Is the blockade of the legs of the bundle of His so terrible? Treatment of blockade of the left leg of the heart Transient blockade of the left leg of the bundle of his.

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

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

What it is?

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

Reasons for the blockade

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

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

Classification

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

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

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

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

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

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

Symptoms

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

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

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

Trifascicular block has the most severe clinical manifestations:

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

What does bundle branch block look like on an ECG?

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

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

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

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

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

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

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

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

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

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

Left bundle branch block

Right bundle branch block

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

Effects

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

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

Treatment for blockade of the legs of the bundle of His

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

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

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

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

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

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

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

Forecast

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

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

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

Prevention

Preventive measures include:

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

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

• Blockade of the legs of the bundle of His
• Etiological factors
• Diagnostic measures
• Treatment tactics

Few people without medical education know what the blockade of the left leg of the bundle of His is and why it occurs. The heart is the most important organ in human body. Its main function is to pump blood and nourish all tissues and organs. It is known that this organ consists of three layers: internal (endocardium), middle (myocardium) and external (epicardium). It is the myocardium that provides the contraction of the heart. The contraction occurs as a result of the generation and conduction of electrical impulses.

It follows from this that the main functions of the heart are as follows:

• excitability;
• conductivity;
• contractility.

Do not forget about the automatism, which is provided by the pacemaker. Additional functions of the myocardium include refractoriness (inertia of cardiomyocytes) and aberration (conduction of excitation along secondary pathways). The blockade of the legs of the bundle of His refers to a conduction disorder. A similar condition is included in the group of arrhythmias, that is, conditions in which the rhythm, frequency, sequence of excitation of individual sections of the heart and contraction as a whole can change. What is the etiology, clinic and treatment of this condition?

At healthy person sinus rhythm. It is provided thanks to the conducting system. This system is a chain consisting of several nodes. In these nodes there are clusters of cells that are able to quickly become excited and conduct an impulse from one department to another. Ultimately, this leads to myocardial contraction. The conducting system includes the following structures:

• sinus node;
• atrioventricular node;
• , consisting of two legs (left and right);
• Purkinje fibers.

The sinus node is the first link. It is located in the right atrium. From it, the impulse enters the atrioventricular node. This is where atrial stimulation occurs. With the help of the left leg of the bundle of His, excitation is transmitted to the left ventricle. The right one, respectively, is responsible for the right ventricle. Currently, the following pathologies of the conduction system are distinguished: a violation of the formation of an impulse and a violation of its progress.

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Blockade of the legs of the bundle of His

consists of several branches: two anterior and posterior. Left bundle branch block (LBBB) is a pathology in which the conduction function is impaired. It is characterized by a slowdown in the passage of the impulse along the left leg or its termination. The diagnosis is made only on the basis of instrumental research(results of the electrocardiogram). It must be remembered that this is not an independent disease, but only a manifestation of any pathology of the heart. It has been established that this condition occurs in 0.6% of the world's population. The risk group is the elderly. Men suffer from this disease more often than women.

There are several forms of blockade of the legs of the bundle of His. In the first case, only one branch of the left leg is affected, in the second, both. The blockade can be complete or incomplete. With a complete blockade, the conduction of excitation along the left leg stops. With partial - excitation of the ventricles is a little late. There are 3 degrees of this pathological condition. At grade 1, all impulses go to the ventricles, but the time of their conduction increases. At grade 2, part of the impulses does not reach the ventricles. The first 2 degrees refer to incomplete blockade. Complete blockade is the most severe condition. In this case, the impulses do not arrive, and the left ventricle begins to contract on its own. The normal frequency of contractions is 60-80 beats per minute. With a complete blockade of the left leg, the frequency of contraction is 20-40 beats per minute.

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Etiological factors

What are the causes of left bundle branch block? Today, there are many causes of blockade of the leg. Most often, the cause is associated with cardiac diseases in humans. Conduction disturbance can be a manifestation of coronary heart disease (heart attack), myocarditis, heart failure, various malformations of this organ. Of no small importance in the development of the blockade is intoxication with drugs (cardiac glycosides, diuretics, sympathomimetics). In some cases, the blockade of the left leg of the bundle of His is a consequence of smoking, alcoholism, and the use of drugs. Other possible etiological factors include electrolyte disturbances (lack of potassium or its excess, lack of magnesium). The cause of the blockade may be thyrotoxicosis.

