Violation and slowdown of intraventricular conduction

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

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

In order to cure intraventricular blockade, most patients are prescribed cardiac glycoside. An exception may be patients suffering from atrioventricular blockade of the first or second degree, they are prescribed the drug with extreme caution. To reduce the risk of heart failure in patients who are afraid to inject glycoside, a probe electrode is introduced into the cavity of the right ventricle.

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.

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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.

  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.

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

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

To cure the intraventricular blockade, most patients prescribe cardiac glycoside. The exception may be patients suffering from atrioventricular blockade of the first or second degree, they prescribe the drug with extreme caution. To reduce the risk of cardiac arrest in patients who are afraid to inject glycoside into the cavity of the right ventricle, doctors inject a probe electrode. This is a preventative measure.

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

Features of the pathological process

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.

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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).

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.

Symptoms of the disease

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

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

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

Determination of intraventricular conduction is performed by decoding the ECG. The main element indicating a violation is the QRS complex, which characterizes the work of the ventricles. 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).

Polnaja blokada pravoj nozhki puchka Gisa - Violation and slowdown of intraventricular conduction

Therefore, the QRS complex on the electrocardiogram is expanded, its length exceeds 0,12 seconds. In the pectoral leads, the complex is split and consists of 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.

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 there is more R wave during the pathology of the right part, then the blockade of the posterior branch is diagnosed. Also pay attention to the time spent by the impulse 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.

Electrocardiography is the main diagnostic method for the pathological process. Violation of intraventricular conduction on the ECG will manifest itself with specific signs.

Blockade on the right leg of the heart leads to expansion and deformation (the appearance of chipping) in the QRS complex. Such changes are determined through the right chest leads.

The blockade of the left leg of the heart also expands and deforms the QRS, but pathological signs are detected through the left chest leads. If the left anterior branch is affected, then a deviation of the electrical axis of the heart to the left is observed. The diagnosis can be confirmed by comparing the ECG waves – in the second and third leads S will be higher than R. If the pulses do not go through the left posterior branch, then the axis deviates to the right, S is higher than R in the first lead.

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.

Danger to health

What is a conduction disturbance of the heart? The disease can be characterized as a change in the normal sequence of heart contractions due to the inability of the conducting system to perform its functions. Blockades can be classified according to different characteristics. Depending on the location, the following forms are distinguished:

    Violation of intraventricular conduction of the heart. The reason is the formation of an obstacle to the movement of the impulse along the left or right leg of the bundle of His. The path and time of excitation passing through the ventricles changes. This is the most common type of violation.

Sino-arterial (sinus) block. Conducting an electrical impulse from the sinus node to the atrium is lost.

  • Intertrial block. It develops by slowing the passage of the impulse from the sinoatrial node to the left atrium.
  • Atrioventricular block. The passage of an electrical impulse localized at the level of the bundle of His bundle and atrioventricular node is disrupted.
  • Complete blockade. The frequency of contractions of the ventricles drops to 30 per minute (at a rate of 65-85), and there is completely no conduction. If the interval between them is several seconds, a person may lose consciousness, pallor and cramps appear (Morgagni-Adams-Stokes attack syndrome). This may result in the death of the patient.
  • Partial blockade. Some pulses are not carried out, or their conduction is significantly slowed down. Pathology does not lead to death, but causes severe pain.

    The degree of development of blockades The disease can occur with or without symptoms. Athletes may show physiological disturbances. These cases are associated with a high load on the parasympathetic nervous system, and they make up 5-10% of the total. More than 90% of blockades are associated with problems of the system of conduct (physiological or organic form).

    Any malfunctions in the heart rhythm are dangerous to human health. They lead to circulatory disorders, due to which there are dysfunctions of the internal organs. Damage to only 1 leg of His is usually not particularly evident, but the pathological process is gradually exacerbated. A minor blockade without treatment can go to stage 3, which is characterized by the following complications:

    • heart failure;
    • acute attacks of bradycardia;
    • heart failure;
    • atrial fibrillation;
    • myocardial stroke.

    Disruption (and retardation) of intraventricular conduction

    The author of the article: Yachna Alina, oncologist surgeon, higher medical education with a degree in General Medicine. From this article you will learn about a violation of the intraventricular conduction of the heart: what it is, what symptoms this condition manifests itself, what treatment methods are used. areas of the ventricles can exist for a long time and turn out to be an accidental find on the electrocardiogram, or they arise suddenly as a result of heart disease. With this violation, a blockage in the passage of impulses occurs along one of the sections of the His bundle – the conducting system of the ventricles of the heart.

