Slow intraventricular conduction what are these ECG indicators

Surely you remember from the course of school anatomy that special, nerve tissues are responsible for the transmission of nerve impulses. Myocardial contractions are also caused by the transmission of impulses for which the cardiac conduction system is responsible.

It consists of nodes and branches, called the bundle of His. Anatomically, it is located in the interventricular septum, in its structure there are two legs – left and right, which conduct impulses to the corresponding ventricles.

  • The right leg of the bundle of His is a single bundle of fibers that branches out at the bottom of the right ventricle and is responsible for conducting impulses to this area.
  • The left leg has two branches, the left and right, each of which conducts an impulse to a specific wall of the left ventricle. The branches of the left leg have their own name, these are Purkinje fibers. 2720b1bcf7f94247c9886ae49ca39b2c - Slow intraventricular conduction what are these ECG indicators

The sinus node (Kate-Flac node) is the atrial system, the Bachmann bundle is the atrioventricular node (Aschoff – Tawar node) is the bundle of His.

Conductivity disorders in any area are called blockages. In the modern classifier of diseases of non-specific intraventricular blockade, the code according to ICD-10 is assigned – I45.4.

Violation of the rhythm and conduction of the heart are formed as a result of a malfunction in a certain area of ​​the myocardial conducting system, specialists distinguish the following types of blockades.

Blockade of the sinus node (sinoatrial) is a condition when conduction from the sinus node to the atrium is disturbed. In this case, a violation of cardiac conduction on the ECG looks like this: the rhythm is sinus, but incorrect, the RR interval is greatly lengthened, there are periods of loss of PQRST cycles. Kinds:

  1. Atrial block – due to defects in the atrial conduction, manifests itself in the form of rhythm disturbances. On the ECG, the P wave expands or “jagged”. a1c6aa40557f8f2c67174873d67ddc01 - Slow intraventricular conduction what are these ECG indicators
  1. Atrioventricular block is a condition when impulse conduction in the atrioventricular node or in the bundle of His bundle is impaired. In turn, in the />
    1. Intraventricular block or conduction of the ventricles of the heart – in this condition, conduction in the legs of the bundle of His suffers. Intraventricular cardiac blockade occurs in adults and children, can occur in pregnant women. They have their own classification and symptoms, we will consider them in more detail.

    With any type of intraventricular blockade, the impulse along the nervous structures of the legs of His is stopped. The violation may be complete or partial, but in any case affects the repolar and depolar activities. Conduction pathologies are always visible on the cardiogram.

    Depending on the localization of disorders, the following types of intraventricular blockade are distinguished:

    • Single beam (monofascicular). In this case, the delay of the nerve impulse occurs in the right or one of the bundles of the left leg of His. 29c04d3140ae8710afaf1aa6140e0b0d - Slow intraventricular conduction what are these ECG indicators
    • 2-beam (bifascicular). It happens one-s >87a59b3ba3644fab40384bdc387bdcf5 - Slow intraventricular conduction what are these ECG indicators

    Relative to the total number of cardiac pathologies detected by ECG recording, 2,4% of intraventricular blockades are involved.

    Extensive blockades, such as three-beam, complete, require the supervision of a cardiologist and adequate therapy, as they are dangerous for the patient. If the conduction is impaired in the right bundle, no medication is prescribed.

    Blockade of the right leg is infrequent, it is full or partial.

    Partial damage is provoked by the use of certain medications (digitalis preparations, Quinidine), and sclerotic myocardial disorders. A possible cause of BPNPH is considered to be inflammatory processes in it, as well as electrolyte disturbances.

    The main reasons for the absolute BPNPG are:

    • coronary artery disease e70d16b65fb6568b69cfc4c9d5ca9cd4 - Slow intraventricular conduction what are these ECG indicators
    • heart attacks
    • myocardial malformations,
    • valve stenosis
    • chronic lung pathology.

    Causes of the blockade of the left leg of His:

    • myocarditis,
    • cardiosclerosis
    • aortic defect.

    Causes of 2-bundle blockade with the left anterior branch:

    • various pathologies of the ventricles,
    • vices
    • heart attacks. f495f5a05067e93f0839ddd02d8f2c4e - Slow intraventricular conduction what are these ECG indicators

    A variation of the same blockade, but with the left posterior branch, develops as a result of lesions of the LV walls.

    The causes of three-beam blockades are all of the listed diseases and other cardiac pathologies. The difference between this type of disturbance in the presence of symptoms and the need for competent treatment.

    Violation of CHD in children can occur at any age. Causes of the pathology in the child are congenital malformations and other defects in the development of the fetus; in preschoolers and adolescents, the conductivity of electrical impulses in the myocardium is impaired due to cardiac and extracardial pathologies.

    In infants up to a year, a violation of the electrical conductivity of the ventricles is associated with the following reasons:

    • myocardial hypoxia,
    • premature birth
    • birth injuries
    • birth defects
    • vascular congenital pathology,
    • intoxication during pregnancy of the mother, including drug,
    • rheumatic diseases
    • diseases of the central nervous system and psyche.

    There are no vivid symptoms that help the doctor suspect a violation of CHD. The asymptomatic course of the disease allows it to progress without treatment. A violation is detected by accident – during auscultation during colds or when recording an electrocardiogram.

    Common symptoms of CHD in children are:

    It’s not worth thinking that the baby will grow up and everything will pass by itself, since dysfunctions of electrical conductivity do not always disappear without a trace. Sometimes they disappear with age, but in some cases, a complete block is fraught with complications such as loss of consciousness, ischemia, rhythm disturbances, heart failure up to a complete stop of myocardial activity.

    If there are disturbing symptoms, be sure to show the child to a doctor, he will give the necessary recommendations, and also send the baby for a consultation with a cardiologist who will conduct a detailed diagnosis.

    If malaise and other painful manifestations are present, they usually mean the presence of another causative factor that led to conduction disturbance. If the cause of the pathology ischemia, the patient complains of shortness of breath, chest pain, myocarditis is characterized by pain and shortness of breath, hypertension – pain in the occipital and frontal region, visual impairment, tremor. Atrial and other types of arrhythmias can significantly slow down the patient’s pulse and can also be accompanied by one or another blockade.

    Physicians should be alarmed by the complete blockade, revealed for the first time, if it is accompanied by a sternum or chest pain on the left.

    The left-sided form is dangerous in that it masks signs of acute heart attack, which is difficult to recognize on the ECG due to significant changes in the ventricular complexes.

    In case of suspected heart attack, the patient needs urgent hospitalization and emergency care. Only in a hospital can you conduct a detailed diagnosis and determine how to further treat the patient.

    The beginning of the diagnosis for intraventricular blockade is always an ECG record. A cardiologist can detect both complete and incomplete blockades on the ECG tape.

    Of the additional diagnostic methods used:

    • Ultrasound of the heart (Echo-KG). Assign with suspected myocarditis, heart muscle defects, heart attack.
    • Holter monitoring. It is necessary if the patient has a transient form of blockade.
    • In coronary heart disease, coronary angiography may be prescribed if stent placement or bypass surgery is necessary. Coronary angiography technique

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    Principles of treatment

    As such, special treatment for intraventricular cardiac conduction disorders is not provided, unless they are caused by other pathologies that require specific therapy.

    Cardiologists always differentiate primary nonspecific blockades from secondary conditions, and on the basis of diagnosis they decide on the appointment of medications. Sometimes drugs alone are not enough; surgical correction of a defect, such as heart disease, is required.

    If the cause of the blockade is a heart attack, the treatment of local disorders of the intraventricular conduction of the heart can be carried out in two ways – by stenting or by the medication method in the infarction unit.

    Stent placement technique

    It is very important to recognize in time 2-beam conduction disturbances. Their feature is the ability to quickly transform into an extremely life-threatening condition – a complete blockade of the atrioventricular node. If bifascicular blockade is detected, the optimal treatment method is to install a pacemaker. If you do not resort to it, the patient may suddenly die.

    Forecasts

    Forecasts of asymptomatic single-beam conduction disturbances are usually favorable. The only thing that is important in this case is not to neglect the supervision of a doctor so as not to miss the development or degeneration of the pathology into another form. Doctors say the following:

    • It is difficult to predict disorders that cause organic pathology. Their course is completely due to the underlying pathology. The patient should be regularly examined, observed and receive adequate treatment of the underlying pathology.
    • Left-sided conduction disorders increase the percentage of mortality from heart disease by five times. If defects arose due to a heart attack, this can lead to death in half the cases.
    • Right-sided blockade is not a sign of myocardial pathologies.

    Pathology during pregnancy

    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: hypothyro >Polnaja blokada pravoj nozhki puchka Gisa - Slow intraventricular conduction what are these ECG indicators

      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.

      If the pathology is detected in the child, then most often this indicates congenital malformations or violations against the background of heredity. With a partial violation, panic is not worth it, since more often it appears within normal limits. There are no other specific features of the pathology in children and adolescents.

      Symptoms by which a pathology in a child can be identified are as follows:

      • Memory impairment
      • Inattention.
      • The occurrence of shortness of breath.
      • Deterioration in school performance.
      • Chest pain.
      • General malaise.
      • Fatigue at low physical exertion.

      The choice of therapy, as in adults, directly depends on the reasons that provoked this condition.

      The first stage does not need treatment, but the child is taken under medical supervision. In the second case, medications are prescribed, and a more advanced degree requires surgical intervention, that is, implantation of an ECS, an artificial pacemaker.

      In no case should one leave the manifestation of signs without attention; an extensive blockade can cause death.

      A similar disease can manifest itself in a woman during pregnancy. Often the symptoms are unclear, but if there is an unreasonable weakness, dizziness, shortness of breath, unstable mood, then you must consult a doctor without fail.

      article1147 - Slow intraventricular conduction what are these ECG indicators

      Before prescribing therapeutic measures, a thorough examination is necessary to make an accurate diagnosis. To begin with, a woman is sent to an ECG.

      Permanent single-beam blockade of the right leg and individual branches of the left leg in people without cardiac pathology do not affect health and life expectancy.

      The prognosis for the first occurrence of conduction disturbances resulting from organic damage to the heart depends on the severity of the underlying disease.

