Incomplete blockade of the right ICD 10. Indications for planned hospitalization. Right bundle branch block in children

Synonyms

Atrioventricular blockade.

Definition

AV block is a violation of the conduction of impulses from the atria to the ventricles of the heart at the level of the AV junction.

ICD-10 code

I44.0 Atrioventricular blockade of the first degree.

I44.1 Atrioventricular block of the second degree.

I44.2 Atrioventricular block is complete.

I44.3 Other and unspecified atrioventricular block.

Prevention

There are no specific preventive measures. Preventive measures should be aimed at preventing diseases accompanied by the development of AV block.

Screening

No special screening is carried out. To identify the disease as part of clinical observation and preventive examinations, you can use ECG recording in 12 standard leads, as well as Holter ECG monitoring.

Classification

There are congenital and acquired AV blocks. Depending on the nature of the occurrence, acute, intermittent (transient) and chronic (permanent) AV blockades are distinguished, and depending on the level of impulse conduction disturbance - proximal (impulse conduction block above the trunk of the His bundle) and distal (level of block below the trunk of the His bundle) .

Depending on the severity of AV conduction disorders, there are:

First degree AV block - prolongation of the P-Q interval on the ECG by more than 0.2 s.

Second degree AV block:

Mobitz type I - a progressive increase in the duration of the P-Q interval, which ends with the loss of the QRS complex with subsequent resumption of conduction (Samoilov-Wenckebach period) (Fig. 1);
Mobitz type II - sudden (without previous prolongation of the P-Q interval) loss of the QRS complex (see Fig. 2).
High degree AV block (far advanced) - loss of two or more ventricular complexes, or AV block with 2:1 conduction (Fig. 3, 4).

III degree AV block (complete AV block, complete transverse block) - lack of impulse conduction from the atria to the ventricles.

Rice. 1. Atrioventricular block of the second degree, types I and II. The ECG shows signs of the acute phase of myocardial infarction of the lower wall of the left ventricle (elevation of the ST segment in leads II, III, aVF with reciprocal depression in the chest leads). In standard leads in the 2nd and 3rd complexes, a progressive lengthening of the P-Q interval is recorded with loss of QRS after the next P wave (Mobitz I). The loss of QRS after the 1st complex in standard and the 1st and 2nd complexes in the chest leads is not preceded by P-Q prolongation (Mobitz II).

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 Three-fascicular 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.

When the impulse passes through the branches at a slow rate, it is called incomplete 1st degree heart block.
In the case when only some impulses reach the ventricles, heart block of the 2nd degree (incomplete) occurs.
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:

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

Disturbances in the passage of the impulse between the sinoatrial node and the beginning of the branching of the His bundle, which is called heart block, cause disruption of the heart rhythm and decreased blood supply to the brain.
Heart block, in which the passage of the excitation impulse slows down, is considered partial. If the impulse ceases to be transmitted completely, then complete heart block is formed.

When a partial blockade occurs, most patients feel quite healthy, attributing a slight malaise to fatigue after a hard day at work, stress, etc., since they do not feel significant disturbances in cardiac activity. In many cases, it is detected on an ECG during the next preventive examination or when seeking medical help. At the same time, the word “blockade” causes panic among many. So what kind of disease is this, and what danger does it pose to humans? Let's try to explain.

What is heart block?

Let's start with the fact that the normal functioning of the heart is facilitated by electrical impulses generated in the sinoatrial node. From it they are distributed throughout the atria, the contractions of which contribute to the transmission of the impulse further, through the atrioventricular node to the atrioventricular His bundle. From there it is distributed into areas through smaller branches. With a decrease in the automaticity of the sinus node, the passage of the impulse slows down, and the interval between atrioventricular contractions increases (lengthens).

Sometimes the impulse does not travel through the conduction system at all. In this case, there is no contraction of the atria or ventricles. A long pause occurs (atrial asystole), which is called the Wenckebach period. When it occurs, conductivity is restored again, thanks to the ectopic rhythm, which is called the “rescuing” rhythm. And the next atrioventricular interval is already of normal length. Symptoms with incomplete (partial) heart block are almost completely absent, since it does not disrupt the blood supply to the brain. Most often, partial heart block is accompanied by slight dizziness and slight malaise.

