Left ventricular obstruction what is it

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

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

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

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

Why is a violation of cardiac intraventricular conduction

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.

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.

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.
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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.

Diagnosis: signs on ECG and halter

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.

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.

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.

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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.

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).

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.

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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.

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.

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Svetlana Borszavich

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

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