    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).

    In children, identified problems with intraventricular conduction may indicate congenital malformation or hereditary pathology. A partial blockade of the right leg, found in a child, is often a variant of the norm. There are no other specific differences of this pathology in children. Some types of blockade (for example, partial blockade of the right leg of His) are not dangerous 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, even death, sometimes pathology can be completely eliminated, sometimes it is impossible. A cardiologist is involved in the treatment of pathology. Diagnosis is based on electrocardiography and electrophysiological findings.

    Blockade occurs due to the influence of many factors. Basically, people are too delaying a visit to the doctor, do not treat the heart, abuse bad habits and are constantly in stressful situations. The full list of causes of a failure in conduction inside the ventricles is divided into 3 groups:

    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.

    symptomatology

    Symptoms of intraventricular conduction disturbance are less pronounced than in other types of blockade (for example, atrial atrial). One-bundle and two-bundle conduction 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 decreased bradycardia);
    • 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.

    Problems with the conduction system may not be noticeable and may not appear in everyday life. The main symptom may be an accidental decrease in heart rate. In this case, therapy is not required, it is necessary to pay attention to health and general health, as well as to carry out preventive measures.

    • insufficient flow of blood to the myocardium and brain tissue;
    • pressure fluctuation in the arterial system;
    • violation of blood circulation in large and small circles.

    The main manifestations of the disease are as follows:

    irregular heartbeat at a slower pace;

  • pauses in the heartbeat;
  • fatigue and weakness due to physical activity;
  • pressure jumps;
  • lack of air;
  • noise in the head;
  • swelling of the extremities;
  • impaired consciousness, darkness in the eyes and fainting;
  • shortness of breath, appearing independently and after exercise.
  • With atypical forms of the disease, patients may complain of an unexplained cold in the myocardium. Companions of pathology are sharp mood swings, impaired memory and the emergence of an incomprehensible sense of fear. In severe cases, twitching of the muscles of the extremities and the front part, as well as involuntary muscle contraction on the back appears.

    narushenie vnutrizheludochkovoy provodimosti simptomy lechenie 5 - Violation and slowdown of intraventricular conduction

    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.

    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.

    disease prevention

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

  • Long walks in the fresh air.
  • A healthy diet high in calcium.
  • The intake of vitamins.
  • Compliance with the daily routine, sufficient rest.
  • Small regular exercise. Physical education classes.
  • Elimination of power sports, especially for bodybuilding, which adversely affects the state of the heart vessels.
  • Try to avoid severe stressful situations.
  • Whenever possible, relax at sea every year. You can relax in the forest.
  • 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.

    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.

    zamedlenie vnutrizheludochkovoj provodimosti chto ehto takoe 1 - Violation and slowdown of intraventricular conduction

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

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

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

    Course of therapy

    The restoration of impaired intraventricular conduction depends on the presence of other pathologies. If they are not identified, the cardiologist will advise taking drugs that improve energy metabolism (Preductal, Antisten) and vitamin complexes (Magne B6, Vitrum Cardio). When diagnosing grade 3 blockade, the patient is advised to think about installing a pacemaker as an artificial pacemaker.

    It is advisable for elderly people to go to the hospital for a detailed examination if the problem with conductivity manifests itself for the first time. In stationary conditions, specialists will carry out all the necessary diagnostic procedures to accurately determine the cause of the pathological process that has arisen.

    If the slowdown of intraventricular conduction is caused by cardiac pathology, then it must be eliminated or stopped. The following recommendations will help to solve the problem:

    • Coronary heart disease is treated with coronarytics, that is, drugs to saturate the myocardium with oxygen by expanding the coronary arteries.
    • Inflammation is eliminated by a course of hormonal or antibacterial agents.
    • Heart failure is stopped by diuretics (diuretics).

    After eliminating the cause or reducing its effect, arrhythmia partially or completely eliminates itself. The degree of recovery of intraventricular conduction will depend on the effectiveness of the course of treatment and the severity of the underlying pathological process.

    Correction of lifestyle will help accelerate recovery and prevent the further development of heart diseases. The following rules are most relevant:

    • give up alcohol and smoking;
    • get enough sleep (7-8 hours a day);
    • play sports at a moderate pace without overloading;
    • remove fatty foods from the diet and reduce the amount of salt;
    • completely treat all diseases;
    • follow the instructions of the doctor and be examined annually;
    • try to avoid stressful situations.