      There are different opinions about the degree of influence of the left leg blockade on mortality rates. Some researchers do not consider single- and double-beam blockades as risk factors that reduce patient survival. According to other sources, a constant or recurring form of pathology can increase the likelihood of death from cardiac complications by 5 times.

      The development of the left leg blockade in the acute period of myocardial infarction significantly worsens the prognosis: the mortality rate rises and is 40–50%.

      The most unfavorable prognosis is trifascicular block due to the high risk of developing asystole.

      If a person has symptoms of these diseases, then an urgent examination by a cardiologist or arrhythmologist is necessary. After preliminary external examination, recording of patient complaints, they will direct the patient to undergo laboratory tests for the purpose of making a diagnosis. The following types of checks and tests are usually assigned:

      1. 1.
        Electrocardiograms are monitored using the Holter method. It is needed in order to detect impulse transmission for 24 hours.
      2. 2.
        The patient must undergo special tests with the results recorded on an electrocardiogram. For these purposes use exercise bikes, treadmill – testing. The patient can walk on a treadmill or pedal on a standing bicycle, and electrodes from an electrocardiogram will be attached to it at this time. This allows you to establish the exact relationship between impaired conductivity and the load on the patient.
      3. 3.
        At the next stage, an examination of the heart muscle is carried out using ultrasound equipment, which can reveal a pathology in the structure of the heart, evaluate the performance of the myocardium.
      1. 1.
        Vitamin and mineral complexes.
      2. 2.
        drugs that significantly improve the nutrition of the heart with blood, for example, ATP, Preductal and others.

      If the patient is diagnosed with a complete blockage of the ventricles due to the impulse not passing through, then a pacemaker may be required, otherwise bradycardia occurs in the heart muscle, which can lead to complications, and even death.

      With non-specific impairment of the passage of impulses, no drugs usually help. Therefore, doctors prescribe a special diet for patients and a long rest. This inhibits negative processes, which allows to lengthen the patient’s life

      If a non-specific lesion is not treated, then the disease progresses rapidly, and this can cause the following consequences:

      1. 1.
        Sudden death (with complete blockade).
      2. 2.
        The development of heart failure.
      3. 3.
        The appearance of other serious diseases.
      4. 4.
        Impaired blood circulation in the brain. In this case, a stroke develops.
      5. 5.
        Surgery may be required.
      6. 6.
        Thrombi begin to form in large quantities on the vessels.

      If the disease is detected on time, then when a person switches to a healthy lifestyle (diet, quitting cigarettes, stopping the use of alcohol, medications may sometimes be needed), the development of the disease can be stopped.

      With complete blockage in any part or throughout the heart muscle, sudden cardiac arrest can occur with a fatal outcome. In some cases, ventricular fibrillation occurs. Therefore, the prognosis is unfavorable.

      For any disturbance of intraventricular conduction, interruptions in the passage of pulses to a greater or lesser extent are characteristic. Such interruptions are called blockages. In most cases, obstruction of the ventricular direction characterizes the level of myocardial damage.

      For the normal functioning of the heart and the maintenance of vital processes, the normal conductivity of the heart muscle is a prerequisite. For each patient, the causes of intraventricular conduction disorders are different.

      There is a standard list of causes of pathology:

      • a change in processes in the cardiovascular system without accompanying organic abnormalities;
      • a person has suffered ischemia, myocarditis, cardiomyopathy or had a congenital defect;
      • surgery and complications;
      • side effect and negative effect of taking medication.

      In most cases, a blockage of the right bundle occurs in children, which may appear due to pathologies of the heart. Pathologies of the left bundle rarely occur, more often pathology manifests itself in the form of congenital blockade. In this case, a violation of intraventricular conduction in a child does not give characteristic symptoms.

      Often during pregnancy, there may be a functional disorder in which there is no need to take medication and it goes away by itself. However, in case of severe conduction disturbance, the cardiologist together with the obstetrician-gynecologist prescribe medication, taking into account the condition of the child and possible consequences for his future health.

      In most cases, doctors recommend taking vitamins, herbal remedies, and potassium preparations. Women who have heart disease or blockages are planning a cesarean delivery to prevent serious heart failure.

      Any disturbances in the conduction of the heart can be in women in position. It is not a fact that all symptoms will appear, but it is not worth excluding such a possibility. And if you notice frequent dizziness, general weakness, shortness of breath and nervous instability, then these are obvious symptoms of the disease.

      Before prescribing a medical course of treatment for a woman, an ECG study is needed to confirm the diagnosis.

      According to studies, approximately 5% of healthy children have some form of myocardial conduction disturbance. If we are talking about AV blockade of 1 degree, then it can progress to subsequent degrees of the disease. The causes are infections, other heart pathologies that may occur in the future. More serious conduction disorders can develop after rheumatism, heart surgery, with congenital malformations, etc.

      Signs of illness in children include decreased memory, attention, poor performance, weakness, shortness of breath, heart pain.

      Treatment in children with malfunctions in cardiac conduction will, like in adults, depend on the cause of the disease. The first degrees of blockade require dynamic observation without treatment. In the second degree, supportive medications may be recommended; the setting of a pacemaker is occasionally recommended. With blockade of grade 3, the child should undergo surgery to implant EX – an artificial pacemaker. Sometimes in children there are cases of spontaneous full recovery as they grow older.

      Pregnant women most often develop functional conduction disorders, which do not require medication and pass spontaneously. But with severe conduction disorders, a woman has to take medications that are selected by a cardiologist together with an obstetrician-gynecologist, taking into account minimal harm to the baby.

      Most often, vitamins, herbal remedies, potassium preparations are recommended. The implantation of ECS should be timely and performed, if necessary, before delivery. Childbirth in women with organic heart pathologies and AV blocks should be planned only by Caesarean section, so as not to provoke serious malfunctions in the rhythms of the heart.

      1. The feeling of a slowing heartbeat or a feeling of its complete stop.
      2. Nausea.
      3. Dizziness.
      4. Fainting.
      5. Epileptiform seizure.
      6. Low blood pressure.

      Diagnosis of conduction disturbances

      One of the properties that a person’s heart possesses is conduction. It consists in the sequential transmission of nerve impulses from the main pacemakers to other parts of the heart. Impulse transmission is carried out using special branches, which include the bundles of His.

      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.

      Diseases of the heart and blood vessels are extremely common lately. The same applies to cardiac arrhythmias (arrhythmias). This disorder also refers to this pathology.

      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.

      It should be understood that a violation of the conduction of a nerve impulse does not mean its mandatory absence. It only says that there is a violation in the conductive system, which can manifest itself in slowing down of pulses when it occurs by rhythm reduction. Or manifests itself in the complete cessation of nerve impulses and then there is a complete cardiac arrest.

      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 organic – the structures of the conduction system of the heart change. These changes often accompany myocarditis, heart attack, angina pectoris, cardiosclerosis and other coronary heart diseases. In addition, organic changes are observed with congenital heart defects, cardiomyopathies, sometimes after surgical interventions.

      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.

      Medicinal causes are observed when taking certain drugs that affect the rhythm of the heart, causing deviations. Blockades of this group are distinguished by the severity of the course and tropidity (difficult to treat).

      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
      • In the presence of blockages in which atrioventricular conduction is not impaired, therapy consists in identifying and treating the underlying disease.

      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.

      In the case of trifascicular blockade, if there is a violation of atrioventricular conduction II and III degree, if necessary, the patient is injected with a probe electrode into the cavity of the right ventricle.

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

      The leading function of the heart and its myocardium (muscle walls) is the transmission through the system of special nodes and fibers of electrical impulses. In order for the heartbeat to be sufficient for blood circulation, excitation waves must be transmitted through the cardiac sections in a certain sequence and at a constant speed.

      Normally, impulses pass from the sinus node, the atrial part to the atrioventricular – atrioventricular. Thus, first the upper sections are excited, and then the lower ones.

      • Violation of intraventricular conduction is a pathology of a focal (local) nature, in which the patency of the electrical impulse in the ventricles of the heart (one of the parts of the conducting system) is impaired.
      • The impulse originates in the sinus node, which is the source of the sinus rhythm (considered the norm of heart contraction in the range from 60 to 90 beats per minute), passes through the atria and atrioventricular node and enters the bundle of His, which is divided into the left and right legs.
      • The right one is a branch in the right ventricle, and the left is divided into anterior and posterior branches, which are responsible for the contraction of the anterior and posterior walls of the left ventricle.
      • With conduction disorders of this type, the impulse is blocked on the bundles of His, violating the correct contractions of the ventricles.

      In rare cases, the disease is congenital, and, usually without compromising the quality of life, is accidentally detected during a medical examination.

      However, much more often its cause is the disease:

      • atherosclerosis;
      • myocarditis;
      • cardiac ischemia;
      • arterial hypertension;
      • heart failure;
      • arterial hypertension;
      • heart defects;
      • cardiomyopathy;
      • myocardial hypertrophy.

      In newborns, infants, children and adolescents, a violation of conduction can provoke:

      • prematurity;
      • an open oval window is an opening between the atria, which serves for blood supply during the development of the embryo. In a born child, it closes during the first year of life;
      • congenital heart disease;
      • diseases of the endocrine system (e.g., thyroid gland, adrenal gland, reproductive system).

      In children and adults, the causes can also be acute cardiac disorders after intoxication with drugs or drugs, surgical interventions.

      Classification

      The classification of intraventricular conduction disorders is based on the internal structure of the His bundle.

      TypesLesion localization
      Single beam
      • conductivity is broken in the right leg (PNPG);
      • conduction is partially disturbed, only at the level of the anterior branch of the left leg (while the impulse passes, but through the lower wall of the ventricle);
      • local disturbance only at the level of the posterior branch of the left leg (this means that Purkinje fibers are used to reduce the ventricle, the impulse reaches the posterior wall through them).
      Double beam
      • prolapse of the left leg, that is, conduction on both branches of the left ventricle is impaired;
      • conduction in the right leg and in the front, or rear branch of the left is violated;
      Three-beamConductivity is broken at the level of the right and left legs (on both branches).

      symptomatology

      • shortening (slow flow) of nerve impulse conduction, or AV delay, is focal local in nature and can occur in babies;
      • difficulty in conduction or AV block, which is functional in nature or manifests itself against a background of organic heart disease.

