Interpretation of ECG violation of intraventricular conduction. Treatment of intraventricular conduction disorders of the heart. The mechanism of a two-bundle blockade of the right leg with the left anterior branch

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Questions and answers on: ECG intraventricular conduction disorder, what is it?

2011-05-27 00:31:44

LYUDMILA asks:

I am 51 years old, I made an ECG conclusion: Sinus rhythm 60 in -1, Horizontal position, disturbance of intraventricular conduction. what is it and how to treat it

2012-06-10 17:17:28

Tatiana asks:

Hello. I’ve been diagnosed with MVP since I was probably 14 years old (I’m 22 now). It’s actually never bothered me. But Lately My heart began to pound, feel sick, feel dizzy, my blood pressure jumped sharply, then dropped. I don’t have enough air, and when I take a deep breath, it hurts again. The doctor said that there is no pain from MVP. And the ECG interpretation: Violation of intraventricular conduction, signs enlargement of the left ventricle. I would like to ask how MVP, my symptoms, explanation. Are they related to each other, and are they related at all? Is it dangerous?

Answers Fesyuk Galina Nikolaevna:

Dear Svetlana. For now, we should consider MVP and the manifestations you described as united by a cause-and-effect relationship. The option of inadequate loads immediately arises - therefore ECG studies in this situation it is not enough: ECHO cardiography is necessary.

2011-04-06 23:27:01

Dmitry asks:

I did an ECG and the transcript says sinus rhythm 60 68 eos vertical Disturbance and slowing of intraventricular conduction! what does it mean?? I did an ECG 3 weeks ago, the pressure was 170 over 60, now it’s 120 over 64; aching pain appeared in the heart area! I am a bodybuilder, 23 years old, height 179, weight 90 kg

Answers Bugaev Mikhail Valentinovich:

Hello. Bodybuilding is not a path to health, rather the opposite. Static loads are harmful to the heart. There is nothing particularly scary right now, but it may appear in the future. There's already pressure
began to rise, this is the path to hypertension and a lot of problems.

2016-09-21 20:17:57

Elena asks:

Hello. I am 27 years old and had an ecg done at a regular health commission. The conclusion says the following: sinus rhythm with heart rate 61 beats per minute. Accelerated A-B conduction. Local disturbance of intraventricular conduction. Tell me what this means. Is any treatment necessary?

2013-08-30 14:42:48

Zinaida asks:

Hello doctor delivered clinical diagnosis hypertonic disease Article 2 WHO risk 3 sinus tachycardia CH I f. class NYHA dyslipidemia Holter conclusion - single paired supraventricular extrasystole transient A-V 1st degree blockade light form COAC Ultrasound of the heart conclusion thickening of the walls of the aortic root fibrosis of the aortic valve leaflets hypertrophy of the left ventricular myocardium ECG - SINUS RHYTHM 78 beats. intraventricular conduction disorder I am 58 years old, weight 80 kg, how is it treated and what to operate on

Answers Selyuk Maryana Nikolaevna:

Good afternoon, Zinaida! Unfortunately, the echocardiogram report is incomplete. There are no parameters by which one can say whether the valves should be replaced or not, since “thickening of the walls of the aortic root, fibrosis of the aortic valve leaflets” is not enough to talk about any hemodynamic insufficiency. The main thing is that hypertension must be treated. You must constantly take medications to control blood pressure numbers, since there are already certain structural changes in the heart that will progress. To control lipids you need Atoris (I can’t write the dose because I don’t know the level total cholesterol. If additional consultation about antihypertensive drugs is needed, write down your blood pressure level in the morning, evening (several days) and what drugs (necessarily with doses) you are taking.

Answers Amonov Odil Shukurlaevich:

Hello: treatment does not require surgery, you need to write complaints and based on the complaints you need to make a conclusion. And the indicators of the devices do not always reflect the clinical picture of the disease.

2012-05-23 07:51:46

Nadezhda asks:

Hello! I am 26 years old. My heart never bothered me. Made an ECG - Duration of intervals: RQ (OR) =0.14 sec. QRS=0.08 sec. QT=0.36 sec. The rhythm is sinus, accelerated with a heart rate of 96 per minute. Horizontal position electrical axis heart (EOS). Violation of intraventricular conduction. Myocardial change back wall left ventricle. I'm terribly scared, what does this diagnosis mean? I was a little nervous during the ECG, maybe this had an effect?