With pathology of the anterior and posterior branches of the left leg, the causes may vary somewhat. Thus, the pathology of the anterior branch in most cases occurs against the background of anterior infarction, cardiosclerosis, hypertension, aortic valve disease, mitral insufficiency. The cause may be a defect in the septum between the atria, the deposition of calcium salts, cardiomyopathy, inflammation of the heart muscle. Blockade of the posterior branch may be the result of posterior infarction, atherosclerosis, calcification, myocarditis. Less commonly, a two-beam blockade is detected when pathology is observed in both the posterior and anterior branches of the left leg.

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Characteristics of the blockade of the left leg

If there is a block of the anterior branch of the left leg, then the passage of the impulse will be disturbed in the region of the anterior-lateral surface of the left ventricle. The right ventricle is not involved in the process, since the right leg of the bundle of His is responsible for it.

According to statistics, this pathology can be diagnosed in 3 out of 4 elderly people, that is, in 75%. Often, conduction disturbance is the most important sign diseases of the cardiovascular system.

With the blockade of the anterior branch of the left leg of the bundle of His, the symptoms are non-specific or they are completely absent. In rare cases, arrhythmia is observed.

As for the pathology of the posterior branch, the conduction of excitation in the posterior and lower parts of the left ventricle is disturbed. It is often possible to meet such a condition when there is a blockade of the left and right legs at the same time. This indicates pronounced changes in the heart muscle.

In the last decade, the percentage of reported deaths from various heart diseases has increased significantly.

However, not every patient, having heard, for example, such a diagnosis as a complete blockade of the left leg of the bundle of His, imagines what it is and what methods of treating such an ailment exist in modern medical practice.

Therefore, this article will answer all the exciting questions.

General characteristics of the disease

Taking into account the natural structure of the structure of the His bundle, the blockade can be single-beam or multi-beam.

In a particular case, this refers to the fact that the pathological process has spread to both branches or has reached directly to their branch. This disrupts the normal conduction of the impulse.

As a rule, the complete blockade of the left leg is attributed to the organic type of damage to the characteristic organ. The electrical signal going along the right side has an exciting effect not only on the ventricle located in this area, but also on the septum.

Then the wave impulse affects the left ventricle. At the same time, it increases total time movement of the activation wave.

Of course, with the disease in question, conductivity will be observed, but much more slowly and along a workaround.

It should be noted that the disease does not show itself for a long time and at the initial stage of its development does not pose a great threat to human health.

The clinical picture takes on a clear outline only during the period of rapid progression of ventricular arrhythmia (tachycardia).

Attention! If even slight signs of malfunctioning of the heart are found, then you should immediately contact a cardiologist.

Causes of a dangerous deviation

Electrocardiogram (ECG) is enough effective method detection of pathologies human organ. However, even with its help, it is very difficult to detect complete LBBB in time. This phenomenon occurs due to a long asymptomatic course of an abnormal process.

To confirm the doctor's assumptions, the use of other methods is usually required. instrumental methods and diagnostic methods:

If the blockade has never been diagnosed before, then its appearance is primarily associated with an acute type of myocardial infarction.

There are also other common causes of the formation of such a dangerous condition:

The true provocative factor is able to establish a purely qualified specialist.

Classic clinical manifestations

With the blockade of the described type, special clinical manifestations occur some time after the onset of the development of the pathology. Moreover, specific changes are easily detected during normal listening to the tones of the patient's characteristic organ. The patient may talk about such alarming symptoms:

After all, as you know, the bundle of His consists of a trunk and several legs, and if at least one of its elements does not function correctly, then the full operation of the entire conducting system is under threat.

Such a clinical picture cannot go unnoticed.

There have been cases of sudden death if the patient was not given first aid.

Occasionally, on the ECG, a slight deviation of the axis of the characteristic organ to the left is noticeable, which indicates the presence of a blockade in a person, provided that he does not have any concomitant ailment.

An effective treatment regimen for the disease

There is no urgent need for specific treatment of the blockade. As a rule, the struggle is aimed at eliminating the underlying disease, which caused the problem in question. The attending physician prescribes the following groups of medicines to the patient:

1. Glycosides.
2. Nitrates.
3. Tablets that lower blood pressure.
4. Adrenoblockers.
5. Antiplatelet agents.

Medicines should be taken strictly according to the instructions of the doctor. If, after a course of therapy, obvious improvements still do not occur, then a decision on surgical intervention is considered.