Complete heart block is characterized by the occurrence of bradysystole - a sharp decrease in the number of ventricular contractions (up to 30-40), when the number of atrial contractions remains normal. This almost always causes significant circulatory problems. Patients complain of shortness of breath, dizziness, and their vision suddenly becomes dark.

Sometimes a drop in cardiac activity (a sharp decrease in ventricular contractions to 15 per minute) causes cerebral ischemia. In this case, a Morgagni-Adams-Stokes (MAS) attack occurs: epileptiform convulsions develop, and the person loses consciousness for several minutes. Before it occurs, he begins to feel weak, a feeling of intense heat arises in his head, then he suddenly turns pale and loses consciousness. This condition is called instantaneous blockade. It develops when a violation of sinus rhythm turns into ventricular automaticity. Repeated attacks of MAS often cause death.

Video: heart block on ECG

The video shows an intermittent (alternating) blockade of either the right or left bundle branch

Heart blockades - briefly about the types

The following types of blockade are distinguished depending on where the obstacles that arise that cause disruption of the impulse patency are localized.

Sinoatrial blockade

Sinoatrial (SA) block is usually caused by excessive stimulation of the vagus nerve or organic damage to the sinus node. It is characterized by conduction disturbances in the area between the atria and the sinoatrial node, accompanied by loss of complete cardiac contraction, which is detected by auscultation (listening). The nature of the loss is irregular.

Sinoatrial blockades also develop under the influence of glycosides prescribed for the treatment of heart disease, potassium supplements and quinidine. It also occurs in people in excellent health who engage in various sports when their physical activity increases.
Partial (incomplete) blockade, associated with a decrease in the activity of the sinoatrial node, is asymptomatic. No treatment is required for this type of blockage. If there is a significant decrease in the activity of the sinus node caused by increased excitability of the vagus nerve, a course of therapy with atropine administered subcutaneously is carried out, and sympathomimetics can be used.

Intraatrial block

When it occurs, the patency of the excitation is disrupted inside the atria.

Atrioventricular block

The cause of atrioventicular (AV) blockade is the pathology of the passage of the impulse that excites the ventricles simultaneously through all three branches of the His bundle. They are divided according to degrees, which determine the severity of the disease.

1st degree

First degree heart block occurs when there is a delay in the passage of the electrical impulse through the atrioventricular region. It is detected only through an ECG. If cardiac activity is normal, the duration of the interval of impulse passage from the atria to the ventricles (P - Q) is 0.18 s. When a 1st degree blockade develops, the impulse conduction interval (P – Q) increases to 0.3 s and higher.

2nd degree

A 2nd degree block is characterized by a further increase in conduction disturbances in the atrioventricular node. This disorder has three types (Mobitz).

3rd degree

With the 3rd degree of blockade, the transmission of impulses in the atrioventricular node stops completely. And they begin to contract spontaneously, regardless of each other. Myocardial pathologies, drug intoxication and other factors lead to the development of complete blockade.

Intraventricular block

Intraventricular blockades (ventricular) are associated with the formation of pathology of the pathways located below the atrioventricular node: in the His bundle or one or more of its legs. With this type of blockade, the exciting impulse directed to the ventricles is delayed or not transmitted at all.

Video: Lesson on Heart Blocks

Etiology

Basically, the causes of heart block lie in the progression of diseases, such as:
myocarditis of thyrotoxic, diphtheria or autoimmune type;

diffuse connective tissue diseases;

heart defects and tumors;

sarcodia and amyloidosis;

myxedema;

syphilis affecting the heart and myocardial defects caused by rheumatism;

myocardial infarction or cardiosclerosis.

No less common causes are drug poisoning caused by exceeding the dosage of certain drugs: quinidine (against arrhythmia), Corinfar, verapamil, digitalis and a number of others. Digitalis preparations are especially dangerous for heart blockades of any kind.

Incomplete blockade often occurs in completely healthy people. Most often it is caused by overexcitation of the vagus nerve, which is caused by increased stress during training or physical work.

There have been cases of congenital blockade that occurs as a result of pathology of intrauterine development. In this case, newborns are diagnosed with heart defects, etc.

