home→Ulcer→ Partial blockade of the bundle of hys in adults. What threatens the incomplete blockade of the right leg of the bundle of hys

Partial blockade of the bundle of hys in adults. What threatens the incomplete blockade of the right leg of the bundle of hys

Incomplete blockade of the right bundle branch block is a fairly common diagnosis after an ECG. Many may not even suspect that there are problems with their heart. This pathology is early stages can be asymptomatic, this is the insidiousness of the disease.

Causes of disease in modern world may be many factors. The older the person, the greater the likelihood of failures in the conduction system of the heart, and for children this can be the norm if they do not have other signs and complications. But in no case, in any other case, this disease cannot be ignored.

If you are faced with such a problem as an incomplete blockade of the right leg of the His bundle, do not panic, the treatment provided on time will give a positive result. In this article we will tell you what kind of ailment it is, what symptoms and treatment methods can be.

In the case of such a disease, the conduction of an electrical impulse along the right leg worsens or stops. At the same time, pathological processes do not spread to the left leg, and impulses through it are carried out fully, albeit with a delay. Intact branches provide excitation of the ventricular myocardium, but the transmission process is slow.

In this case, there is such a violation as incomplete heart block of the 1st degree. However, even passing through the intact bundle branch of His, not all impulses can reach the ventricular myocardium. This indicates the development of complete blockade hearts 2 degrees.

If the impulses from the atria do not pass to the ventricles, then this condition is characterized as a complete blockade of the bundle branch of His. Isolated incomplete blockade of PNPG is isolated separately. The causes of the latter remain unknown.

Any of the situations described can be detected only with the help of instrumental diagnostics. Patients with symptoms of this disease are prescribed a mandatory electrocardiogram. How does incomplete blockade of PNPG manifest itself on the ECG?

The legs of the bundle of His are the conductive element of the cardiac system, responsible for conducting electrical signals through the ventricles of the heart. The bundle of His consists of three separate parts:

posterior leg of the bundle of His;
right anterior and left anterior leg of His.

Blockade of the legs of the bundle of His is an intracardiac conduction disorder characterized by a complete cessation or slowing of the conduction of the excitation impulse along several or one of the branches of the bundle of His.

In addition, this violation can only occur when:

instrumental research methods;
symptomatic disorders heart rate;
bouts of loss of consciousness;
frequent dizziness.

Similar symptoms of the disease are the most characteristic of incomplete blockade of the right leg of the bundle of His. Diagnosis of blockade of the bundles of His is carried out by electrocardiography.

Treatment of this disorder can be reduced to the elimination of the main causes of the disease (conduction disorders).
In some cases, it is possible to install an artificial pacemaker.

Incomplete blockade of the right leg of the bundle of His is a variant of the norm, when the heart impulse travels along a longer propagation path, while, in any case, reaching its specific goal.

As a comparison, let's give one specific example: approaching any building, you can go around or in a straight line, still reaching your final goal (go through open doors). However, in the first case, your path will be a little shorter, and, in the second, a little longer.

Blockade of the right leg of the bundle of His does not require any special methods of treatment. You should not feel any anxiety about this. A completely different matter can be observed with the blockade of the left leg of the His bundle, since this violation is very serious and requires active therapy from a cardiologist. The legs of the bundle of His are responsible for regulating the rhythms of the heart.

Incomplete blockade of the right leg of His is a common violation of intraventricular conduction, occurring mainly in middle-aged and older people. Common causes of this pathology are various diseases leading to organic damage to the heart muscle, such as coronary heart disease, essential hypertension (hypertension), rheumatic malformations and many others.

However, in some cases, incomplete blockade of the right bundle of His is detected in relatively healthy individuals, which indicates a previous heart disease (myocarditis and others) rather than the functional nature of conduction disturbance.

The right leg of the bundle of His is the most important part of the conduction system of the heart, which ensures the conduction of electrical impulses to the myocardium of the right ventricle. An incomplete block of the right leg of the His bundle leads to a violation of the excitability and, accordingly, the contractility of this part of the heart, which, however, is not accompanied by any significant symptoms and hemodynamic changes.

By itself, partial blockade of the right bundle of His bundle does not require specific treatment, but it serves as a factor aggravating the course of the underlying cardiac disease, which necessitates correction of therapy.

Such diseases include heart defects (congenital, in which there is an excessive load on the right ventricle, defects in the partitions between the atria, ventricles), mitral stenosis, heart disease, coronary artery disease, acute conditions (heart attack), arterial hypertension and cardiosclerosis.

The causative factors for the development of an incomplete type of blockade are intoxication or overdose of medications (from the group of digitalis, adrenoblockers), electrolyte metabolism disorders. Due to the development of the blockade, the conduction of impulses through the heart system slows down, which leads to the fact that there is no physiological, full-fledged excitation of the right sections.

The diagnosis of blockade separately at the level of the right leg can only be established on the basis of an electrocardiographic study. At deciphering the ECG changes in the QRS complex are detected (expansion and serration of its final part), while the duration of the complex itself is usually increased.

IN chest leads the R wave will be enlarged and serrated, the ST segment will be lowered. What kind congenital causes exist:

violations of the interatrial septum;
congenital heart defects that overload the right ventricle;
M.Lev disease (unexplained etymology);
ventricular septal defects;
Legere's disease (cardiac conduction disorders in children);
arterial stenosis of the pulmonary vessels;
underdevelopment of the right leg of the bundle of His.

Acquired Causes:

progressive pathologies in sarcoidosis (myocardium and the like);
overdose of novocainamide, quinidine, cardiac glycosides;
increased potassium content (hyperkalemia);
muscular progressive dystrophy;
cardiac neoplasms;
blunt trauma to the sternum;
obstructive chronic pulmonary diseases.

Incomplete blocking of the right leg of the bundle of His is a partial violation of the electrical impulse passage along the right leg of the His.

Incomplete blockade of the right leg of the bundle of His, as untreated, does not carry with it absolutely no threat to the life of a pregnant woman. Even with the progression of the disease, it is only necessary to treat it.

Who is at risk

Various types of blockades of the right leg, as medical statistics show, most often occur in men. Blockades of the left leg, on the contrary, are most characteristic of women aged 50 to 70 years who suffer from hypertension.

The older the person, the more likely it is that the violation in the transmission of cardiac impulses that has appeared in him will have a complete form.

In children, incomplete blockades of the right leg are not uncommon, but this deviation does not pose a danger to the health of the child when he does not have cardiac pathology, disorders in the functioning of the cardiovascular system and respiratory organs.

Even if incomplete blockade is asymptomatic, it affects the functioning of the ventricles. Therefore, when predicting the development of any type of blockade, the state of the ventricular tissues is taken into account without fail.

There is a whole list of diseases that can provoke the occurrence of an incomplete blockade of the right leg of the Gis launch. Complete and incomplete forms of the disorder can be congenital and acquired. Is blockade inherited?

Controversial question. Today it is generally accepted that it is not transmitted, but the predisposition to problems with the transmission of electrical impulses in the internal organ can still be inherited. To provoke the occurrence of an incomplete blockade of the right leg are capable of:

congenital and acquired heart defects;
ischemic disease;
stenosis;
heart failure;
myocardial infarction.

An overdose of the use of drugs entails various disorders in the functioning of internal organs, kidney and liver failure. In medical practice, it is not uncommon for medications used against arrhythmias cause a complete and partial disruption of the transmission of electrical impulses in the heart.

Lung pathologies also have an effect on the heart. If a person is diagnosed with, for example, pulmonary hypertension, it is likely that it will cause the appearance of a complete or incomplete form of blockade of the legs.

Acute myocardial infarction and cardiosclerosis are fertile ground for disturbances in the conduction of electrical impulses. Tricuspid valve insufficiency and right ventricular hypertrophy can lead to a similar result.

The general state of the body and destructive changes in the functioning of internal organs are closely interconnected. When the balance of electrolytes is disturbed in the body, conditions are created for the occurrence of blockades of the legs of the bundle of His.

When the violation becomes acute, drug therapy is required. But here there is another important point: all the drugs that modern medicine has are able to have a temporary effect, and their treatment of the blockade can lead to unpredictable consequences, among which there is an aggravation of the pathological condition.

For the blockade of any of the legs of the bundle of His, a persistent or transient form is characteristic. In the second case, the blockade state can either disappear or appear, but intraventricular conduction will remain the same.

There is also an alternating form of partial disruption of the transmission of electrical impulses in the heart, when the state of blockade is observed alternately on one or the other leg. Blockade symptoms are difficult to detect. This is due to two main reasons:

most blockades are asymptomatic;
the disturbances they cause in the functioning of the heart are characteristic of already existing pathologies internal organ.

Heart rhythm and heart rate disturbances are common in many heart diseases, but these symptoms are not observed with incomplete blockades.

If the blockade of the His release leg is not partial, patients may complain of dizziness, clouding of consciousness, and the fact that it often becomes difficult for them to breathe. All these are the consequences of a violation of the transmission of cardiac electrical impulses, but they are typical for various pathologies of internal organs, including the lungs.

It is necessary to carry out diagnostics in order to check the condition of the legs of Gis when a person, for no apparent reason, often began to feel increased fatigue and an unreasonable decrease in efficiency.

Important to know: a clinical analysis of blood and urine will not be able to help determine the deviation in the transmission of impulses. To detect a violation, it is necessary to undergo an examination of the hormonal status and Hotler ECG monitoring. The latter method is unique in that it allows you to identify a complete and incomplete violation of the transmission of electrical impulses in the internal organ.

This type of ECG allows doctors to record changes that entail different kinds blockade. Differentiation of clinical symptoms of cardiac pathologies and pathological abnormalities is a rather difficult issue, especially when disorders in the functioning of the internal organ have typical and atypical signs.

Holter ECG monitoring makes it possible to determine in each case clinical symptoms at the time of blockade. Indispensable conditions for the effective implementation of the diagnosis are the simultaneous recording of the patient's sensations and monitoring of clinical symptoms.