A pacemaker is surgically installed, which will correct the operation of the “motor” human body. The patient's condition in postoperative period will improve these non-drug methods of recovery:

The consequences of the disease

To treat the described disease, of course, it is necessary. Like any other pathological process, it tends to progress and worsen.

Over a certain period of time, an uncontrolled contraction of the fibers of the heart muscle occurs.

Such a phenomenon is incompatible with life. Therefore, the disease often ends in the death of the patient.

True, with such a frivolous attitude to health, less frightening complications may arise, including:

Sometimes a slight lesion of LBPH is considered the norm (mainly in young people). However, only an experienced cardiologist can confirm this fact after a series of examinations.

Scenario for the development of a pathological condition

Forecast at the same time pathological condition can be very favorable. This is especially true for patients who have not experienced a sharp deterioration in well-being or severe symptoms at the entire stage of the course of the disease, as well as its therapy.

The acute form of the disease requires immediate hospitalization of the patient. In addition, what the prognosis will be is significantly affected by the underlying disease, since there is a connection with the organic component of the blockade.

Therapy will also take more time, effort and patience if serious complications have developed.

They get rid of the blockade of the left leg of the His bundle by various methods, up to the use of a defibrillator. Then a course of effective drug therapy is prescribed.

True, bringing yourself to a critical state is extremely unreasonable. Moreover, each patient requires individual approach in the treatment of pathology.

Persons old age it is usually advised to adhere to additional preventive measures (for example, do not forget about clinical nutrition).

Absolutely each of us knows that thanks to the work of the heart, the whole organism functions. And when it fails, irreversible health processes begin, especially with late diagnosis and improper treatment.

Probably, every person at least once felt discomfort in the thoracic region and palpitations caused by physical exertion or stressful situations. But this state passed in a few minutes.

The danger of this disease lies in the absence of symptoms on early stages, the edge of the main pathology and it can be detected using an ECG. But if you notice one of the signs indicated in the article, do not postpone a visit to a cardiologist, because this can lead to more serious complications. What is an incomplete blockade of the left leg of the His bundle, how it manifests itself, diagnostic methods and methods of treatment, we will consider with you below.

His bundles are altered elements of cardiac tissue that are part of the conduction system of the heart. Excitatory impulses pass through them from the sinus node to the heart muscle. Normally, the main generator of nerve impulses in the heart is the sinus node, from which the trunk goes to the atrioventricular node and is divided into the right and left branches (legs), the so-called bundles of His.

The elements of the right bundle of His, respectively, go to the muscles of the right ventricle, and the left - to the muscles of the left. This ensures synchronous contraction of the right and left parts of the heart. With incomplete blockade, there is a difficulty in the passage of nerve impulses, with complete - their complete cessation.

This leads to a violation of the contractile function of the heart. Groups of causes causing blockades (detailed causes will be discussed below):

1. Cardiac, that is, pathologies from the side of the heart.
2. Drug group of causes (or drug) - as a result of taking certain medicines.
3. A group that includes changes in the electrolyte composition of the blood (potassium, sodium, magnesium, phosphorus).
4. A group that combines toxic factors that lead to poisoning of the body and cause conduction blockade in the heart.
5. A group of vegetative disorders (vegetative nervous system), it is responsible for controlling the rhythm of the heart.
6. Hormonal causes(diseases of the endocrine organs).
7. A group of causes that cause oxygen starvation of the heart muscle.
8. Idiopathic causes, which are not determined during the examination of the patient.

If the electrical discharges of the upper chambers are not transmitted, as they should, to the lower chambers, then a blockade of the legs of the His bundle occurs. This is reflected in the cardiogram.

As a rule, all blockades are divided into 3 main varieties:

• Single-beam - it can affect the right leg, as well as one of the branches of the left process.
• Two-bud - this variety immediately affects both left-sided branches or the right and one of the branches of the left.
• Three-beam - the most serious pathology, in which 3 branches suffer at once.

In turn, LBBB can occur in several scenarios:

• blockade occurs in a certain part of the trunk up to the branching border;
• the stem part is completely affected before it branches;
• the blockade affects the process on both sides after branching;
• both peripheral parts of the left process are blocked;
• scattered changes in the middle muscle layer of the heart.

Incomplete blockade of the left leg of the bundle of His - characteristic

Under incomplete blockade is meant a violation of the conduction of an electrical signal along one of the branches of the left leg. To determine which part suffers, the electrographic deviation of the total vector of the electrodynamic force of the heart is evaluated at the position of the recording electrodes on the right upper and left lower extremities.

