Local slowdown of intraventricular conduction

The conduction system originates from the node of the sinoatrial zone, in which the sinus rhythm originates, from here the impulses go to the atrioventricular node and enter the legs of the bundle of His.

Partial blockades appear in healthy people, therefore, do not apply to diseases. But if their origin is observed against a background of heart diseases, then it is required to take medical measures.

The causes of the following:

  • A heart attack.
  • Ischemic disease
  • Cardiosclerosis is a pathological process that affects the myocardium, proliferation of connective tissue is observed, scars of different sizes and localization are formed. In this case, the pathology is observed against the background of atherosclerosis.
  • Heart failure.
  • Heart disease.
  • High levels of thyroid hormones.
  • High blood pressure.
  • Heart hypertrophy – a lesion with difficulty in contracting.
  • Myocarditis is an inflammatory lesion of the heart muscle.
  • Cardiomyopathy – an increase in the size of the heart, its insufficiency, worsening heart rate, conduction.

The provocateurs of the violation can be an imbalance of electrolytes, excessive intake of certain drugs, lung disease, pulmonary embolism and other factors.

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

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

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.

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.

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.

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

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

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

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

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

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

438 01 - Local slowdown of intraventricular conduction

Conduction of the heart muscle is a concept that reflects the excitation of the parts of the conduction system, which is represented by the sinoatrial node in the right atrium, the conductive fibers in the wall of the atria, the atrioventricular node between the atria and ventricles, and two legs of the bundle of His in the thickness of the ventricles ending in Purkinje fibers.

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

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

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

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

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

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

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

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

How is the diagnosis

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.

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.

article1147 - Local slowdown of intraventricular conduction

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).

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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

Polnaja blokada pravoj nozhki puchka Gisa - Local 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.

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.

To detect impaired atrial conduction, the ECG gives the most information. A standard technique is not always sufficient, then Holter monitoring, transesophageal registration, or electrophysiological examination are used.

The duration of the P wave exceeds the norm (0,12 s). It should be noted that in only 3% of cases it reaches 0,13-0,15 seconds, in the vast majority – about 0,125 s. If the blockade is not constant, then the duration of P is always greater than PR. The atrial tooth can become flat, biphasic, deformed. Often, degree 1 blockade is combined with nodular or intraventricular conduction disturbances, extrasystole.

Second degree

Each subsequent contraction has an ever longer P, and then a wave appears, emanating only from the right atrium, and the left does not contract. This corresponds to the first option 2 degrees of blockade. There is also a variant in which there is no gradual increase in P, and the pulses periodically do not reach the left atrium.

Signals from the right atrium are completely blocked. The left atrium produces its own slow rhythm – about 40 contractions per minute. In shape, the ectopic P is small, the intervals between them and ordinary teeth are not regular. An additional atrial rhythm is atrial fibrillation or atrial flutter, unilateral tachycardia.

The right atrium and ventricles receive excitation waves from a normal (sinus) source, while abnormal signals never propagate to them, and the main rhythm does not affect the ectopic. This is the main symptom of atrial dissociation.

Expert opinionAlena AricoExpert in the field of cardiology

Not always this picture reflects a serious heart disease. False atrial dissociation can appear on the ECG with a poor fit of the electrodes, the doctor touches the patient during the registration of the cardiogram, in a cold room, with respiratory failure, hiccups, parkinsonism.

The intra-atrial blockade does not pose a direct threat to life, however, its presence in the patient may indicate that he has a high risk of atrial fibrillation, which can lead to dangerous complications.

atrial fibrillation – a dangerous complication of atrial conduction

If the patient has found such symptoms, he needs to contact a cardiologist, and preferably an arrhythmologist for further examination and to decide on the need for treatment.

The doctor will prescribe additional research methods:

  • Holter ECG monitoring for more accurate diagnosis of conduction disturbances at different times of the day,
  • ECG tests with load – treadmill – test, bicycle ergometry. Walking on a treadmill or pedaling on a stable bike with superimposed ECG electrodes will help to more accurately identify the connection of conduction disturbances with the load,
  • Ultrasound of the heart (echocardiography) visualizes the anatomical structures of the heart, reveals heart disease, and also allows you to evaluate the function of myocardial contractility.

Important! If you notice symptoms of conduction disturbances, or they were detected on an ECG, you should consult a doctor as soon as possible in order to exclude dangerous heart diseases that require active treatment.

