ICD code complete AV block. Video: lesson on bundle branch blocks. Etiology and pathogenesis

Atrioventricular(AB) third degree blockade(complete transverse block) - complete cessation of conduction of excitation from the atria to the ventricles. The atria and ventricles excite and contract independently of each other.

Code according to the international classification of diseases ICD-10:

• I44.2

Symptoms (signs)

Clinical manifestations depend on the frequency of the replacement rhythm; with a rare rhythm, a decrease in cardiac output and an increase in blood pressure due to an increase in peripheral vascular resistance are observed, which leads to pronounced disturbances in organ hemodynamics.

Classification: see Atrioventricular block.

Types. Proximal AV blockade of the third degree (nodal, AV blockade type A) - the conduction of impulses from the atria to the ventricles is completely interrupted at the level of the atrioventricular node. The frequency of ventricular contractions is determined by the activity of the replacement pacemaker from the atrioventricular junction and usually does not exceed 40 -50 per minute.. Ventricular complexes are not widened, the duration of the QRS complex is £ 0.11 s.. Episodes of loss of consciousness are possible.. Complete AV blockades can be acute (transient) or chronic (permanent). Acute third-degree AV blockades are 3-4 times more likely to complicate the course of posteroinferior MI compared to anterior infarctions, last in most cases 2-3 days, and rarely become permanent. Distal AV blockade of the third degree (trunk, AV blockade type B) occurs if the conduction of impulses from the atria to the ventricles completely stops below the atrioventricular node (level of the His bundle or the level of the His bundle branches) - the so-called three-fascicular block.. Replacement source rhythm is usually located in one of the branches of the His bundle.. QRS complexes are widened and deformed, QRS ³ 0.12 s.. Heart rate is 30-40 per minute or less.. Acute distal complete AV blockades, complicating myocardial infarction of the anterior wall, are prognostically unfavorable ( mortality up to 80%), their occurrence is due to severe damage to the interventricular septum. Chronic distal AV blockades of the third degree in half of the cases are caused by sclerotic and degenerative changes in the conduction pathways... Idiopathic bilateral fibrosis of the legs - Lenegra's disease (idiopathic chronic heart block), which occurs mainly in young and middle age... Progressive sclerosis and calcification of the membranous part and the upper part of the muscular part of the interventricular septum - Lev's disease.

Diagnostics

ECG - identification. Two independent rhythms: a more frequent atrial rhythm (P-R intervals) and a less frequent ventricular rhythm (R-R intervals).

Treatment

Treatment. Implantation of a pacemaker is indicated (see Cardiac pacing); in case of MI, a temporary endocardial pacemaker is indicated. Intensive therapy is necessary if bradycardia causes Morgagni-Adams-Stokes syndrome (or its equivalents - shock, pulmonary edema), arterial hypotension, anginal pain, a progressive decrease in heart rate or an increase in ectopic ventricular activity. Temporary endocardial or transthoracic external pacemaker. Drug therapy allows you to gain time to prepare for ECS: ... atropine 1 mg IV, repeat after 3-5 minutes until the effect is achieved or the total dose of 0.04 mg/kg is reached.. if there is no effect - aminophylline IV bolus slowly 240-480 mg.. if there is no effect - dopamine 100 mg or epinephrine 1 mg in 250 ml of 5% glucose solution IV, gradually increasing the infusion rate until a minimum sufficient heart rate is achieved.

Synonym. Third degree atrioventricular block.

ICD-10. I44.2 Complete atrioventricular block

Note. Frederick's syndrome (Frederick's phenomenon) is a combination of complete AV block with atrial fibrillation or flutter. The ECG shows waves of flutter (FF) or fibrillation (ff) of the atria, there are no P waves, but the ventricular rhythm is correct - 30-50 per minute, QRS complexes can be widened and deformed. Frederick's syndrome is observed in 10-27% of cases of complete AV block.

Bundle branch block is a hindrance or obstacle to the normal passage of the sinus impulse through the cardiac conduction system. Such an impulse is formed in the sinus node, goes beyond its boundaries, enters the atrium system and excites both atria as it passes. During its passage, the sinus impulse undergoes a considerable physiological delay, reaching the atrioventricular junction and entering the small conduction system of the ventricles.

Features of the disease

Blockade of the left or right bundle branches is a dangerous disease associated with the heart, which is necessary for the normal functioning of the heart.

• Very rarely, the disease is diagnosed in young people and the general figures range from about 0.1% of known cases.
• The older the person, the more often this disorder is diagnosed.
• At age 40, the percentage is already 4.5%.

Most often the disease occurs in men. And quite often it is provoked by an anterior transmural infarction. In the case of a posterior infarction, a partial blockade of the right/left bundle branch is determined.

ICD-10 codes:

• Intraatrial blocks:
  • I45.8 Other specified conductivity faults.
• Intraventricular blocks:
  • I44.4 Block of the branch of the (anterior) left bundle branch.
  • I44.5 Block of the branch of the (posterior) left leg.
  • I44.7 Left leg block, unspecified.
  • I45.0 Right leg block.
  • I45.2 Double bundle block.
  • I45.3 Trifascicular block.

Types and forms

According to the anatomical structure of the blockade

According to the anatomical structure of the His bundle block, they are divided into:

• single-beam;
• two-beam;
• three-beam.

Single-bundle blockades affect only one leg: blockade of the right leg, the left anterior leg and the left posterior leg. Double-bundle blockade - when 2 branches of the His bundle are affected simultaneously (branches of the posterior and anterior left legs, right legs and left anterior branches, branches of the posterior left and right legs). Three-bundle blocks - damage to all three branches of the His bundle.

According to the degree of impulse conduction disturbances

Blockades of the legs of His are also divided according to the degree of impulse conduction disturbances:

• incomplete;
• full.

Incomplete blockade is a violation of the passage of impulses along one branch of the His bundle. In this case, the function of the second leg or branch is not impaired. Excitation of the ventricular myocardium in this case occurs more slowly than it should, and is provided by healthy branches.

1. When the impulse passes through the branches at a slow rate, it is called incomplete 1st degree heart block.
2. In the case when only some impulses reach the ventricles, heart block of the 2nd degree (incomplete) occurs.
3. 3rd degree block or complete block is defined as the complete inability of cardiac impulses to pass into the ventricles. Because of this, the latter contract independently, at a speed of 20 to 40 beats per minute.

Even more useful information on the issue of incomplete bundle branch block is contained in the following video:

By duration

Leg blocks are:

• transient (intermittent);
• permanent (irreversible).

In rare cases, disturbances in the passage of impulses begin to develop with changes in heart rate. For example, when or .

Causes

Provoking factors for His bundle conduction disorders include:

• previous ;
• hypertonic disease;
• chronic respiratory diseases with obstruction;
• blunt chest trauma;
• neoplasms on the heart;
• progressive muscular dystrophy;
• overdose of certain medications;
• myocardial pathology;
• high potassium levels in the blood.