2011-08-14 11:50:28

Tatiana asks:

Good time days!
Man, 51 years old, has been playing volleyball, football, basketball (amateur) since school and to this day.
I was often sick lacunar tonsillitis, in 1999 2 times in a row in Once again I had lacunar tonsillitis (purulent) They did an ECG: RR interval 0.8; transition zone V3-V4; PQ intervals 0.16; QRS 0.08; QRSТ 0.36; The QRS complex is not changed AVF is jagged. Conclusion: sinus rhythm with heart rate 75 per minute, normal position email axis of the heart, disturbance in the stomach. conductivity.. In 2001 they were concerned pressing pain in the chest area (mainly at rest, in the morning) Was at outpatient treatment(10 days) Diagnosed with coronary artery disease, angina pectoris 3 pounds. cl, there were no examinations other than an ECG. ECG 2001: signs of LV hypertrophy with subepinardial ischemia of the anterior wall. Violation of intraventricular conduction. The attacks were not long lasting up to 2 minutes and not frequent, mostly without nitroglycerin, he refused at the end of treatment because... I had severe headaches. He didn’t go to the hospital again, but he took part in football and volleyball competitions, and went fishing 20 km away. At the same time, he was diagnosed with a duodenal ulcer, he treated the ulcer folk remedies, but I didn’t take any medications for my heart. Until 2007, isolated attacks passed while sitting, after which nothing bothered me at all, and to this day the attacks have never recurred. Leads the same way active image life, there is no shortness of breath, no swelling, he always walks, headaches do not bother him. Again in 2008 purulent sore throat., from t to 41, they somehow knocked it down. at home, it dropped sharply to 36.8, but the next day at the doctor’s appointment it was already 38.5.
In 2008 he was hospitalized as planned to clarify the diagnosis
Diagnosis: stage 11 hypertension. CNS o-1, ischemic heart disease, angina pectoris 1, PICS? Infective endocarditis, remission?, peptic ulcer duodenum, remission
Examination data: Ultrasound of the heart
MV: pressure gradient - normal, regurgitation - subvalve, thickening of the scapular vein. AK: aortic diameter (it is not clear further) - 36mm, aortic diameter at the level of the ascending section - 33mm, aortic walls are compacted, systolic divergence of the leaflets - 24, pressure gradient max - 3.6mm Hg, regurgitation - no, formation d = 9.6mm in the field of RCC-vegetation?. TC-regurgitation of the subvalve, LA-regurgitation of the subvalve. LV: KDR-50 mm, KSR-36mm, RV-23mm, LP-37mm, MZhP-10.5mm, ZSLZh-10.5mm, FV-49. The pericardium is not changed.
ECG test with doses. physical load (VEM) - test negative tolerance in/sterd
Holter ECG monitoring: daily dynamics of heart rate - 63-151 during the day, 51-78 at night, sinus rhythm. Rhythm disturbances in the ide: single PVCs - 586 in total, single PE - 31 in total, SA blockade with pauses up to 1719 ms - 16 in total. ECG signs of myocardial ischemia were not recorded. The esophagus was checked and diagnosed with gastro-duodenitis. Ultrasound kidney pathologies No kidneys were detected. An examination at the Heart Institute (PE_EchoCG, CVG) is recommended. I did not take prescribed medications. I was not examined anywhere in 2009.
2010 - examination at the Regional Cardiology Department. Diagnosis: IHD. Angina pectoris 11fk, PICS (undated), hypertension stage 11, to degree, correction to normotension, risk 3. Transient W-P-W syndrome, formation of the right coronary cusp, CHF 1 (NYHAI FC)
Examination:
Emergency Echo-CG: on the right coronary cusp a rounded, suspended formation (d 9-10mm) on a pedicle (pedicle 1¬6-7mm, thickness 1mm) is located, emanating from the edge of the cusp
Treadmill: At the 3rd step of the load, the proper heart rate has not been achieved. Maximum increase in blood pressure!:)/85 mmHg. Under load - transient WPW syndrome, type B, single ventricular extrasystole. No changes in ST, z.T were detected. The load tolerance is very high, the recovery period is not delayed.
24-hour blood pressure monitoring: Daytime hours: max SAD-123, max DBP-88, min SAD-101, min DBP 62. Night hours: max SAD-107, max DBP57, min SAD-107, min DBP-57
Daily ECG monitoring: Closing: Sinus rhythm Heart rate 46-127 per minute (average 67 per minute). No episodes of ST segment elevation or depression were recorded, ventricular ectopic activity: single ZhES-231, Bigeminy (number of ZhES)-0, paired ZhES (couplets)-0, VT runs (3 or more NZhS)-0. Supraventricular ectopic activity: single NVES-450, paired NVES 9 verses)-15, runs of NVES (3 or more NVES)-0. Pauses: registered-6. Max. duration - 1.547s.