      Features of the disease

      Normally, impulses pass from the sinus node, the atrial part to the atrioventricular – atrioventricular. Thus, first the upper sections are excited, and then the lower ones. The conducting system is represented by special Purkinje fibers and a bundle of His, which is divided into three branches. Two left (front and back, completely cover the left ventricle), and one right ensure the delivery of electrical impulses in the corresponding direction.

      2035985004 elektrofizicheskij metod - Slow intraventricular conduction what are these ECG indicators

      The cause of this pathology can be both organic heart disease and other factors. Most often, intraventricular conduction is impaired with vascular atherosclerosis, progressive cardiac failure and hypertension, a condition after a heart attack, myocarditis or cardiodystrophy. Congenital malformations or injuries, severe endocrine pathology of the thyroid gland, poisoning with chemicals or drugs can also trigger a disorder.

      Of course, a person wonders about the cause of the violation of intraventricular conduction. What could it be? There are a number of prerequisites for the development of pathology:

      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.

      The mechanism of conduction disturbance: in the case of a complete block of the right branch of the bundle, the right ventricle and the adjacent half of the ventricular septum get excited in another way. The wave of cell depolarization passes here from the left side of the interventricular septum, from the other ventricle. They are excited first, and the fibers slowly transmit impulses to the right ventricle.

      Incomplete blockade is distinguished by the correct way of transmission, but the slowed down speed of the pulse.

      The causes of the complete block are mainly diseases accompanied by overload of the right ventricle:

      • chronic lung diseases with the formation of a “pulmonary heart”;
      • congenital malformations, valve failure in children;
      • of acquired defects, mitral stenosis is important, creating increased pressure in the pulmonary circulation;
      • chronic ischemic disease, combined with arterial hypertension;
      • myocardial infarction of the posterior diaphragmatic and apical region, the detection of pathology is regarded as an indicator of the high prevalence of the zone of necrosis and ischemia.

      Radiologically overloaded right ventricle is seen by the expansion of the contours in the upper right

      With a healthy heart, this type of blockade is rare.

      The reasons for the incomplete blockade should be added:

      • myocarditis (rheumatic heart disease, consequences of infectious viral diseases in a child);
      • diffuse and focal cardiosclerosis;
      • thickening of the left ventricle with hypertension;
      • intoxication with drugs (digitalis derivatives, quinidine, β-blockers).
      • non-specific electrolyte disturbances.

      In these cases, delayed conduction indicates ventricular hypertrophy. Possible as a variant of the norm in athletes.

      2035985003 infarkt miokarda - Slow intraventricular conduction what are these ECG indicators

      The mechanism of conduction disturbance: there are always obstacles to conducting excitation along the front and side walls of the left ventricle. First, the impulse passes through the left posterior branch, activates the interventricular septum and the bottom of the posterior wall. Then, through the Purkinje fibers, an excitation wave directed from the bottom up goes to the anterolateral part of the left ventricle.

      The reasons are the pathology of the left chambers of the heart:

      • myocardial infarction of the anterior or lateral wall;
      • focal cardiosclerosis;
      • hypertension;
      • non-closure of the atrial septum;
      • aortic malformations;
      • insufficiency of mitral valve cusps;
      • myocarditis;
      • hypertrophic cardiomyopathy;
      • myocardial dystrophy with metabolic changes.

      The mechanism of conduction disturbance: impulse delivery is inhibited in the posterior lower part of the left ventricle. Excitation goes along the left anterior bundle to the myocardium of the anterolateral region, through the fibers of Purkinje spreads to the posterior and lower sections. The myocardium is activated along the front wall from top to bottom.

      This type of block is rarely isolated, more common with blockade of the right bundle branch block.

      Causes – focal changes in the left ventricle from the back wall with:

      • posterior diaphragmatic myocardial infarction;
      • cardiosclerosis;
      • myocarditis;
      • cardiomyopathies;
      • idiopathic calcification of the conductive system.

      ECG picture for myocardial infarction with left leg blockade

      The mechanism of conduction disturbance: the block of the common trunk of the left leg should be located before branching into the front and rear branches or at the same time block the flow of pulses along both branches. The right ventricle is excited in the usual way, after it the wave is transmitted through the contractile cells to the left ventricle from right to left. In the case of an incomplete block, some of the pulses, although slowly, “break through” along the left leg.

      2035985005 bradikardiya serdca - Slow intraventricular conduction what are these ECG indicators

      The reasons for the occurrence of this type of conduction disturbance must be sought in a very extensive damage to the left ventricle with:

      • acute transmural myocardial infarction;
      • diffuse cardiosclerosis;
      • aortic malformations and coarctation;
      • malignant course of arterial hypertension.

      The mechanism of conduction disturbance: the obstacle is located simultaneously in the right leg and the left front bundle (branch). The first through the intact left posterior branch excite the posterior wall and lower part of the left ventricle, along the anastomotic pathways – front and side. With a big delay, in a roundabout way, the impulses reach the right ventricle. This is the most common variant of intraventricular disturbances in the spread of arousal.

      • chronic ischemic disease;
      • acute widespread myocardial infarction with seizure of the interventricular septum;
      • heart defects;
      • diffuse sclerotic, inflammatory and degenerative lesions of the ventricles in Lenegra disease (degeneration, calcification and sclerosis of the conduction system inside the ventricles), Levy disease (fibrous growths in the interventricular septum).

      The mechanism of conduction disturbance: through the left intact anterior branch, excitation enters the front and side walls of the left ventricle, then along the anastomoses it covers its posterior and lower sections. Lastly, impulses reach the right ventricle.

      The causes do not differ from the widespread and deep lesions of the left ventricular wall described above. ECG signs combine changes in the chest leads during blockade of the right leg with a right-sided deviation of the electrical axis.

      One of the functions that the heart performs is its ability to conduct nerve stimulation. Due to this, impulses enter the atria and ventricles of the heart.

      For this, there is a mass of cells inside the heart that are connected in branches – bundles or legs of His. In case of violation of conductivity, the pulse is partially transmitted or ceases to pass completely. In this case, the patient develops a blockade.

      The state of the blockade entails a slowdown in the speed of impulses in all parts of the heart. The treatment of the disease is directly dependent on the cause that caused the pathology.

      If the impulse began to pass much more slowly into the ventricles, then we are talking about blockade of the bundle of His. To help understand what its role is in heart contraction, general information about this process will help:

      • an impulse originates in the sinoatrial node;
      • then it advances into the atrioventricular node;
      • after contractions of the atria, he goes into the trunk of the bundle of His and its branches;
      • further, the impulse enters the myocardium and causes contraction.

      If the His bundle is blocked for certain reasons, then the signal falls much slower to the myocardium. To find out what the violation of intraventricular conduction means, depending on the damage to one of its branches, the following information will help:

      • Violation of signal transmission through LDL leads to malfunctions of the left ventricle.
      • Slowed impulse conduction along PNPH affects the right ventricle.

      The left leg, although not longer than the right, is divided in two, so it’s correct to talk about the 3 branches of the bundle of His. Damage to one of them is considered a partial blockade. The heart muscle contracts due to the surviving branches, but with a delay, due to which bradycardia occurs. A complete blockade is characterized by the absolute absence of pulse conduction.

      Stage nameDescription
      FirstImpulse conduction slows slightly.
      The secondSome signals do not reach the muscle tissue of the ventricle.
      The thirdPulses are completely blocked and cannot get to the myocardium.

      According to statistics, a violation of intraventricular conduction on an ECG (electrocardiogram) is detected in every 100 patients. The problem concerns mainly elderly people due to age-related changes. In a child, such a violation is diagnosed mainly in the presence of an oval window in the cardiac septum.

      Types of blockade

      Impaired conduction within the ventricles of the heart is classified as follows:

      • by the number of damaged branches (mono-, bi-, trifascicular);
      • according to the degree of blockade (full or partial);
      • adrift (persistent or transient);
      • by the nature of the damage (focal or local).

      2035985006 budte zdorovy - Slow intraventricular conduction what are these ECG indicators

      Blockade forms are also distinguished, localized at the end of the legs and passing from one type to another, for example, from 1 degree to 3. Each variety has its own characteristics and course of treatment. A pathological malfunction is detected in the conductor system using a cardiogram and other diagnostic methods.

      Three-beam blockade

      The mechanism of conduction disturbance: when incomplete, an electrical impulse follows from the atria into the ventricles along one of the branches (less affected). In this case, signs of atrioventricular block are detected. Complete blockade is characterized by a third degree of atrioventricular obstruction and an altered source of ventricular rhythm.

      The reasons are severe organic myocardial lesions already listed above.

      The shape of the teeth indicates the type of intraventricular block

      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.

      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 below reaches the left ventricle (its anterior lateral part).

      59e10d35b7a7059e10d35b7ab3 - Slow intraventricular conduction what are these ECG indicators

      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.

      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.

      Complications

      If untreated, there is a danger of the following complications:

      • Heart failure.
      • Deterioration of blood flow to the brain, followed by the development of a stroke.
      • The formation of blood clots.
      • The need for surgery.
      • Fatal outcome with complete non-conductivity.

      With partially impaired conduction through the heart, the prognosis is favorable. If a complete blockade of any part of the heart muscle develops, the prognosis is poor, as this can lead to complications – cardiac arrest and sudden death, ventricular fibrillation and thromboembolic complications, such as pulmonary embolism and ischemic stroke.

      Possible causes of development

      Disorders of intraventricular conduction are not considered as independent diseases. The prognosis can be determined only after clarifying the main diagnosis, against which a specific type of blockade has begun to develop.

      The blockade of the right leg most often does not cause trouble and requires only observation, while blockade of the left leg aggravates the course of acute forms of cardiac pathologies, requires serious treatment, and may result in the death of the patient.

      In addition, the localization of the lesion should be taken into account. Single-beam blockades do not cause a risk to health, provided that they did not appear due to pathological reasons. Two and three-beam lesions are much more dangerous with the possibility of fatal complications.