Hereditary factors:

• defective development of the segment of the right bundle branch;
• , leading to increased load on the right ventricle.

Symptoms

Incomplete isolated blockades of the right and left bundle branches have little effect. It may be detected incidentally using an ECG. Clinical symptoms of the disease can manifest themselves only with complete blockade of the right leg. In a third of patients, signs of disturbance during routine cardiac listening may be observed.

Possible symptoms include:

• dizziness, lightheadedness, fainting;
• fatigue, weakness;
• shortness of breath and lack of air.

Diagnostics

The diagnosis is made based on the patient’s complaints, examination and listening to the heart. An ultrasound of the heart and an ECG are required to identify complete or incomplete blockade of the left or right bundle branch. The examination does not make it difficult to establish a diagnosis; such disorders are revealed by a comprehensive examination of the patient.

Read on to learn more about treatment methods for complete or incomplete blockade of the right/left bundle branch.

The following video will tell you more about how an ECG occurs in the case of right/left bundle branch block:

Treatment

Blockage of the left (right) leg usually does not imply any treatment. The emphasis is on the disease that provokes such disorders.

Medication

Prescribe vitamin and restorative medications, a diet excluding sugar and fats. The emphasis in food is on eating fresh vegetables and fruits.

In the event that cardiac conduction disturbance is complicated by angina pectoris, heart failure, arterial hypertension, therapy is carried out using:

• nitrates;
• cardiac glycosides;
• antihypertensive drugs.

Surgical

It is produced in the ineffectiveness of drug therapy and with frequent fainting, as well as in malignant processes.

In case of AV blockade, indications for pacemaker implantation can be considered. In case of His bundle block, which occurs without obvious clinical manifestations, dynamic observation is carried out.

Prevention

Preventive measures include:

• daily routine, full and restful sleep;
• refusal of fried, canned and spicy foods;
• consumption of foods with a significant fiber content: fresh fruits and vegetables, herbs;
• avoidance of stressful situations;
• taking medications only prescribed by a doctor and under his supervision;
• timely diagnosis and treatment of diseases of all organs, not just the heart;
• mandatory consultation with a doctor if symptoms of the disease appear.

Read on to learn about the consequences of complete and incomplete blockade of the right/left bundle branch.

Complications

The main consequences of the disease include:

arterial hypertension and cardiomegaly also increases the risk of an unfavorable outcome.

All parents whose children have undergone right/left bundle branch block and other concomitant diseases should watch the following video:

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2014

Bifascicular block (I45.2), Other and unspecified atrioventricular block (I44.3), Second degree atrioventricular block (I44.1), First degree atrioventricular block (I44.0), Complete atrioventricular block (I44.2), Sick sinus syndrome (I49.5), Trifascicular block (I45.3)

Cardiology

general information

Short description

Approved
at the Expert Commission on Healthcare Development
Ministry of Health of the Republic of Kazakhstan
Protocol No. 10 dated July 04, 2014

AV block represents a slowdown or cessation of impulses from the atria to the ventricles. For the development of AV block, the level of damage to the conduction system may vary. This may be a conduction disorder in the atria, AV junction, and ventricles.

I. INTRODUCTORY PART

Protocol name: Cardiac conduction disorders

Protocol code

ICD-10 codes:
I44.0 First degree atrioventricular block
I44.1 Second degree atrioventricular block
I44.2 Complete atrioventricular block
I44.3 Other and unspecified atrioventricular block
I45.2 Double bundle block
I45.2 Trifascicular block
I49.5 Sick sinus syndrome

Abbreviations used in the protocol:
HRS - Heart Rhythm Society
NYHA - New York Heart Association
AV block - atrioventricular block
BP - blood pressure
ACE - angiotensin-converting enzyme
VVFSU - sinus node function recovery time
HIV - human immunodeficiency virus
VSAP - sinoauricular conduction time
ACE inhibitors - angiotensin-converting enzyme inhibitors
IHD - coronary heart disease
HV interval - impulse conduction time according to the His-Purkinje system
ELISA - enzyme immunoassay
LV - left ventricle
MPCS - maximum duration of the stimulation cycle
SVC - sinus cycle duration
PCS - duration of the stimulation cycle
SA block - sinoatrial block
HF - heart failure
SNA - sinoatrial node
FGDS - fibrogastroduodenoscopy
HR - heart rate
ECG - electrocardiogram
EX - pacemaker
ERP - effective refractory period
EPI - electrophysiological study
EchoCG - echocardiography
EEG - electroencephalography

Date of development of the protocol: year 2014

Protocol users: interventional arrhythmologists, cardiologists, therapists, general practitioners, cardiac surgeons, pediatricians, emergency doctors, paramedics.

Classification

Classification of AV block by degree:

First degree AV block is characterized by a slowdown in the conduction of impulses from the atria to the ventricles. The ECG shows a prolongation of the P-Q interval of more than 0.18-0.2 seconds.

. With second degree AV block, single impulses from the atria sometimes do not pass into the ventricles. If this phenomenon occurs rarely and only one ventricular complex is lost, patients may not feel anything, but sometimes they feel moments of cardiac arrest, during which dizziness or darkening occurs in the eyes.

AV block of the second degree, type Mobitz I - the ECG shows a periodic prolongation of the P-Q interval followed by a single P wave, which does not have a subsequent ventricular complex (type I block with Wenckebach periodicity). Typically, this variant of AV block occurs at the level of the AV junction.

AV block of the second degree, type Mobitz II, is manifested by periodic loss of QRS complexes without a previous prolongation of the PQ interval. The block level is usually the His-Purkinje system, the QRS complexes are wide.

. Third degree AV block (complete atrioventricular block, complete transverse block) occurs when electrical impulses from the atria are not conducted to the ventricles. In this case, the atria contract at a normal rate, and the ventricles contract rarely. The frequency of ventricular contractions depends on the level at which the center of automaticity is located.

Sick sinus syndrome
SSS is a dysfunction of the sinus node, manifested by bradycardia and accompanying arrhythmias.
Sinus bradycardia - a decrease in heart rate less than 20% below the age limit, migration of the pacemaker.
SA block is a slowdown (below 40 beats per minute) or cessation of impulse transmission from the sinus node through the sinoatrial junction.

Classification of SA block by degree :

The first degree of SA block does not cause any changes in cardiac activity and does not appear on a regular ECG. With this type of blockade, all sinus impulses pass to the atria.

With second-degree SA block, sinus impulses sometimes do not pass through the SA junction. This is accompanied by loss of one or more atrioventricular complexes in a row. With a second degree block, dizziness, a feeling of irregular heart activity, or fainting may occur. During pauses of SA blockade, escape contractions or rhythms may appear from underlying sources (AV junction, Purkinje fibers).