Recommendations: consultation at the Heart Institute to resolve the issue of surgical treatment. Doesn't take medication. At the next inspection they wrote that they were given 1 year of work as a gas compressor station operator, then for professional suitability
2011 Heart Institute (from May 24 to May 25)
Diagnosis: ischemic heart disease, vasospastic angina, post-infarction cardiosclerosis (with posterior Q wave, undated)
Echo KG:AO-40 voskh+40 arc 29, S1 22, S2 17, LP-38*49*59, Vlp 53.9, PZh26, thickness st.PZh5, KSRLV-, KSO96, KDO164, UO67, FV40- 41, UI35,
SI 2.4, MZhP14, ZSLZh13, PP43-53, NPV17, VTLZh22, Vel/TVI/Pg 0.6/1.4, AK not changed, AK (disc.)20, FK25, Vel/TVI/Pg 0, 9/3.2, MC not changed, FC 40, MTD=34mm, area 7 cm2, TC not changed, LA32,Vel/Pg 0.9/3.3/1.7, P average LA 10. Conclusion: PPT =1.96 m2, slight dilatation of the RA, slight LVH, hypokinesis of the posterolateral, lower walls at the basal level, infero-septal segment. LV function is reduced, LVDD type 1
Coronography (radiation dose 3.7 mSv): no pathologies, type of blood circulation is right, LVGA is normal Conservative treatment is recommended
07/18/2011 underwent Echo-CG without presenting a diagnosis, just get checked
Results: Dimensions: KSR-35mm, KDR-54mm, KSO-52ml, KDO 141ml, Ao-31mm, LP-34*38*53mm, PP-35*49mm, PS-4mm, MZHP-13mm .,ZS-12mm.,PZh-28mm.,La-26mm,NPV-17mm. Function: EF-62%., VO-89 ml., FU-32%. Valves: Mitral valve: Ve-57cm/sec., Va-79cm/sec., VE/Va Results of the 1st: left atrium:parasteral-41;
-Ch-K position-51-38; aorta: diameter-035; opening AO class-21; left ventricle: KDR-59; KSR-42; KDO-171; KSO-79; UO-92; FV-54%; MZhP-15; ZSLZh-14/15
right atrium: long axis - 48; short axis - 40; right ventricle: parasternal-25; NVP, diameter-23; NVP,% collapse-No.; pulmonary artery: diameter-23; SDPA-No.; aortic cell: area-No.; mitral cell.: area-No.
Conclusion: the aorta is not dilated, moderate dilatation of the left chambers of the heart, symmetrical LV hypertrophy, impaired diastolic function type 1, LVMI 240 g/m (m squared) - above normal, valves are not changed, no violations of local myocardial contractility have been identified, global contractility slightly reduced. An ultrasound scan was performed by a doctor highest category.
Results of the 2nd study.
AO-37v-35;S1-17;S2-16;LP-34x42x51;
V lp-45ml;RV-22;LVKSR-44;LVKDR-62;KSO-89;KDO-197;UO-108;FV-55;FU-29;MZhP-12;ZSLZh-12;Myocardial im-204; PP-31x43;pericardium-No.;AC-not changed;AC 9opened)-27;FK-23;VeI/TVI/Pg-1.0/4.0; regurgitation - not detected; MK - not changed; FC-32; VeI/Pg-o.5/1.0; regurgitation - not detected; TK - not changed; regurgitation - not detected; LA-25; VeI/Pg-0 .77/2.3; R average LA-19.0
Conclusion: PPT - 1.93 m2, pronounced LV dilatation (LV EDV index - 102 ml/m2; pronounced eccentric LVH (OTC - 0.39; myocardial MI - 204 g/m2), no significant zones of LV asynergia were identified, LV systolic function is satisfactory , LVDD type 1, valves are not changed, normal pressure in LA. The ultrasound scan was performed by a doctor of the highest category, head of the cardiology department. We go through so many ultrasounds to prove that my husband didn't have a heart attack because... the results of the examination do not confirm this, and he is fired from work due to the diagnosis. His blood pressure was 123/80, recently it was 130/80, pulse 72, at the doctor’s appointment the pressure was registered as 140/82, heart rate 75. We submitted a request to the expert commission to reconsider the diagnosis. Questions: 1) how are the latest ultrasounds of the heart interpreted (given that everything is fine in other examinations? 2) If he had PICS since 2001 or 2004, could he have medicines, feel so wonderful? 3) can there be a myocardial infarction with clean coronary vessels? 4) can frequent sore throat affect the thickening of the walls (according to the last ultrasound, we were told that he had thickening of the walls, which may have been mistaken for a post-infarction scar, and even before that, when he underwent a medical commission, some doctors saw an alleged scar, others did not, and were very surprised that he had ischemic heart disease and a heart attack, because again, nothing was confirmed, but he was persistently rewritten from year to year) His parents do not have ischemic heart disease, his mother is 78 years old, she has low blood pressure. I would like to know your opinion on to this man? (MRI of the heart is not done in our region, because they also do myocardial scintigraphy). Thanks in advance for the answers!