  • Causes of organic origin (they are caused by abnormal processes in the structure of signal paths).
  • Functional causes (pathological disorders of the heart and blood circulatory system do not occur, the principle of functioning of the signaling system changes, unbalanced functioning of the sympathetic and parasympathetic systems is noted).
  • Taking medications that affect the rhythmic functioning of the heart, the nature of such anomalies is manifested by acute symptoms and a weak reaction to the therapeutic effect.
  • cardiac ischemia;
  • myocardial infarction;
  • cardiosclerosis;
  • pathologies associated with cardiomyopathy;
  • benign tumors of fibrous connective tissue, or fibroma;
  • tumors or metastases in the region of the heart;
  • amyloidosis;
  • manifestations of angina pectoris;
  • high degree of hypothermia.

symptomatology

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

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

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

Most blockade of the His bundle is found only on the ECG without any symptoms or against the background of the main manifestations of the disease that caused this deviation. With poor circulation, weakness, dizziness, and fainting appear. They are associated with low discharge of blood into the arterial network due to non-synchronous contraction of muscle fibers.

Blockade PNPG

The right ventricle is excited by signals coming from the left heart. This is manifested by an expanded S, high, wide R, the ventricular complex acquires a qRS configuration, it is elongated to 0,11 seconds.

Blockade of the LDL

With a complete defeat, there is no movement of signals along the trunk or two branches at once. The excitation spreads to the left ventricle from the right through Purkinje cells. The electrical axis is deflected to the left, the QRS is wide and deformed.

The front part of the leg is responsible for the contraction of the anterolateral wall. With blockade, impulses approach from the back wall in the direction from the top of the heart to the base. When the rear branch is blocked, the excitation waves go in the opposite direction. It is characterized by an increase in ventricular complexes on the electrocardiogram.

It is possible to suspect a violation of conduction on PNPG and the front part of LDL by expanded QRS, S notch, negative T, displacement of the axis of the heart to the left. If the right leg and the back branch of the left are affected, then on the ECG there are signs of a blockade of PNPG and a deviation of the axis to the right. This combination is often found with common injuries (extensive heart attack, myocarditis).

If all three branches are blocked, then the waves pass along the less broken, atrioventricular blockade joins. With a complete stop of the atrial signals, they function in a normal rhythm, and the ventricles contract with their own (idioventricular) frequency. On the ECG, different durations of PQ intervals are noted. Often, a complete three-beam blockade leads to atrial fibrillation or stopping contractions.

If the results of standard ECG recordings were not convincing enough, then the transesophageal method or Holter monitoring, rhythmocardiography can be used. To detect the cause of conduction blockade, patients are prescribed ultrasound of the heart, MRI, MSCT, positron emission tomography.

Causes of conduction disturbance may be:

  • general diseases accompanied by a change in metabolism (endocrine pathology, systemic collagenoses);
  • local damage to the conduction system by areas of ischemia, inflammation, cardiosclerosis, myocardial distension with hypertrophy of individual sites.

After scarring of the necrosis zone, myofibrils and conducting cells are gradually replaced in areas of cardiosclerosis

Inflammatory reaction (myocarditis) is most often found with:

  • acute infectious diseases of a viral and bacterial nature (influenza, acute respiratory viral infections, diphtheria in children, rheumatic attacks after tonsillitis);
  • autoallergic processes on the background of vasculitis with the involvement of coronary vessels;
  • productive granulomatous inflammation.

The area of ​​ischemia caused by insufficient blood supply to the conducting fibers depends on thrombosis in both the right and left branches of the coronary arteries. Sometimes by the type of intraventricular blockade they judge the possible localization of a heart attack.

Pathology is observed in acute heart attack, chronic coronary insufficiency.

Heart defects cause deformation of the heart chambers, overstretching and hypertrophy. Therefore, a violation of conduction in children with congenital changes in the structure of the chambers and valve apparatus is not uncommon.

The development of left ventricular hypertrophy with hypertension, cardiomyopathy also leads to interruption of the ventricular impulse propagation paths. In these cases, the degree of blockade indicates the severity of the lesion.

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

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

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

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

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

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

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

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

  • 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.