This information is of particular value in determining the cause of disturbances in the transmission of electrical impulses by doctors. Classical ECG is also widely used to diagnose blockades. To perform a traditional ECG, the transesophageal method is used.

It is one of the most informative ways. During such a diagnosis, sinus arrhythmia is also determined, which is characteristic of an incomplete blockade of the right leg of the His bundle.

She must not be disturbed. This rule applies to incomplete blockade of the right leg, which is not as dangerous as violations that occur on the left. Treatment of partial blockade is required:

if its appearance coincided with an exacerbation heart disease;
when a blockade of the left leg is observed in parallel.

In such cases, pacing methods help to restore the normal functioning of the internal organ. If in an elderly person the development of an exacerbation of cardiac pathology coincides with any of the forms of blockade of the right leg, he needs urgent hospitalization.

When the deterioration of the patient's condition with progressive cardiac pathology and incomplete blockade continues, drug therapy is used.

In such cases, doctors prescribe to the patient the intake of anticholinergics, drugs that increase the effect of symptoms on the cardiac conduction system, glucocorticosteroid hormones, and agents that reduce the content of potassium in the body.

All of them are usually administered intravenously. They are not able to completely cure the blockade, but they are able to restore the transmission of electrical impulses. The prognosis of blockade therapy is usually favorable if the risk of aggravation of concomitant cardiac pathology is excluded or minimal.

Clinically incomplete blockade of the right branch of the bundle of His does not manifest itself in any way. In most cases, pathology is detected by chance during a routine preventive electrocardiographic examination.

Due to the fact that impulse conduction disturbances inside the ventricles most often occur against the background of organic damage of the heart, patients with this pathology may present "cardiac" complaints, such as:

Chest pain.
Dyspnea.
Edema on the legs.
Raise blood pressure.
Cyanosis of the mucous membranes and skin (bluish tint).

In some rare situations, incomplete blockade of the right n p of His may be accompanied by a decrease in heart rate to 55-60 beats per minute or lower, which is due to the redistribution of the excitation wave along the conduction system of the heart and the relative activation of the Purkinje fibers that transmit impulses from the branches of His to the cardiomyocytes proper.

It should be noted that, despite such frightening reasons, usually an incomplete blockade of the right leg proceeds quite benignly. Moreover, with an isolated incomplete blockade of the right leg, that is, in the absence of organic disorders in the myocardium, the process rarely turns into a complete blockade.

An isolated incomplete blockade of the right leg of the bundle of His does not manifest itself in any way and, as a rule, is an accidental finding during an ECG for completely different reasons, for example, during a routine medical examination or a medical examination before being drafted into the army.

In other cases, there will be symptoms of the underlying disease, since the incomplete blockade of the bundle branch itself has no symptoms and is detected only by auscultation (listening) of the myocardium and ECG.

The only option in which you can suspect the presence of a blockade before electrocardiography is the usual auscultation of the heart, or listening to it with a phonendoscope. The doctor may suspect this by ear if there is a splitting of tones that is not felt by the patient.

The next stage is a regular, routine ECG, during which a special form of ventricular complexes in the first chest leads is determined, as well as a slight increase in the duration of the gastric QRS complex up to 0.11 seconds.

It is clear that this increase in time arises due to the "circular path", and the indirect following of the impulse along the blocked leg of the His bundle.

Holter monitoring is also shown, in which functional or transient options for the development of the blockade can be identified. This can happen, for example, due to an overdose of certain drugs during the treatment of diseases.

In the event that the blockade of the leg occurred against the background of a cardiac disease, then an intracardiac electrophysiological study is performed. Its main task is to determine whether there are indications for the placement (implantation) of a permanent pacemaker.

Additionally, in order to identify diseases that can cause cardiac conduction disorders, the doctor may prescribe other examination methods:

general clinical blood and urine tests;
biochemical analysis blood;
daily Holter monitoring of the electrocardiogram of the heart is prescribed in order to identify transient disorders;
transesophageal electrocardiography is a very accurate research method, and therefore can be prescribed as an additional diagnostic method;
echocardiography - one of the most popular methods for studying the heart muscle, shows organic cardiac pathology, the degree of myocardial contractility, gives an accurate assessment of the cardiac output fraction;
with an unclear diagnosis, it is possible to prescribe a multispiral computed tomography(CT) or, if appropriate equipment is available, magnetic resonance imaging (MRI) of the heart.

Cardiogram changes

By deciphering the performed ECG, it is possible to detect changes in the QRS complex, which are expressed in serration and expansion of its final part. There is also an increase in the duration of the complex. The R wave in the chest lead is serrated and enlarged, and the ST segment in this part is omitted.

ECG signs of incomplete blockade of the right leg of the bundle of His:

The presence in the right chest lead VI of the QRS complex type rSr 'or rsR ', the presence of a slightly broadened S wave in leads I and V6.
A slight increase in the duration of the QRS complex (up to 0.09 - 0.11 sec).

With such a violation, a slowdown in the conduction of the excitation impulse along the right leg of the His bundle is observed. Incomplete blockade of PNPG on the ECG is often diagnosed in absolutely healthy young people. In such cases, changes are considered as a physiological norm.

In most cases, the disease is detected by chance during a physical examination, listening to the heart (auscultation) and electrocardiography. Incomplete blockade of the right bundle branch of His is rarely accompanied by clinical manifestations.

Only in isolated cases, when cardiac output decreases, the following symptoms can be observed:

regular dizziness;
frequent bouts of bradycardia;
pre-fainting and fainting states.

For example, congenital malformations in modern conditions can be operated on in a cardiac surgery clinic (if there are appropriate indications for this). If the patient suffers from heart failure, angina pectoris, hypertension, therapy is carried out with cardiac glycoside preparations, antiarrhythmic, antihypertensive drugs.

In some young people, this type of blockade is the norm, so therapy is not prescribed. Only dynamic monitoring and examination by a cardiologist can be recommended.

Depending on the identified underlying disease, the patient needs to be monitored and treated by a cardiologist or a general practitioner. Observation provides for an assessment of the dynamics of changes in the ECG and correction of the prescribed therapy based on a clinical and laboratory examination.

Due to the asymptomatic course and relatively favorable course, incomplete blockade of the right bundle of His bundle does not require special treatment. The main efforts should be aimed at combating the causative disease, which in most cases is cardiological pathology.

As the main drugs used in the treatment of diseases of the cardiovascular system, use:

calcium antagonists.
Antiplatelet agents.
Antiarrhythmics.
Anticoagulants.
Beta blockers.
Diuretics (diuretics).
ACE inhibitors.
Cardiac glycosides (digoxin), and others.

The complex and rational use of these drugs allows to level the symptoms of the underlying disease, improve myocardial function, as well as increase the survival rate and quality of life of the patient.

If an incomplete blockade of the right leg of the His bundle is first detected in a patient complaining of chest pain, shortness of breath, and in whom a decrease in blood pressure is determined, then he is urgently taken to the cardio intensive care unit to exclude acute myocardial infarction.

If there is a threat of transformation of the blockade of the right leg of the bundle of His into a complete atrioventricular blockade, as well as in the presence of recurrent fainting, the patient is shown implantation pacing. A cardiologist deals with the treatment of heart diseases. The choice of a specialist depends on the life and health of the patient.

If the patient does not have serious abnormalities, folk remedies can be recommended that normalize the heart rhythm and conduction of nerve impulses. These home remedies have been tested for generations and proven to be effective.

Ramson (bear onion). Wild garlic bulbs contain ascorbic acid (a natural analogue of aspirin), allicin, healing mineral salts and essential oils, as well as sugars that normalize the activity of the heart muscle.

As an auxiliary and prophylactic agent, herbalists recommend taking an infusion of wild garlic. Recipe: combine a teaspoon of chopped wild garlic bulbs with 300 ml of cold water.

Steep for one hour, then strain and refrigerate. Take 30 ml of the resulting drink three times a day. Attention! Treatment of wild garlic is contraindicated in gastritis and stomach ulcers!

The jaundice is spreading. Spreading jaundice is another plant unique to the heart.

It contains cardiac glycosides - erysimoside and eryzimin, as well as organic acids and fatty oils.

The main indication for the use of jaundice is defects mitral valve(and it is precisely with this ailment that the blockade of the right and left legs of the bundle of His is often associated).

In general, the plant normalizes blood circulation, increases the conductivity of electrical impulses, protects against heart attack and stroke, and improves the general well-being of the patient. You can use an aqueous or alcoholic tincture of jaundice spreading.

To prepare a water tincture, you will need a teaspoon of herbs in 200 ml of boiling water. Dosage - a teaspoon three times a day (for atrial fibrillation, the dosage can be increased to 1 tablespoon 3 times a day).

To prepare an alcohol tincture, you will need 20 g of herb jaundice spreading and 100 ml of alcohol. The mixture is infused in a dark place for 2 weeks, after which it must be filtered.

Dosage - 10 drops 3 times a day before meals (you can drink drops with water). Continue treatment for 6-10 months to obtain a stable long-term effect.

Common hazel. Hazel will calm the nervous system, increase the effectiveness of the treatment of heart diseases, and prevent serious pathologies in the ventricles.

We recommend making tea from this plant. To do this, you will need a tablespoon of bark or hazel leaves (in dry crushed form) and a glass of boiling water. Infuse the mixture for 20 minutes, then take 100 ml twice a day.

Stonecrop is caustic. IN traditional medicine popular treatment with drugs from the herb sedum caustic.

This plant contains alkaloids, mineral salts, tannins and organic acids, which tone the body in general, and the heart in particular.

With the blockade of the bundle of His bundle, we just need such a remedy. Recipe: grind a dry plant, brew a teaspoon of stonecrop in a glass of boiling water. This is your daily dose. Drink it in a day. Therapy should last t 3 months to a year.

Cushweed is another highly effective herbal raw material for the preparation of a drug for problems with the bundle of His.