Answers Bugaev Mikhail Valentinovich:

Hello. Alas, it is sometimes easier for us to stick a diagnosis of a heart attack than to remove it. Inertia is at work. You will have to do myocardial scintigraphy; ultrasound cannot reliably identify scars; you don’t have to do it that often.

2011-05-26 14:39:55

Tatiana asks:

Good afternoon My mother is 54 years old, she recently had an ECG and in conclusion they wrote: Sinus rhythm, heart rate 80 beats,
Horizontal EOS 27 degrees.
Violation of intraventricular conduction in the posterior diaphragmatic region of the left ventricle. Please tell me what this means and is it dangerous or not?

2011-01-21 15:34:19

Elena asks:

Good afternoon! Help me understand the diagnosis of heart disease based on the results of examinations. I am 45 years old, I have been feeling unwell, especially for the last six months: arrhythmia, frequent heart palpitations, a feeling of heaviness in the heart area, weakness.
History: 1997 - surgery to remove the uterus and appendages - oncology. Hernia cervical spine spine, portrusions in thoracic region spine.
Tests for tumor markers and hormones (taken in October 2010) were normal.

Holter from 11/11/2010: A total of 115,178 QRS complexes were recorded, of which 5,921 were classified as artifacts. The main rhythm is sinus. Average heart rate 79 beats/min, Max. Heart rate-141 beats/min. (8h.01min.), Min. Heart rate-49 beats/min. (6 hours 02 minutes). Normal QRS complexes - 108497, aberrant complexes - 0.
Dynamics of the ST segment (channel V5). The ST segment level was determined at a distance of 80 ms. from point j. 6 episodes of ST segment depression of more than (-1.0) mm were recorded, with a total duration of 30 minutes, with a heart rate at the beginning of the episode averaging 109 beats/min. Max. cont. episode 7 min. 30 sec. at 12.41 min. Max. ST depression -1.3 mm at 03:43. No episodes of ST segment elevation of more than (2.2) mm were detected.
Ventricular ectopic activity: Registered in a number of 754 VES, on average, 33.6 VES/hour, which amounted to 0.65% of total number QRS complexes. Ventricular ectopic activity is multifocal (2 types). Single VES -712, Bigeminy (number of VES) -4, Paired VES (couplets) - 19, VT runs -0.
Supraventricular ectopic activity: Single NVES -6, Paired NVES (couplets) - 0, SVT runs -0.
Pauses - not registered
Conclusion. Signs of chronic coronary insufficiency FG II (periods of horizontal displacement of the ST segment during physical activity when the heart rate increases more than 110). Ventricular extrasystole III, IVA gradations according to Zonn.

Echo-ECG dated October 25, 2010: Moderate degenerative changes in the valves of the mitral valve. I-II Art. Additional ZSMK chord. Additional Chords of the left ventricle. Hyperkinit.cord.syndrome.

Electrocardiogram dated January 18, 2011 (while taking allopinin, preductal, cardiomagnyl, Mildronate injections - 10 pcs. for 1.5 months)
Heart rate, bpm -72; R-R max., ms – 854; R-R min. ms – 796; R-R avg. ms – 830; P, ms – 108; Р-R(Р-Q), ms – 141; QRS, ms -106; QT, ms – 390; QTс, ms – 428; QRS axis - 77
Conclusion: Vertical position electrical axis of the heart. Violation of intraventricular conduction. Diffuse muscular changes in the myocardium with manifestations of hypoxia in the posterolateral region of the left ventricle. The presence of HKN cannot be ruled out.
How serious is this? Is there any way to treat this and how to improve the quality of life?

Intraventricular conduction disorder is a pathology in 1, 2 or 3 bundle branches that transmit synchronization signals. Violations of intraventricular conduction of the heart of this type are respectively called mono, bi- and trifascicular block. It usually means the occurrence of any interference in the path of the movement of nerve synchronization impulses in the conductive channels of the heart muscle. Violation of intraventricular conduction of the heart means not only complete blocking of the impulse. This concept also includes its slowdown, partial breakdown.

general information

Disturbances in intraventricular conduction can cause so-called blockades, which can be partial or complete. In the first case, a slowdown in the passage of the nervous control signal and a decrease in the frequency of pulsations may occur. In the second case, the impulses cannot penetrate to other structures of the myocardium, which leads to a complete disruption of the functioning of the heart muscle, and cardiac arrest is possible, which can lead to the death of a person.