      Blockade of stage 1-2 has a very favorable prognosis. The degree of recovery will depend on the causative factor. If conductivity is completely impaired, then the chances of developing blood clots, ventricular fibrillation and cardiac arrest are very high, which often leads to death.

      Slowing of the impulse within the ventricles occurs due to the defeat of one or all of the legs of the bundle of His. Pathology manifests itself in the form of arrhythmia and its characteristic symptoms. To eliminate the blockade, the patient will have to be examined. Based on the results, the doctor will recommend treatment methods and give tips on lifestyle correction.

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

      59e10d35c290759e10d35c2954 - Slow intraventricular conduction what are these ECG indicators

      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.

      Among cardiovascular diseases, rhythm disturbance is quite common. The thing is that many patients do not treat chronic diseases of the heart and blood vessels, often have various bad habits. In addition, stress and tension wear out the nervous system, which leads to problems with nerve impulses, but there are a number of reasons.

      There are three causes of pathology:

      With organic, the structure of the entire conductive cardiac system changes.

      The reason for this may be:

      • inflammation of the heart muscle;
      • heart attack;
      • pathological growths in the myocardium;
      • IHD;
      • operative interventions;
      • congenital heart defects.

      With a medicinal reason, rhythm changes occur due to the intake of certain types of drugs. Such blockades are difficult to treat and are particularly severe.

      Blockade can occur in a completely healthy person, if, with congenital pathology, the child has an open oval window in the heart.

      Absolute blockade can occur in the following conditions:

      • an increase in heart muscle;
      • valve defects;
      • IHD;
      • acute heart attack;
      • heart inflammation;
      • obstructive bronchitis;
      • cardiosclerosis;
      • cardiomyopathy.

      In rare cases, the disease is congenital, and, usually without compromising the quality of life, is accidentally detected during a medical examination.

      In children and adults, the causes can also be acute cardiac disorders after intoxication with drugs or drugs, surgical interventions.

      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.

      Functional: disturbances as a result of external factors, for example, physical exertion, diet, psycho-emotional overstrain, taking certain medications (overdose of cardiac glycosides or opiates). Pathology is often reversible and eliminated along with external factors.

      The conduction system begins with the sinoatrial node, which is the source of the sinus rhythm. From it, impulses through specialized cells enter the atrioventricular node located in the zone of connection of the atria and ventricles. Further, the passage of pulses is carried out through a system of His fibers.

      Signs of a partial blockade of impulses in the region of the right leg are sometimes found against the background of complete health and are considered congenital features.

      59e10d35d116559e10d35d11b6 - Slow intraventricular conduction what are these ECG indicators

      Conduction disorders are sometimes caused by electrolyte imbalance, drug intoxication, thyrotoxicosis, chronic obstructive pulmonary pathology, pulmonary thromboembolism.

      Since the pathology of conduction is not isolated, but is a consequence of other diseases, prediction is permissible only taking into account the clinical course, the effectiveness of treatment of the underlying disease.

      Blockade of the left bundle branch block increases the risk of death by 5 times. The right leg block is not considered a risk factor for heart disease.

      Two-beam disorders precede the transition to complete atrioventricular blockade annually in 5% of patients. Fear of increasing conductivity should be with an intermittent type of change.

      If blockades arose in the acute stage of myocardial infarction, then mortality increases to 50%. This indicates a common focus of necrosis.

      Intraventricular conduction cannot be considered in isolation from all cardiac pathology. The type of blockade is important in the diagnosis, purpose and choice of treatment.

      In the event that the blockade of the legs of the bundle of His is asymptomatic, the prognosis is most often favorable. Such patients do not need to undergo treatment measures. It is only important to observe the dynamics of changes at the cardiologist. This will help to identify organic lesions in a timely manner.

      If blockades occur against a background of organic pathology, the prognosis directly depends on the severity of the underlying disease. In any case, it is important to monitor your health and not to avoid doctors. So, screening is extremely important. Even asymptomatic blockade is very easy to detect when conducting an ECG study.

      It should be noted that blockades are one of the prognostic factors in the course of major diseases. So, you need to highlight the following points:

      1. Blockade of the left leg increases the mortality of cardiac pathologies by 5 times.
      2. In the event that blockades occur against a background of myocardial infarction, this indicates a large area of ​​necrosis. In this case, mortality can reach 50%.
      3. Blockade of the right leg is not considered a risk factor for cardiac pathologies.

      In any case, any disease is easier to prevent than to treat. As already mentioned, conduction disorders by themselves do not harm a healthy person. Therefore, to prevent the development of serious pathologies, it is important to carefully monitor yourself. Eliminate bad habits, do not lead a sedentary lifestyle, and also follow a diet. All this will help prevent diseases that can lead to the appearance of blocks for conducting an impulse to the ventricles.

      Violation of intraventricular conduction of the heart – what is it? If during the behavior of the examination of the patient with complaints of pain in the heart muscle this disease is detected, which is clearly visible on the ECG (electrocardiogram), then the patient is progressing to block 2 or 3 degrees.

      Types of disease

      Disruption of ventricular conduction is very dangerous. It is divided into 2 main subspecies:

      1. 1.
        An impulse does not pass through a particular area of ​​the heart muscle. This causes a blockade that is life threatening to the patient.
      2. 2.
        The impulse moves in the right direction, but passes with a certain delay. Slowing causes an incomplete blockage of the heart.

      Such complete or partial blockages appear on the so-called legs of the bundle of His.

      If a local violation of intraventricular conduction occurs on the right side of the bundle of His, then the rhythm of the normal contraction of the right ventricle is disrupted. If this occurs along the left leg of the bundle of His, then the left ventricle suffers accordingly. Along with this, there can be various types of lesions with intraventricular impulse conduction. They are as follows:

      1. 1.
        Weak local lesions.
      2. 2.
        Complete blockage of the left ventricle, characteristic of acute myocardial infarction.
      3. 3.
        Nonspecific lesions with blockade of intraventricular impulses.

      All of them have their own specifics of diagnosis and treatment, and for some forms of diseases of this type, the treatment process is not carried out at all.

      09 e1469635436428 - Slow intraventricular conduction what are these ECG indicators

      Causes of the disease

      The causes of the appearance of the disease can be completely different. The following are considered the main ones:

      1. 1.
        In an absolutely healthy person, local disturbances of intraventricular conduction on the right leg of the so-called His bundle comparatively often occur.
      2. 2.
        If the child has an oval window open on the heart muscle, then this can lead to local disturbance of the intraventricular conduction of the heart in children.
      3. 3.
        It is possible to completely block any of the legs of the bundle of His. This can occur due to the occurrence of diseases of the heart muscle such as myocardial hypertrophy (thickening and proliferation of the heart) during the development of valvular defects on the valves, acute myocardial infarction on the heart muscle, coronary heart disease. The same problems can occur during diseases of the bronchi and lungs, for example, with obstructive bronchitis, bronchiectasis, during the development of bronchial asthma. Doctors encounter similar phenomena during the appearance of myocarditis, cardiomyopathy, post-infarction cardiosclerosis.
      4. 4.
        In some cases, a non-specific violation of intraventricular conduction is possible, which occurs due to improper, uncoordinated operation of one or more systems of the heart muscle. Usually, this can cause a slowdown in heart contractions with incomplete blockade, and in case of complete failure of the control impulse, a practical stop of the myocardium is possible. Such violations occur due to the appearance of the prophet of the heart, the formation of scars or scars on it, and splitting in the ventricles themselves. Most often this happens due to inflammatory processes or organic exposure. It may also result from the improper use of certain medications.

      5521 - Slow intraventricular conduction what are these ECG indicators

      Main symptoms

      The signs of the development of such a lesion with partial or complete non-passage of control impulses along the heart muscle are as follows:

      1. 1.
        With partially impaired conduction, most people can almost feel nothing, since such a condition in many cases does not manifest itself clinically.
      2. 2.
        If a person has a complete blockage of the passage of an impulse on the legs of the bundle of His, then signs such as tenderness in the chest, rare impulses appear, a complete loss of consciousness is possible.
      3. 3.
        When examining a patient who complains of sudden, strongly pressing pain behind the sternum, a sharp, unreasonable weakness, the appearance of a cold sweat, a complete block of the left ventricle is usually detected on the electrocardiogram. This allows you to determine the development of acute myocardial infarction, which is usually disguised as impulse obstruction. The patient has a rare pulse, he often becomes sick. It is quite difficult to determine the presence of a heart attack in a person from an electrocardiogram the first time, therefore, if this lesion is suspected, patients are urgently hospitalized.

      3 2 - Slow intraventricular conduction what are these ECG indicators

      Symptoms in non-specific cases of the disease

      With such a violation of the passage of pulses, most often there are no signs of the disease, since the shifts on the electrocardiogram are so small that it is very difficult to distinguish them. But still there are some signs, having noticed which, it is urgent to take the patient to the doctor. Typically, a patient has a disease as follows:

      1. 1.
        A person complains of a rather frequent head spin.
      2. 2.
        The patient has a noticeable shortness of breath, which does not disappear even if he is at rest.
      3. 3.
        Often a patient with a nonspecific impulse passage complains of an incomprehensible cold in the region of the heart muscle.
      4. 4.
        Such a person gets tired in a fairly short period of time, and he does not have enough strength to finish the job.
      5. 5.
        If you measure the pulse of such a patient, it turns out that he slowed down greatly.
      6. 6.
        A person begins to complain of memory impairment. He cannot remember much, sometimes even what he did recently.
      7. 7.
        During daylight hours, the patient may experience several mood swings.
      8. 8.
        A sick person suffers from an incomprehensible feeling of fear. He has disturbing thoughts for which there are no prerequisites. Usually the patient complains to his family about the fear of death, which haunts him even in a dream.
      9. 9.
        Nonspecific impairment of impulse conduction in the ventricles of the heart muscle can suddenly manifest itself as a person falling on a completely flat surface.

      111 1 - Slow intraventricular conduction what are these ECG indicators

      If the patient has at least one of these symptoms, then it is urgent to call a doctor, as hospitalization may be required.