Each blockade has its own characteristics. They depend on the localization of the focus of the violation. Most often, with incomplete blockade, there are no obvious manifestations of the pathology, except for ECG readings. Complete blockade can manifest itself with symptoms of different intensity, for example:

  1. With sinoatrial complete blockade, shortness of breath, chest pain, a rare and weak pulse are felt.
  2. Atrioventricular complete block is characterized by a significant slowdown in the rhythm of the heart, fainting is possible.
  3. With atrial conduction disturbance, the blockage, as a rule, passes without visible signs. Sometimes shortness of breath occurs, legs swell.
  4. Intraventricular absolute blockage (in the branches of His) is manifested by a decrease in heart rate, sharp weakness, nausea, loss of consciousness, secretion of cold sweat.
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Therapies

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

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

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

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

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).

Stable long-term intraventricular block does not require specific treatment. The initial detection of intraventricular changes, especially in an elderly patient, requires hospitalization and a full examination to determine the causes.

Ischemia involves the use of coronaryolytics and the careful use of weak β-blockers.

If the inflammatory nature of the changes is detected, a course of antibacterial therapy, hormonal drugs is carried out.

In the case of combination with chronic heart failure, small doses of digitalis and diuretics are used.

It is important to timely resolve the issue of the appropriateness of installing a pacemaker. This is especially true for cases of two- and three-beam blockades.

Treatment is carried out under the supervision of a local doctor in a clinic or in the cardiology (arrhythmology) department. Therapy should begin with the elimination of the cause of the conduction disturbance. If no heart diseases are detected, vitamins and drugs are prescribed that improve the nutrition of the heart muscle, for example, preductal, ATP, etc.

With a complete violation of conduction, which causes severe bradycardia, the issue of installing an artificial pacemaker is resolved.

With the syndrome of ERW and shortened PQ with severe symptoms of tachyarrhythmias, radiofrequency ablation (RFA) is possible. This is the destruction of additional conduction beams by introducing equipment through arteries into the heart cavity.

  1. If a person has a violation of intraventricular conduction, treatment that would directly affect the existing block is not carried out. With this pathology, all resources should be directed to the identification and treatment of the underlying disease. For example, if the disease is caused by hypertension, it is necessary to take antihypertensive drugs, as well as follow a proper diet and lead an active lifestyle.
  2. In the event that the blockade is asymptomatic, it is necessary to observe it in dynamics until the first changes are detected. Then also start therapy for the underlying disease.
  3. In the event that the development of an atrioventricular block is noted, the installation of a pacemaker may be necessary. This intervention consists in implanting an artificial pacemaker to the patient, in the role of which special devices act. The reasons for installing the stimulator are:
  • Conduction disturbances leading to fainting or severe shortness of breath.
  • Patient disability.
  • The inability to treat the underlying disease.
  • The formation of circulatory failure.

You must understand that the use of pacemakers requires compliance with certain rules, in particular:

  • Avoid procedures based on magnetic impulse (MRI).
  • Do not resort to physiotherapeutic treatment.
  • Avoid electric shock.
  • Do not injure your chest.

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.

If there is a threat of developing an atrioventricular focal block, the patient is immediately hospitalized and a method such as catheterization is prescribed.

Take care of yourself and be healthy!

The pathways of the main organ of the circulatory system include the following departments: the synotrial center in the area of ​​the right atrium, the atrial tissues, the atrioventricular center at the junction of the atria and ventricles of the heart, the bundle of His and its right and left branches, the distant area is the branches of the Purkinje bundle.

The path contributes to the origin and passage of the contractile signal through the heart, so that it performs contractile actions. This activity contributes to the pumping of blood inside the chambers and sending it to the blood vessels. Sometimes there is a violation of the intraventricular conduction of the heart. What it is? This is the suspended passage of the pulse through the wire channels or its complete absence. As a result of such phenomena, arrhythmia develops.

The choice of therapeutic effect depends on the cause of conduction disturbances inside the ventricles. For example, with myocarditis, antibacterial drugs are usually prescribed, as well as glucocorticosteroids. If the problem is thyroid dysfunction, an endocrinologist should be involved in the treatment.

In the absence of heart disease, it will be useful to prescribe vitamin complexes that strengthen the heart muscle, drugs to improve organ nutrition. If shortened conductivity is observed, there are no organic disorders, treatment is not carried out.