With third-degree SA block, impulses from the SPU do not pass through the SA junction and cardiac activity will be associated with the activation of the following rhythm sources.

Tachycardia-bradycardia syndrome- combination of sinus bradycardia with supraventricular heterotopic tachycardia.

Sinus arrest is a sudden cessation of cardiac activity with the absence of contractions of the atria and ventricles due to the fact that the sinus node cannot generate an impulse for their contraction.

Chronotropic insufficiency(incompetence) - inadequate increase in heart rate in response to physical activity.

Clinical classification of AV blocks

According to the degree of AV block:
. 1st degree AV block

AV block II degree
- Mobitz type I

Type Mobitz II
- AV block 2:1
- High degree AV block - 3:1, 4:1

AV block III degree

Fascicular block
- Bifascicular blockade
- Trifascicular block

By time of occurrence:
. Congenital AV block
. Acquired AV block

According to the stability of AV block:
. Permanent AV block
. Transient AV block

Sinus node dysfunction:
. Sinus bradycardia
. Sinus arrest
. SA blockade
. Tachycardia-bradycardia syndrome
. Chronotropic insufficiency

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

List of basic and additional diagnostic measures

Basic (mandatory) diagnostic examinations performed on an outpatient basis:
. ECG;
. Holter ECG monitoring;
. Echocardiography.

Additional diagnostic examinations performed on an outpatient basis:
If organic cerebral pathology is suspected or in case of syncope of unknown origin:

X-ray of the skull and cervical spine;

. EEG;
. 12/24-hour EEG (if epileptic genesis of paroxysms is suspected);


. Doppler ultrasound (if pathology of extra- and intracranial vessels is suspected);

General blood test (6 parameters)

General urine analysis;


. coagulogram;
. HIV ELISA;



. FGDS;

The minimum list of examinations that must be carried out when referring for planned hospitalization:
. general blood test (6 parameters);
. general urine analysis;
. microprecipitation reaction with antilipid antigen;
. biochemical blood test (ALAT, AST, total protein, bilirubin, creatinine, urea, glucose);
. coagulogram;
. HIV ELISA;
. ELISA for markers of viral hepatitis B, C;
. blood type, Rh factor;
. plain radiography of the chest organs;
. FGDS;
. additional consultations with specialized specialists in the presence of concomitant pathology (endocrinologist, pulmonologist);
. consultation with a dentist or otolaryngologist to exclude foci of chronic infection.

Basic (mandatory) diagnostic examinations carried out at the hospital level:
. ECG;
. Holter ECG monitoring;
. Echocardiography.

Additional diagnostic examinations carried out at the hospital level:
. carotid sinus massage;
. exercise test;
. pharmacological tests with isoproterenol, propronolol, atropine;
. EPI (performed in patients with clinical symptoms in whom the cause of the symptoms is unclear; in patients with asymptomatic His bundle branch block, if pharmacotherapy is planned that can cause AV block);

If organic cerebral pathology is suspected or in case of syncope of unknown origin:
. radiography of the skull and cervical spine;
. examination of the fundus and visual fields;
. EEG;
. 12/24 - hourly EEG (if epileptic genesis of paroxysms is suspected);
. echoencephaloscopy (if there is a suspicion of space-occupying processes in the brain and intracranial hypertension);
. computed tomography (if there is a suspicion of space-occupying processes in the brain and intracranial hypertension);
. Doppler ultrasound (if pathology of extra- and intracranial vessels is suspected);

Diagnostic measures carried out at the stage of emergency care:
. blood pressure measurement;
. ECG.

Diagnostic criteria

Complaints and anamnesis- main symptoms
. Loss of consciousness
. Dizziness
. Headache
. General weakness
. Determine the presence of diseases predisposing to the development of AV block

Physical examination
. Pale skin
. Sweating
. Rare pulse
. Auscultation - bradycardia, first heart sound of varying intensity, systolic murmur above the sternum or between the apex of the heart and the left edge of the sternum
. Hypotension

Laboratory tests: not carried out.

Instrumental studies
ECG and daily ECG monitoring (main criteria):

With AV block:
. Rhythm pauses of more than 2.5 seconds (R-R interval)
. Signs of AV dissociation (lack of conduction of all P waves to the ventricles, which leads to complete dissociation between P waves and QRS complexes)

With SSSU:
. Rhythm pauses of more than 2.5 seconds (P-P interval)
. Increase in the P-P interval by 2 or more times the normal P-P interval
. Sinus bradycardia
. No increase in heart rate during emotional/physical stress (chronotropic insufficiency of the heart rate)

EchoCG:
. Hypokinesis, akinesis, dyskinesis of the walls of the left ventricle
. Changes in the anatomy of the walls and cavities of the heart, their relationship, the structure of the valve apparatus, systolic and diastolic function of the left ventricle

EFI (additional criteria):

. With SSSU:

With AV block:

Prolongation of the HV interval more than 100 ms

Indications for consultation with specialists (if necessary, according to the decision of the attending physician):

Dentist - sanitation of foci of infection

Otolaryngologist - to exclude foci of infection

Gynecologist - to exclude pregnancy, foci of infection

Differential diagnosis

Differential diagnosis of cardiac conduction disorders: SA and AV blockade

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Treatment

Treatment goals:

Improving life prognosis (preventing sudden cardiac death, increasing life expectancy);

Improving the patient's quality of life.

Treatment tactics

Non-drug treatment:

Bed rest;

Diet No. 10.

Drug treatment

with acute development of AV block, SSSU before pacemaker installation(mandatory, 100% probability)

Drug treatment provided on an outpatient basis before hospitalization:

List of essential medicines(having a 100% probability of application).

List of additional medicines(less than 100% chance of application)

Drug treatment provided at the inpatient level

List of essential medicines(having a 100% probability of application)

List of additional medicines c (less than 100% probability of application).

Drug treatment provided at the emergency stage

Other treatments:(at all levels of medical care)

For hemodynamically significant bradycardia:

Place the patient with the lower limbs elevated at an angle of 20° (if there is no pronounced congestion in the lungs);

Oxygen therapy;

If necessary (depending on the patient’s condition), closed heart massage or rhythmic tapping on the sternum (“fist rhythm”);

It is necessary to discontinue drugs that could cause or worsen AV block (beta-blockers, slow calcium channel blockers, antiarrhythmic drugs of classes I and III, digoxin).

These measures are carried out until the patient’s hemodynamics are stabilized.

Surgical intervention

Electrocardiostimulation- the main method of treating cardiac conduction disorders. Bradyarrhythmias account for 20-30% of all heart rhythm disorders. Critical bradycardia threatens the development of asystole and is a risk factor for sudden death. Severe bradycardia worsens the quality of life of patients, leading to dizziness and syncope. Elimination and prevention of bradyarrhythmias will solve the problem of threat to life and disability of patients. ECS are implantable automatic devices designed to prevent bradycardic episodes. The electrical stimulation system includes the device itself and electrodes. According to the number of electrodes used, pacemakers are divided into single-chamber and double-chamber.