Blockade can also be caused by certain types of surgical interventions used to eliminate various heart defects and other anomalies.

Blockades of intraventricular localization

The most common is intraventricular heart block. It has several varieties, which are classified based on which branch of the His bundle the pathology arose. The mechanism by which the excitatory impulse is transmitted to the ventricles from the atria includes three branching segments. They are called the legs of His. First there is a branch to the RV (right ventricle). It is called the bundle branch (right). Next comes the left segment (leg), which is directed downward. Being a continuation of the main trunk, it is thicker than the others. Just below the segment branching to the pancreas, the left segment divides into posterior and anterior branches. Along the posterior branch, excitation is transmitted to the septum, and along the anterior branch - directly to the ventricle, located on the left side.

Damage to any branch of the His bundle contributes to the formation of a single-bundle block. If conduction is impaired in two branches, then we are talking about a two-bundle blockade. If the pathology develops in all three legs (complete bundle lesion), this means the occurrence of a complete three-bundle transverse block of the atrioventricular (distal) type.

Based on the location of the conduction pathology, there is a division into right ventricular and left ventricular blockades. If conduction pathology occurs along the anterior or posterior part of the left segment of the His bundle, a blockade of the left ventricle of the heart is formed.

Pathology of the conduction of the anterosuperior left leg mainly progresses with the development of diseases leading to thickening of the wall of the left ventricle (its hypertrophy). This may be myocarditis, anomalies of the interventricular septum, aortic heart disease, heart attack, etc. There is a violation of the patency of the excitation along the anterior section of its side wall. It is distributed abnormally, starting from the lower areas and gradually rising upward. That is, the septum between the ventricles is first excited, then the impulse is transmitted to the lower portion of the posterior wall. At the end of the period, along the anastomoses, the excitation reaches the anterior section of the lateral wall. The cardiogram shows that the QRS interval is wider than during the normal passage of the impulse by 0.02 s. The R wave is of greater height, and the S wave is of greater depth. At the same time, abnormal Q waves are formed.

When excitation completely ceases to be transmitted through the His bundle (along its left leg), a complete left ventricular block occurs. But along the segment on the right side the impulse passes in a normal rhythm. And only after excitation occurs in the right part of the septum and RV, the impulse is sent to the left ventricle. Conduction disorders of this type are caused by severe heart diseases, which give complications in the form of various defects of the myocardium and impulse-conducting system.

When the left ventricular block is incomplete, the passage of the electrical impulse to the branching slows down. It is brought to the LV transseptally, in a retrograde direction (from left to right) along the right branch of the His bundle, starting from the RV.

The development of blockade of the right ventricle in most cases is caused by diseases leading to its overstrain and the formation of wall thickening. Anomalies of this type are often caused by intoxication of the body with medications prescribed to eliminate disturbances in the functioning of the heart (beta blockers, quinidine, etc.). RV block very often develops in people whose hearts are completely healthy. The anomaly in the patency of the impulse in this case lies in the fact that the septum and LV are first excited, and only then the impulse is transmitted to the RV.

From the above, the conclusion follows: the pathology of the passage of the excitation impulse in any of the branches of the His bundle is a partial blockade of one of the ventricles, on the side of which a pathological interruption of the branch occurred. Excitation to the blocked ventricle is transmitted in an abnormal “bypass” way: through the septum and the ventricle corresponding to the normally functioning branch.

Intraventricular blockades can be identified mainly by electrocardiographic examination. The cardiogram shows a deviation of the electrical axis to the left by an angle of up to 90° with a negative value in case of left ventricular block caused by conduction disturbances in the anterior segment. Deviation of the electrical axis to the right by an angle of up to 90° with a positive value indicates a blockade of the left posterior area. The QRS complex remains unchanged. To clarify the diagnosis, Holter monitoring is performed (taking readings for 24 hours or more).

Video: lesson on bundle branch blocks

Why is heart block dangerous?

Complete atrioventricular block is considered the most dangerous, as it has serious consequences, manifested in the following:

The occurrence of chronic heart failure, accompanied by fainting and collapse. Over time, it will progress, causing exacerbations of cardiovascular diseases (in particular coronary artery disease), chronic kidney diseases, etc.