If there is a pronounced deviation of the total vector of the electrodynamic force of the heart to the left, then a blockade of the anterior branch is diagnosed, and if a pronounced rightogram is observed, then this indicates a lesion of the posterior branch.

Incomplete LBBB usually does not cause serious clinical abnormalities and no abnormalities are observed when listening to the patient. And if an incomplete blockade of the right leg is found, then the condition can be regarded as corresponding to the physiological norm and an additional examination in this case is completely optional.

The blockade of the left leg of the bundle of His (or LBBB) is a pathology, which may be based on damage to the heart apparatus at different levels. For example, the left leg in the trunk of the bundle of His may be affected. Or the main trunk of the left leg before branching.

The anterior and posterior branches of the leg can be affected at one moment after the end of the place of their release from the body of the main trunk. The left good half of the septum between the ventricles is also damaged, along with this, both branches of the pedicle are involved in the process.

The circumstance may also lie in pronounced diffuse transformations of the myocardium in the peripheral branches of the posterior and anterior branches. With LBBB, the passage of excitation to the myocardium of the left ventricle along the left leg is difficult.

It is carried out by an unusual method, as a result of which the QRS complex is widened, and the direction of repolarization in the left ventricle changes. We will not consider this in detail, this is a task for hearty experts. Consider some of the features of this disease.

Damage to the leg can be the result of fibrous processes, which are associated with coronary sclerosis and less often with limited myocarditis (syphilitic, rheumatic, diphtheria, infectious). It is very rare, but not uncommon, that the blockade appears with a completely healthy heart.

Complete and incomplete blockade of the left leg of the bundle of His is not uncommon. If it comes to complete, excitation at first covers only the septum between the ventricles, and not the entire ventricle entirely. Incomplete blockade begins with violations of electrolyte metabolism, or an overdose of drugs, or various kinds of intoxication.

As a result, the normal conduction of the cardiac system is disturbed, and the full excitation of the left section does not occur. It is possible to diagnose this violation using a simple electrocardiogram; when deciphering, transformations will be visible.

If the blockade has spread to only one leg, then no, it is not life-threatening, despite the fact that there is certainly nothing good in this.

Many modern cardiologists are sure that this deviation has already ceased to be a deviation in those cases, at a time when it is not the result of other heart diseases. The complete blockage of both legs is terrible, in such cases it is required to implant a pacemaker.

Causes

The causes of pathology include:

• Atherosclerotic cardiosclerosis - replacement of part of the heart muscle with connective tissue.
• Aortic valve defects. Such a defect leads to the expansion and increase in the size of the left half of the heart, which disrupts the conduction of nerve impulses in this part of the heart.
• Cardiomyopathy, myocardial dystrophy, bacterial endocarditis are diseases characterized by damage to the myocardium (heart muscle) and with it Purkinje fibers (the smallest cells in the conduction system of the heart).

Types of incomplete blockade of the left side of the bundle of His:

• at the level of the left leg in the very trunk of the beam;
• blockade occurring in the left leg until it is divided;
• difficulty in conducting an impulse in both branches after their separation;
• a variant when the spread of the lesion to half of the interventricular septum in its left part joins the previous type;
• blockade at the level of the extreme, smallest branches of the branches of the left leg.

An important role in the occurrence of this disorder is played by drug intoxication of the body. In this case, poisoning with diuretics, cardiac glycosides, sympathomimetic drugs is observed.

Sometimes the development of blockade leads to excessive consumption of alcoholic beverages, smoking, and taking drugs. Also appearance this disease may be the result of deviations in the electrolyte balance of the body.

The development of blockade of the His bundle leads to a deficiency of magnesium, a lack or an excessive amount of potassium. Also, the cause of the development of the blockade may be the appearance of thyrotoxicosis.

The causes of damage to the anterior and posterior branches of this part of the organ can differ significantly. So, the following factors most often lead to problems in the work of the anterior branch:

• anterior infarction;
• arterial hypertension;
• aortic valve disease;
• cardiosclerosis;
• mitral insufficiency.

Also, the blockade of the anterior branch of the left leg may be the result of a violation of the integrity of the septum between the atria. It often leads to cardiomyopathy and calcium salt deposits.

Often the cause of the deviation lies in the inflammatory process that affects the heart muscle. Violation of the posterior branch develops under the influence of such factors:

• atherosclerosis;
• infarction, which differs in posterior localization;
• deposition of calcium salts;
• myocarditis.

In more rare cases, a two-beam blockade can be detected - in this case, both the anterior and posterior branches of the organ suffer.