Periodically, a course of treatment with this herb can be taken by all people suffering from heart disease (especially older people).

It contains vitamin B1, phytosterols, ascorbic acid, alkaloid gnafalin, due to which it has a vasodilating effect, normalizes the balance of nerve impulses and tone smooth muscle heart muscle.

Recipe: brew a teaspoon of dry grass cudweed marshmallow in a glass of boiling water and leave for half an hour. Take 3-4 tablespoons of infusion 4 times a day 20 minutes before meals. "Core" is also recommended to take wine from cudweed.

To do this, pour a handful of dry grass with a liter of high-quality red wine, leave for 2 weeks, then strain and add 100 ml of liquid lime honey. The resulting wine drink 50 ml every night before bed.

Herbs in collections are more effective, since they simultaneously act “on all fronts”: they restore the normal functioning of the bundle of His bundle, reduce heart failure, and prevent complications. So, in Russia, most often herbalists recommended such a phytomixture:

Raspberries - 20g;
Birch leaves - 10g;
Herb motherwort heart - 10g;
Grass or dill seeds - 10g;
Periwinkle leaves - 20g.

Brew a tablespoon of this collection in a thermos with 0.5 liters of boiling water, close the lid and leave for at least an hour. Every time 15 minutes before a meal, drink half a glass of this drink. The course of treatment is from one month to a year (depending on the patient's condition).

In an ancient French reference book on herbal medicine, we found this recipe:

Sage herb - 50g;
Dill seeds - 50g;
Herb initial drug - 50g;
White mistletoe - 30g;
Fragrant rue herb - 10g;
St. John's wort - 10g.

Combine all ingredients. Take a liter of water for 2 tablespoons of the collection, bring the mixture to a boil, and immediately remove from heat. Let the drug brew for half an hour, then strain it and drink a glass 4 times a day. In severe heart failure, the dosage is halved.

An excellent therapeutic effect is given by the following collection:

Blood-red hawthorn flowers - 30g;
Small periwinkle leaves - 30g;
Melissa leaves - 10g;
Spring adonis herb - 10g;
branches of lavender spikelet - 10g.

Take a tablespoon with a slide of this collection, pour a glass of cold water and hold for half an hour. Then put the drug on the fire, boil for 5 minutes and cool. Drink the medicine received during the day in small portions. The course of treatment should last at least 2 months so that you feel a stable effect.

Incomplete blockade of the right leg of the bundle of His does not in itself pose a significant danger to the life and health of the patient. In the vast majority of cases, the pathology is not accompanied by any symptoms, and it is detected by chance during a routine electrocardiographic study.

In this regard, incomplete RBBB does not require specific treatment. However, taking into account the fact that incomplete blockade of the right bundle of His bundle often develops against the background of an existing heart disease, it is natural to expect that it will have some effect on the course of the underlying pathology.

Indeed, studies confirm that RBBB worsens the course of cardiac disease, increases the risk of cardiovascular complications and mortality in the years after its onset.

It is important to note the unstable nature of the incomplete blockade of the right leg of the bundle of His. With the aggravation of the underlying heart disease, this type of intraventricular conduction disturbance can transform into complete RBBB, or even into complete atrioventricular blockade, which will require a significant change in therapeutic tactics.

How dangerous is an incomplete blockade of the right leg of the bundle of His? The prognosis for this condition is not at all determined by this formulation of the diagnosis. As mentioned above, the degree of development of the underlying disease is decisive, as well as the risk of developing a complete atrioventricular block (in which the atria and ventricles can contract each in its own rhythm, disorganized).

It is the latter fact that can lead to the development of ventricular arrhythmias. It should be noted that the blockade, especially incomplete, does not mean the automatic presence of arrhythmia. Simply, in the presence of predisposing and unfavorable factors, this can happen, and then the blockade of the leg, albeit incomplete, can increase the risk of sudden cardiac death.

Thus, the probability of the appearance of a complete atrioventricular block in persons with partial conduction disorders of the legs of the bundle of His is 1% per year.

Of course, this figure takes into account conditions in which there is a pronounced cardiac pathology. It is in the presence of AV blockade that treatment will already be required, which may consist in the installation of a pacemaker.

With this pathology, sinus arrhythmia is often traced, which is expressed by a violation of the heart rhythm, the rhythm of contractions is not produced at regular intervals.

For diagnosis, the transesophageal method of the electrocardiogram is best suited. Patients sometimes experience:

weakness;
feeling of "fading" of the heart;
quick shocks.

To get rid of sinus arrhythmia, you need to contact a cardiologist who will select the best treatment. Basic preventive measures:

In heart disease, a diet rich in potassium, calcium and magnesium is important.
To prevent heart disease, it is important to avoid stress and anxiety.
Give up bad habits.
Go in for sports (on the recommendation of a doctor).

With incomplete blockade of the right leg of the bundle of His, sport is not contraindicated. Indeed, cardiologists are concerned about those conditions that increase the risk of sudden cardiac death, as well as various undiagnosed valvular defects, especially aortic stenosis, which, with increased stress on the heart, can lead to unpredictable complications.

Isolated and asymptomatic conduction disorders, especially at a young age, do not lead to a significant increase in complications. In extreme cases, Holter monitoring can be performed, which will be carried out against the background of sports training.

If the analysis of the results does not reveal the progression of the volume of the blockade, the appearance of arrhythmia, or signs of an atrioventricular junction disorder, then there are no contraindications to sports activities. All that remains is to undergo an ECG annually in order to timely know the state of affairs with intraventricular conduction.

With regard to service in the armed forces, then, as we remember, in the absence of an unambiguous interpretation, the entire emphasis is on "impairment of function." In this case, given the absence of pronounced organic damage and the asymptomatic course, such a young man will be drafted into the army in category B-4, that is, "fit with minor restrictions."

This actually means that he is unfit for the elite units of the RF Armed Forces, that is, where it is more or less prestigious to serve. As a result, he will be sent somewhere to the infantry, or to the signal troops, where, of course, no restrictions will be observed, since the “automatic” definition of the type of troops is already and will serve as a guarantee that such restrictions have already been made.

In the event that incomplete blockade is the norm, no special treatment is needed. It is enough to periodically observe a cardiologist and check the heart on an electrocardiogram. And you need to take care of the prevention of complications:

Give up all bad habits.
Try to avoid any overload.
Sleep well and relax after a day at work.

Eat right, eat natural fresh vegetables and fruits rich in potassium:

grape;
bananas;
fresh juices from them.

Do not ignore cases if they appear:

pain in the sternum;
heaviness;
weakness;
dizziness.

It is appropriate to urgently contact a cardiologist and do an ECG, an ultrasound of the heart, everything that the doctor prescribes. With blockades, lily of the valley flowers and hawthorn fruits are good means of treatment and prevention, which can be consumed only after consulting a doctor.

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10.4. Intraventricular conduction disorders

10.4.1. Right bundle branch block (RBBB)

Right bundle branch block (RBBB) in young people occurs in 0.1-0.2% of cases. With age, its frequency increases, reaching 0.3-0.24-4.5% in people over 40 years old. RBBB occurs more often in men.

In acute myocardial infarction, RBBB appears in 2-3.7% of cases and mainly in anterior infarction, more often in transmural. Partial RBBB also occurs in posterior myocardial infarction.

Etiology. In young people, the blockade of the right leg of the His bundle is often (21-50% of cases) benign, not associated with cardiac pathology. In other cases, especially in the elderly,

RBBB is caused by hypertension (60% of cases), coronary artery disease (although it often causes blockade of the left bundle branch block). Less commonly, the cause of BPBB can be a congenital anomaly - underdevelopment of the initial segment of the right bundle of His bundle; congenital heart defects (atrial defect, rarely interventricular septum, stenosis of the mouth of the pulmonary artery); stretching of the right ventricle with pulmonary embolism or obstructive chronic diseases lungs (then more often there is a partial blockade of the right leg of the bundle of His); diseases of Lev and Lenegre; acute myocardial infarction; cardiomyopathy; blunt chest trauma; hyperkalemia, progressive muscular dystrophy; overdose of novocainamide, quinidine, less often cardiac glycosides; neoplasms of the heart; cardiac surgery, such as vertical ventriculotomy; syphilitic gum.

clinical picture.

Can be detected Clinical signs organic disease that caused RBBB. In addition, in 1/3 of the patients, some changes are determined during auscultation: splitting of the II tone, which is more common, and splitting of the I tone, which is less common (due to asynchronous contraction of the ventricles).

Diagnostic ECG criteria. Complete RBBB: duration of complex #R5>0.12 s; a high R or R' wave in lead Vi, sometimes in V2, h (a small p is usually recorded in front of the R wave. In the aVR lead, there is often a deep Q wave and a wide, serrated R wave. In I and left chest leads, various sizes are usually detected R wave and wide, serrated S wave); ST and T deviated discordantly from the main direction of the QRS complex. When rejected electrical axis to the left in lead Vj, the forms rR serrated R or qR are recorded. When the electrical axis deviates to the right in lead V1, a qR shape is observed.

Partial RBBB: The morphology of the QRS complex is identical to complete RBBB, but its duration is 0.11 s. As the degree of block increases, the duration of the QRS complex increases and R' flexion in lead Vi becomes higher. More often (in 87% of cases) RBBB is constant, less often - intermittent.

Treatment.

blockade of the right leg of the bundle of His does not require special treatment. The appearance of RBBB in the acute period of myocardial infarction does not prevent prophylactic epdocardial stimulation.

requires. If necessary, treat the underlying disease that caused RBBB.

Prognosis: in young people without organic heart disease, relatively favorable. Most authors believe that isolated RBBB never turns into complete AV block, and even a joint finding of atrioventricular block of the first degree has no prognostic value, since in such cases, as a rule, only prolongation of the AH interval is found, indicating worsening of AV conductance in the AV junction. However, some authors point to a rare (1.8-6%) progression of RBBB to II or III degree AV block.