Incomplete blockade leads to the passage of nerve signals with a lower frequency, which somewhat disrupts the functioning of the myocardium, but does not lead to the death of the patient. Blockades are divided into distal and proximal, and the former are much more dangerous than the latter and require serious medical intervention. Such lesions occur in various parts of the heart muscle, for example, on the so-called branches of the His bundle (right or left).

With these pathologies, there may be various types of intraatrial conduction:

1. Local, weak lesions often occur, which can appear even in completely healthy person.
2. Complete blockade of the left ventricle most often causes acute attacks myocardial infarction.
3. Sometimes a nonspecific violation of intraventricular conduction occurs, which is very dangerous looking defeats.

All specified types blocking of control pulses is diagnosed various methods, and everyone has their own methods of treatment. And in some cases healing process almost impossible to carry out.

Causes

The reasons causing the deterioration of intraatrial conduction are different. This mainly happens due to functional disorders, various organic changes, under the influence of drugs:

1. In the absence of any pathologies in the cardiovascular system, changes in the functioning of the conduction channels, which are controlled by the sympathetic and parasympathetic systems. Of these, the first enhances the passage of the impulse, and the second restrains it. If an imbalance occurs between these systems, this will lead to a functional shift in the performance of the heart muscle as a whole.
2. With organic changes, the structure of conducting channels most often changes. In this case, a person develops myocarditis, angina pectoris, heart attack, cardiosclerosis and a number of other ischemic heart diseases. Various organic changes appear when there is a defect in the heart muscle, the occurrence of cardiomyopathy. Sometimes similar phenomena occur after surgery on the heart muscle.
3. When used to treat certain types of patients medications one can observe their serious influence on the heart rate. In some cases, this causes ventricular conduction disturbances. Blockades caused by such factors are difficult to cure.

Almost all of these types of diseases are detected using electrocardiography. If there are lesions that change their characteristics over time, then so-called Holter monitoring using an ECG can be used for diagnosis.

Symptoms

Signs of development of signal obstruction in the heart may vary. Blockades and arrhythmias in this organ can be identified when the following symptoms are present:

1. The patient's heart rate increases.
2. You can often notice gaps in heart contractions.
3. The heart is working with some interruptions.
4. Pain resembling angina pectoris occurs in the myocardium.
5. The patient experiences fainting, severe shortness of breath, he complains of dizziness. This often happens when the brain is not getting enough oxygen due to poor blood supply.

For nonspecific conduction disorders, the symptoms are slightly different:

1. In addition to shortness of breath (it also manifests itself in calm state patient) and dizziness, the person feels cold in the heart area.
2. The patient gets tired very quickly, and his pulse often slows down greatly.
3. Signs of memory loss may occur, and daytime The patient's mood suddenly changes several times.
4. The patient develops an incomprehensible fear of death and anxiety.
5. This type of attack can occur suddenly and the man will fall out of the blue.

If the patient has at least one of the symptoms described above, he must be urgently transferred to a medical facility and hospitalized.

Delay may result in the death of the patient.

Treatment

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More about the conduction system

The intraventricular conduction system is integral part conduction system of the heart. The main function of the system is to conduct an impulse from the place of its formation to its final destination. Normally, formed in sinus node(SU), an electrical impulse runs from the atria to the ventricles, alternately exciting them. So, first the right and left atria are excited, then the right and left ventricles. Each chamber of the heart has its own time to receive a charge.

When the atria contract, they push blood into the ventricles. During the time when the ventricles are preparing to expel blood into large vessels To deliver it to the entire body, the atria “stock up” with a new portion of blood in order to give it to the ventricles. The intraventricular conduction system is represented by conduction pathways that form the so-called bundle of His (PH). This bundle collects all the pathways coming from the atria.

It arises from the atrioventricular node and is located at the junction of the right fibrous triangle with the superior membranous part of the interventricular septum. Its length ranges from 8 to 20 mm, and its width is only 2-3 mm. Having traveled some distance from its origin, the bundle of His is divided into right and left legs. The right one gives off branches to all the walls of the right ventricle. The left leg is in turn divided into anterior and posterior branches. Having reached the ventricular myocardium, the branches of the bundle branches (PH) disintegrate into Purkinje fibers.

2 Causes of conduction disorders

It takes from 0.06 to 0.10 seconds to conduct an impulse through the ventricular system. If there is some kind of obstacle, then the impulse passes with a delay. If impulse transmission is blocked along all fibers, they speak of a complete blockade. If some of the fibers of the intraventricular conduction system still transmit an impulse, they speak of. The reasons for the delay or blocking of impulse transmission can be both functional and organic in nature.