Surgical intervention provided on an outpatient basis: no.

Surgical intervention provided in a hospital setting

Indications for permanent pacing in AV block

Class I

Third degree AV block and progressive second degree AV block of any anatomical level associated with symptomatic bradycardia (including heart failure) and ventricular arrhythmias due to AV block (Level of Evidence: C)

Third degree AV block and progressive second degree AV block of any anatomical level associated with arrhythmias and other medical conditions requiring medical treatment causing symptomatic bradycardia (Level of Evidence: C)

Third degree AV block and progressive second degree AV block at any anatomical level with documented periods of asystole greater than or equal to 2.5 seconds, or any escape rhythm<40 ударов в минуту, либо выскальзывающий ритм ниже уровня АВ узла в бодрствующем состоянии у бессимптомных пациентов с синусовым ритмом (Уровень доказанности: С)

Third degree AV block and progressive second degree AV block of any anatomical level in asymptomatic patients with AF and documented at least one (or more) pause of 5 seconds or more (Level of Evidence: C)

Third degree AV block and progressive second degree AV block of any anatomical level in patients after catheter ablation of the AV node or His bundle (Level of evidence: C)

Third degree AV block and progressive second degree AV block of any anatomical level in patients with postoperative AV block if its resolution is not predicted after cardiac surgery (Level of Evidence: C)

Third degree AV block and progressive second degree AV block of any anatomical level in patients with neuromuscular diseases with AV block, such as myotonic muscular dystrophy, Kearns-Sayre syndrome, Leiden dystrophy, peroneal muscular atrophy, with or without symptoms (Level of Evidence: B )

Third degree AV block, regardless of the type and location of block, with associated symptomatic bradycardia (Level of Evidence: B)

Persistent third-degree AV block of any anatomical level with an escape rhythm of less than 40 beats per minute while awake - in patients with cardiomegaly, LV dysfunction, or an escape rhythm below the level of the AV node who do not have clinical manifestations of bradycardia (Level of Evidence: B)

AV block II or III degree, occurring during an exercise test in the absence of signs of coronary artery disease (Level of evidence: C)

Class IIa

Asymptomatic persistent third-degree AV block at any anatomic site, with a mean awake ventricular rate >40 beats per minute, especially with cardiomegaly or left ventricular dysfunction (Level of Evidence: B, C)

Asymptomatic AV block of the second degree, type II at the intra- or infragisial level, detected by EPI (Level of evidence: B)

Asymptomatic second degree AV block type II with narrow QRS. If asymptomatic second-degree AV block occurs with a widened QRS, including isolated RBBB, the indication for pacing moves to a Class I recommendation (see next section on chronic bifascicular and trifascicular block) (Level of Evidence: B)

AV block I or II degree with hemodynamic disturbances (Level of evidence: B)

Class IIb

Neuromuscular diseases: myotonic muscular dystonia, Kearns-Sayre syndrome, Leiden dystrophy, peroneal muscular atrophy with AV block of any degree (including AV block of the first degree), with or without symptoms, because there may be unpredictable disease progression and deterioration of AV conduction (Level of Evidence: B)

When AV block occurs due to the use of drugs and/or their toxic effects, when resolution of the block is not expected, even if the drug is discontinued (Level of Evidence: B)

First-degree AV block with a PR interval greater than 0.30 sec in patients with left ventricular dysfunction and congestive heart failure in whom a shorter A-V interval results in hemodynamic improvement, presumably by reducing left atrial pressure (Level of Evidence: C)

Class III

Asymptomatic 1st degree AV block (Level of evidence: B)

Asymptomatic AV block of the second degree, type I, with conduction block at the level of the AV node or intra- or infra-gisial (Level of evidence: C)

Expected resolution of AV block or unlikely recurrence (eg, drug toxicity, Lyme disease, increased vagal tone, sleep apnea in the absence of symptoms) (Level of Evidence: B)

Indications for continuous electrocardial stimulation in chronic bifascicular and trifascicular blockades

Indications for planned hospitalization:

AV block II-III degree

Indications for emergency hospitalization:

Syncope, dizziness, hemodynamic instability (systolic blood pressure less than 80 mm Hg).

Information

Sources and literature

1. Minutes of meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2014
   1. 1. Brignole M, Auricchio A. et al. 2013 ESC The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Guidelines on cardiac pacing and cardiac resynchronization therapy. European Heart Journal (2013) 34, 2281–2329. 2. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Masotti G, Moya A, Raviele A, Sutton R, Theodorakis G, Ungar A, Wieling W; Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 2004;6:467 – 537 3. Epstein A., DiMarco J., Ellenbogen K. et al. ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008;117:2820-2840. 4. Fraser JD, Gillis AM, Irwin ME, Nishimura S, Tyers GF, Philippon F. Guidelines for pacemaker follow-up in Canada: a consensus statement of the Canadian Working Group on Cardiac Pacing. Can J Cardiol 2000;16:355-76 5. Gregoratos G, Abrams J, Epstein AE, et al. ACC/AHA/NASPE 2002 17 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices-summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Am Coll Cardiol. 40: 2002; 1703–19 6. Lamas GA, Lee K, Sweeney M, et al. The mode selection trial (MOST) in sinus node dysfunction: design, rationale, and baseline characteristics of the first 1000 patients. Am Heart J. 140: 2000; 541–51 7. Moya A., Sutton R., Ammirati F., Blanc J.-J., Brignole M., Dahm, J.B., Deharo J-C, Gajek J., Gjesdal K., Krahn A., Massin M., Pepi M., Pezawas T., Granell R.R., Sarasin F., Ungar A., ​​J. Gert van Dijk, Walma E.P. Wieling W.; Guidelines for the diagnosis and management of syncope (version 2009). Europace 2009. doi:10.1093/eurheartj/ehp29 8. Vardas P., Auricchio A. et al. Guidelines for cardiac pacing and cardiac recynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Recynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association. European Heart Journal (2007) 28, 2256-2295 9. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. 48: 2006; e247–e346 10. Bockeria L.A., Revishvili A.Sh. et al. Clinical recommendations for electrophysiological studies and catheter ablation and for the use of implantable antiarrhythmic devices. Moscow, 2013
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Bundle branch block is a hindrance or obstacle to the normal passage of the sinus impulse through the cardiac conduction system. Such an impulse is formed in the sinus node, goes beyond its boundaries, enters the atrium system and excites both atria as it passes. During its passage, the sinus impulse undergoes a considerable physiological delay, reaching the atrioventricular junction and entering the small conduction system of the ventricles.

Features of the disease

Blockade of the left or right bundle branch is a dangerous disease associated with disruption of the cardiac impulse necessary for normal heart function.

