The reasons that can cause a violation of the excitation along the structures of the bundle of His are divided into cardiac and extracardiac.
Cardiac blockade causes:
- congenital and acquired heart defects (stenosis of the aortic orifice, pulmonary artery, left atrioventricular foramen, coarctation, or segmental narrowing, aortic orifice, insufficiency of the aortic, mitral valves, pulmonary valve, atrial septal defects);
- cardiomyopathy (including hypertrophic obstructive cardiomyopathy);
- coronary artery disease;
- dystrophic changes in the myocardium;
- intoxication with drugs of the cardiac glycoside group, quinidine, beta-blockers;
- electrolyte imbalance;
- severe or persistent diabetes mellitus;
- Iron-deficiency anemia;
- metabolic syndrome;
- nutritional obesity;
- chronic alcoholic disease;
- autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, autoimmune thyroiditis);
- pulmonary embolism;
- chronic obstructive pulmonary disease (obstructive bronchitis, bronchial asthma);
- long smoking history.
Most often, when an electric signal does not completely pass along the right leg, a person does not notice any symptoms. Defects in the process of the planned passage of electrocardiography.
Patients may feel signs of a underlying pathology that impaired cardiac conduction. Wherein:
- difficulty breathing;
- soreness periodically appears in the chest;
- the rhythm of the contractions of the heart is upset.
Therefore, the therapy of such diseases should be carried out on time.
But, if the signal is blocked completely:
- weakness is constantly felt;
- the patient periodically loses consciousness;
- pain occurs in the heart;
- the body works intermittently;
- clearly palpitations.
When such violations occur, an urgent examination should be carried out, as this can occur in dangerous chronic diseases.
Although with incomplete blockade, healthy people do not need specific therapy, since this condition is considered quite normal.
Forms of the disease
Blockade of the legs of the bundle of His is called a violation of conduction in a group of cells of the conduction system of the heart in the area of the interventricular septum.
Pathology is manifested by dizziness, short-term loss of consciousness, impaired heart rhythm, or it is detected using an electrocardiogram.
A complete blockade of the legs of the bundle of His in a child may develop during fetal development or may be the result of previously transferred heart diseases.
Varieties of such a blockade are as follows:
- right leg;
- left leg;
- front branch of the left leg;
- back branch of the left leg;
According to the degree of conduction disturbance, blockade can be complete and incomplete, as well as transient and permanent. About the danger of incomplete blockade of the bundle branch block in children, a pediatric cardiologist will tell you during the appointment.
Various diseases can be the causes of intracardiac conduction disturbance. So, in adolescents and children of primary school age, a partial blockade of the right leg of the bundle of His can indicate small anomalies in the development of the heart. The blockade of one or both branches of the left leg is the result of acquired heart disease.
- acquired and congenital heart defects;
- myocardial dystrophy and cardiomyopathy of various origins (metabolic, autoimmune, food);
- viral or bacterial myocarditis;
- chronic lung diseases;
- myocardial infarction;
- prolonged hypertension;
- pulmonary embolism.
On our site Dobrobut.com you can make an appointment with a cardiologist and get answers to exciting questions about this pathology. The doctor will prescribe the necessary examination and talk about the treatment of sinus blockade of the right leg of the bundle of His.
The blockade of the right leg is asymptomatic, and it is often diagnosed by accident when undergoing electrocardiography. The absence of symptoms is also characteristic of the blockade of the branches of the left bundle branch block. The clinical manifestations here are caused by the underlying disease.
The blockade of both branches of the left leg is manifested by pain of varying intensity in the heart, dizziness, and heart palpitations. One of the causes of pathology can be myocardial infarction.
Symptoms of the blockade of both legs of the bundle of His (complete and incomplete) will be frequent dizziness, a tendency to fainting, interruptions in the work of the heart. This blockade of the legs of His is one of the causes of sudden cardiac arrest.
The main diagnostic methods include: electrocardiography (ECG), rhythmocardiography, daily ECG monitoring and transesophageal electrocardiography (CPECG). Organic heart lesions can be detected by MRI, multispiral computed tomography (MSCT) and echocardiography (Echocardiography). Additionally, consultations with a cardiologist and cardiac surgeon are recommended.
Signs of blockade of the legs of the bundle of His on an ECG:
- with blockade of the right leg in leads V 1, V2, M-shaped complexes of the Rsr type are visible;
- with blockade of the left leg in leads V5, V6, I, deformed ventricular complexes without a Q-wave with a split apex of the R wave are recorded;
- with blockade of both legs, the signs of blockade of the left and right legs are determined.
Treatment of pathology can be conservative (therapy of the underlying disease) and surgical. An operational method of treating blockade is the installation of a pacemaker to the patient.