Pregnancy research

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Types of disease

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

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

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

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

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

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

09 e1469635436428 - Local slowdown of intraventricular conduction

Causes of the disease

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

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

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Main symptoms

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

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

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Symptoms in non-specific cases of the disease

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

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

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

Pathology Diagnosis

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

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

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

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

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

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

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

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

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

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

Violation of conduction along the atrioventricular node

AV block of 1 and 2 degrees means that the excitation to the ventricles from the atria is delayed, but the impulses still reach the ventricles. A complete blockade of grade 3 indicates that not a single impulse passes to the ventricles, and they contract separately from the atria. This is a dangerous condition, since 17% of all cases of sudden cardiac death are caused by blockade of the 3rd degree.

  • As a rule, atrioventricular block develops with defects, coronary heart disease, in the acute period of myocardial infarction, with myocarditis (inflammatory myocardial damage), cardiosclerosis (replacement of normal heart muscle with scar tissue due to myocardial infarction, myocarditis),
  1. Blockade of degrees 1 and 2 may not be symptomatic if there is a slight decrease in heart rate (50 – 55 per minute),
  2. With grade 3 blockade, as well as if significant bradycardia is observed (less than 40 per minute), attacks of Morgagni – Edems – Stokes (MES attacks) develop – sudden weakness, cold sweat, fainting, and loss of consciousness for several seconds. Convulsions due to depletion of blood flow in the vessels of the brain are possible. An attack requires emergency care, as it can cause complete cardiac arrest and death.

The ECG shows prolapse of the ventricular complexes at a normal atrial contraction rate (the number of P waves is greater than the QRS complexes)

Conducting arousal in the heart can be not only slowed down, but also accelerated. This is due to the functioning of additional pathways for conducting an impulse, for a given pathology of Kent bundles through an atrioventricular junction. As a result, excitation is transmitted to the ventricles much faster than normal, causing them to contract more often, and moreover, the impulses move in the opposite direction to the atria, provoking supraventricular tachycardia.

On the ECG, the arrow indicates a characteristic symptom of ERW syndrome – the “delta” wave at the beginning of the ventricular complex

Causes

ERW – a syndrome is a congenital disease, as normal additional pathways in the fetus are closed after 20 weeks of pregnancy. In the case of ERW syndrome, they remain functioning. The occurrence of this pathology can be affected by a genetic predisposition, negative factors acting on the fetus (radiation, drug use, alcohol, toxic drugs, pregnant women).

Symptoms

The syndrome can manifest itself both in childhood and in adulthood, or it may not appear at all, and then it is diagnosed only by ECG. Signs of sinus tachycardia or atrial fibrillation are characteristic – increased heart rate of more than 200 per minute, chest pain, shortness of breath, feeling of lack of air. In very rare cases, it is possible to develop life-threatening arrhythmias – ventricular fibrillation.

It is a peculiar form of ERW syndrome, only James’s bundles between the atria and the lower part of the atrioventricular node act as abnormal paths. Also an innate feature. If it is diagnosed only by ECG, not accompanied by symptoms, then they talk about the phenomenon of shortened PQ, and if accompanied by signs of tachycardia, then about the syndrome of shortened PQ. Differences between ERW and PQ syndromes in ECG signs.

More often, before the onset of an attack, patients experience prodromal symptoms:

  • note anxiety, excitement;
  • increase in dizziness;
  • noise in the head;
  • numbness of the arms and legs appears.

These signs are also called a mild form, if the further development of symptoms stops.

Further, the manifestations are aggravated:

  • loss of consciousness;
  • a sudden fall of a walking person is possible;
  • the complexion of the skin changes – from redness to pallor with a bluish tinge;
  • respiratory movements become rare and deep;
  • dilated pupils;
  • on the arms and carotid arteries it is impossible to determine the pulsation.

Severe course is characterized by the appearance of:

  • cramps in the form of twitching of facial facial muscles or sharp contractions of limbs, muscles on the back;
  • involuntary discharge of urine and feces.

Seizures with the described clinic affect up to 60% of patients with complete atrioventricular block

The frequency of their appearance varies significantly in different patients, depending on the effectiveness of treatment.

(sinus node dysfunction, Arrest-2-sinus) This pathology is very close to sinoauricular blockade, but differs in that P cells that produce a sinus rhythm, rather than T cells, suffer. In this case, bradycardia is frequent, which is steadily increasing and resistant to vagolitics (atropine and its analogues). Then, as the weakness of the sinus node increases, heterotropic foci in the atria become excited – paroxysmal rhythm disturbances occur:

alina foto supermini - Local slowdown of intraventricular conduction

paroxysmal tachycardia or atrial fibrillation and flutter. Upon exit from tachycardia, the period of systole is within a few seconds, and then sinus bradycardia reappears. This pathological condition is associated with an organic lesion of the sinus node (damage to the P cells), it exhausts the patient, prolonged delay may lead to his death. Arrest-2-sinus syndrome is an indication for constant electrical stimulation – surgical intervention.