• Very rarely, the disease is diagnosed in young people and the general figures range from about 0.1% of known cases.
• The older the person, the more often this disorder is diagnosed.
• At age 40, the percentage is already 4.5%.

ICD-10 codes:

• Intraatrial blocks:
  • I45.8 Other specified conductivity faults.
• Intraventricular blocks:
  • I44.4 Block of the branch of the (anterior) left bundle branch.
  • I44.5 Block of the branch of the (posterior) left leg.
  • I44.7 Left leg block, unspecified.
  • I45.0 Right leg block.
  • I45.2 Double bundle block.
  • I45.3 Trifascicular block.

Types and forms

According to the anatomical structure of the blockade

According to the anatomical structure of the His bundle block, they are divided into:

• single-beam;
• two-beam;
• three-beam.

Single-bundle blockades affect only one leg: blockade of the right leg, the left anterior leg and the left posterior leg. Double-bundle blockade - when 2 branches of the His bundle are affected simultaneously (branches of the posterior and anterior left legs, right legs and left anterior branches, branches of the posterior left and right legs). Three-bundle blocks - damage to all three branches of the His bundle.

According to the degree of impulse conduction disturbances

Blockades of the legs of His are also divided according to the degree of impulse conduction disturbances:

• incomplete;
• full.

Incomplete blockade is a violation of the passage of impulses along one branch of the His bundle. In this case, the function of the second leg or branch is not impaired. Excitation of the ventricular myocardium in this case occurs more slowly than it should, and is provided by healthy branches.

1. When the impulse passes through the branches at a slow rate, it is called incomplete 1st degree heart block.
2. In the case when only some impulses reach the ventricles, heart block of the 2nd degree (incomplete) occurs.
3. 3rd degree block or complete block is defined as the complete inability of cardiac impulses to pass into the ventricles. Because of this, the latter contract independently, at a speed of 20 to 40 beats per minute.

Even more useful information on the issue of incomplete bundle branch block is contained in the following video:

By duration

Leg blocks are:

• transient (intermittent);
• permanent (irreversible).

In rare cases, disturbances in the passage of impulses begin to develop with changes in heart rate. For example, with tachycardia or bradycardia.

Causes

Provoking factors for His bundle conduction disorders include:

• previous myocardial infarction;
• heart valve defects;
• hypertonic disease;
• chronic respiratory diseases with obstruction;
• blunt chest trauma;
• neoplasms on the heart;
• progressive muscular dystrophy;
• overdose of certain medications;
• myocardial pathology;
• high potassium levels in the blood.

Hereditary factors:

• stenosis of the mouth of the pulmonary artery;
• defective development of the segment of the right bundle branch;
• defects of the interventricular and interatrial septa;
• heart defects leading to increased load on the right ventricle.

Symptoms

Incomplete isolated blockades of the right and left bundle branches have little effect. It may be detected incidentally using an ECG. Clinical symptoms of the disease can manifest themselves only with complete blockade of the right leg. In a third of patients, signs of disturbance during routine cardiac listening may be observed.

Possible symptoms include:

• dizziness, lightheadedness, fainting;
• fatigue, weakness;
• shortness of breath and lack of air.

The diagnosis is made based on the patient’s complaints, examination and listening to the heart. An ultrasound of the heart and an ECG are required to identify complete or incomplete blockade of the left or right bundle branch. The examination does not make it difficult to establish a diagnosis; such disorders are revealed by a comprehensive examination of the patient.

Read on to learn more about treatment methods for complete or incomplete blockade of the right/left bundle branch.

The following video will tell you more about how an ECG occurs in the case of right/left bundle branch block:

Treatment

Blockage of the left (right) leg usually does not imply any treatment. The emphasis is on the disease that provokes such disorders.

Medication

Prescribe vitamin and restorative medications, a diet excluding sugar and fats. The emphasis in food is on eating fresh vegetables and fruits.

In the event that cardiac conduction disturbance is complicated by angina pectoris, heart failure, arterial hypertension, therapy is carried out using:

• nitrates;
• cardiac glycosides;
• antihypertensive drugs.

Surgical

It is produced in the ineffectiveness of drug therapy and with frequent fainting, as well as in malignant processes.

In case of AV blockade, indications for pacemaker implantation can be considered. In case of His bundle block, which occurs without obvious clinical manifestations, dynamic observation is carried out.

Prevention

Preventive measures include:

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

Read on to learn about the consequences of complete and incomplete blockade of the right/left bundle branch.

Complications

The main consequences of the disease include:

• sudden death;
• myocardial infarction;
• stroke;
• worsening of the disease that provoked the blockade;
• heart failure;
• thromboembolic disorders.

Below you will find the prognosis for complete or incomplete right/left bundle branch block.

Forecast

In young people without serious organic diseases of the cardiac and vascular systems, the prognosis is favorable. It is known that an isolated blockade of the right leg will never develop into a complete blockade.

The overall prognosis will depend on the underlying disease. In turn, such a violation of cardiac conduction adds the risk of sudden death, as well as the development of various long-term complications. The development of AV block, heart failure, conduction defect, arterial hypertension and cardiomegaly also increases the risk of an unfavorable outcome.

All parents whose children have undergone right/left bundle branch block and other concomitant diseases should watch the following video:

gidmed.com

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

In this case, a disorder such as incomplete heart block of the 1st degree occurs. However, even passing through an intact bundle branch, not all impulses can reach the ventricular myocardium. This indicates the development of incomplete heart block of the 2nd degree.

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

Any of the described situations can be identified only with the help of instrumental diagnostics. Patients with symptoms of this disease are prescribed mandatory electrocardiography. How does incomplete blockade of PNPG appear on the ECG?

The bundle branches are the conducting 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 bundle branch;
• right anterior and left anterior limb of His.

Bundle branch block is an intracardiac conduction disorder characterized by complete cessation or slowing of the conduction of the excitation impulse along several or one of the branches of the His bundle.

In addition, this violation can only occur when:

• instrumental research methods;
• symptomatic heart rhythm disturbances;
• attacks of loss of consciousness;
• frequent dizziness.

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

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

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

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

Right bundle branch block does not require any special treatment methods. You should not feel any anxiety about this. A completely different situation can be observed with blockade of the left bundle branch, since this disorder is very serious and requires active therapy from a cardiologist. The bundle branches are responsible for regulating the rhythms of the heart.

Incomplete right bundle branch block is a common disorder of intraventricular conduction, occurring mainly in middle-aged and older people. Frequent causes of this pathology are various diseases that lead to organic damage to the heart muscle, such as coronary heart disease, essential hypertension (hypertension), rheumatic defects and many others.

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

The right bundle branch is the most important part of the conduction system of the heart, ensuring the conduction of electrical impulses to the myocardium of the right ventricle. Incomplete block of the right bundle branch leads to impaired excitability and, accordingly, contractility of this part of the heart, which, however, is not accompanied by any significant symptoms and hemodynamic changes.