Against the background of a slow rhythm, ectopic arrhythmias develop, including ventricular tachycardia.

A common complication is bradycardia, leading to hypoxia (oxygen starvation) of the brain and attacks of MAS, the frequent occurrence of which in older people is the cause of dementia.

Sometimes an attack of MAS causes ventricular fibrillation, leading to sudden death. Therefore, it is important to provide emergency assistance in a timely manner: if necessary, perform a cardiac massage (indirect) or perform forced ventilation.

During heart attacks or post-infarction conditions, complete heart block can cause cardiogenic shock.

Diagnosis

When some of the ventricular contractions are lost, their number decreases. This happens both with complete and partial blockade, including functional blockade. To identify the nature of its occurrence, a so-called atropine test is used. The patient is given atropine. An incomplete blockade, the occurrence of which is not associated with pathological changes, then disappears literally after half an hour.

On the electrocardiogram, only the waves are modified, showing that the impulse exciting the contraction passes from the atrium to the ventricle very slowly. With partial second-degree heart block, the cardiogram shows that the impulse passes with a slowdown. The wave of atrial contraction is recorded, but there is no wave indicating ventricular contraction. Partial blockade of the right leg is recorded on the cardiogram by slight changes in the thoracic leads on the right side and the appearance of small notches on the S wave.

Pathology treatment method

Treatment for heart block (antrioventricular) is prescribed depending on the type and cause of its occurrence. For first-degree atrioventricular block, constant clinical monitoring of the patient is sufficient. Drug therapy is carried out if his condition worsens. If the blockade develops against the background of a heart disease (myocarditis or acute myocardial infarction), then the underlying disease is first eliminated. The treatment method for 2nd and 3rd degree blockade is selected taking into account the location of the conduction disorder.

If the blockade is of the paroxysmal type, then treatment is carried out with sympathomimetic agents (isadrin) or subcutaneous administration of atropine.

With a distal blockade, drug therapy does not give the desired effect. The only treatment is electrical stimulation of the heart. If the blockade is acute and occurs as a result of myocardial infarction, then temporary electrical stimulation is performed. In case of persistent blockade, electrical stimulation should be carried out continuously.

In case of sudden complete blockade, if it is not possible to perform electrical stimulation, an Isuprel or Euspiran tablet (or half a tablet) is placed under the patient’s tongue. For intravenous administration, these drugs are diluted in glucose solution (5%).

Complete heart block that develops against the background of digitalis intoxication is eliminated by withdrawing glycosides. If the blockade, the rhythm of which does not exceed 40 beats per minute, persists even after discontinuation of glycosides, Atropine is administered intravenously. In addition, Unitol injections are given intramuscularly (up to four times a day). If necessary (for medical reasons), temporary electrical stimulation is performed.

Under the influence of drugs on the vagus nerve, there are often cases when complete heart block turns into partial.

help yourself

In case of incomplete blockade, specific drug treatment is not required. But care must be taken to reduce the likelihood of its transition to more severe forms. And the symptoms that arise, such as dizziness and heaviness in the chest, also cannot be ignored. Therefore, it is recommended to reconsider your lifestyle and diet, and give up bad habits. If you experience discomfort caused by the blockade, do the following:

Complete heart blocks

Let's look at what a complete intraventricular block caused by pathological changes looks like on an ECG. The amount of damage to each branch of the left leg of His is indicated by the deviation of the isoline towards negative or positive values. It is located neutrally (zero position), when excitation is transmitted to the ventricles in a normal rhythm. If the passage of the impulse is disrupted, a widening of the QRS complex is recorded, which in some cases reaches more than 0.18 s.

With a significant increase in depolarization caused by conduction disturbances in the His bundle, early repolarization occurs. On the electrocardiogram this process is recorded as follows:

The ST segment in the left chest is shifted below the isoline; the T wave takes the shape of a negative equilateral triangle.

The ST segment in the right parts of the chest is above the isoline, the T wave has a positive value.

When the right ventricular block occurs, the following occurs:

A low S wave of greater width is formed;

The R wave, on the contrary, is narrow but high;

The QRS complex is shaped like the letter M.

