction, temporary electrical stimulation is indicated. With a persistent form of blockade, constant electrical stimulation is prescribed.

If a complete blockade suddenly occurs, an injection of Euspirana or Izuprela with glucose solution (5%) will help relieve the patient’s acute condition, you can use the same drugs in the form of tablets. With prolonged exposure to medications for neurovascular disease, complete cardiac blockade can become partial.

The danger to the patient’s life is a complete heart block on the background of digital intoxication. In this case, to normalize the state, the intake of glycosides is canceled. If a complete blockade with a rhythm of 30-40 beats per minute persists, Atropine injections are administered intravenously and Unitol is administered intramuscularly (2-4 times a day), therapy can be supplemented with temporary electrical stimulation.

The group of cells of this tissue is located directly behind the atrioventricular node and has both a right leg and a left one.

  • When a blockage of any of the existing legs of this beam occurs, this means the occurrence of certain changes directly in the system itself, which conducts excitation pulses.
  • Such a change leads to the fact that the normal movement of the sinus impulse generated by the cells of the sinus node and passing through one of the legs creates serious obstacles.
  • Such a disease is diagnosed in patients not only of the elderly, but also of a rather young age and is called blockade of the bundle of the bundle of His.
  1. The consequences of the disease of the blockade of the bundle of His bundle are rather difficult to predict, since it is inherently not a separate disease, but only a peculiar symptom of another pathology present.
  2. In the variant, when there is a partial (incomplete) blockade of only one bundle, which is also not accompanied by existing pulmonary and heart diseases, there is no reason for concern.
  3. A completely different matter is a complete blockade of the bundle leg. Its consequence may be the occurrence of such dangerous complications, which include:
  • A stroke, which is a reduction or complete cessation of blood supply to a specific area of ​​the brain;
  • Blood clotting, leading to all kinds of thrombosis;
  • The appearance of a violation of the heart (dysfunction), which entails a violation of stability in the work of the whole organism.

Diagnostics

  • The treatment of blockade of the bundle of His bundle must begin with the >

The detection of this disease often happens by accident – during an electrocardiogram or while listening to the myocardium.

Based on the results of the examination, a specialist in this area is prescribed treatment for the blockade of the right leg of the bundle of His, which can be both medical and surgical.

Methods of treatment

During the medical treatment of blockade of the right leg of the bundle of His, a doctor can be prescribed together with vitamins and drugs to strengthen the therapeutic diet.

In addition, with the exact establishment of the cause of the occurrence of BPNPG, treatment should be aimed at reducing the existing symptoms or completely eliminating the symptoms of this disease.

  • Vitamin group, which includes thiamine, riboflavin, as well as nicotinic acid;
  • Sedatives that have a general calming effect on the body – valerian, St. John’s wort, sage and motherwort;
  • A group of antioxidants, which include carnitine, preductal and mexidol;
  • Drugs prescribed for coronary heart disease. The basis of such medicines are nitrates;
  • Drugs that lower the amount of cholesterol in the blood;
  • Medicines used to combat thrombosis. These include aspirin-cardio and cardiomagnyl;
  • Drugs used during the treatment of chronic pulmonary obstruction – berodual, pulmicort.
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Evidence

Symptoms of the blockade of the right leg of the bundle of His can be:

  • The decline in human performance due to the rapid onset of fatigue. All this happens against the background of the general weakness of the whole organism;
  • Frequent dizziness, sometimes accompanied by fainting;
  • The appearance of shortness of breath;
  • The emergence of an acute feeling of lack of air.

However, in most cases, partial blockage of the beam proceeds unnoticed, without causing any specific symptoms.

Causes

The causes of this disease are many, but the following can be attributed to the main ones:

  • Heart failure, during which the basic functions of the heart are not performed to the proper extent;
  • Heart disease when there is damage to the heart muscle;
  • Coronary disease, when in the process of improper blood supply occurs the so-called oxygen starvation, which causes the necrosis of a certain part of the heart muscle (myocardial infarction);
  • Congenital and acquired heart defects;
  • Inflammatory processes occurring inside the heart muscle (myocarditis);
  • Autoimmune diseases, during which some parts of the heart are damaged by their own immune system.
  • Large congestion of the heart caused by constantly increased blood pressure, resulting in a gradual deformation and changes in the work of the heart;
  • Uncontrolled and long enough use of certain medications, which include various diuretics, cardiac glycosides and other drugs;
  • Frequent or constant exposure to the body of dangerous toxins, which, without a doubt, include alcohol and tobacco;
  • Disruptions in the hormonal balance of the body that occur due to inflammation of the thyroid gland, the presence of diabetes mellitus, as well as with an existing violation of the adrenal glands.

Prevention

In order to avoid the occurrence of a serious disease, to which the blockade of the bundle of the bundle belongs, certain preventive measures should be taken. First of all, it is worth noting strict adherence to the ratio of work and rest, during which special attention should be paid to the duration of sleep.

Smoking and drinking should be completely excluded from everyday life, since all this is the cause of many diseases.

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

Body description

The contraction of the muscles of the heart provides a conductive system. It contains sinus and atrioventricular nodes, a bundle of His, and Purkinje fibers.

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

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

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

Body description

Reasons for the development of blockade of the bundle of His

Among birth defects, dangerous anomalies deserve special attention, such as deformation of the atrial and interventricular septa, stenosis of the mouth of the artery of the lung, underdevelopment of the leg segment of GHG, and other defects that cause overload of the right ventricle.

Failures in the heart can provoke acquired diseases:

  • heart tumors;
  • myocardial pathology;
  • chest injuries;
  • an overdose of heavy medications;
  • hyperkalemia with elevated potassium levels;
  • progressive types of muscular dystrophy;
  • chronic diseases of the respiratory tract, which are complicated by obstruction.

The development of deviations in the conduction system of the heart is also affected by:

  • toxic poisoning;
  • hormonal disorders – the pancreas plays an important role in metabolic processes;
  • disorders of the autonomic system – an imbalance of nerve functions affects the state of the whole organism;
  • electrolyte disturbances – insufficient blood levels of potassium, sodium and magnesium can cause serious malfunctions in the work of all organs and systems.

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