In itself, partial blockade of the right bundle branch does not require specific treatment, however, it serves as a factor that aggravates the course of the underlying cardiac disease, which necessitates adjustment of therapy.

As a rule, the blockade develops against the background of heart disease. Conduction disorders inside the heart ventricle are often caused by necrotic, sclerotic, and inflammatory processes. In addition, the cause may be those pathological processes that lead to a state of overload of some parts, in particular the ventricle.

Such diseases include heart defects (congenital, in which there is an excessive load on the right ventricle, defects of the septa between the atria and ventricles), mitral stenosis, coronary heart 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, adrenergic blockers), and disturbances in electrolyte metabolism. Due to the development of the blockade, the conduction of impulses through the heart system slows down, which leads to the fact that physiological, full excitation of the right sections does not occur.

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 are detected (expansion and jaggedness of its terminal part), 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. What 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 pulmonary vessels;
• underdevelopment of the right bundle branch.

Acquired reasons:

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

Incomplete blocking of the right bundle branch is a partial disruption of electrical impulse transmission along the right bundle branch.

Incomplete blockade of the right bundle branch, as not subject to treatment, poses absolutely no threat to the life of a pregnant woman. Even if the disease progresses, only it needs to be treated.

Who is at risk

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

The older a person is, the more likely it is that the disorder he develops in the transmission of cardiac impulses will have its full form.

In children, incomplete blockades of the right leg are not uncommon, but this deviation does not pose a danger to the child’s health if he does not have cardiac pathology or disturbances 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 condition of the ventricular tissues is certainly taken into account.

There is a whole list of diseases that can provoke the occurrence of incomplete blockade of the right bundle branch of His. Complete and incomplete forms of the disorder can be congenital or acquired. Is the blockade inherited?

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

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

An overdose of medications leads to various disturbances in the functioning of internal organs, kidney and liver failure. In medical practice, there are often cases when medications used against arrhythmia cause complete or partial disruption of the transmission of electrical impulses in the heart.

Pathologies of the lungs also have an impact on the heart. If a person is diagnosed with, for example, pulmonary hypertension, there is a high probability that it will cause the appearance of a complete or incomplete form of leg block.

Acute myocardial infarction and cardiosclerosis are favorable conditions for disturbances in the conduction of electrical impulses. Tricuspid heart valve insufficiency and right ventricular hypertrophy can produce a similar result.

The general condition of the body and destructive changes in the functioning of internal organs are closely interrelated. When the balance of electrolytes in the body is disturbed, conditions are created for the occurrence of bundle branch blocks.

When the disorder becomes acute, drug therapy is required. But there is another important point here: all the drugs available to modern medicine can have a temporary effect, and treating the blockade with them can lead to unpredictable consequences, including aggravation of the pathological condition.

Blockade of any of the bundle branches is characterized by a persistent or transient form. In the second case, the state of blockade 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. Symptoms of blockades are quite difficult to detect. This is due to two main reasons:

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

Abnormalities in heart rhythm and heart rate are inherent in many heart diseases, but with incomplete blockades these symptoms are not observed.

If the blockade of the branch of His is not partial, patients may complain of dizziness, clouding of consciousness, and that it often becomes difficult for them to breathe. All these are consequences of impaired 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 to check the condition of the legs of His when a person, for no apparent reason, often begins to feel increased fatigue and an unreasonable decrease in performance.

It is important to know: a clinical analysis of blood and urine cannot help determine deviations in the transmission of impulses. To detect a disorder, it is necessary to undergo a hormonal status examination and Hotler ECG monitoring. The latter method is unique in that it allows one to detect complete and incomplete disruption of the transmission of electrical impulses in an internal organ.

This type of ECG allows doctors to record changes that entail various types of blockades. Differentiating clinical symptoms of cardiac pathologies and pathological abnormalities is a rather difficult issue, especially when disturbances in the functioning of an internal organ have typical and atypical symptoms.

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

This information is of particular value when doctors determine the cause of disturbances in the transmission of electrical impulses. 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, characteristic of incomplete blockade of the right bundle branch, is also determined.

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

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

In such cases, cardiac stimulation methods help restore the normal functioning of the internal organ. If an elderly person develops an exacerbation of cardiac pathology that coincides with any form of right leg block, he requires urgent hospitalization.

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

In such cases, doctors prescribe the patient to take anticholinergic drugs, drugs that enhance the effect of symptoms on the cardiac conduction system, glucocorticosteroid hormones, and drugs that reduce potassium levels in the body.

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

Clinically, incomplete blockade of the right branch of the His bundle 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 disturbances in impulse conduction inside the ventricles most often occur against the background of organic damage to the heart, patients with this pathology may present “cardiological” complaints, such as:

• Retrosternal pain.
• Dyspnea.
• Swelling in the legs.
• Increased blood pressure.
• Cyanosis of the mucous membranes and skin (bluish tint).

In some rare situations, incomplete blockade of the right side of His can 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 Purkinje fibers, which transmit impulses from the branches of His to the cardiomyocytes themselves.

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

Isolated incomplete blockade of the right bundle branch 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 conscription into the army.

In other cases, there will be symptoms of the underlying disease, since incomplete blockade of the bundle branch itself does not have any symptoms and is detected only by auscultation (listening) of the myocardium and ECG.

The only option in which one 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 to conduct a normal, routine ECG, during which the special shape of the ventricular complexes in the first chest leads is determined, as well as a slight increase in the duration of the gastric QRS complex to 0.11 seconds.

It is clear that this increase in time occurs due to the “circular path”, but the indirect following of the impulse along the blocked bundle branch.

Holter monitoring is also indicated, in which it is possible to identify functional or transient variants of the development of the blockade. This can happen, for example, due to an overdose of certain medications during treatment of diseases.

If the blockade of the leg occurs 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 placement (implantation) of a permanent pacemaker.

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

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

Cardiogram changes

By decoding the ECG performed, you can detect changes in the QRS complex, which are expressed in jaggedness and widening of its final part. An increase in the duration of the complex is also noted. The R wave in the chest lead is jagged and enlarged, and the ST segment in this part is lowered.

ECG signs of incomplete right bundle branch block:

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

With this disorder, there is a slowdown in the conduction of the excitation impulse along the right bundle branch. 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 accidentally during a physical examination, listening to the heart (auscultation) and electrocardiography. Incomplete right bundle branch block is rarely accompanied by clinical manifestations.

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

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

Therapeutic measures for incomplete blockade consist in treating the disease that is the cause 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 defects 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 glycosides, antiarrhythmics, and antihypertensive drugs.

In some young people, this type of blockade is normal, so therapy is not prescribed. We can only recommend dynamic observation and examination by a cardiologist.