    Are intraventricular conduction disturbances dangerous?

    Date of publication of the article: August 24.08.2018, 4.09.2018; Date of the update of the article: September , ; Author of the article: Julia Dmitrieva (Sych) – practicing cardiologist; Violation of intraventricular conduction – a pathology of 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 )

    article1147 - Violation and slowdown of intraventricular conduction

    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 the atrioventricular node and enters the bundle of His, which is divided into the left and right legs. The right is a branching 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. For conduction disorders of this type, the impulse is blocked on the bundles of His, violating the rules ventricular contractions of the ventricles.

    Forecast

    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.

    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. 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 death the patient.

    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 asymptomatic course of the disease does not require medical or surgical intervention. The cure fully occurs after the elimination of the factors that caused the disease. If they cannot be eliminated or there is a pathology of the heart, then it is necessary to take measures to ensure the normal functioning of the body, in particular, take the necessary medications.

    In the absence of timely treatment, the formation of numerous blood clots, impaired blood circulation in the brain, the development of stroke conditions and sudden death are possible. Violation of conduction increases the risk of death by 2,5 times. In order to minimize the consequences of the disease, it is necessary to adhere to the recommendations of a cardiologist and arrhythmologist. The appearance of symptoms of the disorder cannot be ignored – this can cause the development of a serious pathology.

    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.

    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.

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

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

    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.

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

    Among them, the most common can be distinguished:

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

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

    • 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.

    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.

    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.

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

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

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

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

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

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

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

    Pathology development mechanism

    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 >

      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.

      In order to fully understand the nature of deviations within the framework of this form of the process, you need to turn to the anatomical and physiological information.

      The generation of an electrical impulse in cardiac structures occurs in a natural pacemaker, the so-called sinus node. This is an accumulation of special cells of cardiomyocytes capable of spontaneous excitation.

      Through the fibers known as His bundles, the signal passes to the ventricles and other structures, providing normal contractility of the entire organ. The indicated “conductors” of the pulse are formed by two legs. Right and left. Further, they branch already within the framework of cardiac structures.

      With partial or complete blockade as a result of injuries or congenital malformations, the signal cannot move on.

      Some part of the heart is excluded from work, because the contraction of muscle fibers does not occur. In some cases, this does not endanger life and health; in some situations, a fatal outcome is likely.

      It all depends on the localization of the process, and on the other hand, on the volume of the lesion and the prescription of the course of the condition.

      The likely consequences of an acute or prolonged current conduction disturbance:

      • Cardiogenic shock. A sharp drop in blood pressure in combination with arrhythmia and generalized hemodynamic dysfunction. It is almost impossible to get the patient out of this condition; mortality is approaching 100% in some forms. In other cases, the chances of survival are slightly higher (mortality rate of about 60%).
      • The attack of Morgagni-Adams-Stokes. Drop Blood pressure amid impaired cardiac output. In itself, it is accompanied by a swoon, a stroke or a heart attack can follow. Requires urgent treatment of the underlying disease. A pacemaker is installed.
      • Cardiac arrest (asystole). This is the main cause of sudden death of patients.
      • Ischemia of the kidneys and liver. As a result, dysfunctional disorders.

      All of these phenomena are potentially fatal. What are the risks – can only be determined in the course of a long observation.

      In rare cases, the disease is congenital, and, usually without compromising the quality of life, is accidentally detected during a medical examination. However, more often it is caused by diseases:

      • 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

      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.

      Within the ventricles, three types of pathological process are observed.

      • Blockade of the legs of His. A particularly common form of the disease. It is accompanied by a minimal clinical picture with damage to the right branch. The left-hand version is much more dangerous, since the operation of the camera of the same name is disrupted. In the absence of an adequate signal, a large circle of blood circulation suffers, generalized hypoxia, from all organs and tissues simultaneously. This in the long run leads to atrophy, multiple organ failure, cardiac arrest, stroke, vascular dementia. Clinically non-hazardous options can last a lifetime without visible manifestations.
      • Insufficient speed of the electric pulse along the fibers. The severity of the clinical picture and the threat to life again depends on the nature of the pathological phenomenon. However, this is a less dangerous variety compared to the classic complete blockade of the legs of His. Slowing down intraventricular conduction is the result of chest injuries, operations, or congenital heart defects.
      • Atrioventricular (AB) block. More rare type. It is characterized by selective stopping of the movement of electrical signals along cardiac structures.