Conservative therapy for the blockade of one or both legs is to treat the underlying cause of the pathology.
Drugs recommended for blockade of the bundle of His:
- antioxidants (carnitine, mexidol);
- sedatives (valerian, motherwort);
- hypotensive (to reduce blood pressure);
- antianginal (for the treatment of coronary heart disease);
- drugs to prevent blood clots in blood vessels;
- cardiac glycosides;
- vitamins of group B;
- drugs for the treatment of bronchopulmonary diseases;
- nonsteroidal anti-inflammatory drugs.
If the reason for the blockade of the right bundle of His bundle is not ascertained (if the disease that caused it is not diagnosed), treatment is not prescribed. A cardiologist at the reception will tell about the nuances of the therapy for blockade of the left leg of the bundle of His.
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The complications of the bundle of His bundle include: ventricular fibrillation, paroxysmal tachycardia, thromboembolism, heart failure (acute, chronic) and asystole.
The prognosis in this case depends on the underlying disease, since the blockage of the bundle of His is only its sign. The most favorable prognosis for blockade of the right leg.
If you still have questions, including whether they will be taken into the army during the blockade of the legs of the bundle of His, make an appointment and get a consultation with a doctor. Recording is carried out on the website and by the indicated phones.
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In accordance with the anatomical structure of the atrioventricular bundle, the following types of blockades are distinguished:
- single-beam – one of the structures suffers (the right leg of the bundle of His, anterior or posterior branch of the left leg);
- two-beam – a combined defeat of the right leg and one of the branches of the left or violation of the conduction of nerve impulses along both branches of the left leg;
- three-beam – simultaneous defeat of the right and left legs of the bundle of His.
If you do not carry out diagnostic procedures, then a suitable treatment option cannot be selected. A complete or even partial violation of the progress of the electrical signal leads to the fact that the number of contractions of the ventricle decreases. To confirm such changes, electrocardiography is performed and blood is examined for hormones.
Incomplete blockade of the right leg of the His bundle on the ECG is manifested by the slow passage of the electrical signal. In this case, a tooth is present showing atrial contractions, but there is no tooth characteristic of ventricular contraction. This disturbance is characterized by the appearance of small notches on the S wave and changes on the right appear.
To identify pathological conditions that can disrupt the advancement of the impulse, the patient must additionally undergo procedures in the form of:
- General and biochemical studies of urine and blood.
- Ultrasound examinations of the heart.
- Computer and magnetic resonance imaging. These procedures are necessary in severe cases to obtain a complete picture of the state of the heart.
- Transesophageal electrocardiography.
- daily monitoring of electrocardiography. This helps to identify transient disorders.
According to the results of the study, the diagnosis is confirmed and the appropriate treatment option is selected.
Incomplete blockade of the right bundle branch block: causes, symptoms, diagnosis, treatment
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.
Incomplete blockade of the right leg can occur under the influence of many diseases. Most scientists are inclined to think that such violations are not associated with a hereditary predisposition. Although, in the presence of pathologies of the heart and blood vessels in close relatives, the likelihood of their development increases significantly.
Violation of conduction on the right leg occurs in different cases:
- with ischemic disorders in the heart;
- as a result of tumor processes;
- with abnormalities in the development of the organ;
- with inflammatory processes in the endocardium or myocardium;
- if one pulmonary artery is clogged;
- with cardiosclerosis;
- if a prolonged course of hypertension has led to an increase in the heart;
- with pathologies in the respiratory system that led to the appearance of a pulmonary heart;
- after a heart attack;
- under the influence of bad habits;
- with constant emotional overstrain.
An electrical impulse is transmitted more slowly than it should if a person was taking large doses of antiarrhythmic drugs.
Incomplete blockade of the right leg of His occurs when the vagus nerve is in an overexcited state. This happens if a person is subjected to excessive physical exertion.
Blockades also develop if surgical treatment of heart disease was performed.
Incomplete blockade of the right leg of the bundle of His is a pathology that does not require special therapy if there are no other problems in the body. But with congenital anomalies in the structure of the heart, they resort to surgical treatment. If there are signs of disease, the patient is shown a reception:
- sedatives based on medicinal plants;
- B vitamins;
- blood thinners;
- medicines to normalize blood pressure;
- diuretics in case of insufficient heart function.
So that there are no diseases of the bronchi and lungs that can cause pulmonary heart syndrome, they resort to glucocorticosteroids. If the lining of the heart is affected by the inflammatory process, the patient should take antibacterial drugs.
If the passage of the impulse is completely blocked, then you can not do without surgical therapy. During such treatment, an artificial pacemaker is established for the patient. If there is a pacemaker in the body, it is not advisable to be close to electrical devices.