Anatomy

At the junction of the superior vena cava and the right atrium there is a group of cells that generates the initial electrical impulse of each normal heart beat – the sinus node (SU). The electrical impulse of these pacemaker cells spreads to neighboring cells, which leads to stimulation of the heart chambers in an ordered sequence.

Impulses propagate within the atrium to the atrioventricular junction (AB) through the preferred conduction of atrial interstitial tracts and non-specialized myocytes. AV delay time affects the heart rate and is modulated by autonomic tone and catecholamines circulating in the bloodstream to maximize cardiac performance at any time.

The atria are electrically isolated from the ventricles by the fibrous ring everywhere, except for the anterior septum. There is a bundle of His (continuation of the AV node), which enters the interventricular septum, where it bifurcates into left and right bundles.

Types of ventricular blockade

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 >438 02 - Local 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.

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

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

Any violation of intraventricular conduction entails a more or less pronounced interruption of the pulse transmission method. Such changes are called blockades. They are functional or organic in nature. Most often, obstruction of the ventricular tract reflects the degree of damage to the heart muscle by a pathological process.

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

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

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

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

By prevalence among the population:

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

Impaired conduction in the posterior lower bundle is rare.

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

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

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

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

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

ECG – deformed ventricular complexes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Violations are divided by the frequency of the lesion: intraventricular block of the left ventricle proximal and distal, bpn.

Violation of the intraventricular conduction of the heart occurs if the time changes pathologically, during which the electrical impulse of the sinoatrial node must pass through the conducting heart system and reach the ventricular myocardium. Atrioventricular conduction and its quality play a huge role in the activity of the heart, therefore, any of its violations entail various diseases and complications.

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.

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 blockade of the right leg with the left rear branch

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

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

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

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

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

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

The reasons for the incomplete blockade should be added:

  • myocarditis (rheumatic heart disease, consequences of infectious viral diseases in a child);
  • diffuse and focal cardiosclerosis;
  • thickening of the left ventricle with hypertension;
  • intoxication with drugs (digitalis derivatives, quin >438 05 - Local slowdown of intraventricular conduction

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

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

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

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

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

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

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

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

ECG picture for myocardial infarction with left leg blockade

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

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

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

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

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

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

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

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.

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.

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

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

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

preventive measures

There are no special preventive measures. The only way to reduce the risk of developing cardiac conduction disorders is to lead a healthy lifestyle, prevent advanced cardiac pathologies and drug overdoses, be regularly examined by a therapist and cardiologist if there are appropriate indications.

To prescribe the treatment of blockades, it is necessary to determine their main cause. To differentiate organic lesions from the increased influence of the vagus nerve, in mild cases, an atropine test is performed.

Subcutaneous administration of a small dose of Atropine can remove the effect of the parasympathetic nervous system. If the ECG picture is restored during control, then the patient is recommended to use belladonna-based preparations (candles in the rectum, Zelenin drops inside, Bellaspon or Bellataminal tablets) inconstantly.

The detection of myocarditis, the effects of metabolic changes, hormonal disruptions, ischemia, hypertrophy allows the use of therapy according to the pathogenetic principle:

  • anti-inflammatory drugs (antibiotics, corticosteroids, cytostatics);
  • alkalizing agents;
  • β-blockers and calcium channel blockers;
  • antiplatelet agents and thrombolytics;
  • funds for lowering blood pressure;
  • prompt elimination of heart disease.

Theofedrine – an analogue of ephedrine, is contraindicated in hypertension

When a classic Morgagni-Edem-Stokes attack occurs, the patient needs emergency care, because cerebral circulation is at risk. There is no time to talk about the reasons anywhere in the discovery. An adult is able to:

  • lay the patient on a hard surface;
  • inflict intense fist on the sternum;
  • start conducting cardiopulmonary resuscitation events in the maximum accessible volume (only heart massage or in combination with artificial respiration);
  • ask others to call an ambulance.

Doctors in such cases quickly listen to the heart to make sure of weak rare strokes, measure blood pressure.