Depending on the identified underlying disease, the patient needs observation and treatment from a cardiologist or therapist. Observation involves assessing the dynamics of changes in the ECG and adjusting prescribed therapy based on clinical and laboratory examination.

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

The main drugs used in the treatment of diseases of the cardiovascular system are:

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

The integrated and rational use of these drugs makes it possible to neutralize the symptoms of the underlying disease, improve myocardial function, and also increase the patient’s survival and quality of life.

If incomplete blockade of the right bundle branch is first detected in a patient who complains of chest pain, shortness of breath, and who has a decrease in blood pressure, then he is urgently taken to the cardiac intensive care unit to exclude acute myocardial infarction.

If there is a threat of transformation of the right bundle branch block into complete atrioventricular block, as well as in the presence of recurrent fainting conditions, the patient is indicated for implantation of cardiac pacing. A cardiologist treats heart diseases. The patient’s life and health depend on the choice of specialist.

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

1. 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 preventive remedy, herbalists recommend taking an infusion of wild garlic. Recipe: combine a teaspoon of chopped wild garlic bulbs with 300 ml of cold water.

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

2. Jaundice spreading. Spreading jaundice is another plant unique to the heart.

It contains cardiac glycosides - erizimoside and erizimin, as well as organic acids and fatty oils.

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

In general, the plant normalizes blood circulation, increases the conductivity of electrical impulses, protects against heart attack and stroke, and improves the patient’s overall well-being. You can use a water or alcohol tincture of common jaundice.

To prepare a water tincture, you will need a teaspoon of herbs per 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 20g of spreading jaundice herb 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 wash the drops down with water). Continue treatment for 6-10 months to obtain a stable, long-term effect.

3. Common hazel. Hazel will calm the nervous system, enhance the effectiveness of 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 hazel bark or leaves (dry crushed) and a glass of boiling water. Leave the mixture for 20 minutes, then take 100 ml twice a day.

4. Sedum is caustic. In folk medicine, treatment with preparations from the herb sedum is popular.

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

For bundle branch block, this is exactly what we need. Recipe: chop the dry plant, brew a teaspoon of sedum in a glass of boiling water. This is your daily dose. Drink it in a day. Therapy should last from 3 months to a year.

5. Dry grass is another highly effective herbal raw material for preparing a potion for problems with the His bundle.

All people suffering from heart disease (especially older people) can undergo periodic treatment with this herb.

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

Recipe: Brew a teaspoon of dry herb cudweed 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. People with heart problems are also recommended to take wine made from cucumber.

To do this, pour a handful of dry herbs with a liter of high-quality red wine, leave for 2 weeks, then strain and add 100 ml of liquid linden honey. Drink 50 ml of the resulting wine every evening before bed.

Herbal mixtures are more effective because they simultaneously act “on all fronts”: they restore normal functioning of the bundle branch, reduce heart failure, and prevent complications. So, in Rus', herbalists most often recommended the following herbal mixture:

• Raspberry fruits – 20g;
• Birch leaves – 10g;
• Leonurus cordial herb – 10g;
• Herb or dill seeds – 10g;
• Periwinkle leaves – 20g.

Brew a tablespoon of this mixture with 0.5 liters of boiling water in a thermos, close the lid and leave for at least an hour. Every time 15 minutes before meals, 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 herbal medicine reference book we found the following recipe:

• Sage herb – 50g;
• Dill seeds – 50g;
• Medicinal cap herb – 50g;
• White mistletoe – 30g;
• Fragrant rue herb – 10g;
• St. John's wort herb – 10g.

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

The following collection provides an excellent therapeutic effect:

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

Take a heaping tablespoon of this mixture, pour a glass of cold water and leave for half an hour. Then put the medicine on the fire, boil for 5 minutes and cool. Drink the resulting medicine in small portions throughout the day. The course of treatment must last at least 2 months for you to feel a stable effect.

Incomplete blockade of the right bundle branch in itself does not 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 is detected incidentally 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 branch often develops against the background of 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 diseases and increases the risk of cardiovascular complications and mortality in the coming years after its development.

It is important to note the unstable nature of the incomplete blockade of the right bundle branch. If the underlying heart disease worsens, this type of intraventricular conduction disorder can transform into complete RBBB, or even complete atrioventricular block, which will require a significant change in therapeutic tactics.

How dangerous is incomplete right bundle branch block? The prognosis for this condition is not determined by this formulation of the diagnosis. As mentioned above, the degree of development of the underlying disease is decisive, as well as the presence of the risk of developing complete atrioventricular block (in which the atria and ventricles can each contract in their 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 automatically mean the presence of arrhythmia. It’s just that, 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 a complete atrioventricular block in individuals with partial conduction disorders of the bundle branches is 1% per year.

Of course, this figure takes into account conditions in which there is severe cardiac pathology. It is in the presence of AV block that treatment will be required, which may include installing a pacemaker.

With this pathology, sinus arrhythmia is often observed, which is expressed by a violation of the heart rhythm; the rhythm of contractions is not performed at equal intervals.

The transesophageal electrocardiogram method is best suited for diagnosis. Patients sometimes experience:

• weakness;
• feeling of “fading” of the heart;
• frequent tremors.

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

• For heart disease, a diet with foods rich in potassium, calcium and magnesium is important.
• To prevent heart disease, it is important to avoid stress and anxiety.
• Give up harmful addictions.
• Play sports (as recommended by your doctor).

In case of incomplete blockade of the right bundle branch, sports are not contraindicated. After all, cardiologists are concerned about those conditions that increase the risk of sudden cardiac death, as well as various undiagnosed valve defects, especially aortic stenosis, which, when the load on the heart increases, can lead to unpredictable complications.

Isolated and asymptomatic conduction disorders, especially at a young age, do not lead to a significant increase in complications. As a last resort, you can perform Holter monitoring, which will be carried out against the background of sports training.

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

As for service in the armed forces, then, as we remember, in the absence of a clear 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 unsuitable 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, naturally, no restrictions will be observed, since the “automatic” determination of the type of troops will already serve as a guarantee that such restrictions have already been made.

If incomplete blockade is normal, no special treatment is needed. Periodic monitoring by a cardiologist and a heart check using an electrocardiogram are sufficient. And you need to take care to prevent complications:

• Give up all bad habits.
• Try to avoid any overload.
• It's good to get enough sleep and relax after a working day.

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

• grape;
• bananas;
• fresh juices from them.

Do not ignore cases if they appear:

• chest pain;
• heaviness;
• weakness;
• dizziness.

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

The disease is a disorder of the conduction of electrical impulses through the His bundle (RBBB).

1st degree AV block code according to ICD 10 I44 (international classification according to the approved medical classifier) ​​is one of the most common heart rhythm disorders among people of all age categories; the risk of getting sick increases with age.

Men are especially at risk; women suffer less.

Pathogenesis of the disease: excitation of one half of the interventricular septum and the right ventricle occurs atypically.