      You can also classify the process on such a basis as the nature and degree of deviations in conductivity.

      narushenie vnutrizheludochkovoj provodimosti serdca lechenie 1 1 - Violation and slowdown of intraventricular conduction

      • Complete blockade. The signal does not pass at all. This is the most dangerous clinical option. Outside the course of symptoms, in many cases, cardiac arrest is noted.
      • Partial ventricular conduction. The likelihood of fatal complications is present, the clinical picture is expressed, but to a lesser extent compared with the first process.
      • Conductivity slowdown. Almost not noticeable until a certain point.

      Finally, classification based on the extent of change is possible.

      • Generalized conductivity. Not only the ventricles, but also the atria suffer.
      • Focal (local) conduction disturbances. One or two ventricles are involved. It proceeds relatively easily, without pronounced symptoms, life risks are determined by the localization of the process. If the left side is affected, the probability of a fatal result is almost three times higher.

      A more accurate version would look like this:

      • Single beam conduction. With the blockade of a single branch.
      • Bifascicular form.
      • Full variety. When three fibers are blocked.

      Clinical types are important for developing treatment tactics.

      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 presence of such a pathology is determined by a violation of one of the ventricles. This type provokes the formation of AV blockade.

      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.

      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.

      The classification of intraventricular conduction disorders is based on the internal structure of the His bundle. The number of bundle elements that fall out of the conducting system and determines the types of intraventricular blockades:

      • 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).
      • 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;
    • 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.
    • 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.
    • 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.
    • Blockade of the legs of branch block and branches (left, right, front bundles). Pulses arrive more slowly or do not pass at all.

      The presence of such a pathology is determined by a violation of one of the ventricles. This type provokes the formation of AV blockade. 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.

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

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

      Clinical case

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

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

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

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

      The nature of the violations distinguishes:

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

      According to the type of violations, there are:

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

      Symptoms and manifestations

      There are no separate signs that definitely indicate a violation of conductivity. Often the course of the disease is asymptomatic.

      Some patients tolerate symptoms easily, because the picture is blurry. In a separate group of people there is a significant deterioration in well-being. The manifestation of symptoms directly depends on the location of the disorders.

      Pathology is more often detected by the following group of symptoms:

      • The occurrence of shortness of breath at the slightest exertion.
      • Dizziness, which appears due to a deterioration in the blood supply to the brain.
      • Pain discomfort in the chest area, it is observed against a background of worsening heart function.
      • Swelling of the extremities, it is often accompanied by a blue skin.
      • Severe weakness, including fainting.
      • The manifestation of cold sweat.
      • A sharp decrease in heart rate (less than 50 beats per minute).
      • A feeling of lack of air, choking.

      Sinoatrial blockade usually manifests itself as chest pain, lack of air, rare pulse. Violations of atrial conduction are often asymptomatic or are manifested by swelling and shortness of breath. AV-slowdown is detected by severe bradycardia, fainting is not uncommon.

      Violation of the bundles of His is accompanied by a general malaise, a decrease in the frequency of contractions of the heart muscle.

      Sinoatrial blockade usually manifests itself as chest pain, lack of air, rare pulse. Violations of atrial conduction are often asymptomatic or are manifested by swelling and shortness of breath. AV-slowdown is detected by severe bradycardia, syncope is frequent. Violations of the bundles of His are accompanied by general malaise, a decrease in the frequency of contractions of the heart muscle.

      Pathology in children

      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 the normal range. 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 ECS – an artificial pacemaker. It is impossible to leave the manifestation of symptoms without attention, an extensive blockade can cause death.

      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.

      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.

      narushenievnutrizheludochkovoyprovodimos 65A3A817 - Violation and slowdown of intraventricular conduction

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

      Pathology during pregnancy

      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.

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

      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, you need to consult a doctor without fail. Before prescribing therapeutic measures, a thorough examination is necessary to establish an accurate diagnosis. To begin with, a woman is sent to an ECG.

      How is the treatment?

      Treatment rarely consists in eliminating only the manifestations and consequences of pathology. Therapy is aimed at eliminating the causes that provoked a conduction disturbance. Physiological disorders, characterized only by impulse slowdown and due to congenital features or, for example, sports, do not need treatment (but people with such a diagnosis should undergo routine examinations and receive ECG findings).