Significant changes in the hormonal background, due to certain external influences, are also additional causes of the blockade of the left leg of the His bundle.

The most common etiological factors that can largely influence the occurrence of the first signs of blockade include the following:

1. Poisoning of the patient's body with a large amount of residues of drugs that were used in the treatment of concomitant heart diseases. These include different kinds diuretics, symptomatic and cardiac glycosides;
2. Abuse bad habits, which adversely affect the entire human cardiac system. It can be alcoholism, the use of narcotic drugs, smoking;
3. thyrotoxicosis;
4. Insufficient amount of certain substances in the body. These are potassium, magnesium, which are responsible for the electrolytic balance in the body. Their significant amount, as well as some of their lack, affect the balance in the work of the cardiac system.

As a result of the above situations, the anteroposterior bundle loses its rhythm of work, ventricular contractions pass regardless of the receipt and conduction of impulses through the tissues of the pedicle.

With the blockade of the anterior branch of the left leg of the bundle of His, uniform violations are determined regardless of the location of the lesion. This is due to the fact that the reaction of the excitable structure does not reach the upper sections of the anterior wall of the left lower chamber of the heart.

Therefore, using standard electrocardiography, it is impossible to accurately determine the place subject to blockade.
With BPVLNPG, excitation in the right lower cardiac chamber occurs in a standard way. In the lower left chamber, the reaction of the excitable structure propagates in stages.

First, it passes along the posterior branch of the left leg, and then spreads to the upper parts of the left-sided lower chamber.

This deviation can be detected against the background of a number of cardiac pathologies:

• chronic myocardial damage, which is based on pathological processes in the system coronary arteries and this especially concerns the anterior wall of the left-sided lower chamber;
• ischemic necrosis of the myocardium of the anterior wall of the left-sided lower chamber;
• inflammation of the heart muscle;
• significant thickening of the wall of the left ventricle;
• pathological expansion of the left lower chamber of the heart, caused by insufficiency of the aortic valve;
• primary isolated sclerosis and calcium deposition in the walls of the conducting system;
• congenital heart defects.

According to statistics, LBBB appears over the age of 50 in 1.25% of male patients. And in most cases, this indicator is the only sign developing pathology in the muscular middle layer of the heart.

With the blockade of the posterior branch of the left leg of the bundle of His, serious conduction disturbances occur in the posterior branch, which can proceed with different indicators. The same deviations are noted on the ECG, which are difficult to differentiate using standard electrocardiography.

This condition develops in pathologies similar to those in BPVLNPG:

• insufficiency of blood supply to the myocardium;
• atherosclerosis of the coronary arteries;
• necrosis of a portion of the myocardium affecting the left ventricle;
• inflammation and other changes in the heart muscle caused by a variety of reasons;
• deposition of calcium and degeneration of tissues into a solid connective tissue.

If we talk about the blockade of the anterior branch, then in electrocardiography this is a fairly well-studied section. And the defeat of the posterior branch gives non-specific signs, and this section is still under development. It is impossible to diagnose a lesion of the posterior branch only on the basis of the results of a standard cardiogram.

As a rule, for clarification, you need to resort to additional methods diagnostics. In any case, any of the above blockades is detected during a full examination and the specialist, if necessary, will prescribe additional studies before making an accurate diagnosis.

Single-beam blockade is asymptomatic, it is detected by an ECG. Violations such as constant fatigue, pain in the sternum, shortness of breath, in this case, are caused by a disease that caused a violation of electrical conductivity.

Signs of blockade of the left leg of the anterior or posterior branch are also not felt by the patient. The blockade of the left complete gives such symptoms as: dizziness, pain in the heart, strong heartbeat. The symptoms are caused by severe changes in the left ventricular muscle (myocardial infarction).

Incomplete blockade of the left leg of the bundle of His three-beam is characterized by the following features:

• interruptions in the work of the heart;
• constant fainting caused by oxygen starvation brain;
• dizziness.

Three-beam incomplete blockade leads to a sudden lethal outcome.

A cardiogram shows a problem with electrical conductivity. Right incomplete blockade, in the absence of clinical symptoms and concomitant diseases is considered the norm and additional examinations are not carried out.

ECG signs of a two-beam blockade serve as a reason for hospitalization of the patient, since there is a danger of developing serious conditions. The revealed blockade of the His bundle on the ECG, the three-beam also requires immediate hospitalization, followed by a surgical operation.