The impulse captures the left ventricle and the left half of the interventricular septum and reaches the muscle of the right ventricle along the LPN. The conduction of the impulse is difficult along the PNJ.

Experts divide the causes of BLNP into organic and functional according to the code classifier.

Functional reasons:

• a drop or rise in potassium levels in the blood;
• overdose of cardiac glycosides;
• improper use of medications.

Organic causes of PNH blockade:

Conduction disorder classification:

• transistor;
• persistent;
• intermittent;
• alternating;
• isolated blockade;
• atrioventricular.

Clinical picture

The disease is generally asymptomatic and therefore difficult to detect in the early stages.

However, there are physical changes and symptoms that may indicate the disease.

First signs:

• heart failure;
• pain on the left, in the chest area;
• fainting state.

Diagnostic measures

A specialist can make the correct diagnosis. To identify the disease, an ECG or Holter monitoring is used, which is a daily recording of the heart’s work.

Band block is characterized by an increase in the duration of the QRS complex and its splitting.

The examination group includes laboratory tests, as well as angiography, x-ray and echocardiography.

Features of the course in children

Right bundle branch block in children is congenital and is often accompanied by CHD:

• cardiac hypotrophy;
• valve defects;
• overload of the right side of the heart;
• cardiac septal defects.

Risk group

As mentioned above, middle-aged and older men are at risk. In children, incomplete blockade is not dangerous if there are no complex heart defects and the hemodynamics of the body are not impaired.

The risk group includes patients taking a large number of medications, mainly antiarrhythmics, which partially or completely disrupt the transmission of impulses through the His bundle.

Lung diseases, such as pulmonary hypertension, can also cause disruption.

Impulse disturbance as a complication is of concern in cardiosclerosis, valvular insufficiency and right ventricular hypertrophy.

Treatment of nbpng

In case of conduction disturbance, the disease that caused it is treated first. Congenital heart defects are corrected surgically.

Drug treatment is carried out for diseases such as heart failure, angina pectoris, hypertension.

Patients are prescribed cardiac glycosides, antihypertensive drugs, and antiarrhythmics.

If incomplete blockade is considered normal, then medications are not prescribed, patients are regularly examined, they are recommended to eat a diet and moderate physical activity.

For surgical treatment, the patient is hospitalized in the clinic. This is necessary to conduct a full examination and make a decision regarding treatment tactics.

As a rule, surgery is prescribed in the most severe cases; medical measures are mainly aimed at treating the underlying cardiac disease.

Complex therapy helps improve the prognosis and significantly prolong a person’s life.

If there is a threat of an incomplete blockade developing into a complete one, patients are recommended to undergo cardiac stimulation.

ethnoscience

In the absence of complications, it is advisable to supplement drug therapy with traditional medicine. Below are some healthy recipes.

Regarding the use of plants, consultation with a cardiologist is necessary; not all herbs can be combined with pharmaceutical medicine.

Helps restore health after stroke and heart attack, improves physical condition and improves tone. To make an aqueous infusion of jaundice, you need to take a teaspoon of dry raw material and pour a glass of boiling water.

Drink one teaspoon three times a day; if atrial fibrillation bothers you, the dosage is increased to a tablespoon at a time.

An alcohol infusion is also used for treatment, for the preparation of which you take twenty grams of dry raw materials and one hundred milliliters of alcohol.

Jaundice is infused in alcohol for two weeks, after which it is filtered and ten drops are taken in water before meals. The course of treatment is six months. Alcohol infusion should not be given to children.

Hazel

Hazel tea is a gentle sedative that enhances the effectiveness of cardiac medications. Tea is made from hazel leaves or bark.

A tablespoon of the dry mixture is poured into a glass of boiling water and left for thirty minutes. Drink tea twice a day, half a glass.

sedum

Contains substances that help with blockades of varying severity. To prepare tea, take a teaspoon of dried herb and pour a glass of boiling water. This glass must be drunk within 24 hours.

Sports and the military

Incomplete blockade does not prevent sports at a young age; in the case of serious training, cardiologists recommend undergoing Holter monitoring to determine the physical condition of the athlete.

If the conduction disorder does not progress, then there are no obstacles to serious training; a person must undergo an ECG examination every year to analyze the functioning of the ventricles.

Young men are drafted into the army with the mark “fit for service with minor restrictions.” This means that he will be taken into the infantry or signal troops.

Small restrictions mean the branch of the military; in the army there will be no other restrictions. Such a young man will not get into the elite troops.

Preventative care measures

If electrical conductivity is impaired to an incomplete extent, treatment is not necessary. The patient undergoes examination and mandatory ECG every year.

If you experience pain in the chest, weakness, or dizziness, you should immediately consult a doctor for advice.

It is important to remember that the development of an incomplete form into a full one can lead to death, so you need to monitor your condition.

It is advisable to always carry your medical card with you and have the cardiologist's phone number with you.

A correct lifestyle, lack of stress, sleep and rest patterns are important. Preventive measures are aimed at timely treatment of emerging diseases, taking all necessary vitamins and restoratives.

Patients with blockades are prescribed spa treatment in specialized sanatoriums, mud therapy, massages and walks in the fresh air.

Sea bathing under the supervision of specialists is also prescribed. In places where there is no sea, they take baths with sea salt.

The diet in such sanatoriums is calculated individually; the diet depends on the diagnosis and characteristics of the person’s disease. Obese people are helped to lose weight by reducing the calorie content of meals.

Prevention measures for children include massages, physical therapy, balanced nutrition and sanatorium treatment.

Children with incomplete blockades should not be protected from life; they can attend school and kindergarten on a general basis; they are not exempt from physical education lessons unless there are serious violations.

Long walks in the fresh air are beneficial at any time of the year. Vaccinations are given according to the general schedule; exemptions from vaccinations are not given.

Children with conduction disorders in the His bundle are registered with a cardiologist and undergo an annual examination to identify emerging problems.

If a child experiences weakness, dizziness, or pain, parents should immediately contact their doctor. The telephone numbers of a specialist and an ambulance should always be at hand.

During periods of peak viral infections, the child is protected from visiting crowded places, since the flu causes severe complications, leading to complete disruption of the impulse and disability.

If symptoms such as cough or runny nose appear, you should immediately show your baby to a doctor to avoid serious consequences.

Speaking about prevention, it is very important not to forget about nutrition, especially for children. It should be high in calories and contain all the necessary minerals and vitamins. In the off-season, it is recommended to take pharmacy vitamin complexes.

Very fatty, heavy foods and store-bought foods are excluded from the diet. Fresh fruits, herbs, vegetable salads, milk and sour milk should be present in the child’s diet every day. The correct mode of sleep and wakefulness, study and rest is important.

It is significant: to teach a child the basics of a healthy lifestyle and balanced nutrition, since they live with a cardiological diagnosis all their lives.