      If the condition is caused by acquired heart diseases or serious pathologies, then treatment is necessary. Many heart diseases can be cured or well compensated, in such cases, conduction disorders can disappear. Three-beam blockade is of particular danger. With it, external stimulation of heart contractions and surgical intervention with the installation of a permanent pacemaker are performed.

      Children with incomplete blockages are observed by the doctor, as there is a risk of disease progression. Therapy in a child is carried out as well as in adults. In case of serious deviations, an operation to install a pacemaker can be performed. In women, conduction disorders may be temporary due to pregnancy.

      Treatment is carried out with the participation of obstetrician-gynecologists in order to reduce the risks of injury to the fetus with medications. If surgical intervention is required, then the operation to install a pacemaker should be carried out before childbirth, in case of serious pathologies, natural birth is contraindicated. Drug treatment involves taking:

      • drugs that improve myocardial metabolism (mildronate, riboxin);
      • cardiac glycosides;
      • antiplatelet agents (aspirin, clopidogrel);
      • adrenostimulants (isadrine, norepinephrine);
      • anticholinergics (atropine, platifillin);
      • anti-ischemic agents (nitroglycerin, isoket).

      Diagnosis of heart rhythm and conduction

      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.

    • 1. A completely healthy person comparatively often has local disturbances in intraventricular conduction on the right leg of the so-called bundle of His.
    • 2. If the child has an oval window open on the heart muscle, this can lead to local disturbance of the intraventricular conduction of the heart in children.
    • 3. It is possible to completely block any of the legs of the bundle of His. This can be due to the occurrence of diseases of the heart muscle such as myocardial hypertrophy (thickening and proliferation of the heart) during the development of defects on the valves, acute heart attack 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. In some cases, non-specific disturbance 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.

      When patients turn to a cardiologist with pain in the chest area, they are prescribed an ECG. Often this procedure determines violations of the intraventricular conduction of the heart. What is it and why is it developing? This will be discussed further.

      Heart disease can significantly worsen the general condition of the body, reduce its functionality and lead to serious complications. The pathology of the conduction function of the heart is especially dangerous, as it can lead to death.

      A cardiac impulse is formed in the cells of the sinus node, passes through the atrioventricular junction and goes to the ventricles, in which the pathways are represented by a bundle of His. At first it goes along the septum, then it is divided into branches, the right one descends to the ventricle of the same name, and the left one is divided into anterior and posterior, simulating contractions of the left ventricle.

      Directly in the muscle layer of the heart, conductive cells are small Purkinje fibers.

      With a decrease in the propagation velocity of the pulse, blockade of the legs occurs. This is not an independent disease, but occurs when damage to the heart muscle, pulmonary pathology, electrolyte imbalance.

      An anamnesis and physical examination may reveal arrhythmias and suggest possible causes, but the diagnosis of arrhythmias requires an ECG in 12 leads. The data obtained during the examination establish the relationship between symptoms and rhythm.

      ECG as a systematic approach, allows you to measure intervals and identify subtle irregularities. The main diagnostic signs are the frequency of atrial contractions, the frequency and regularity of ventricular contractions and the relationship between them. Incorrect activation of atrial and ventricular contractions are classified as regularly irregular or irregularly irregular (pattern cannot be detected). Regular short-term disturbance in a regular rhythm (for example, extrasystole).

      Bradyarrhythmias

      ECG diagnosis of bradyarrhythmias depends on the presence or absence of P-waves, the morphology of P-waves and the relationship between P-waves and QRS complexes.

      In bradyarrhythmias, out of the relationship between P-waves and QRS complexes, one can suggest AV dissociation; a slipping rhythm can be nodular (narrow QRS complex) or ventricular (wide QRS complex).

      Regular bradyarrhythmia with a 1: 1 ratio between P-waves and QRS complexes indicates the absence of AV block. P-waves preceding QRS indicate sinus bradycardia (if P-waves are normal) or sinus arrest with atrial bradycardia (if P-waves are different from sinus). P-waves after QRS complexes indicate a sinus arrest with nodular or ventricular rhythm with retrograde activation of the atria. Ventricular rhythm leads to the appearance of a wide complex of QRS; nodal slipping rhythm, as a rule, has a narrow QRS form.