The functional nature of a failure implies deviations in normal conduct impulse without structural changes in the elements of the conducting system. With an organic conduction disorder, the impulse cannot pass freely due to the restructuring of the conduction pathways as a result of a previous or existing disease. Functional reasons: physical activity, psycho-emotional stress, taking medications, increased content potassium in the blood, etc.

Organic reasons: ischemic disease heart (myocardial infarction), developmental anomalies of cardio-vascular system, heart defects, hypertension, cardiomyopathies, cor pulmonale, diabetes, dystrophic changes on the background systemic diseases(amyloidosis, sarcoidosis). A separate point is more rare cases idiopathic blockades, when the cause cannot be identified. Such blockades are called Lenegra's disease, Lev's disease, etc.

3 Classification

Depending on how difficult it is for the impulse to pass through the branches of His, complete and incomplete blockade of the bundle branches is distinguished. If the changes are permanent, the blockade is called persistent. If the blockade appears under the influence of certain factors, they speak of a transient blockade. There is also a classification that distinguishes conduction disorders depending on the number of bundles involved. IN Latin fasciculus is spelled "fasciculus", so the adjective "fascicular" is synonymous with fasciculus.

Single-bundle (monofascicular) - one bundle is partially or completely blocked. This may be a blockade of the right bundle branch, anterior or posterior branch of the left bundle.

Double-beam (bifascicular) - two bundles are involved in the process. This may be the left leg, as it consists of two bundles: the anterior and posterior branches; the right leg and the anterior or posterior branch of the left leg.

Three-fascicular (trifascicular) - the left leg is completely blocked and the right leg is partially blocked, the right leg is completely blocked and incomplete blockade anterior and posterior branches of the left leg.

4 Diagnostics

He may find out that a patient has a blockade quite by accident. This applies to mono- and bifascicular blockades, since they do not affect the state of blood circulation. Patients with three-fascicular blocks may complain of dizziness, palpitations, fainting states, shortness of breath, chest pain. Most often, patients present complaints of the underlying disease, which led to the development of conduction disorders.

Inspection, palpation and auscultation do not give a clear idea of ​​the existing disturbances in conduction, since there are no specific signs. A doctor can suspect something is wrong by the presence of split tones.

Electrocardiography (ECG) is the main method for identifying such disorders in the conduction system of the ventricles. The main feature complete blockade right bundle branch is a change in the ventricular QRS complex in the right precordial leads - V1 and V2. Complexes exceed normal duration and change, acquiring an M-shaped appearance.

In addition to changes in the ventricular complex, a decrease in the ST segment with a negative T may be observed. With incomplete blockade, the existing changes appearance complexes and segments do not exceed their normal duration. In the case of blockade of the left leg, these changes are localized in the left chest leads - V5 and V6. Blockade of the anterior branch of the left leg is characterized by a sharp deviation of the electrical axis of the heart to the left, and of the posterior branch to the right.

Holter monitoring allows you to identify possible provoking factors for conduction disorders through long-term recording of an electrocardiogram throughout the day.

Intracardiac electrophysiological examination of the heart may be performed when a patient is being considered for possible implantation of a pacemaker.

5 Conduction disorders in children

Conduction disorders in children may disappear as they grow older. In other situations, the disorder may develop into chronic form. The reasons for the development of ventricular conduction disturbances in children may be the following:

• premature babies,
• hypoxia of the heart muscle,
• birth injury,
• congenital heart defect,
• medicines,
• unclosed oval window,
• infective endocarditis,
• rheumatism, etc.

6 Treatment

Treatment of intraventricular blockades in both adults and children begins with identifying the cause. If the identified causes are functional in nature, then, as a rule, their elimination leads to full recovery patient.

If the cause of this type of conduction disturbance is a disease, then treatment is aimed at the underlying disease. Drugs are prescribed or adjusted when arterial hypertension(AH), coronary heart disease, etc.

Attention is also paid to issues of therapeutic diet.

In case of ineffectiveness drug treatment When clinical symptoms are severe, the patient is implanted with a device that artificially stimulates the ventricular myocardium.

7 Forecast

The prognosis of existing conduction disorders differs sharply depending on what caused the disorder. Patients with two- and three-fascicle blocks are at risk of developing complete atrioventricular block and ventricular arrhythmias. They also pose a risk of sudden cardiac death to the patient. Although the likelihood of developing such dangerous complications is small, it still exists. Therefore, you should be attentive to your health and the recommendations of your treating specialist. Take care of your heart!

• Causes and symptoms of this disease
• Main types of blockades
• Research methods and types of treatment
• Study of illness in pregnant women

Intraventricular conduction disorders are various occurrences of obstacles to the healthy passage of nerve impulses throughout the cardiac muscle system. Knowing all this, it is worth considering: general disorder is not its complete absence, because in its absence a complete stop of the heart occurs.