Joining RBBB against the background of hypertopic disease or coronary artery disease worsens the prognosis, increasing mortality by almost 3 times. The prognosis is worsened by cardiomegaly, heart failure, lengthening H-V interval. The prognosis for RBBB is always better than for left bundle branch block.

Against the background of acute myocardial infarction, the appeared complete or partial BPIP does not, according to our data [Reingardene D. 1975], into a complete AV blockade and does not worsen the outcome of the disease. Some authors [Doshchitsin V. L. 1979, et al.] note an increase in mortality in RBBB, but only in extensive transmural myocardial infarction with heart failure. RBBB does not affect the long-term prognosis of a heart attack, although there is an opposite opinion.

Incomplete blockade of the right leg of the bundle of His

Blockade of this level refers to violations at the level of conduction inside the ventricle of the heart, that is, it is an intraventricular blockade. Sometimes this can be found in practically healthy young people, which should be regarded as a variant of the physiological norm. Given that the blockade of one of their legs reflects a conduction disorder, it is necessary to examine the patient in order to identify the disease that led to the development of disorders.

Causes of blockade of the right leg of the bundle of His

As a rule, the blockade develops against the background of heart disease. Conduction disorders inside the ventricle of the heart are more often caused by necrotic, sclerotic, inflammatory processes. In addition, the cause may be those pathological processes that lead to a state of overload in some departments, in particular the ventricle. Such diseases include heart defects (congenital, in which there is an excessive load on the right ventricle, defects in the partitions between the atria, ventricles), mitral stenosis, heart disease, coronary artery disease, acute conditions (heart attack), arterial hypertension and cardiosclerosis.

The causative factors for the development of an incomplete type of blockade are intoxication or overdose of medications (from the group of digitalis, adrenoblockers), electrolyte metabolism disorders. Due to the development of the blockade, the conduction of impulses through the heart system slows down, which leads to the fact that there is no physiological, full-fledged excitation of the right sections. The diagnosis of blockade separately at the level of the right leg can only be established on the basis of an electrocardiographic study. When deciphering the ECG, changes in the QRS complex (expansion and serration of its final part) are detected, while the duration of the complex itself is usually increased. In the chest leads, the R wave will be enlarged and jagged, the ST segment will be lowered.

Treatment of blockade of the right leg of the bundle of His

Therapeutic measures for an incomplete version of the blockade consist in the treatment of the disease that is the cause of the development of the blockade. That is, there is no specific therapy for the blockade itself, it is necessary to treat the underlying disease. For example, congenital malformations in modern conditions can be operated on in a cardiac surgery clinic (if there are appropriate indications for this). If the patient suffers from heart failure, angina pectoris, hypertension, therapy is carried out with cardiac glycoside preparations, antiarrhythmic, antihypertensive drugs.

In some young people, this type of blockade is the norm, so therapy is not prescribed. Only dynamic monitoring and examination by a cardiologist can be recommended.

Blockade of the legs of the bundle of His on the ECG

Quite often in the electrocardiographic conclusion it is possible to meet the term "blockade of a leg of a ventriculonector". The blockade can be complete and incomplete, capture the right or left legs, or branches of the left leg. Let's see what it is.

What it is?

The electrical impulse that excites the heart comes from sinus node through the atria to the atrioventricular node, which lies between the atria and ventricles. From the atrioventricular node begins the conducting path, called the "bundle of His". This bundle splits into two smaller trunks - the right and left legs, which conduct excitation to the right and left ventricles. The left leg then divides into anterior and posterior branches. These branches further break up into many small branches that conduct electrical impulses to the muscle fibers of the heart.

Under various physiological and pathological conditions, the conductivity along these pathways is disturbed. There are blockades of the legs of the bundle of His and their branches.

The blockade can be complete or incomplete. With incomplete blockade, conduction along the leg slows down. With a complete blockade, excitation goes in an unusual way "bypassing" the place of the blockade.

Sometimes there are blockades of two or three of the listed branches at once. They are called, respectively, "two-beam" and "three-beam" and occur with serious heart disease.

Causes

Incomplete blockade of the right leg of the bundle of His can be recorded in healthy young people and is not a deviation from the norm. Incomplete blockade of the legs can appear with an increase in heart rate, which in some cases can be regarded by the doctor as a pathological sign.

Blockade of the legs of the bundle of His, both complete and incomplete, can be a sign of heart disease, in particular, myocardial dystrophy, angina pectoris. myocardial infarction and cicatricial changes after it, diffuse cardiosclerosis. hypertension, heart defects and others. Any pathological process of the heart muscle can also affect the conduction system, as a result, this electrocardiographic sign develops.

Complete blockade of the right leg of the bundle of His is most often a sign of an increase in the right ventricle with some heart defects, as well as with the formation of chronic cor pulmonale therefore, it is often found in chronic obstructive pulmonary disease, emphysema, severe bronchial asthma.

Complete blockade of the left leg of the His bundle most often appears against the background of coronary heart disease (angina pectoris, cicatricial changes after myocardial infarction). In this case, it is associated with a poorer prognosis for such patients, as it reflects severe damage to the heart muscle.

Symptoms

These electrocardiographic signs are not clinically manifested.

Diagnostics

The main diagnostic method is electrocardiography. Signs of transient blockade can be seen during the daily (Holter) monitoring of the electrocardiogram.

Treatment

The prognosis, ability to work, the ability to perform physical activity is determined by the severity of the underlying disease.

Often in the conclusion of a doctor of a functional and decoded cardiogram, the term of incomplete blockade of the right leg of the bundle of His (NBPNPG) sounds.

Most patients are frightened by such a result and turn for further explanations about the nature of the pathology and further prognosis.

Concerns are also raised by the fact that there are no symptomatic manifestations of such a change, but an incomplete blockade of the right leg of the His bundle is found on the ECG during routine ECG recording.

Causes and mechanism of occurrence

This type of rhythm disorder occurs when the conduction of an electrical impulse along the right leg of the His bundle is suppressed, in contrast to a complete blockade, when the propagation of the excitation wave completely stops.

The etiological factors of such a deviation can be:

Coronary diseases (mitral valve stenosis, tricuspid valve insufficiency, ischemic disease, acute myocardial infarction, myocarditis, myocardial dystrophy).
Intoxication medicines(beta-blockers, digitalis preparations, quinidine).
chronic lung disease ( bronchial asthma, chronic obstructive pulmonary disease, emphysema).
Pulmonary embolism.
An increase in the right ventricle, which leads to a slow propagation of the excitation impulse along the myocardial fibers.

It is worth noting that incomplete blockade of RBBB can be detected on the ECG in perfectly healthy young people and in children. In newborns, the size of the right atrium prevails over the left, and up to 2 years, the growth of the atria outstrips the growth of the ventricles.

At the age of 2–6 years, this difference is smoothed out and a uniform growth of all parts of the heart is noted. Therefore, in an infant, the detection of a partial blockade of the right leg of the bundle of His is a variant of the norm. In schoolchildren, such a violation indicates the following pathologies:

Significant psycho-emotional stress.
Myocardial dystrophy.
Myocarditis.

However, sometimes this type of blockade indicates an open oval window, an additional chord of the left ventricle.

Clinical picture

In most situations, symptomatically incomplete blockade of the right bundle branch block does not appear. The clinical picture is due to the signs of the underlying disease that caused the arrhythmia.

Sometimes patients complain of dizziness, periodic loss of consciousness, sweating, flies flickering before their eyes.

This may indicate a hereditary pathology - Brugada syndrome. This condition is dangerous with a risk of developing ventricular tachycardia.

Diagnostics

When questioning, examining the patient, it is impossible to identify specific signs of blockade. Deviations are found, allowing only to suspect the presence of a violation of intraventricular conduction - an increase in the boundaries of the heart, auscultatory noises, discoloration of the skin, shortness of breath, peripheral edema, and a number of others.

Electrocardiographic examination and 24-hour Holter monitoring remain the gold standard for diagnosis.

Like any rhythm disorder, intraventricular conduction disturbance has specific criteria.

ECG signs n complete blockade of the right branch of the bundle of His are:

The rhythm is sinus, correct.
Presence in lead V1 ventricular complex by type rSr' or rsR'.
In leads Ι and V6, the S wave is slightly broadened.
The duration of the ventricular complex is 0.09-0.11 seconds.

The delay in the propagation of an electrical impulse, which is normally found in children and young people, is characterized by certain signs:

The rhythm is sinus, correct.
The ventricular complex in lead V1 looks like rSr’.
The amplitude of the r wave is no more than 7 mm, and r’ is no more than 6 mm.
The r wave is present in only one lead, V1 or V2.
Normal S wave in leads V5 and V6.

In the case of a combination of incomplete blockade of the right bundle branch block with depression of the ST segment, they speak of Bruton's syndrome.

The appointment of daily Holter monitoring allows you to identify transient and combined rhythm disturbances. Laboratory, instrumental (ultrasound, electrophysiological examination) diagnostics gives an idea of the functional and structural changes leading to arrhythmia.

Treatment

If an incomplete blockade of PNPG is detected on the ECG, it must be understood that this condition does not require therapeutic measures. Patients suffering from various diseases need adequate correction of the underlying pathology.

For this purpose, I use various groups of drugs:

Anti-ischemic.
Antihypertensive.
Antiplatelet agents.
Statins.
Diuretics.
Cardioprotectors.
Means intended for the treatment of diseases of the bronchopulmonary system.
Antibiotics, non-steroidal anti-inflammatory drugs for myocarditis.

If necessary, surgical correction is carried out, which is carried out on the basis of the underlying disease, the severity of the condition, and individual characteristics.

Forecast

Healthy individuals with impaired intraventricular conduction have a favorable prognosis, since this does not affect their well-being and does not lead to hemodynamic disorders.

The exception is patients with Bruton's syndrome, which can be complicated by ventricular tachyarrhythmia with the threat of subsequent cardiac arrest.

In patients with various diseases, the prognosis is determined by the nature of the course of the underlying pathology.