      Pathology Diagnosis

      If a person has symptoms of these diseases, then an urgent examination by a cardiologist or arrhythmologist is necessary. After preliminary external examination, recording of patient complaints, they will direct the patient to undergo laboratory tests for the purpose of making a diagnosis. The following types of checks and tests are usually assigned:

      1. 1.
        Electrocardiograms are monitored using the Holter method. It is needed in order to detect impulse transmission for 24 hours.
      2. 2.
        The patient must undergo special tests with the results recorded on an electrocardiogram. For these purposes use exercise bikes, treadmill – testing. The patient can walk on a treadmill or pedal on a standing bicycle, and electrodes from an electrocardiogram will be attached to it at this time. This allows you to establish the exact relationship between impaired conductivity and the load on the patient.
      3. 3.
        At the next stage, an examination of the heart muscle is carried out using ultrasound equipment, which can reveal a pathology in the structure of the heart, evaluate the performance of the myocardium.

      2 2 - Slow intraventricular conduction what are these ECG indicators

      1. 1.
        Vitamin and mineral complexes.
      2. 2.
        drugs that significantly improve the nutrition of the heart with blood, for example, ATP, Preductal and others.

      If the patient is diagnosed with a complete blockage of the ventricles due to the impulse not passing through, then a pacemaker may be required, otherwise bradycardia occurs in the heart muscle, which can lead to complications, and even death.

      With non-specific impairment of the passage of impulses, no drugs usually help. Therefore, doctors prescribe a special diet for patients and a long rest. This inhibits negative processes, which allows to lengthen the patient’s life

      If a non-specific lesion is not treated, then the disease progresses rapidly, and this can cause the following consequences:

      1. 1.
        Sudden death (with complete blockade).
      2. 2.
        The development of heart failure.
      3. 3.
        The appearance of other serious diseases.
      4. 4.
        Impaired blood circulation in the brain. In this case, a stroke develops.
      5. 5.
        Surgery may be required.
      6. 6.
        Thrombi begin to form in large quantities on the vessels.

      If the disease is detected on time, then when a person switches to a healthy lifestyle (diet, quitting cigarettes, stopping the use of alcohol, medications may sometimes be needed), the development of the disease can be stopped.

      With partial impairment of the passage of pulses, the prognosis is most often favorable.

      With complete blockage in any part or throughout the heart muscle, sudden cardiac arrest can occur with a fatal outcome. In some cases, ventricular fibrillation occurs. Therefore, the prognosis is unfavorable.

      Prevention

      Prevention measures will make it possible to strengthen blood vessels and improve the functioning of the heart muscle, even with existing pathology. This will reduce the risk of disease formation and prevent complications:

      1. Long walks in the fresh air.
      2. A healthy diet high in calcium.
      3. The intake of vitamins.
      4. Compliance with the daily routine, sufficient rest.
      5. Small regular exercise. Physical education classes.
      6. Elimination of power sports, especially for bodybuilding, which adversely affects the state of the heart vessels.
      7. Try to avoid severe stressful situations.
      8. Whenever possible, relax at sea every year. You can relax in the forest.
      9. Timely undergo medical examinations and eliminate identified pathologies.

      Whatever the prognosis of the disease, you need to remember that modern medicine helps to cope with almost any disorders, but for this it is necessary to listen to your body and make every effort for the sake of your own health.

      Violation of intraventricular conduction is a pathology in which the conduction of an electrical impulse through the ventricles slows down or stops. The rhythm and frequency of contractions changes, their strength decreases. With the progression of the disease, the heart may stop. Timely diagnosis and rationally selected treatment reduce the likelihood of developing complications and prolong life.

      Even in the absence of intraventricular conduction disturbances, prophylaxis is necessary in a timely manner to reduce the risk of disease. The main measures to prevent pathology in people of any age will be walks in the fresh air.

      This is the key to good blood circulation and oxygen supply to all tissues and cells of the body. You need to eat food that is enriched with vitamins and potassium.

      Compliance with diet and healthy sleep greatly improves the state of health. To do light jogging, gymnastics. Power sports are undesirable, for example, bodybuilding has a negative effect on the vascular system. Stress and anxiety also adversely affect the body.

      The only way to reduce the risk of disease remains a healthy lifestyle. Do not start heart pathologies, as well as overdose with drugs. Constantly, when the corresponding symptom appears, go to the therapist and cardiologist.

      Principles of treatment

      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).

      Symptoms of the disease

      With complete blockade of the right leg of the bundle of His, the impulse reaches the right ventricle late, using the interventricular septum. In this case, the asynchronism of repolarization is manifested – the rise of the ST complex, which is responsible for showing the heart rate (repolarization is not a pathology, it is a cardiogram phenomenon that disappears if the patient does several physical exercises).

      Therefore, the QRS complex on the electrocardiogram is expanded, its length exceeds 0,12 seconds. In the chest leads, the complex splits and consists of the R1 teeth (the work of the interventricular septum) and R2 (excitation of the right ventricle). Between two teeth, strongly lowered in relation to them, there is a tooth S, showing how the left ventricle works. The axis of the heart is usually located vertically.

      With complete blockade of the left leg, there is also repolarization. On the results of the cardiogram, the state is expressed by deformation of the QRS complex, it splits into two teeth or has a wide top, the duration of the complex gt; 0,12 sec. The indicator of the right ventricle is not formed – the S wave is absent on the graph.

      59e10d35dcdb659e10d35dce01 - Slow intraventricular conduction what are these ECG indicators

      Indicators of incomplete blockades of the anterior or posterior branches of the left ventricle are similar to those for complete blockade, but their expression is minimal and is determined by the values ​​of the S and R. teeth. When the pathology of the left heart region is visible, the S indicator increases, this indicates impaired patency of the anterior branch. If, in the pathology of the right department, the R wave is larger, then the blockade of the posterior branch is diagnosed.

      Also pay attention to the time spent by the pulse when moving from the sinus node to the walls of the ventricles. Normally, the reduction should take place in 0,07-0,09 seconds (the upper limit of the norm is 0,12 seconds). With complete blockages, the diagnosis is made with an increase in this indicator. In cases of incomplete blockade, the QRS is deformed, its length does not exceed 0,12 seconds.

      Particularly noteworthy are cardiac blockades of a non-specific format. ECG reveals changes that do not correspond to a specific pathology. For example, the QRS complex changes – it splits and deforms without expansion. Such symptoms are noted with local damage to the heart tissue against a background of a heart attack, inflammatory process, etc.

      Additional information is provided by such research methods:

      • cardiac echocardiography;
      • radiography of the lungs;
      • functional tests;
      • CT scan.

      We obtain significant information on the work of the heart muscle during Holter ECG monitoring. The study lasts 24 hours. This method allows you to continuously record signals and identify abnormalities that are not visible on a regular cardiogram. On such a record, changes are noted that occur not only at rest, but also during movement, physical activity. The compact recorder is attached to the belt. The patient leads a familiar lifestyle, and the system captures the work of the heart in a continuous mode.

      • 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.

      Violation of myocardial conduction during pregnancy

      In those situations where a complete block of the right leg is noted, the excitation of the right ventricle is carried out in another way. An impulse to the right ventricle comes from the left parts of the interventricular septum. That is, the excitement of the left departments is initially noted, and only then the right. If there is an incomplete block, the excitation of the right ventricle occurs correctly, however, the speed of the impulse will decrease.

      Usually, the following diseases are the causes of blockade of the right leg:

      • Chronic lung pathology.
      • Mitral stenosis.
      • Coronary heart disease.
      • Myocardial infarction with a large area of ​​ischemia.
      • Congenital malformations.
      • Diseases accompanied by damage to the valvular apparatus of the heart.
      • Also among the factors that increase the risk of developing this pathology, we can name hypertension, as well as improper adrenergic blocking. It is also worth noting that in some athletes, a violation of conduction in the right leg may be a variant of the norm.

      One of the features that is necessary for the occurrence of this lesion is an overload of the right ventricle. In healthy people, this type of disease practically does not occur.

      For this violation to occur, it is imperative that there is an obstacle that interferes with the impulse to the side and front wall of the left ventricle. In this case, the excitation passes along a healthy branch and from the lower wall passes to the parts of the heart that are left without an impulse.

      The main cause of the occurrence can be called pathological processes that somehow affect the left parts of the heart, namely:

      • Hypertonic disease.
      • Coronary heart disease.
      • Congenital and acquired heart defects.
      • Cardiomyopathy.
      • Myocardial dystrophy.

      As an independent disease, this blockade does not occur.

      The following pathologies lead to the development of this condition:

      • Myocardial infarction.
      • Atherosclerosis.
      • Inflammatory myocardial diseases.
      • Sclerosis of the conductive system.

      With complete blockade, the impossibility of an impulse to go along a typical path is noted, therefore, as in the case of blockade of the anterior branch, the excitation passes from the bottom up, through the Purkinje fibers. Most often, a combined lesion of both the left posterior branch and the right leg is observed.

      The causes of blockades with the defeat of two bundles are diseases such as:

      • Rheumatic carditis.
      • Myocarditis of diphtheria nature.
      • Severe atherosclerosis.
      • Myocardial infarction.

      vitaminy dlya serdca Depositphotos 90280886 m 2015 - Slow intraventricular conduction what are these ECG indicators

      The following variants of two-beam blockades are distinguished:

      1. Complete blockade of the left leg.
      2. Blockade of the posterior branch of the left leg with complete blockade of the right.
      3. Blockade of the anterior branch of the left leg with complete blockade of the right.

      Most often, two-beam blockades are a harbinger of the defeat of all beams and the occurrence of a three-beam blockade.

      The formation of a blockade of all three beams is caused by the same lesions as in the case of two-beam ones. When there is a complete loss of the possibility of conducting bundles in the His, there are pauses in the work of the ventricles. Thus, there comes an independent rhythm of excitation of these parts of the heart. At the same time, the atria continue to work as usual. This can lead to a complete atrioventricular block.

      In some cases, you may need to assign the following additional studies:

      • Ultrasound of the heart.
      • Echocardiography
      • Exercise tests.
      • Daily ECG monitoring.