Incomplete blockade of the right leg of the bundle of His in a child can be considered a variant of the norm, therefore, medications are not prescribed. But the doctor should observe the condition of the baby. Although the problem does not require conservative therapy, it is necessary to ensure that partial blockade does not become complete.
If there are signs of deterioration in health, you should consult a doctor, as this may indicate the development of serious diseases. When an attack associated with not passing an impulse occurs, you need to do the following:
- with severe dizziness, you need to lie down or sit down;
- perform exercises to normalize breathing, consisting of deep breaths and exhalations.
To improve well-being, it is recommended to use traditional medicine. Useful properties are infusion of hawthorn fruit or tincture of May lily of the valley. But to prescribe more suitable treatment options, you need to see a doctor.
If there is no disturbance in the work of the heart, then we can count on a favorable outcome. Most often, with a blockade of the right leg, there is no threat to health. Dangerous complications are characteristic for blocking the left leg. But sometimes a right-wing blockade can cause trouble.
Patients often develop ventricular tachycardia. In this condition, the heart rate increases, which gradually causes various complications. This type of arrhythmia increases the likelihood of ventricular fibrillation, during which, if there is no timely help, the patient may die.
In order to detect severe changes in time, you need to visit a cardiologist from time to time. Self-medication is strictly contraindicated, as they can cause a worsening of the situation. Especially, it concerns antiarrhythmic drugs.
If the disease is not accompanied by any symptoms, then the patient may well lead a familiar lifestyle. But, so that the disease does not progress, it is necessary to exclude excessive physical and emotional overstrain, to ensure a sufficient amount of rest. You need to sleep at least eight hours a day.
You should adjust your diet. A person should abandon salt, sugar, animal fats.
Any medications should not be taken without consulting your doctor.
With such violations, electrocardiography should be performed every year. If a pacemaker was installed, then you need to visit specialists no later than three months after discharge. After this, you need to visit doctors every six months.
Violation of the passage of the pulse along the right leg is not considered a persistent violation of conductivity. This condition is not considered a pathology that may interfere with the passage of military service.
Patients do not need to make significant changes in their lifestyle. But increased loads are still recommended to be excluded, since they can aggravate the situation and cause complete obstruction.
The main diagnostic measures:
- daily ECG monitoring;
- transesophageal electrophysiological examination of the heart.
Laboratory research methods do not allow to diagnose the blockade of the legs of the bundle of His and can be used to identify the underlying disease that led to impaired conduction.
Blockade of the right bundle branch block: prognosis
The prognosis depends on the severity of the underlying disease. With a single-beam blockade or blockade of the right leg, the prognosis is favorable.
The blockade of the left bundle branch block and the complete three-bundle blockade are prognostically less favorable. Mortality in this case increases 5 times, the average survival is 3,3 years; with a normal heart size, it lengthens to 4,3 years, with an increase in heart size, the average survival is shortened to 2,5 years.
The prognosis is worsened by heart failure, cardiomegaly, angina pectoris, a history of myocardial infarction, atrial fibrillation, a deviation of the electrical axis to the left.
Registered in acute myocardial infarction, regardless of whether it was before a heart attack or developed in connection with it, blockade of the left leg of the bundle of His increases the mortality of patients up to 60%.
An isolated form of the disease in young people most often has a good prognosis. The blockade of the right leg of the bundle of His almost never transforms into a complete atrioventricular. This option is possible only if any serious illness joins. BPNPH, which developed with arterial hypertension or coronary heart disease, worsens the prognosis of the underlying disease.
A blockade that occurs in an acute form of a heart attack, in most cases, does not affect the outcome of the disease. Some experts believe that mortality in BPNPG increases only in the case of transmural extensive heart attacks. The main danger of blockades is a significant distortion of the electrocardiogram. For this reason, using an ECG it is difficult or impossible to detect a heart attack.
In cases of absence of “aggravating” factors (heart and vascular diseases), the prognosis of blockade of the right bundle branch block in young people is quite favorable. In the overwhelming majority of cases, this block does not go into an atrioventricular block of 2 and 3 degrees, and atrioventricular block of 1 degree has no prognostic value and is considered by many as a variant of the norm.
The blockade of the right leg of the His bundle against the background of coronary heart disease or hypertension dramatically worsens the prognosis, increasing the likelihood of death by almost 3 times. Another prognosis is worsened by: – heart failure; – cardiomegaly.
But the prognosis in cases of blockade of the right bundle branch block is always better in all cases than with blockade of the left leg.
The blockade of the right leg of the bundle of His on the background of acute myocardial infarction does not worsen the prognosis of the outcome of the disease, but with extensive transmural infarction increases the likelihood of death.
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