Nowadays, you will not meet a person who could say that he is absolutely healthy. Constant stress and the wrong way of life - do their job. Our heart is subjected to constant stress, wears out, which further leads to malfunctions in its work.

Many do not want to go to the hospital because they are afraid to hear that there are problems with their health. But heart disease is not to be trifled with. Only thanks to modern methods of diagnosis and treatment, you can prolong your life.

If you did not have any symptoms of heart disease, but passing the examination, you were diagnosed with blockade of the right leg of the His bundle, do not rush to panic. It is worth asking the doctor about everything and undergoing additional diagnostics. Sometimes, no special treatment is required. In this article, we will consider what kind of pathology it is, its variety, causes, characteristic symptoms as manifested on the ECG and treatment methods.

Blockade of the right leg of the bundle of His

The bundle of His is located below the atrioventricular node (atriventricular node), but there is no clear boundary between them. Its length is about 2 cm, but this figure may be different, depending on the individual characteristics of the person.

The constituent segments of the bundle of His are:

Penetrating or initial. This is part of the bundle of His, characterized in that it does not come into contact with the myocardium. And also its feature is that this segment is not sensitive to disruption of the functioning of the coronary arteries.

But if pathologies develop in fibrous tissue, which surrounds the beam, then the penetrating part quickly becomes inflamed.

Branching or membranous. This part of the bundle is located in the interventricular septum. First, it enters the membranous part of the septum, and then passes into the myocardium.

In the initial segment there are cells that are located in the lower part of the atrioventricular node, which have the function of cardiac automatism. It is these cells that produce about 40-60 impulses per minute. The automatism of the beam is called second-order automatism. The bundle of His is divided into right and left legs.

The left one is shorter, but it branches into 2 more parts. The trunk of the bundle of His is located above the interventricular septum, and the right and left legs diverge, respectively, on the RV and LV. Further, the legs branch into small Purkinje fibers in the heart muscle.

It should be noted that the main function of these structures is to conduct an impulse from the right atrium, or rather, from the sinus node, to the ventricles. As a result, the ventricles contract with the same frequency and force as the atria.

Blockade of the right leg of the bundle of His - a general characteristic

The human heart is made up of muscles that have autonomy and conduction. Myocardial tissues can create and conduct excitation. The fact that the human heart produces contractions and supplies blood to the entire human body is possible only due to the work of myocardial fibers.

A small collection of cells in the conduction system of the heart, only about 2 cm in size, is called the bundle of His. It is also called the atrioventricular bundle. It includes the right and left legs and is located near the interventricular septum and two nodes:

atrioventricular;
atrioventricular.

To fully understand the subtleties of this disease, you need to imagine how the human heart works. The ability of the heart to generate rhythms is possible only due to the presence of specialized pacemaker cells (in other words, pacemakers). These include:

sinoatrial;
sinoatrial nodes, which are located in the right atrium.

The rhythm from them is transmitted to the atria, and from there to the bundle of His to the ventricles. Interruptions in the transmission of the bundle of His are directly related to the disruption of the conduction of the rhythm. And if the rhythm is disturbed, then the heart does not work correctly, which can lead to disastrous consequences. Depending on whether the blockade has arisen - complete or incomplete, there are different consequences.

With incomplete blockade, the deviation is partial, and with complete blockade, the end of the impulse conduction occurs. As world medical practice shows, this defect is most often found in people of age, and, as studies show, most often in the male half of the population. Younger people are much less likely to experience this phenomenon. The risk of disease increases with age.

The blockade of the right leg of the bundle of His is observed in both young people and the elderly. According to statistics, this disorder is more common in men. 30% of young patients do not have any cardiac pathologies due to violations of the conduction system of the heart.

The anatomical structure of the branches of the bundle of His is such that blockades can be single-beam, two-beam and three-beam. The reasons for this phenomenon are different. From these reasons will depend on the further prognosis. The factors that cause this pathology are:

ischemic heart disease (CHD);
congenital heart defects;
myocardial infarction;
chest injury;
cardiomyopathy (damage to the heart muscle);
hyperkalemia (excess potassium in the blood);
overdose of heart medications;
progressive muscular dystrophy;
syphilis;
surgical intervention on the heart;
stretching of the right ventricle;
smoking;
alcohol abuse;
autonomic disorders in neurosis;
hormonal disorders;
hypoxia in diseases of the respiratory system.

Also, the blockade of the right leg of the bundle of His can develop due to hypertrophy of the right ventricle, mitral stenosis, tricuspid valve insufficiency. Such a violation may be congenital and be considered as a variant of the norm that does not require treatment.

Heart block may be functional. This means that it can occur under certain loads and pass on its own, but this does not pose any danger. The listed reasons are acquired.

But defects that provoke blockades can also be congenital. For example, in children whose mothers were ill diabetes during pregnancy, there may be congenital Lenegre disease (conduction disorders). Heart defects various etiologies, anomalies of the atrial septum, pulmonary artery stenosis are also congenital factors due to which a violation of the heart muscle is possible.

Symptoms

How can you suspect this violation? If the blockade of the right leg of the bundle of His is incomplete isolated, then there will be no pronounced symptoms. It can only be detected by examination with an ECG. But since such a pathology can be a “companion” of other cardiac pathologies, there may be symptoms in the form of a change in heart tones when listening.

For example, during auscultation (listening), splitting of the second tone is heard and its intensification during inspiration, because the closing of the valve leaflets slows down.

In addition to this symptom, you may experience:

dizziness;
fainting;
dyspnea;
feeling of lack of air;
weakness;
fast fatiguability;
decrease in working capacity;
panic attacks.

The blockade of the legs of the bundle of His can be complete or partial (incomplete), persistent and transient. Even with a complete blockade, there may be no symptoms if there is no serious heart disease. It is possible to detect such violations only with an ECG.

Sometimes disorders in the cardiac system are associated with the fact that a person had a number of infectious diseases in childhood, such as tonsillitis, measles, influenza, scarlet fever. By the time it is discovered, treatment is no longer required.

BNPG are classified according to different criteria. If we consider it from the position of the conduction of impulses, then it is incomplete when the impulse slows down, but still passes. Complete blockade is called the absolute cessation of impulse transmission.

Separation by the number of non-conductive beams:

Single-beam - the right leg suffers more often, but conduction may disappear only in the left or only in the back.
Two-beam - covers the branch of the left; one branch of the left and right leg.
Three-beam - there is an incomplete or complete blockade of the right and left legs.

Classification by type of development:

Intermittent - during the cardiogram, it appears and disappears.
Constant - can be traced during the study constantly.
Transient - blockade of the right leg of the His bundle on the ECG appears from time to time.
Alternating. This form is characterized by manifestations of the blockade on the right, then on the left leg.

Stages of excitation of the ventricles in the blockade of PNPG

The process of excitation of the ventricles in the blockade of RBBB can be divided into three stages:

Normal depolarization of the interventricular septum.
Normal LV depolarization.
Delayed excitation of the pancreas.

The stages of excitation of the ventricles in the blockade of PNPG are presented on the electrocardiogram by two-phase complexes in the chest leads:

in lead V1, the rSR’ complex with a wide R’ wave;
lead V6 has a qRS complex with a wide S wave.

The first stage of depolarization of the ventricles is normal - excitation of the interventricular septum. First, the left part of the septum is excited along the LNPG. Normally, the electrocardiogram shows a small septal r wave in lead V1 and a small q wave in lead V6.

It is clear that blockade of RBBB should not affect the septal stage of ventricular excitation, since its stimulation depends on LDL. The second stage of ventricular excitation is the simultaneous depolarization of the LV and RV. RBBB should also not affect this stage, as the LV is usually electrically dominant over the right, causing deep S waves in the right precordial leads and tall R waves in the left precordial leads.

The change in the QRS complex in the blockade of RBBB is a consequence of the lengthening of the time required for excitation of the pancreas. This means that after complete LV depolarization, RV depolarization continues.

Delayed RV depolarization is the third stage of ventricular excitation. Electric potentials in this stage are directed to the right and reflect the slow propagation of the depolarization wave along the pancreas. For this reason, in the right chest leads (for example, in lead V1), this stage of ventricular excitation is electrocardiographically manifested as a positive wide R wave.

Slow propagation of delayed RV depolarization potentials to the right results in the formation of a wide negative S wave in the left precordial leads (eg, in lead V6). If you understand the mechanism of these stages, you can imagine the electrocardiogram of the chest leads in the blockade of RBBB.

Lead V1 has an rSR’ complex with a wide R’ wave. A QRS complex with a wide S wave is recorded in lead V6. A high wide R wave in the right precordial leads and a deep S wave in the left leads also reflect the slow propagation of delayed depolarization potentials through the RV.

To suggest the presence of RBBB, it is necessary to evaluate leads V1 and V6. The typical QRS complexes in these leads facilitate the diagnosis.

In some patients, incomplete blockade of the right bundle branch block is a feature of their physiology. However, to refuse a complete examination of the heart in this case is not worth it. A thorough diagnosis will allow you to establish the exact cause of the blockade and exclude the development of unwanted complications.

Such a pathology can develop against the background of the following conditions:

ischemic necrosis of the myocardium;
neoplasms in the heart muscle;
persistent high blood pressure;
replacement of heart muscle cells with scar tissue;
violation of protein metabolism in cardiac tissues;
heart valve defects;
severe form of hypothyroidism;
excess potassium in the body;
against the background of drug treatment;
chest injury.

With incomplete blockade of the right leg, the complete absence of excitation is not recorded. It is observed, but the process is rather slow. In some cases, incomplete RBBB is fixed with an increase in the middle muscle layer of the pancreas and is a manifestation of this particular pathology, and not a consequence of a violation of general conduction.

It is quite difficult to detect incomplete RBBB on an ECG. Such a pathology can greatly distort the results of the cardiogram. In addition, such a state can be temporary and changeable. Signs of blockade either appear or disappear, respectively, the electrocardiogram can fix deviations that are replaced by normal values. These are the so-called transient blockades.