How to see the problem with the electrical conductivity of the bundle of His on the cardiogram. Signs of blockade of the right leg:

• Rsr or rSR complexes in V 1, V2 (right leads).
• Wide S wave in V5, V6 (left leads).
• QRS complex greater than 0.11 s.

Signs of impaired conduction of the left leg:

• left leads V5, V6, I do not have a Q wave;
• ventricular complexes are deformed;
• the top of the R wave is split;
• right leads V1, V2, III are characterized by a deformed top of the S wave, the width of the complex is more than 0.11 s.

Differences of the three-beam blockade:

• all signs of left and right;
• drawing of the cardiogram shows an atrioventricular blockade.

LBBB can be caused by damage at various levels:

1. The defeat of the left leg in the trunk of the bundle of His;
2. The defeat of the main trunk of the left leg before its branching;
3. Simultaneous defeat of the anterior and posterior branches of the left leg after their isolation from the main trunk of the left leg;
4. The defeat of the left half of the interventricular septum with the involvement of both branches of the left leg in the process;
5. The presence of expressed diffuse changes myocardium of peripheral branches of the anterior and posterior branches of the left leg.

Despite the above options, as a result, in LBBB, excitation cannot pass in the usual way along the left pedicle to the left ventricular myocardium - excitation is carried out in an unusual way.

What causes a slowdown in the passage of excitation through the ventricles, as evidenced by the widening of the QRS complex and a change in the direction of repolarization in the left ventricle:

• in the left chest leads the QRS complex is represented by a wide tooth RV5,V6 with a notch;
• in the right chest assignments the QRS complex like rS, QS with a wide and deep tooth of SV1, V2 is registered.

It should be borne in mind that with the blockade of the left leg of the bundle of His:

1. Arousal stage 1:

• the left ventricle and the left part of the interventricular septum are not excited;
• excitation along the right leg is transmitted in the usual way and causes excitation of the right half of the interventricular septum (the vector is directed to the V6 electrode);
• at the same time, excitation of the right ventricle begins (the vector is directed to the V1 electrode);
• excitation from the right half of the interventricular septum passes to the left and flows slowly;
• as a result, the total EMF vector is directed to the V6 electrode, since the total thickness of the interventricular septum significantly exceeds the mass of the right ventricle: the beginning of the RV6 wave and the QV1 or rSV1 wave are recorded (this is due to the fact that at the beginning of the electrical systole the vector of the right ventricle is close to the V1 electrode, which sometimes allows a small rV1 to be recorded).

• due to excitation of the left ventricle, which goes in an unusual way and proceeds slowly;
• a further descent of the SV1 (QSV1) waves and a further rise of the RV6 are recorded, with a notch usually observed on the RV6 tooth, located on the ascending knee (there are several options for explaining this phenomenon, such as;
• the presence of a small time interval between stages 2 and 3;
• the predominance of the vector of the final excitation of the interventricular septum over the vector of the initial excitation of the left ventricle;
• different interaction of the interventricular septal vector and the left ventricular vector). Due to the slow propagation of excitation, a widening of the QRS complex is noted.

The process of repolarization in the left ventricle is associated with delayed depolarization, and spreads from the endocardium to the epicardium. As a result, the repolarization vector of the left ventricle has the same direction as the right one - to the V1 electrode (registration of positive TV1, the ST segment in this lead is located above the isoline.

With incomplete blockade of the left leg, excitation can pass, but somewhat slowly. In incomplete RBBB, the QRS complex is shaped like a left bundle branch block, but the QRS width is less than 0.12 s:

• In chest leads V1, V2, the QRS complex has the form rS, QS.
• The STV1,V2 segment can be located on or above the isoline, the TV1,V2 wave is usually positive.
• In the chest leads V5, V6, an ECG is recorded that looks like an R wave (qV5, V6 is absent).
• The STV5,V6 segment can be located on the isoline or below it, the TV5,V6 prong can be of any shape.

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

To additional measures include:

• Daily ECG monitoring is necessary to detect a transient form of the disease that manifests itself at different times of the day.
• Electrocardiographic studies of the esophagus are necessary for the diagnosis of arrhythmias.
• A heart echo is performed to detect organic pathologies in the structure of the heart and to assess the state of the myocardium.
• MRI is prescribed in case of controversial issues in the diagnosis.

The most effective is considered to be an electrocardiogram and emission tomography - these research methods make it possible to make an accurate pre-diagnosis, to identify the main causes of this cardiac pathology.