Secondary repolarization (early) is reflected in the chest leads on the right by an upwardly convex ST segment, which has a slight downward shift. In this case, the T wave is inverted (upside down).

Complete atrioventricular block, which occurs as a result of pathological changes in the myocardium or against the background of an overdose of certain types of drugs, can develop in a distal or proximal type.

The proximal type of block occurs when the ventricular pacemaker is located in the atrioventricular node. On the ECG, this type of blockade is indicated by a normal (not widened) QRS complex, the frequency of ventricular contractions is quite high (up to 50 per minute).

In the distal type, the ventricular pacemaker has a lower idioventricular location. It is the bundle of His with all its branches. It is called a third-order automatic center. The electrocardiogram shows that the number of ventricular contractions is reduced, it does not exceed 30 per minute. This is indicated by a widening of the QRS complex of more than 0.12 s and the layering of the P wave on the ventricular QRS complex. It may have a changed shape (if the automatic impulse occurs below the point at which the His bundle begins to branch). The ventricular complex retains an unchanged shape if the initial point of localization of the automatic impulse is located in the bundle itself.

With atrioventricular block, simultaneous contraction of the ventricles and atria occurs. This gives an increased sound of the first tone, which is called “cannon”. It is clearly audible when listening. The symptoms of this type of blockade depend on the degree of circulatory disturbance and the causes that cause it. If the frequency of ventricular contractions is high enough (at least 36 per minute), and there are no concomitant diseases, then patients do not experience discomfort or unpleasant sensations. In some cases, when cerebral blood flow decreases, dizziness occurs, and consciousness begins to periodically become confused.

With an increase in the duration of the interval between ventricular contractions, partial AV block can become complete, causing acute circulatory disorders in the brain. It is often accompanied by a slight eclipse of consciousness and heart pain. In more severe cases, MAS attacks occur, accompanied by convulsions, and the person loses consciousness for a short time. Prolonged ventricular arrest can cause instant death due to ventricular fibrillation.

Drug therapy for complete blockade

Therapy for complete blockade of any type is carried out based on etiology and pathogenesis.

Radical methods include implantation of a pacemaker. Indications for its use are:

low ventricular rate;

increased period of asystole (more than 3 s);

occurrence of MAS attacks;

complete blockade, complicated by persistent heart failure, angina pectoris and other diseases of the cardiovascular system.

Forecast

A favorable prognosis is given only with partial blockades. The development of a complete third-degree block leads to complete disability, especially if it is complicated by heart failure or occurs against the background of myocardial infarction. The implantation of a pacemaker will make it possible to make more favorable prognoses. When used, some patients may experience partial restoration of their ability to work.

Features of heart block localizations

His bundle and its blockade

His bundle block has distinctive features. It may be constant or appear periodically. Sometimes its occurrence is associated with a certain heart rate. But the most important thing is that this type of heart block is not aggravated by severe disease. And although this blockade in itself does not pose a threat to human health, it can serve as a harbinger of more serious heart disease (in particular myocardial infarction). Therefore, it is necessary to periodically undergo a heart examination using an ECG.

A pathological conduction disorder, the location of which becomes the bundle branch, can pose a threat to life. This is explained by the fact that she is a fourth-order pacemaker. It regenerates low-frequency pulses (no more than 30 per minute). It should be noted that the highest frequency impulse (up to 80 per minute) is formed in the sinoatrial node. The second-order atrioventricular node that follows it produces impulses with a decrease in frequency to 50 per minute. The His bundle (third-order pacemaker) generates impulses at a frequency of 40 per minute. Therefore, in the event of obstruction of the excitatory impulse along the pacemakers of all levels, they are automatically formed in the Purkinje fibers. But their frequency decreases to 20 per minute. And this leads to a significant decrease in the blood supply to the brain, causes its hypoxia and leads to pathological irreversible disorders in its work.

Sinoatrial heart block

A distinctive feature of sinoatrial block (SB) is that it can occur simultaneously with other types of heart rhythm disturbances and conduction pathologies. Sinoatrial block is sometimes caused by a weak sinus node. It can be permanent, transient or have a latent form.

In this case, three stages of its manifestation are distinguished.

At the first stage, the passage of the impulse through the sinoatrial region is delayed. It can only be detected by electrophysiological studies.