      It is important to understand that for the proper treatment of this disease, it is important not only to identify the affected area, but also to diagnose the underlying pathology, which led to impaired conduction of the impulse. That is why when the first symptoms of the disease appear, it is so important to consult a doctor immediately. Timely medical care will reduce the risk of serious complications.

      Varieties of these pathologies are determined by decoding the ECG. Violation of the sequence of the impulse affects the biochemical processes that occur in the heart muscle, and also disrupts cardiac output.

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

      The causes of the appearance of the disease can be completely different. The following are considered the main ones:

      1. 1.
        In an absolutely healthy person, local disturbances of intraventricular conduction on the right leg of the so-called His bundle comparatively often occur.
      2. 2.
        If the child has an oval window open on the heart muscle, then this can lead to local disturbance of the intraventricular conduction of the heart in children.
      3. 3.
        It is possible to completely block any of the legs of the bundle of His. This can occur due to the occurrence of diseases of the heart muscle such as myocardial hypertrophy (thickening and proliferation of the heart) during the development of valvular defects on the valves, acute myocardial infarction on the heart muscle, coronary heart disease. The same problems can occur during diseases of the bronchi and lungs, for example, with obstructive bronchitis, bronchiectasis, during the development of bronchial asthma. Doctors encounter similar phenomena during the appearance of myocarditis, cardiomyopathy, post-infarction cardiosclerosis.
      4. 4.
        In some cases, a non-specific violation of intraventricular conduction is possible, which occurs due to improper, uncoordinated operation of one or more systems of the heart muscle. Usually, this can cause a slowdown in heart contractions with incomplete blockade, and in case of complete failure of the control impulse, a practical stop of the myocardium is possible. Such violations occur due to the appearance of the prophet of the heart, the formation of scars or scars on it, and splitting in the ventricles themselves. Most often this happens due to inflammatory processes or organic exposure. It may also result from the improper use of certain medications.
      • palpitations – tachycardia;
      • skipping beats in a heart rhythm;
      • the heart muscle contracts randomly;
      • heart pain (similar to angina pectoris);
      • poor circulation of the brain, due to which there may be shortness of breath dizziness, fainting.

      The main characteristic that indicates the appearance of a violation is cardiac blockade.

      The following symptoms may appear on a person:

      • fainting;
      • frequent shortness of breath;
      • it seems that the heart is beating;
      • general poor condition, weakness, and apathy;
      • heart rate is below normal;
      • memory problems;
      • sharpness of mood swings;
      • it seems to the patient that he is in danger, anxiety does not disappear;
      • moving on flat terrain, the patient may fall for no reason.

      Symptoms: what most often bothers a person

      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.

      4e511e6d6b6d68d87ee66886798bbb42 - Slow intraventricular conduction what are these ECG indicators

      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.

      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.

      Diagnostic measures

      • Ultrasound of the heart (Echo-KG). Assign with suspected myocarditis, heart muscle defects, heart attack.
      • Holter monitoring. It is necessary if the patient has a transient form of blockade.
      • In coronary heart disease, coronary angiography may be prescribed if stent placement or bypass surgery is necessary.

      narushenie vnutrizheludochkovoj provodimosti serdtsa 11 - Slow intraventricular conduction what are these ECG indicators

      Coronary angiography technique

    There are no special preventive measures to prevent diseases. The only recommendation to reduce the risk of developing cardiac conduction pathology is a healthy and active lifestyle, prevention of drug overdoses, timely visits to a cardiologist and general practitioner.

    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.

    There are no independent signs of slowing intraventricular conduction. Symptoms depend on the disease that caused the rhythm disturbance. With this violation, the following symptoms are observed:

    • shortness of breath in a calm state;
    • frequent dizziness (impaired blood circulation in the brain);
    • swelling of the lower extremities;
    • feelings of sinking heart;
    • feelings of lack of air, anxiety, fear;
    • mood swings;
    • spaces in memory;
    • bradycardia – sinus rhythm disturbance;
    • falling out of the blue;
    • general weakness, fatigue.

    ECG readings will vary depending on the specific disease of the cardiovascular system. Partial conduction disturbance may not be accompanied by any symptoms. Complete blockade is characterized by:

    • slow heartbeat;
    • pain in the heart;
    • loss of consciousness.

    In the event of a sharp heartache, cold sweat, malaise, the pulse is felt slowly: less than 45-50 beats per minute. If the ECG shows complete blockade, an acute infarction may develop. This condition requires urgent hospitalization. If a person has discovered any symptoms of a slowdown in intraventricular conduction, or they have been detected on an ECG, an urgent need to consult a doctor. Only he will be able to correctly decrypt the cardiogram, which will help to identify dangerous heart diseases in a timely manner.

    With such a violation of the passage of pulses, most often there are no signs of the disease, since the shifts on the electrocardiogram are so small that it is very difficult to distinguish them. But still there are some signs, having noticed which, it is urgent to take the patient to the doctor. Typically, a patient has a disease as follows:

    1. 1.
      A person complains of a rather frequent head spin.
    2. 2.
      The patient has a noticeable shortness of breath, which does not disappear even if he is at rest.
    3. 3.
      Often a patient with a nonspecific impulse passage complains of an incomprehensible cold in the region of the heart muscle.
    4. 4.
      Such a person gets tired in a fairly short period of time, and he does not have enough strength to finish the job.
    5. 5.
      If you measure the pulse of such a patient, it turns out that he slowed down greatly.
    6. 6.
      A person begins to complain of memory impairment. He cannot remember much, sometimes even what he did recently.
    7. 7.
      During daylight hours, the patient may experience several mood swings.
    8. 8.
      A sick person suffers from an incomprehensible feeling of fear. He has disturbing thoughts for which there are no prerequisites. Usually the patient complains to his family about the fear of death, which haunts him even in a dream.
    9. 9.
      Nonspecific impairment of impulse conduction in the ventricles of the heart muscle can suddenly manifest itself as a person falling on a completely flat surface.

    If the patient has at least one of these symptoms, then it is urgent to call a doctor, as hospitalization may be required.

    symptomatology

    Single-beam and double-beam conductivity have nonspecific symptoms. These types of violations do not manifest themselves brightly and can be detected by chance. Two-beam blockade often occurs as a result of large-focal myocardial infarction.

    Intraventricular blockade of the third type is a serious violation, which is characterized by the following symptoms:

    • sinus arrhythmia (tachycardia – increased heart rate, or bradycardia – decreased);
    • dyspnea;
    • chest pains;
    • severe dizziness and fainting;
    • worsening heart disease (e.g., ischemia);
    • intolerance to physical exertion;
    • cardiogenic shock.

    In the initial stages of the pathology, it is worth paying attention to light dizziness, a decrease in the pulse rate (not as serious as with the three-beam), general weakness.

    The clinical picture in this case depends on the factor that influenced the failure during the pulse. Mostly people are worried about the following symptoms:

    • the occurrence of edema on the legs;
    • manifestation of shortness of breath even without physical exertion;
    • frequent dizziness due to disruptions in cerebral blood supply;
    • feeling of sinking heart;
    • a feeling of lack of air, accompanied by fear and panic;
    • memory impairment;
    • fatigue;
    • bouts of bradycardia;
    • constant mood swings;
    • violation of coordination of movements;
    • general weakness.

    Sometimes a blockade of 1-2 degrees does not manifest itself in any way, in contrast to its full form. For the advanced stage of the disease, the following symptoms are characteristic:

    • sudden loss of consciousness;
    • heartache;
    • reduction in the frequency of contractions up to 30-40 per minute.

    cd6ef834f60c81db415ca370593bee12 - Slow intraventricular conduction what are these ECG indicators

    Blockade of the 3rd degree is manifested by complete dissociation of the ventricles and atria, which can lead to death. If you add a feeling of malaise and cold sweat to the voiced symptoms, then such a clinical picture is often a harbinger of imminent myocardial infarction. Help the patient can timely contact the clinic for hospitalization and treatment.

    • sinus arrhythmia (tachycardia – increased heart rate, or bradycardia – decreased);
    • dyspnea;
    • chest pains;
    • severe dizziness and fainting;
    • worsening heart disease (e.g., ischemia);
    • intolerance to physical exertion;
    • cardiogenic shock.
    • 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.

    Types and typology

    The human heart muscle has 4 cameras, several departments, they are responsible for the transmission of impulses. The blockade is able to hit one of the departments or several at once. Local disturbances are distinguished by nodes and pathways.

    Certain types of blockade are highlighted:

    1. Sinoatrial. It appears in the corresponding node of the right atrium. The impulse is not able to pass due to a small force or because the atrium cannot accept it. Such a blockade has three degrees:
      • There is a delay in the pulse conductivity.
      • It is determined by the frequency of deterioration.
      • The last, third degree is determined by weak impulses or the complete absence of their receipt.
    2. Slowing down intraventricular conduction. It is observed from the sinoatrial node to the left atrium or to the node of the atrioventricular zone. It is characterized by inhibition of impulse conduction.
    3. AV blockade. Several degrees are highlighted:
      • Slow conductivity.
      • The stopping of individual pulses is carried out in periods.
      • From the atrium, impulses cannot pass to the ventricles, while the latter and the atria live, independent of others.
    4. Blockade of the legs of branch block and branches (left, right, front bundles). Pulses arrive more slowly or do not pass at all.

    The first degree refers to partial deviations, the second and third to complete. The former do not belong to the category of diseases, but can serve as the reason for the formation of a complete blockade. And the latter in turn provokes dangerous complications.

    Failures in pulsed conduction may not manifest themselves for a long time, they are detected during a cardiogram due to the presence of other pathologies. In some cases, they appear as complications of heart ailments.

    With such violations, conductivity deterioration occurs in certain sections of the bundles of His, each of which is divided into right and left legs. The latter has an anterior and posterior branch.

    8033400279f1ae323be0377ba70d6392 - Slow intraventricular conduction what are these ECG indicators

    Three types of violations were identified:

    • Single beam – feed stops on one branch.
    • Two-beam – deterioration on two branches.
    • Three-beam – blocking on three branches.