They most often occur against the background of damage to the tissues of an organ or conduction system under the influence of stress factors, metabolic disorders, or a secondary cardiac disease. With transient blockade, the QRS complexes, which are recorded when the stomachs of the "blocked" leg are excited, periodically alternate with normal QRS complexes.

Complete blockade

Complete blockade of the right leg of the bundle of His is usually manifested by Wilson's blockade and indicates a clear violation of the process of distribution of automatic rhythmic self-excitation through the muscular structures of the ventricles and is not so rare.

For such a blockade, it is characteristic that the RV is reduced not through the transmission of nerve impulses emanating from the right leg, but due to those that spread from the LV. However, similar ECG results can also give an independent increase or other pathologies of the pancreas.

The main signs of a pathological condition:

violation of pulse waves;
rapid and difficult breathing even with minimal exertion;
"illusion of movement" in the head;
a state close to fainting;
loss of consciousness;
increased fatigue;
drowsiness;
prostration;
depression.

Complete blockade of PNPG on the ECG can be observed in such conditions:

angina pectoris, heart attack, atherosclerotic cardiosclerosis;
inflammation of the heart muscle or enlargement of the pancreas;
pathological anastomosis between the right and left atrium;
increase and expansion of the right parts of the heart;
myocardial dystrophy on the background of endocrine and autoimmune disorders.

Concomitant diseases can also provoke pathology, which cause an increase and a load on the heart chambers on the right. As a rule, these are various pulmonary pathological processes: bronchial asthma, emphysema, pulmonary embolism, pneumonia in a prolonged form, chronic bronchitis.

Rarely, RBBB can be the result of a strong emotional load or fright, even in healthy people.

In a full-fledged ECG conclusion, when diagnosing this pathology, they indicate the nature of heart contractions, the total amount of bioelectrical changes occurring in the heart muscle with each contraction, characterize the blockade, and also mention the lengthening of the QT interval. However, to confirm the diagnosis, only a cardiogram is often not enough, therefore, additional diagnostic methods are resorted to.

In children, this pathology may appear in fetal development, at the time of the formation of the heart. Or after birth as a result of previous diseases of the cardiovascular system. The symptoms of this disease will be as follows:

poor blood supply, lack of oxygen will lead to heart ischemia;
the death of the His bundle due to oxygen starvation will lead to myocardial infarction, scar tissue is formed;
as a result of heart failure;
diseases resulting from myocardial damage; underdevelopment of the heart during the prenatal period;
inflammatory processes in the heart muscle; surgical intervention;
in the presence of an autoimmune disease, a violation in the work of the heart may occur;
an increase in blood pressure, as a result of which, at high loads, a change in the structure and work of the heart can occur.

Congenital blockade in children may occur as a result of:

diffuse lesions connective tissue future mother;
if future mom suffers from diabetes mellitus (insulin-dependent);
underdevelopment of the right leg of the bundle of His;
pathological development of the cardiac septa.

This pathology can be the result of injury to the heart. This can occur as a result of improperly performed surgical operations, as a result of a blow chest in case of a fall or push, in case of a traffic accident.

If there is an incomplete blockade of the legs of the bundle of His, then special treatment is not required. The only thing that needs to be done is to prevent the transition to more severe forms. Do not ignore the symptoms that appear.

As soon as there is a pressing feeling in the chest, dizziness, it is necessary to put the child to bed. Do breathing exercises with him: take a deep breath, while exhaling, hold your breath for a couple of seconds, and then exhale the remaining air. It is advisable to do this exercise several times. Do not put off a visit to the doctor.

The doctor collects data from the anamnesis of life (complaints of parents, symptoms, what treatment was carried out, change clinical picture whether the mother was sick during pregnancy, is there a hereditary predisposition to the appearance of such pathological conditions). Examines the child: measures the heart rate, pulse, conducts auscultation of the organs of the chest cavity, with the help of percussion sets the border of the heart. Assigns laboratory tests. Followed by treatment.

With drug treatment, vitamins, restorative drugs are used, a diet is prescribed. Also held symptomatic treatment. The doctor prescribes diuretics, anticholinergics, sympathomimetics, glucocorticosteroids.

If drug treatment does not bring a positive result, then the possibility of surgical intervention is considered. During this operation, a pacemaker is placed.

Diagnostics

If you complain about the work of the heart, you need to visit a cardiologist. If you have pain in the heart area, extrasystole (heart rhythm disturbance), shortness of breath, fatigue, you should consult a doctor. Although such symptoms may be a sign of other diseases not related to the heart, it will be possible to find out only after an examination.

To make a diagnosis, you need to do:

electrocardiogram;
daily ECG monitoring.

An electrocardiogram is a procedure that captures a curve that reflects the activity of the heart muscle. Such diagnostics is the simplest and most accessible in a regular clinic. Thanks to the ECG, you can see how much the electrical conduction impulses are blocked.

ultrasound ( ultrasound examination) allows you to see the work of the heart in real time. This diagnostic method is also available at the present time. Daily monitoring (according to Holter) helps to determine the work of the heart during the day. A special device is attached to the patient's body and fixes any disturbances both during night sleep and during physical activity during the day.

Thanks to such a study, it can be established whether the blockade is passing. With Holter monitoring, a diary is kept, where the patient enters all his complaints.

characteristic ECG features with RBBB:

In lead V1, an ECG of the rsR’ (rSR’) type is recorded, in some cases both parts of the R’ wave are separated from each other by a notch (the origin of which is not completely clear) located on its ascending knee.
In lead V6, an ECG of the qRS type is recorded.
The STV1 segment is located below the isoline and the TV1 wave is negative.
The STV6 segment is elevated and the TV6 wave is positive.

With RBBB, the QRS complex is broadened and exceeds 0.12 s (6 cells). The diagnosis of "blockade of the right leg of the bundle of His" is made by changes in the ECG in the chest leads:

In leads V1, V2, the QRS complex looks like rsR' (may take the form: rSR', RSR', RsR', rR', M-shaped): R'V1 wave is usually wide and high (R'V1 > rV1 ).
The STV1,V2 segment is usually located below the isoline, with an arc facing upwards.
The TV1 wave is negative, its apex is located close to the end of the wave (sometimes a negative T wave is also observed in other chest leads: V1-V4).
In leads V5, V6, the QRS complex looks like qRS.
The tooth of SV6 is wide, rounded, mostly shallow, sometimes serrated.
The height of the RV5, V6 tooth can be somewhat reduced compared to the norm.
The STV5,V6 segment is usually located on the isoline or slightly elevated.
Prong TV5,V6 is positive.

From the foregoing, it is clear that when moving from the right chest leads (V1, V2) to the left (V5, V6), the first r wave increases, turning into R, and the second R' wave decreases, gradually turning into an S wave (this is clearly seen on the ECG in the right table).

The electrical axis of the heart in RBBB is more often located vertically, but may be normal, less often moderately deviated to the right or an axis of the SI-SII-SIII type is recorded. ECG form in limb leads:

The ECG of the QRS complex in leads I, aVL is similar to the ECG in leads V5, V6 and looks like qRS.
The ECG of the QRS complex in leads III, aVF is similar to the ECG in leads V1, V2 and looks like rsR’ (rSR’).
In lead aVR, there is a late R wave, and the QRS complex looks like a QR or rSR’, the TaVR wave is negative.

RBBB is characterized by prolongation of the electrical systole of the ventricles QT. With incomplete blockade of the right leg, excitation can pass, but somewhat slowly. Often, incomplete RBBB occurs with right ventricular hypertrophy and is a manifestation of hypertrophy rather than a conduction disorder.

With incomplete RBBB, the QRS complex is shaped like a blockade of the right leg, but the width of the QRS lies in the range of 0.08-0.11 s:

In the chest leads V1, V2, the QRS complex has the form: rSr', rSR', rsR', rsr' (the activation time of the right ventricle in these leads is increased).
In the chest leads V5, V6, a qRS-type complex is recorded (the SV5, V6 wave is slightly broadened).
Quite often, a late RaVR wave is observed.
In some cases, there is a decrease in the STV1, V2 segment and a negative TV1, V2 wave, however, these signs are less pronounced than with complete blockade.

In the ECG conclusion, following the nature of the rhythm, the location of the electrical axis of the heart is indicated; give a description of the blockade of the right leg (complete, incomplete); mention the lengthening of the electrical systole of the ventricles; give a general description of the ECG. If at the same time there is hypertrophy of the right or left ventricle, then its description is usually given before general characteristics ECG.

Treatment

As you probably guessed, only those blockade options should be treated, in which there is an increased risk of developing cardiac death, or there is a pronounced desynchronization in the work of the upper (atria) and lower (ventricles) sections of the heart.

As a rule, in this case, we are talking about patients who have clinically significant and reliable signs of heart failure. Such patients are usually hospitalized in the department of interventional cardiac surgery and arrhythmology, or in the diagnostic department of a cardiology hospital.

Hospitalization is needed in order to:

choose a good drug therapy if there is a diagnosed arrhythmia against the background of the blockade;
rule out acute myocardial infarction if it occurs acute blockade legs of the bundle of His (this is always suspicious, but, however, then the left leg is affected, and not the right one);
conduct an electrophysiological intracardiac study;
implant a pacemaker, or perform cardiac synchronization.

To reassure young people and their parents, it is safe to say that a pacemaker is not “just like that” installed.

For this, there must be very strict indications, for example:

Alternating blockade of the legs (when there is a "walking" violation of either the left or the right leg;
Atrioventricular blockade of the 3rd degree with the presence of syncope;
Blockade of the legs that occurred in acute myocardial infarction;
Severe heart failure of the 3rd or 4th functional class, despite the correct treatment.

Thus, it becomes clear that it is not the blockade of the right leg of the His bundle that is “treated” at all, but those conditions and diseases that it can aggravate or provoke. In conclusion, it must be said that in order to avoid confusion and ambiguous interpretation, if there are signs of blockade during the ECG, it is advisable for the patient to undergo an ultrasound of the heart.