438 06 - Local slowdown of intraventricular conduction

Against the background of continued indirect massage and breathing, funds stimulating cardiac activity (Adrenaline solution, Ephedrine) are administered intravenously through the Ambu bag.

Outpatients are recommended to take a maintenance dose of Isadrin, Alupent.

In case of frequent seizures, the issue of indications for the installation of a pacemaker is considered.

Detection of conduction abnormalities in a person with an acute or chronic disease is considered a complication. This symptom requires a review and continued treatment for a longer period.

It is equally important to control the temporary form of blockades. Especially if their cause remains unclear

The patient should undergo an ECG test at least twice a year.

Physiology

To understand the causes of rhythm disturbances, it is necessary to have an idea of ​​the normal physiology of the heart.

Electrophysiology

The passage of ions through the cell membrane of the myocyte is regulated through specific ion channels that cause cyclic depolarization and repolarization of the cell, called the action potential. The action potential of a working myocyte begins when the cell is depolarized from a diastolic – 90 mV transmembrane potential to 50 mV.

At this threshold potential, potential-dependent fast Na channels open, causing rapid depolarization by reducing the concentration gradient of Na ions. Fast Na channels are inactivated and Na influx ceases, but voltage-dependent ion channels are open, which allows Ca to enter through the slow Ca channels (depolarization) and K to escape through K channels (repolarization).

Firstly, these two processes are balanced and support a positive transmembrane potential, and also extend the plateau of the phase of the action potential. During this phase, the Ca entering the cell is responsible for the electromechanical conjugation and contraction of the myocyte. In the end, the influx of Ca ceases and efflux K is enhanced, causing rapid cell repolarization back to 90 mV. During depolarization, the cell is refractory to a subsequent depolarizing event.

There are 2 main types of cardiac cells:

  • Fast channel cells
  • Slow Canal Cells

Cells with fast canals (working atrial and ventricular myocytes, His-Purkinje system myocytes) have a high density of fast Na channels and their action potentials are characterized by a small or complete absence of spontaneous diastolic depolarization, a very fast initial depolarization rate and loss of refractoriness, coinciding with repolarization.

Cells with slow channels (CA and AV nodes) have a low density of fast Na channels and their action potentials are characterized by faster spontaneous diastolic depolarization, a slow initial depolarization rate and loss of refractoriness after repolarization (and therefore have a long refractory period and the impossibility of repeating pulses at high frequencies).

The CA node is the dominant automatic pacemaker in the normal heart. If the CA node does not produce pulses, cells with a slightly lower automatism (for example, the AV node) take on the role of automatic pacemakers. Sympathetic stimulation increases the frequency of activity of pacemaker cells, and parasympathetic stimulation decreases.

Normal rhythm

At rest, the frequency of the sinus rhythm of the heart in adults is usually from 60 to 100 beats/min. A lower frequency rhythm often occurs in young people. An increase in the rhythm frequency occurs with physical exertion, illness, or emotion. As a rule, a noticeable daily decrease in heart rate occurs before morning awakening. Absolutely regular (rigid) sinus rhythm is pathological and occurs in patients with autonomic denervation (for example, in diabetics).

The electrical activity of the heart is presented on an ECG, although the depolarization of the CA site, AV site, and His – Purkinje does not involve enough tissue to be detected.

Three-beam blockade

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

The reasons are severe organic myocardial lesions already listed above.

The shape of the teeth indicates the type of intraventricular block

How is ECG conductivity different?

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

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

Sometimes changes in the ventricular complexes are not considered specific, since they are also present in cases of acute pulmonary heart and right ventricular hyperfunction. Transient blockade simulates ventricular extrasystole.

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

When assessing the features of blockades for a doctor, it is important to look at previous ECGs to be sure of the age of changes. Stable long-term intraventricular block does not require specific treatment

The initial detection of intraventricular changes, especially in an elderly patient, requires hospitalization and a full examination to determine the causes

Ischemia involves the use of coronaryolytics and the careful use of weak β-blockers. If the inflammatory nature of the changes is detected, a course of antibacterial therapy, hormonal drugs is carried out.

It is important to timely resolve the issue of the appropriateness of installing a pacemaker. This is especially true for cases of two- and three-beam blockades.

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

Violation of sinoatrial conduction

438 07 - Local slowdown of intraventricular conduction

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

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

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

Classification

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.

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.

Prevention

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.

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

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

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

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

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

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

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

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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