    Given the area of ​​failure, these types of blockades are distinguished:


      Single-beam (monofascicular), when the delay in the electrical pulse is determined in 1 beam, right leg, front or rear branch of the left leg. When a block appears in one of the areas of the conductive system, the excitation wave travels along the stored branches, and propagates from top to bottom or from bottom through intact fibers to the myocardium of blocked beams. An expanded QRS is not recorded on the cardiogram, however, the amplitude of the R and S teeth changes. When the anterior branch of the left leg is blocked, the state is determined by the relation S2

    • What is a pathology? 1
    • Causes of impaired intraventricular conduction2
    • Etiology of the disease3
    • Species and typology4

How is the diagnosis made?

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.

The following sources of information were used to prepare the material.

Stable contraction of the heart muscle is made possible by the conductive system. Any violations in it lead to the development of arrhythmia. If the case concerns the blockade of the right (PNPG) or left (LDL) legs of the bundle of His, then often we are talking about local deterioration of intraventricular conduction. A pathological process is manifested by a decrease in the heart rate, up to 40 beats per minute.

In the absence of timely intervention, the patient’s condition will worsen, which will lead to death. Such consequences can be prevented if you find out what the slowdown of intraventricular conduction is and how it manifests itself. If you find out the necessary information on time, it will increase the likelihood of improving well-being and avoiding undesirable consequences.

To detect conduction disturbance inside the ventricles, you need to do an electrocardiography of the heart, with the help of which the variety of the disease will be accurately established and the problem areas of the organ indicated. Upon receipt of such an opinion from a doctor, the attending doctor directs the patient to other specialists to clarify the clinical picture of the disease. To find out all the nuances of the pathology, additional examination methods may be needed.

  • Echocardiography is necessary for a thorough examination of the cardiovascular system.
  • Holter ECG monitoring. The patient is connected to a device that records the activity of the main organ during the day, with various loads.
  • MTP diagnosis is used in case of insufficient information content of the echocardiography.
  • Tests using load.

Correctly determining this disease is not difficult, since only with an electrocardiogram everything becomes clear. In some situations, you may need several more diagnostic methods, everything is decided in each case of the disease individually.

Diagnosing

Diagnosis of impaired impulse conduction at an early stage allows you to assign an effective course of treatment, which gives a guarantee of a quick recovery and recovery of the patient. To do this, experts use a number of methods:

  • it is possible to suspect a pathology of impaired patency during an initial examination of the patient, namely when tapping his chest. The doctor may notice an increase in heart size, which indicates the presence of dysfunction;
  • conducting the electrocardiogram method most often and shows the development of the disease. When deciphering the results on an ECG, an increase in the height of the P wave will be noticeable, as well as its significant thickening. In addition, you can see the difference in the duration of the PQ interval, which indicates that the heart contracts with an uneven frequency. Often, experts prescribe electrocardiographic monitoring of the patient’s heart during the day. This method makes it possible to trace the dynamics of the heart rhythm on the ECG over a long period or with an increase in physical activity;
  • conducting a general analysis of the blood and urine of the patient. According to their results, it is possible to determine the amount of specific hormones in the blood and urine that affect the slowdown of heart muscle contraction;
  • using the electrophysiological examination method, you can determine the exact location of the violation. For this, a thin electrode is introduced through which a low-power pulse is applied to the heart. An electrode is inserted through the intestines or cardiac aorta. This method will help to maximize the effectiveness of treatment.

eed685835000b085695530a3068b68f5 - Slow intraventricular conduction what are these ECG indicators

The use of these and other methods will help determine the root cause of the disease, and therefore prescribe such drugs that will quickly eliminate it.

Symptoms

The pathology of impulses along the His system, with the exception of the three-beam blockade, does not manifest specific symptoms. But this does not mean that patients with impaired intraventricular conduction feel good and do not have health problems.

Diseases leading to impaired conduction can manifest with many symptoms. One of the main reasons leading to a suddenly developing cessation of impulses along one or several branches of the bundle of His is myocardial infarction. Such a blockade may indicate myocardial ischemia – insufficient blood supply to the heart muscle. Due to the pronounced deformation of the ventricular complexes, the diagnosis of a heart attack by an electrocardiogram is very difficult.

With complete three-beam blockade, a rare ventricular rhythm is observed: from 20 to 40 beats per minute, not able to provide an adequate level of blood supply. The degree of blockade is established taking into account the severity of the delay in conducting pulses:

  1. The first degree means slowing down the passage of pulses.
  2. In the second degree, part of the pulses are blocked, but the rest pass through a pathologically altered portion of the conducting system.
  3. The third degree means the impossibility of conducting impulses going to the ventricles.

With a three-beam blockade of the His system, the natural passage of impulses in the direction of the ventricles is impossible. This leads to the following symptoms:

  • reduction of heart rate;
  • intolerance to physical exertion, even minor, in which shortness of breath, weakness, pain in the heart occur;
  • fainting, intermittent confusion.

Against the background of severe heart diseases, the sudden development of trifascicular blockade can cause serious complications associated with a decrease in rhythm or a long pause, when contractions of the ventricles are temporarily absent (transient asystole). These complications include:

  • The attacks of Morgagni-Adams-Stokes, in which due to a decrease in cardiac output and, as a result, brain ischemia, the patient turns pale, loses consciousness. After 1-2 minutes, the person comes to his senses, after an attack, redness of the skin often occurs. Repeated attacks can lead to impaired memory and intelligence.
  • Cardiogenic shock.
  • Sudden cardiac death due to asystole (cessation of heart activity).
  • Deterioration of the course of coronary heart disease, aggravation of congestive heart failure, renal pathology.

The main violations of intraventricular conduction, treatment methods

Violation of intraventricular conduction is a condition that does not have pathognomonic signs. So, with a malfunctioning of the His bundle, the following symptoms can be detected in a patient:

  • Dizziness.
  • A feeling of interruption in the work of the heart.
  • General weakness.
  • Dyspnea.
  • Bradycardia.
  • Fainting.

In any case, it is important to understand that the manifestations of conduction disorders are individual and most often directly depend on the underlying disease. That is why, when the first symptoms appear, indicating a malfunctioning of the heart, it is necessary to seek help from a specialist.

The signs of the development of such a lesion with partial or complete non-passage of control impulses along the heart muscle are as follows:

  1. 1.
    With partially impaired conduction, most people can almost feel nothing, since such a condition in many cases does not manifest itself clinically.
  2. 2.
    If a person has a complete blockage of the passage of an impulse on the legs of the bundle of His, then signs such as tenderness in the chest, rare impulses appear, a complete loss of consciousness is possible.
  3. 3.
    When examining a patient who complains of sudden, strongly pressing pain behind the sternum, a sharp, unreasonable weakness, the appearance of a cold sweat, a complete block of the left ventricle is usually detected on the electrocardiogram. This allows you to determine the development of acute myocardial infarction, which is usually disguised as impulse obstruction. The patient has a rare pulse, he often becomes sick. It is quite difficult to determine the presence of a heart attack in a person from an electrocardiogram the first time, therefore, if this lesion is suspected, patients are urgently hospitalized.

Therapy will completely depend on what reason provoked the pathology of cardiac conduction. So, in acute myocardial infarction, a pathogenetic treatment is prescribed aimed at eliminating acute myocardial ischemia, and there is no special effect on conduction disturbances. With myocarditis, antibiotics and glucocorticosteroids are taken, which do not allow progression to violations of atrioventricular and intraventricular conduction. If problems develop due to taking any medications, they should be immediately canceled.

Shortening conductivity in the absence of an organic pathology of the heart, as a rule, does not require treatment. If the disease is accompanied by various arrhythmias, including paroxysmal, an operation to install a pacemaker, or an operation of radiofrequency catheter ablation, is used. In this case, antiarrhythmic drugs are often useless, but as a palliative, they are still indicated. Other possible remedies for intraventricular conduction disorders may be:

  • calcium channel blockers;
  • anti-ischemic agents;
  • vitamins;
  • potassium, magnesium preparations;
  • thrombolytics;
  • anticoagulants;
  • beta-blockers;
  • beta adrenomimetics.

With the sudden development of complete atrioventricular blockade, a temporary electrostimulation technique is used – it is required to supply pulses for emergency restoration of normal cardiac conduction. In the future, almost all patients need an ECS installation.

Heart diseases and other pathologies of the cardiovascular system are one of the most common today. In the article, we consider a violation of intraventricular conduction of the heart, which leads to complications and a worsening of the patient’s condition.

How common are intraventricular blockages?

Impaired conduction within the ventricles can be detected in both children and adults. Among the pathologies detected by electrocardiography, the proportion of intraventricular blockade is up to 2,4%. An increase in the detection rate in elderly patients is noted.

By prevalence among the population:

  • in the first place is a block in the left leg (anteroposterior branch);
  • on the second – the right leg.

Impaired conduction in the posterior lower bundle is rare.

Why is a violation of cardiac intraventricular conduction

The bundle is divided into left and right legs. The left forks into the front and back branches. Blockades are:

  • single-fascicular (single-beam), if one branch is blocked;
  • bifascicular – conducting stops on two branches;
  • trifascicular – the impulse does not pass through the three branches of the His system.

Pathology of the conduction is complete or incomplete (when the conduct is slowed down, but not completely excluded).

Some types of blockade (for example, partial blockade of the right leg of His) are harmless and do not require treatment. In other cases, for example, with trifascicular blockade against a background of heart diseases, a blockade can cause very serious conditions, up to death.

Sometimes pathology can be completely eliminated, sometimes it is impossible.

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Partial blockade of the right leg, accidentally detected by electrocardiography, is usually not a pathology and does not require treatment. But if a violation of intraventricular conduction of the heart occurred suddenly, it is necessary to find out the cause of the condition and prescribe adequate therapy. Treatment is carried out, influencing the causes of conduction disturbance: if conduction disturbance occurs due to myocarditis, aortic defect, pulmonary embolism – treatment of these pathologies is organized.

Often transient blockades develop due to myocardial ischemia. In this case, therapeutic measures are carried out aimed at improving the blood supply to the myocardium, the treatment of atherosclerosis. Treatment of the underlying pathology can lead to the elimination of the problem of impulses.