At the second stage, two types of SB should be considered. With the development of the first type, a periodic blocking of one impulse occurs at the exit from the atria. Sometimes several impulses in a row are blocked at once, with Weckenbach periodicity. The R-R interval corresponding to the pause is extended. But its value is less than twice the R-R interval that precedes the pause. Gradually, the intervals that follow a long pause become shorter. It is detected during a standard ECG, on which the pulse frequency is displayed without change.

The second type is characterized by a sudden disruption of impulse conduction, in which there are no Weckenbach periods. On the cardiogram, the pause is recorded as doubling, tripling, etc. pauses R-R.

The third stage is a complete disruption of impulse conduction in the atria.

Interatrial block

One of the small rare heart rhythm disorders is interatrial block. Like all other types, it has three stages.

The impulse of excitation is delayed.

Periodic blocking of the excitatory impulse entering the left atrium.

Dissociation of atrial activity or complete conduction disturbance.

The third stage is characterized by the automaticity of the formation of impulses from two sources at once: the sinoatrial and gastroatrial node. This is due to the fact that due to the emerging pathology of the sinus node, the number of impulses formed in it sharply decreases. At the same time, an accelerated formation of the number of impulses in the AV node occurs. This leads to simultaneous contraction of the ventricles and atria, regardless of each other. This type of blockade has another name - “Pre-ventricular dissociation” or dissociation with interference. On the electrocardiogram it is recorded together with normal contractions. When listening, a more sonorous “gun” tone is heard from time to time.

Heart block in childhood

In childhood and adolescence, the same types of blockade are formed as in adults, differing only in the cause of occurrence: acquired (due to a disease) or congenital etiology. Acquired forms in children and adolescents are secondary, and develop as a complication after surgery to eliminate various cardiac pathologies, or against the background of diseases with an inflammatory or infectious etiology.

Congenital blockade can be caused by the following reasons:

Diffuse damage to the mother's connective tissue.

The presence of type II diabetes mellitus (insulin-dependent) in the mother. This syndrome is called Legerne disease.

Not fully formed right leg of the His bundle.

Anomaly in the development of the interatrial and interventricular septa.

M.Lev disease

The most dangerous is the third degree of atrioventricular or complete transverse block caused by damage to all three legs of the His bundle. When they occur, the conduction of impulses to the ventricles from the atria is completely absent. It does not always have pronounced symptoms. Its only manifestation is bradycardia.

But as it progresses, there is a gradual stretching of the heart chambers, hemodynamic disturbances with a slowdown in overall blood flow. This leads to a deterioration in the supply of oxygen to the brain and myocardium. As a result of hypoxia, children experience neuropsychic disorders. They remember and assimilate educational material poorly, and lag behind their peers in physical development. The child often experiences dizziness, weakness, and slight fainting. Any stressful situation and increased physical activity can lead to fainting.

In the treatment of complete blockade in children, anti-inflammatory and hormonal drugs, antioxidants, nootropics and vitamin complexes are used. Severe forms, in which drug therapy is ineffective, are recommended to be eliminated by cardiac pacing. Pacemakers are also used in the treatment of congenital forms of heart block accompanied by bradycardia. Emergency assistance for loss of consciousness (attack of MAS) consists of closed (indirect) cardiac massage, administration of atropine or adrenaline. Continuous monitoring of conductivity through an ECG is recommended.

Congenital heart blocks often cause the death of a child in the first year of life. In a newborn they are manifested by the following symptoms:

Blueness or cyanosis of the skin, lips;

Increased anxiety or, conversely, excessive lethargy;

The baby refuses to take the breast;

He experiences increased sweating and increased heart rate.

For mild forms, drug treatment is not required. But the child needs constant monitoring by a cardiologist. In some cases, surgical intervention is recommended, which can save the baby’s life.

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 Three-fascicular 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.

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.

When the impulse passes through the branches at a slow rate, it is called incomplete 1st degree heart block.
In the case when only some impulses reach the ventricles, heart block of the 2nd degree (incomplete) occurs.
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

Possible symptoms include:

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

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.

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:

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.
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.

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!

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.

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.

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.

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 LNPG. 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.

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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.