This type of disease is typical. They are:

• complete (in this blockade the passage of the impulse is completely absent);
• incomplete (in this blockade nerve impulse there is, but it passes very slowly and with the lowest frequency; this kind of disorder can be harmful various areas heart, so you need to know that local disruption of intraventricular conduction will not cause harm to the human body).

Impaired intraventricular conduction is caused by a number of ailments that a person has suffered in the past, namely coronary heart disease, heart attack, disturbances in the amount of potassium, calcium or chlorine in the blood, endocarditis, usually infectious.

Causes and symptoms of this disease

There are basically three main types of reasons why intraventricular conduction disturbances may occur:

Organic reason. As a result of this reason, a complete change occurs in the entire structure of the conduction system of the heart, as a result of which heart attacks, angina pectoris and other heart diseases can be observed. There may also be an organic cause congenital defect heart or occur as a result of surgery.

Nonspecific intraventricular disorders - various notches or splitting of the ventricular complex. These types of changes can easily be attributed to the results organic cause. Changes occur in the myocardium of the degenerative ventricle, there are various inflammations or scars.

Medicinal cause. May occur due to previous medication use. As a result of this they have harmful influence to the heart rhythm. As a rule, this reason requires longer and more thorough treatment, which is much more difficult than in other cases.

Functional reason. The consequence of this reason is the occurrence of pathology in the structure of the entire conduction system. Happening functional shift in the entire functioning of the cardiac system.

If intraventricular patency is impaired, a number of symptoms are observed, such as:

• frequent dizziness;
• constant shortness of breath;
• feeling of a sinking heart;
• periodic feeling of weakness, fatigue, powerlessness;
• low heart rate;
• periodic memory lapses;
• sudden change of mood;
• frequent sudden feelings of anxiety and restlessness;
• falling out of the blue.

Return to contents

Main types of blockades

The most common blockade when intraventricular conduction pathology is detected is longitudinal dissociation (or bundle branch block). This type of blockade is not considered as independent disease due to the fact that it manifests itself solely as a result of various pathologies hearts. Can be more accurately described as a large cluster muscle fibers, which are noticeably changed. It is known that the blockade is divided into right and left legs. The left leg is further divided into anterior and posterior branches.

There are various blockades, and each of them has various characteristics. In cases where a blockade of the right leg is detected, the electrical impulse slows down significantly.

Blockade of the left leg can also be observed in the slow conduction of the above impulse (only by posterior sections left ventricle).

When a two-bundle block is observed, a combination of the right and left legs of the block occurs. This, first of all, indicates that there are Big changes in the myocardium.

Three-fascicle blockade - conduction of impulses from the ventricles to the heart.

Blockades can also be divided into two subtypes:

• permanent or chronic appearance;
• unstable or sharp appearance.

During the excited process of the above blockades, the path and time of excitation of the ventricles change. In the primary form, at the onset of excitation, it is covered interventricular septum, and then the left ventricle is included in the process. It is also worth recalling that the impulse enters the left ventricle naturally, and the excitation impulse enters the right blocked ventricle through a network of fibers, that is, in an unnatural way.

As is known, bundle blockade is not performed on its own. human body dangers, their clinical significance, as a rule, determines how much the disease has begun to progress and at what stage everything is. There are always exceptions. For example, very rarely, but still a trifascicular type of blockade occurs. Then the person needs to constantly wear a pacemaker.

Incomplete blockade right branch His bundle is most often observed in children.

Children with complete blockade of the right branch, as a rule, are diagnosed with intraventricular conduction disorder due to organic heart damage. One should not exclude a blockade of the left branch in children. It is extremely rare and appears, as a rule, after the surgical period.

In some cases, congenital blockages may occur. They, as a rule, do not lead to any diseases, very rarely make themselves felt and do not affect a person’s well-being. Absolutely all types of the above blockades can intersect and be combined with each other. When a diagnosis is made, everything is indicated. This helps in the future to more accurately determine treatment.

Intraventricular conduction disturbance is a type of cardiac arrhythmia. This changes the process of impulse transmission through the ventricular myocardium. The pathology may not have clinical manifestations and is discovered accidentally.

Also, conduction disturbances can develop against the background of another heart disease. Pathology is diagnosed using electrocardiographic examination. The article talks about intraventricular conduction disorders and the manifestation of this condition on the ECG. The causes of the pathology are described and the principles of treatment are indicated.

Ventricular conduction disorders are a type of cardiac arrhythmias.

Normally, the ventricles do not contract on their own. All heart contractions occur harmoniously, and the rhythm is set by the sinoatrial node.