With myocardial infarction, intensive therapy is carried out to limit the area of ​​necrosis, reduce the area of ​​ischemia and combat complications of pathology, including life-threatening ones. The danger is a complete three-beam blockade, as a result of which asystole (cessation of heart contractions and electrical activity) can develop. Treatment is carried out using external and intracardiac pacing.

A temporary pacemaker is installed in case of acute development of a blockade of conduction in two legs of the His system at once. There are certain indications for the installation of a permanent pacemaker in case of intraventricular conduction disturbance:

  1. Blockade of two legs of the bundle of His, manifested by a rare frequency of heart contractions, congestive heart failure, angina attacks.
  2. The combination of conduction pathology in the left or right leg of the bundle of His and atrioventricular block.
  3. The termination of the passage of pulses along the right leg and the posterior branch of the His system.
  4. Persistent conduction disturbance of both legs, persisting 3 weeks after a heart attack.
  5. The attacks of Morgagni-Adams-Stokes.

Conduction of nervous excitement is one of the unique functions of the heart. It provides a sequential transmission of momentum from the main node to the atria and ventricles. For this, special cells connected in the branches pass inside the interventricular septum. By the name of the discoverer, they are called bunches or legs of His.

The endings in the lower part of both ventricles and the apex of the heart form a thin network of Purkinje fibers.

Intraventricular blockade per se is not harmful to heart function. But they seriously complicate the underlying disease, affect other myocardial functions and prognosis.

Disorders of intraventricular conduction do not have typical clinical symptoms, are detected during a control ECG study.

According to the classification of V. L. Doshchitsin, all intraventricular conduction disorders are divided into:

  • mono-, bi- and trifascicular depending on the defeat of one or two or three bundles;
  • focal: local damage is not confirmed in all ECG leads;
  • arborization: localized in the final part of Purkinje fibers;
  • transient: changes alternate with proper conductivity;
  • persistent;
  • complete and incomplete;
  • alternating: one or another type of blockade is revealed.

The pathological process can cause an impulse block at any level.

Depending on the place of interruption of the pulse, blockages are distinguished:

  • monofascicular (single-beam): the block of the left front or back, only the right leg of His;
  • bifascicular (two-beam): it is possible in two versions as one-sided (left leg) or two-sided (right with left front branch, right with left back branch).
  • trifascicular (three-beam).

A variety of blockades is reflected in the decoding of the electrocardiogram. Conducting an impulse from the supraventricular nodes of the heart slows down or is completely interrupted. This violates the sequence of excitation of the ventricles, affects the biochemical processes in the myocardium, the usefulness of the cardiac output.

This type includes complete or incomplete blockade of the legs of the bundle of His. If there is a violation of ventricular conduction along the right leg of the bundle of His, then the contraction of the right ventricle suffers, if on the left, then, respectively, of the left.

  • Incomplete blockade of the right leg can occur in healthy people,
  • In children, an open oval window in the heart can lead to local disturbance of intraventricular conduction
  • Complete blockade of any of the legs indicates heart diseases, for example, myocardial hypertrophy (growth and thickening) with valve defects, coronary heart disease, acute myocardial infarction, myocardial hypertrophy in bronchopulmonary diseases (obstructive bronchitis, bronchial asthma, bronchiectasis), myocarditis, cardiosclerosis, cardiomyopathy.

types of intraventricular blockade – conduction disturbances along the legs of the bundle of His

  1. Partial conduction disturbance may not manifest itself clinically,
  2. Complete blockade is characterized by signs such as a rare pulse, chest pain, loss of consciousness,
  3. If a patient suddenly has intense pressing pain behind the sternum, a sharp weakness, cold sweat, a feeling of lightheadedness, a rare pulse, and a complete left block is revealed on the ECG, most likely an acute myocardial infarction “masked” on the ECG behind the block will develop. It is due to the inability to determine a heart attack on a single ECG with such complaints, urgent hospitalization in a hospital is required.

Non-specific disturbance of intraventricular conduction
– This is an impulse blocking in the most remote areas of the heart muscle – in Purkinje fibers. The causes are the same diseases as with blockade of the His bundle, signs on the ECG are minimal, and clinical symptoms do not occur.

ECG – deformed ventricular complexes

So, in most cases, the diagnosis of “disturbance of intraventricular conduction” in relatively healthy people is a variant of the norm and is due to incomplete blockade of the right leg of the bundle of His.

Types of violations are divided depending on the place of occurrence of blockades:

  • focal – damage is not always visible on the ECG;
  • arborization are formed at the ends of the Purkinje fibers;
  • focal – not always detected by ECG;
  • transient – there is an alternation of conductivity changes;
  • persistent;
  • complete.

With complete blockade, muscle contraction does not occur, there is a complete absence of a nerve impulse. This often leads to cardiac arrest and death.

Incomplete – there is a slowdown in the passage and decrease in the frequency of the impulse to the heart muscle. With this problem, the function of an individual part of the heart is impaired. This type of violation is not deadly.

Alternating symptoms of one or another blockade – pathology causes blocking of impulses anywhere in the heart.

Depending on the place of occurrence, blockades are divided into several types:

  • monofascicular (single-beam): the left front or rear is blocked, only the right branch;
  • bifascicular (two-beam): the left branch is blocked or the right one with the left front branch. Left back with right;
  • trifascicular (three-beam).

And also a non-specific violation of intraventricular conduction is often found, in which the normal functioning of the heart is impossible.

There is a likelihood of focal disorders. Non-specific impairment is called impulse blocking in the most remote part of the myocardium.

The reason is the same disease as with blockade, ECG values ​​are insignificant, and clinical symptoms do not appear.

Intraventricular blockade alone does not cause serious harm, however, it entails a complication of the underlying disease, produces a negative effect on other processes of the heart muscle.

The concept of blockade implies violations of the normal impulse patency through the heart muscle system. But a violation does not mean the complete absence of a nerve impulse. It can simply be a slowdown in the momentum, which will lead to a partial slowdown in heart rate in children, pregnant women and adults. There are signs of the disease, which are accompanied by a lack of nerve conduction, leading to complete cardiac arrest.

Intracardiac pathologies are accompanied by intraventricular blockade of various forms of abduction. And if there is no impulse, then this is a complete violation of the conductivity. When the interventricular impulse is slowed down, it is called incomplete local pathology (PNPH).

Retardation of atrial conduction

  • functional.
  • organic
  • medication;

Functional

Functional disorders are provoked not by heart diseases, but by failures in the autonomic section of the central nervous system. Especially often they arise due to stresses and bursts of hormonal activity (during puberty, during pregnancy and menopause). Because of such problems, the sympathetic part of the autonomic nervous system begins to prevail over the parasympathetic, or vice versa, which leads to the development of arrhythmia.

Organic

This group includes diseases of the heart and blood vessels that can disrupt the conductive system. You can see the most common pathologies below:

  • inflammatory process in the heart muscle (myocarditis);
  • necrosis of a tissue site due to lack of nutrition (heart attack);
  • an increase in size (hypertrophy) of the myocardium;
  • cardiac ischemia;
  • replacement of muscle tissue of the connective (cardiosclerosis);
  • respiratory diseases (obstructive bronchitis, asthma).

If it is not possible to identify the causative factor, then the diagnosis of cardiomyopathy is often made. The disease has an unknown genesis (origin) and is manifested by arrhythmia, heart failure, myocardial hypertrophy and impaired conduction.

Medicamentous

Disorders of the conduction of the ventricles provoked by the use of drugs are one of the most dangerous and extremely difficult to treat. Basically, they appear after self-administration of drugs with antiarrhythmic effects. Such drugs can cause serious malfunctions in the heart rhythm and a lot of side effects, so they should be prescribed by the attending physician, focusing on the results of the examination.

the work of the conduction system of the heart, its key components are indicated

Normally, the heart rate is carried out at a frequency of 60 – 80 contractions per minute. Delayed impulse conduction, which can occur in any part of the heart muscle, leads to the fact that the rhythm “goes astray” at a normal frequency and a complete or partial heart block develops. The reasons for this can be both quite harmless, and due to serious heart diseases.

It is necessary to distinguish between the concepts of “slowdown” and “violation” of conductivity. For example, if the patient saw in the ECG conclusion such a phrase as “atrioventricular conduction is slowed down”, then this means that he has episodes of atrioventricular blockade of the 1st degree.

A slowdown in conductivity indicates that the patient has a degree 1 blockade, which, in principle, is not dangerous at the moment, but with a high probability of progressing to degree 2 and 3 blockade, which can already pose a threat to health and even to life.

If the ECG protocol refers to a violation of conductivity, then this means that the patient has a corresponding blockade of 2 or 3 degrees.

Violation of the conduction of the heart can be complete when the impulse is not carried out completely through a particular part of the heart, or partial (incomplete) when the impulse is carried out, but with a delay. Complete blockades are much more dangerous than incomplete ones.

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atrial fibrillation – a dangerous complication of atrial conduction

How is ECG conductivity different?

Signs of impaired conduction depend on the type of blockade. They differ in:

  • the direction of the electrical axis of the heart;
  • the form of ventricular complexes;
  • place in the chest and standard leads;
  • the width of the teeth and the intervals.

The two-beam type of blockade is regarded as a harbinger of the development of a three-beam lesion. In the three-beam variant, the shape of the ventricular complexes depends on the location of the lesion, while partially maintaining conduction in one of the branches resembles the variants of two-beam blockades. The ECG picture is superimposed on atrioventricular disorders of varying severity.

When assessing the features of blockades for a doctor, it is important to look at previous ECGs to be sure of the age of changes.

Violation of sinoatrial conduction

In another way, this is called sinoatrial blockade. An electrical impulse originating in the sinus node cannot fully reach the atria, and their excitation occurs with a delay. Often found in healthy people and does not require active treatment, but can also occur with organic diseases of the heart tissue.

  1. With partial conduction disturbance, symptoms rarely occur,
  2. With a complete violation of conduction, there is a feeling of interruptions in the heart, discomfort in the chest, dizziness due to a deterioration in the blood supply to the brain due to rare heart contractions,
  3. Pulse becomes rare – less than 50 per minute.

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ECG for sinoatrial blockade – prolapse of the atria and ventricles (PQRS complex)

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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