Only then it will be possible to assess the thickness of the interventricular septum, and to draw a conclusion about the presence or absence of hypertrophy of the walls of the left and right ventricles. Only in this case, the diagnosis of blockade of any of the legs will have a real diagnostic value, since it will be made taking into account the presence or absence of myocardial hypertrophy.

A patient with heart block is prescribed a diet. The diet must include fresh vegetables, fruits and juices. Fried, spicy and canned foods should be excluded from the menu. With heart failure, you can do breathing exercises.

Exercise normalizes heart contractions, reduces hypoxia, accelerates gas exchange and supplies cells with oxygen. Aerobic training relieves fatigue and increases performance. Breathing exercises are contraindicated if the patient has sciatica, acute thrombophlebitis, severe injuries of the spinal column, or a post-infarction condition.

If the patient underwent an operation to install a pacemaker, then breathing exercises in this case will help strengthen the heart and develop joints. Doctors recommend doing three basic exercises a day. The first exercise is called "Wave".

Starting position lying on your back. Legs bent at the knees, feet firmly pressed to the floor. When inhaling, the chest expands in volume, and when exhaling, it lowers, and the stomach inflates. Repeat this exercise should be 15-20 times.

The next exercise is "Frog". Starting position sitting on a chair. Knees shoulder width apart. The elbows should be on the knees. As you exhale, lower your head down so that your forehead touches your knees. On an inhale, we rise to the starting position. Breathing is even and slow.
To perform the next task, you should sit on the floor and cross your legs in the lotus position.

Place your palms on your knees. The back is straight. The chin is slightly raised. Breathing is deep and easy. During breathing, the stomach should not change in volume. As you exhale, hold your breath for a couple of seconds. The duration of the exercise is 5-7 minutes.

Medical treatment

If there are no heart diseases and pathologies The main symptom of the disease is a violation of the heart rhythms of the bronchopulmonary system, then the dynamics of the development of the condition is monitored. However, in the case when the cause of the pathology is various diseases, it is necessary to treat the disease that accompanies this pathological condition.

The following medications are usually prescribed:

Vitamins: a nicotinic acid, riboflavin, thiamine.
Phyto-based sedatives.
Drugs that prevent the formation of blood clots in the vessels: Cardiomagnyl, Aspirin, ThromboAss. Statins: Atorvastatin, Rosuvastatin, Simvastatin.
Anti-inflammatory nonsteroidal drugs: Diclofenac, Nimesulide (in inflammatory processes).
Means with antioxidant action: Preductal, Carnitine, Ubiquinone, Mexidol.
Glycosides and diuretics: Digoxin, Strofantin, Diuver, Lasix, Indapamide.

With ischemia of the heart, Kardiket, Nitroglycerin are attributed. If the blockade is caused by hypertension, Losartan, Valsartan - antagonists, Perindopril, Lisinopril - ACE inhibitors are prescribed. It is also possible to use calcium channel antagonists (Amlodipine, Verapamil) or beta-blockers (Bisoprolol).

However, one should take into account the fact that these drugs reduce the frequency of heart contractions. With a blockade provoked by bronchopulmonary diseases, adrenomimetics for inhalation and glucocorticosteroids are used: Beclazone, Berotek, Berodual. Vitamin therapy is necessary for both complete and partial blockade.

With their help, you can restore the conductivity of the pulse. Usually the complex of vitamins includes:

thiamine;
a nicotinic acid;
riboflavin.

Antioxidants help restore tissues, these drugs help to release decay products. If a complete blockade is combined with a left-sided blockade, then the only salvation is the implantation of an electrical stimulator.

In addition to drug therapy, a specialist can offer surgery, namely, the installation of a pacemaker. To do this, an electrode is inserted into the right ventricle through a central vein. Indications for surgical treatment are:

Frequent loss of consciousness.
Malignant processes in the heart.
The ineffectiveness of medical treatment.

Also, a patient with this pathology is recommended a diet with a predominance of fresh fruits and vegetables. At the same time limit the intake of fats and sugar.

Of course, with the rapid development of medicine and science, innovative technologies, today in our pharmacies you can find medicines for almost any disease. But, unfortunately, they have not yet come up with drugs that would not bring some negative effects to the human body.

In this regard, the question of treatment is so acute. folk methods and means. Today, in order to largely improve the condition of a patient with this disease, a whole range of measures and means has been created, which includes both the intake of various tinctures and herbal preparations and some physical procedures.

Of the exercises, only douches are shown cold water and various types breathing exercises. From natural folk remedies secrete an infusion of herbs, which is designed to maintain the immune nervous and endocrine systems in normal working condition. In addition, its positive effects include a beneficial effect on the kidneys and liver.

To prepare such a tincture with microphytotherapeutic functions, you need the following ingredients:

20 gr. calamus.
30 gr. birch leaves.
40 gr. red hawthorn flowers.
20 gr. sandy immortelle flowers.
20 gr. black elderberry flowers.
30 gr. valerian root.
10 gr. oregano ordinary.
20 gr. hypericum herbs.
30 gr. calendula flowers.
10 gr. nettle leaves.
20 gr. heart-shaped linden flowers.

This is the basic list of ingredients for making herbal infusion. But to achieve a greater effect, you can also add to them:

peppermint leaves - 10 gr.
dandelion root - 20 gr.
plantain leaves - 20 gr.
motherwort - 30 gr.
chamomile - 20 gr.
common yarrow - 20 gr.
black currant leaves - 30 gr.
field horsetail - 20 gr.
three-part series - 10 gr.
rose hips - 50 gr.

The entire list of components is required to crush. Crushed herbs and roots are the basis for obtaining a potion. They need to be mixed well. Such proportions will last long enough, because to prepare this herbal infusion for 0.5 liters of boiling water, you need to add only 0.5 grams of the resulting mixture.

The resulting drink must be left to infuse for at least half an hour. The combination of all these plants and fruits has an incredibly beneficial effect on the human body. On the cardiogram of the blockade of the right and left legs It is recommended to take this herbal tincture three times a day in the amount of 100 ml before each meal.

It is best to brew the tincture and insist daily in the morning. If excess remains, they can be used for washing or rinsing the mouth and throat. On average, if no discomfort was detected during admission, then it is necessary to drink such an herbal infusion for a long time - at least 2 years without interruption.

Also, one of the popular tincture recipes for normalization nervous system, improving heart rate, strengthening sleep, normalizing the walls of blood vessels, is a recipe based on the tincture of such plants:

4 tbsp. peony spoons.
1.5 st. spoons of valerian
2 tbsp. hawthorn spoons.
2 tbsp. motherwort spoons.
1 st. a spoonful of calendula
1 st. mint spoon.

The list of ingredients is not as large as in the previous recipe, but the effect is no less useful. Better yet, take it before the herbal infusion. The intake schedule is simple: three times a day in an amount of 1 to 10 drops. Start accordingly with a minimum and increase the dosage over time.

The course of treatment should be carried out intermittently: we take tincture for 1.5 months, we rest for 3 weeks. After a break, the course can be repeated. Any disturbance in the work of the heart leads to adverse consequences and possibly to other diseases.

This disease, in one form or another, is not uncommon in the medical records of patients, but the prognosis is different for everyone. Often, if the patient does not have respiratory and cardiovascular diseases in parallel, the prognosis is very favorable.

Consequences

Depending on the type of blockade that occurs, the consequences may be different. With an incomplete blockade, the violations will not be serious; with a complete blockade, the ability to conduct impulses can be completely lost. According to numerous studies, complete blockade of the right bundle branch block usually occurs in old age, most often in men.

Pathology is accompanied by a violation of contractions of the heart muscle. Such conditions can be either temporary or permanent. Complete blockade of the right leg of the bundle of His can be detected only with long-term monitoring of the work of the heart muscle.

In a healthy person, impulses are transmitted first to the interventricular septum, then to the left ventricle. In the case of blockage, the signal is transmitted through the tissues of the heart muscle, and not directly. The transmission of impulses by this method leads to changes in the tissues of the right ventricle, as a result of which it expands and deforms.

The residence time of the right ventricle in an excited state also significantly deviates from the norm. With complete blockade, signal transmission occurs only through the tissues of the interventricular septum. Excitation quickly passes to the left ventricle, due to anomalies in the structure of the heart, it affects the network of fibers.

With a partial loss of conductivity, signal transmission occurs with a delay due to its passage through only one leg of the beam. Therefore, some heartbeats are simply excluded. The delay in the conduction of impulses can occur under the influence of factors such as:

failures in the exchange of electrolytes;
body poisoning;
the use of certain potent drugs.

Due to the appearance of such failures in the functioning of the heart muscle, signal transmission occurs with a delay, in the right part of the heart, excitation does not reach a normal level.

The final diagnosis can be made on the basis of the ECG results. On the cardiogram, all violations of the heart rhythm will be clearly visible. In this case, deviations appear in the form of enlarged teeth with lowered areas.

Prevention of heart disease

Cardiovascular disease claims millions of lives every year. This increase in mortality is due to the fact that in most cases people lead an unhealthy lifestyle. Alcohol abuse, smoking, office work, lack of physical activity lead to the fact that even people at a young age suffer from heart problems.

The situation is worsened by the fact that society has stopped eating right. Snacking junk food leads to obesity, which adversely affects the work of the heart. Therefore, prevention should include a change in habitual lifestyle. There are simple rules that will significantly reduce the risk of developing heart disease.

Eat more vegetables and fruits. Choose lean meats and roast them instead of frying them. Experts advise reducing the amount of saturated fat consumed. Drink better throughout the day green tea, because it has useful properties and has a beneficial effect on the vascular system. Get at least 8 hours of sleep.

Regular physical exercise. Just 20 minutes of daily walking will reduce the risk of death from heart disease. avoid and passive smoking which is no less harmful. It is better to replace strong alcoholic drinks with dry red wine. Try to eliminate stressful situations.