Thanks to such a diagnostic study, it becomes possible to determine the most effective method of therapeutic action.

Treatment of this condition is based on comparing the results of the ECG and ECG with normal indicators heart rate. Since bundle block is not recognized as an independent heart disease, this condition usually accompanies a specific heart disease or several diseases.

Therefore, treatment is necessarily directed first of all to the elimination of the root causes of this condition. And the methods of treatment of primary cardiac lesions are determined both by the disease itself and by its degree of development, manifestations and the general condition of the patient's body.

The following methods of influence can be attributed to the most effective:

1. With the root cause of the blockade of the His bundle of heart failure, broad-spectrum cardiac glycosides will often be prescribed, as well as nitroglycerin, antihypertensive drugs that stabilize the heart and its rhythm in the first place;
2. Immune preparations aimed at stimulating the body's defenses and increasing the degree of its resistance to various diseases, including heart disease.

The most popular today is a broad-spectrum drug called "Transfer Factor Cardio": the absence of side effects, a quick effect on the heart muscle and stimulation of the immune system are the main manifestations of taking the drug;

3. Nitrates and antihypertensives are also commonly prescribed drugs for given state. They allow you to stabilize general state restore normal heart rate.

However, it should be borne in mind that there is no universal therapy for blockade of the tissues of the bundle of His; the main focus of the therapeutic effect in this case should be considered the treatment of the underlying disease of the cardiac system with parallel maintenance of the patient's condition.

This pathology has an unpleasant probable consequence if the main treatment is insufficient: a blockade of this type can go on to a complete blockade of the heart and its atria, which has a poor prognosis for the patient and in this situation requires immediate special medical intervention.

There is no specific treatment for patients who have experienced cardiac conduction disorders. Patients in whom blockade of the left leg of the bundle of His was found, drug therapy is not indicated.

Symptomatic treatment of the underlying pathology with one-, two-beam blockade includes such medicines:

• Vitamins ( nicotinic acid, thiamine, riboflavin).
• Sedatives (valerian tincture, motherwort, sage).
• Antioxidants (Preductal, Carnitine).
• Antihypertensive drugs, the action of which is aimed at the treatment of hypertension (beta-blockers, ACE inhibitors, calcium channel antagonists).
• Antiplatelet agents that prevent the appearance of blood clots (Aspirin, Cardiomagnyl).
• Medicines used to treat coronary artery disease (Izoket, Nitroglycerin).
• Medicines that normalize the level of cholesterol in the blood (Simvastatin).
• Tablets and injections for the treatment of pathologies that are the root cause of the appearance of "cor pulmonale".
• Diuretics (indicated in patients with heart failure).
• Non-hormonal agents and antibiotics for the treatment of inflammation of the myocardial membranes (Diclofenac, Penicillin, etc.)

Surgical intervention for dysfunctions of electrical conduction involves the installation of a pacemaker for the patient. Complete blockade (right or left), acting as a consequence of acute infarction, requires temporary stimulation of the myocardium using an electrode.

Three-beam blockade, accompanied by attacks of loss of consciousness and a rare rhythm of ventricular contraction, is considered the basis for constant electrical stimulation of the myocardium. The patient is implanted with a cardioverter.

1. A patient who is not bothered by cardiac symptoms and does not suffer from chronic diseases is well tolerated by normal conditions of life associated with stress.

Three-beam and two-beam blockade will require restriction physical activity. Such patients should not work hard and be in a stressful state. Diet and food composition are very important.

2. The diet for patients with impaired electrical conductivity should restore the correct hemodynamics of the peripheral nervous system and central nervous system, water and electrolyte balance, and reduce the active oxidation of lipid peroxidation.
3. Patients should prefer vegetable oils and avoid heavy animal fats entirely. This choice allows you to quickly reduce the level of bad cholesterol in the blood.
4. Seafood, mussels, sea kale, squids are saturated with useful microelements necessary for the work of the heart muscle.
5. Dishes are prepared without the addition of salt, food is recommended to be slightly salted in finished form.

To prevent the development of blockades and other cardiovascular pathologies, it is recommended to follow the general rules:

• prolonged sleep;
• active lifestyle;
• lack of self-treatment;
• quitting smoking and alcohol;
• balanced nutrition according to the regimen;
• exclusion of stress and nervous shocks;
• regular diagnosis and treatment of heart disease.