      When the rhythm is irregular, P-waves usually exceed the number of ORS complexes. An irregular rhythm with a 1: 1 ratio between P-waves and QRS complexes, as a rule, indicates sinus arrhythmia with a gradual acceleration and deceleration of the sinus rhythm (if P-waves are sinus).

      Pauses in the case of a regular rhythm can occur due to blocked P-waves (atrial extrasystoles usually occur after the T-wave or distort the morphology of the T wave), sinus arrest or AV blockade of the 2nd degree.

      Tachyarrhythmias

      narushenievnutrizheludochkovoyprovodimos 9E65201B - Violation and slowdown of intraventricular conduction

      Tachyarrhythmias are divided into 4 groups: regular, irregular, narrow-complex and wide-complex.

      Irregular tachyarrhythmias with a narrow ORS complex. Tachyarrhythmias include atrial fibrillation, atrial flutter, atrial tachycardia with varying degrees of AV conduction, and multifocal atrial tachycardia. Differentiation is based on atrial ECG waves, which are best distinguished in pauses between QRS complexes.

      Irregular tachyarrhythmias with a wide QRS complex. There are, as a rule, 4 types of tachyarrhythmias. The separation is based on the visualization of atrial waves on an ECG and the presence of polymorphic ventricular tachycardia with a very high heart rate.

      Regular tachyarrhythmias with a narrow QRS complex. These tachyarrhythmias include sinus tachycardia, atrial flutter or atrial tachycardia with a consistent ratio of AV conduction, and paroxysmal supraventricular tachycardia. Vagus tests or pharmacological tests help differentiate these types of tachycardia.

      When using these techniques, sinus tachycardia does not stop, but conduction is slowed down or transient AV block occurs, which helps to detect sinus waves. Also, flutter and atrial tachycardia, as a rule, do not stop, but it is possible to visualize flutter waves or atrial P-waves.

      Regular tachyarrhythmias with a wide QRS complex. They include regular, narrow-complex tachycardia, with blockade of the legs of the bundle of His or by conduction of DFS and monomorphic ventricular tachycardia. Vagus tests help in the differential diagnosis between them. ECG criteria are often used to distinguish VT and SVT with a defect in intraventricular conduction.

      With a stable condition of the patient and the prolonged existence of the blockade, special treatment is not carried out. To improve myocardial conductivity, background disease must be treated.

      narushenievnutrizheludochkovoyprovodimos AB637542 - Violation and slowdown of intraventricular conduction

      Antihypertensive drugs, nitrates may be prescribed depending on the origin of this pathology. With a rare ventricular rhythm and atrioventricular block, the installation of a pacemaker may be required.

      With acute development of the blockade of the legs of His, for a temporary effect, appoint:

      • anticholinergics (Atropine, Platifillin);
      • adrenostimulants (Norepinephrine, Isadrin);
      • corticosteroids in the inflammatory process (Dexamethasone, Hydrocortisone);
      • diuretics to reduce potassium (Lasix);
      • temporary cardiac pacing.

      Types of impaired conductivity

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

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

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

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

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

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

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

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

      narushenievnutrizheludochkovoyprovodimos 5727D46E - Violation and slowdown of intraventricular conduction

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

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

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

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

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

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

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

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

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

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

      narushenievnutrizheludochkovoyprovodimos 94EF3636 - Violation and slowdown of intraventricular conduction

      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 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. But often the sudden problem of impulses is a consequence of heart disease. Possible causes of intraventricular conduction pathology:

      • myocardial infarction
      • attacks of ischemia
      • atherosclerotic cardiosclerosis,
      • heart failure,
      • myocardial dystrophy,
      • myocarditis,
      • heart defects
      • cardiomyopathy
      • arterial hypertension,
      • hypertrophy of the heart.

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

      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 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.

    • The first degree means slowing down the passage of pulses.
    • In the second degree, part of the pulses are blocked, but the rest pass through a pathologically altered portion of the conducting system.
    • 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.

      Treatment of intraventricular blockade

      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 disturbances:

      narushenievnutrizheludochkovoyprovodimos E796F274 - Violation and slowdown of intraventricular conduction

      if conduction disturbance has arisen 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.

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

      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-s >narushenievnutrizheludochkovoyprovodimos 2A84FA14 - Violation and slowdown of intraventricular conduction

      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.

      The causes of different types of blockades differ from each other, cause unequal changes. Consider how a violation of intraventricular conduction is formed in diseases of the myocardium.

  • Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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