Remember that blockade of the right leg of the heart does not make a person's life limited and boring.
For the blockade of the legs of the hys bundle, incomplete or complete blocking of one or two branches simultaneously is characteristic. The latter is a complete blockade of the bundle of His bundle, the first is partial.

This conduction disorder is either intermittent or permanent. The bundle of His consists of the left and right legs. The first is divided into 2 branches: back and front. Impulses pass through them to the ventricles, after which the latter contract. Any blocking of excitatory impulses leads to the development of various kinds of arrhythmias.

BBB is not a separate independent disease, but a consequence and electrocardiological manifestation of the underlying cardiac pathology. In patients with age, the percentage of detection of this disorder increases.

What it is?

The blockade of the legs of the bundle of His is a pathological condition, as a result of which the conduction of an electrical impulse along the RBBB and LRBB is disturbed. As a result, there are violations of the functioning of the conductive system.

Reasons for the blockade

The blockade of the legs of the bundle of His can be caused by various reasons.

Blockade of the right leg of the bundle of His	occurs in diseases accompanied by overload and hypertrophy of the right ventricle - mitral stenosis, atrial septal defect, tricuspid valve insufficiency, coronary artery disease, cor pulmonale, arterial hypertension, acute myocardial infarction (posterior diaphragmatic or upper apex), etc.
Blockade of the left leg of the bundle of His	cause atherosclerotic cardiosclerosis, defects aortic valve, cardiomyopathy, myocardial infarction, myocarditis, bacterial endocarditis, myocardial dystrophy. Less often, blockade of the bundle branch of His develops against the background of pulmonary embolism, hyperkalemia, and intoxication with cardiac glycosides.

Aortic defects (aortic insufficiency, aortic stenosis) and coarctation of the aorta are usually the causes of bifascicular blocks.

Classification

Depending on the number of elements of the His bundle, for which a violation of the conduction of the impulse is noticed, the blockade happens:

Single-beam, when the conduction of an impulse along one element of the bundle of His with a blockade is disturbed:

right leg of the bundle of His;
anterior branch of the left leg of the bundle of His;
posterior branch of the left bundle of His bundle.

Two-beam, when the conduction of cardiac impulses along two elements of the His bundle with blockade is impaired:

anterior and posterior branches of the left leg of the bundle of His;
right leg and anterior branch of the left leg of the bundle of His;
right leg and posterior branch of the left leg of the bundle of His.
Three-beam with blockade on all elements of the bundle of His.

The blockade can be complete and incomplete, permanent or intermittent (appears and disappears when recording one ECG), transient (not registered in the ECG), or alternating (when blockade of different legs occurs when recording one ECG).

Symptoms

The blockade of the right leg of the bundle of His is asymptomatic and is an accidental finding, identified by the results of an ECG study during a routine medical examination, medical examination or treatment for other diseases. Single-beam (anterior or posterior) left blockades also do not have clinically significant manifestations.

The blockade of the left leg of the His bundle has symptoms of the disease that caused it, more often it is:

decreased exercise tolerance;
shortness of breath with little physical exertion;
interruptions in the work of the heart;
palpitations;
pain in the region of the heart;
change in heart tones during auscultation [weakened or prolonged I tone (in 70% of cases), less often (16% of cases) - its splitting, splitting of the II tone (80%)].

Three-beam blockade has the most severe clinical manifestations:

extremely low heart rate - 20-40 beats / min;
severe shortness of breath at rest;
interruptions in the work of the heart;
heart rhythm disturbances;
dizziness;
brief episodes of loss of consciousness;
cyanosis of the skin.

What does bundle branch block look like on an ECG?

TO ECG signs, characterizing the complete blockade of the right leg of the bundle of His, include:

An increase in the duration of the QRS complex over 0.120 seconds.
The presence of a deformed long S wave in leads V4-V6.
The presence of a three-phase (similar to the letter "M") QRS in leads V1-V3.

Speaking about the signs of incomplete blockade of the right leg of the His bundle, it is worth noting the absence of a pathologically long QRS complex on the ECG (its length is either normal or is at upper bound norms ranging from 0.090 to 0.110 seconds), but the presence of three-phase in the visual assessment of the shape of the ventricular complexes.

TO visual signs complete (affecting both branches) blockade of the left leg on the ECG include:

There may be a prolongation of the ventricular complex in excess of 0.120 seconds.
The presence of deep long S waves in leads V4-V6.
The presence of long and deformed R waves in lead I, aVL and V5-V6.
The absence of Q on graphs I, V5-V6.

The blockade of the anterior branch of the left leg of His looks like this:

A pronounced deviation of the axis of the heart to the left side (from -30 to -90 degrees).
Small R-waves associated with deep S-waves in II, III, and aVF.
Small Q waves in I and aVL.

The blockade of the posterior branch of the left leg of His looks like:

Pronounced deviation of the axis of the heart in right side(from +120 to +180 degrees).
Ventricular complex of normal duration.
Small Q-waves associated with high-amplitude R-waves in II, III, and aVF.
Small R waves in I and aVL.

If the ECG shows the above signs that fit the description of the blockade of the legs, the doctor will definitely identify the root cause of this rhythm disturbance and make a diagnosis in accordance with state recommendations, and consider the blockade itself to be a manifestation of the disease.

Left bundle branch block

Right bundle branch block

Blockade of the right leg together with the left posterior branch of the bundle of His

Consequences

The blockade of the legs of the bundle of His requires timely diagnosis, since if left untreated, the disease causes serious consequences, sometimes incompatible with the patient's life. Among them are:

tachycardia;
ventricular fibrillation;
thromboembolism;
heart failure;
heart attack;
stroke;
sudden death.

Treatment for blockade of the legs of the bundle of His

Therapy of pathology depends on the type and electrocardiographic parameters at the time of diagnosis. Special treatment for lesions of the right bundle leg is most often not required. In this case, the patient is recommended to comply with measures aimed at preventing complications of the pathology.

To do this, the patient should adhere to the following rules:

harden, douse with cold water;
adequately respond to stress;
introduce teas into the diet, including soothing herbs (valerian, motherwort, elderberry, linden, nettle, oregano);
give up hard physical work, power sports;
observe proper nutrition, refuse products that increase blood cholesterol levels;
exclude fatty, spicy, fried, smoked foods, mayonnaise, sauces, marinades, ketchups.

There is no specific medical treatment for this conduction disorder. Patients with blockade of the right bundle branch block in the absence of the underlying disease do not need treatment. For patients with single or double bundle blockade, the following groups of drugs can be prescribed for the treatment of the underlying disease:

antioxidants - ubiquinone, carnitine, mexidol, preductal;
vitamins - thiamine (vitamin B1) with lipoic acid, riboflavin (vitamin B2), nicotinic acid (vitamin PP);
sedative preparations of plant origin (St. John's wort, motherwort, valerian, sage);
antiplatelet agents to prevent thrombosis in the heart and in the vessels - aspirin, cardiomagnyl, thrombus Ass;
lipid-lowering drugs to normalize cholesterol levels - statins (rosuvastatin, atorvastatin, simvastatin);
ananginal drugs for the treatment of coronary heart disease - short-acting and long-acting nitrates (nitroglycerin, isoket, kardiket, monocinque);
drugs for the treatment of diseases of the bronchopulmonary system that caused the development of a "pulmonary" heart - inhaled adrenomimetics and glucocorticosteroids (berotek, berodual, spiriva, beclazone);
antihypertensive drugs for treatment arterial hypertension- ACE inhibitors (perindopril, lisinopril), angiotensinogen II receptor antagonists (losartan, valsartan), beta-blockers (bisoprolol, atenolol), calcium channel antagonists (amlodipine, verapamil). The last two groups should be administered with caution, as they reduce the heart rate;
antibiotics, non-steroidal anti-inflammatory drugs for inflammation of the membranes of the heart - penicillin; nimesulide, diclofenac;
diuretics and cardiac glycosides in the development of chronic heart failure - indapamide, diuver, lasix; strophanthin, digoxin.

In addition to medication, it is used surgical method blockade treatment, which consists in the installation of a pacemaker (EX) to the patient. Complete right blockade, especially in combination with left hemiblockade (blockade of one branch of the left leg), and complete left blockade, which developed in the acute period of myocardial infarction (10-14 days), are an indication for temporary pacing by inserting an electrode through a central vein into the right ventricle.

Three-beam blockade with complete atrioventricular block, a rare rhythm of ventricular contractions and Morgagni-Edems-Stokes attacks (attacks of loss of consciousness) is an indication for permanent pacing (implantation of an artificial pacemaker or a cardioverter-defibrillator).

Forecast

In conclusion, it should be said that the blockade of the legs of the bundle of His is not a disease, but symptoms of heart disease that can manifest themselves clinically or be detected on an ECG. It is necessary to take into account the causes of the blockade, prescribe adequate treatment, and in this case it is possible to assume the consequences of a particular blockade.

If the patient has a single-beam right blockade and there are no pathologies of the heart and lungs, we can talk about a favorable prognosis.

An unfavorable prognosis in the case of a complete blockade of the left leg due to myocardial infarction, since in this case the mortality rate is 40-50 cases out of 100. In cases where the blockade is three-beam, the likelihood of developing asystole is high and the prognosis is also unfavorable.

Prevention

Preventive measures include:

avoidance of stressful situations;
giving up alcohol and smoking;
daily routine, full and restful sleep;
refusal of fried, canned and spicy foods;
taking medications only prescribed by a doctor and under his control;
the use of foods with a significant content of fiber: fresh fruits and vegetables, greens;
timely diagnosis and treatment of diseases of all organs, not only the heart;
Mandatory consultation with a doctor when symptoms of the disease appear.

If an operation was performed to install a pacemaker, a person should exclude the influence of electrical devices on him, mobile phone. In case of illness, it is important to visit the attending physician in a timely manner to assess the condition of the heart and the general well-being of the patient.