This is a complex nerve cells, capable of generating an electrical impulse. It is located in the upper corner of the right atrium. In a healthy person, the sinoatrial node produces 60-80 impulses per minute.

After the impulse appears in the SA node, it spreads throughout the myocardium through a special conduction system. This is a network of nerve cells and fibers that ensure contraction of each part of the heart.

The impulse spreads to the ventricles from the atrioventricular node. Next, the ventricular conduction system begins, consisting of the His bundle, its two legs and Purkinje fibers (photo). These elements ensure contraction of all areas of the ventricles.

With any changes in the conduction system, a violation of intraventricular conduction develops. More often than not, this condition is invisible to the general public. contractile function heart, but sometimes rhythm disturbances may develop.

Causes

Sometimes conduction disturbances can occur against the background of complete health.

But more often there are predisposing factors for this:

• bad habits;
• stress;
• heart disease;
• hypertension;
• thyrotoxicosis;
• the effect of certain medications;
• lung diseases.

Transient conduction disturbances can occur with dehydration.

Manifestations on the ECG

Diagnosis of intraventricular conduction disorders is mainly carried out using an electrocardiogram.

There are several types of ventricular rhythm disturbances on the ECG:

• slowdown and cessation of conduction;
• Re-entry type violation (re-entry of an impulse);
• conduction acceleration.

Each type of pathology has its own development mechanism and its own manifestations on the ECG.

Intraventricular blocks

IN in this case there is a slowdown or complete blocking of the impulse passing along the right or left bundle branch. The left leg of the bundle has two branches that can also block the impulse.

The main sign of slowing intraventricular conduction on the ECG is a change in the shape of the QRS complex:

• with incomplete blockade, its width is 0.1-0.12 s;
• with complete blockade, the complex expands for more than 0.12 s.

There are permanent and transient forms of blockade.

Table. Bundle block on ECG:

Sometimes combined blockades occur. Most often, the blockade of the right leg and the anterior branch of the left leg are combined. The pathology itself does not require treatment; the underlying disease is treated.

Paroxysmal tachycardia

This is an acceleration of ventricular contraction to 140-220 per minute. Pathology develops according to the mechanism of re-entry, or backward wave.

The essence of this mechanism is that the impulse does not go through the conduction system, but spreads to the myocardium and returns again to the node generating the impulse. Subsequently, “the impulse moves in a circle.” This leads to more frequent contractions of the ventricles.

Such a violation of the conductivity of the ventricles of the heart according to the ECG is determined by the following signs:

• expansion of QRS complexes to 0.14-0.16 s;
• the electric axis tilts to the left;
• the R or S waves in the chest leads are directed in one direction;
• complexes are recorded that, in shape and width, represent the average between the atrial and ventricular ones.

Pathology can occur both against the background of health and during organic lesions hearts. Treatment is required in the presence of other diseases and is carried out using conservative and surgical methods.

Ventricular fibrillation and flutter

This dangerous violations rhythm that occurs against the background of a heart attack, dehydration, or electrical injury. Ventricular flutter on the ECG looks like a sinusoid or zigzags with a frequency of up to 300 per minute.

With fibrillation, a chaotic rhythm is observed. These arrhythmias lead to circulatory arrest and therefore require emergency resuscitation.

Brugada syndrome

This malignant appearance arrhythmias, which is one of the causes sudden death. Often occurs in young men. The ECG shows ST segment elevation as in a heart attack. But clinical symptoms at the same time no. Electrocardiographic changes may be transient, making diagnosis difficult.

Wolff-Parkinson-White syndrome

This is the process of premature excitation of the ventricular myocardium. It occurs in the presence of an additional pathway called the bundle of Kent. Most patients have no signs of other heart disease. The ECG shows a shortening P-R interval, the appearance of a delta wave, indicating premature arousal parts of the myocardium.

The peculiarity of the syndrome is that it is asymptomatic, but if atrial rhythm may indicate ventricular fibrillation. Treatment consists of preventing attacks of tachycardia.

Intraventricular conduction disorders are most often diagnosed accidentally on an ECG. Only two of them - fibrillation and flutter - are life-threatening. The remaining variants are not clinically manifested, specific treatment not required.

Questions for the doctor

Good afternoon. When passing medical examination I was diagnosed with left ventricular overload on my ECG. What is this, is there a need for treatment?

Yulia, 24 years old, Penza

Good afternoon, Yulia. This condition usually occurs in situations involving left ventricular tension. This happens to athletes during training, when physical stress, long run. Then no treatment is required, the condition is transient. But there are also some diseases that increase the load on the left ventricle - asthma, hypertension. In this case, you need to be examined by a doctor.