For example, the blockade of the legs of the bundle of His is associated with the pathology of the conduction of electrical signals through the myocardium of the heart, or rather, through the section of the conduction system responsible for the contraction of the ventricles. The result of the development of pathology is a violation of the sequence, strength, speed of excitation, contraction of the heart. In severe cases, there may be no contraction of any part of the myocardium at all, which can have unpleasant and even fatal consequences.

Features of the disease

The leg of His, or rather the legs of the bundle of His, is an element of the cardiac conduction system that is responsible for conducting excitation impulses in the ventricles. The legs of the heart (bundle of His) are three - left, right front legs and one back. The last part of the bundle of His is thicker than the rest and is a continuation of the trunk of the bundle of His, and the left and right legs are its branches. Between the branches of the legs of the bundle of His there is a network of anastomoses. The entire bundle of His consists of atypical muscle fibers. The end of the legs in the region of the right and left ventricle breaks up into the smallest elements of the conduction system - the Purkinje fibers.

The main function of the bundle of His is the transmission of impulses from the right atrium to the ventricles of the heart, which begin to contract in the rhythm of the atria. For any reason, children and adults may experience a partial or complete violation of the conduction of an impulse at the level of one or two legs. In cardiology, such heart diseases are called bundle branch block (BBB). Pathologies often do not manifest themselves clinically, while they are diagnosed in 6 people out of 1000 of the population. With age, the incidence of the disease increases, and after 55 years of blockade, it occurs already in 20 out of 1000 people, more often in men.

The classification of the disease according to the degree of violation of the conduction of excitatory impulses into the ventricles is as follows:

1. Incomplete blockade of the bundle of His (slowing down the transmission of impulses).
2. Complete blockade of the bundle of His (complete cessation of impulse transmission).

In addition, the following types of blockades are distinguished:

1. Single-beam - covers the right leg, or is a blockade of the posterior or anterior branch of the left leg.
2. Two-beam - affects both branches of the left leg or includes a blockade of the right leg, coupled with a lesion of one branch of the left leg.
3. Three-beam - the right and left legs are blocked.

According to the type of development of BNPG, it can be:

• intermittent (appears and disappears during the recording of one ECG study);
• constant (always present on the ECG);
• transient (not recorded on all ECGs);
• alternating (can change localization, that is, appear in the region of different legs).

Causes of the blockade of the legs of the bundle of His

Signs of pathology can appear in children from birth, in which case they can be triggered by congenital diseases:

• defect of the interventricular and interatrial septum;
• underdevelopment of the segment of the right leg of the bundle of His;
• stenosis of the mouth of the pulmonary artery;
• coarctation of the aorta;
• other heart defects that cause an overload of the right ventricle.

AT childhood incomplete single-beam blockades can be recognized as a variant of the norm if they are not accompanied by organic damage to the heart. So, in many babies, an incomplete blockade of the right leg of the His bundle is detected, combined with small anomalies of the heart - an additional chord, prolapse mitral valve etc. The blockade of the left leg is more often provoked by acquired diseases and is often also recognized as a variant of the norm.

Among the cardiac causes that can cause BBB, doctors call the following:

• acute and chronic heart failure;
• myocarditis of viral, bacterial origin;
• rheumatism of the heart;
• endocarditis;
• various cardiomyopathies;
• myocardial dystrophy of the heart;
• cardiosclerosis;
• tumors of the heart, metastatic lesions of the heart;
• chest trauma;
• surgical interventions on the heart, coronary vessels;
• autoimmune pathologies that affect the heart muscle;
• severe arterial hypertension, or long-term hypertension;
• myocardial infarction.

There are other reasons that can lead to partial or complete blockade of the legs of the bundle of His, including transient ones:

• chronic diseases respiratory system accompanied by obstructive processes, for example, bronchial asthma, emphysema, cor pulmonale, chronic bronchitis;
• pulmonary embolism;
• progressive muscular dystrophy;
• hyperkalemia, as well as other electrolyte disturbances - disruptions in the balance of magnesium, sodium;
• overdose of certain drugs - cardiac glycosides, diuretics, antiarrhythmics, etc.;
• long smoking history;
• alcoholism;
• dysfunction of the autonomic nervous system;
• diseases of the adrenal glands, thyroid gland;
• diabetes;
• severe anemia.

In the absence of obvious reasons, after the diagnosis, an idiopathic blockade of the legs of the bundle of His can be established.

Symptoms of manifestation

Many clinical cases of BBB occur without any manifestations. Incomplete single-beam blockades almost never show themselves as symptoms, therefore they are detected only by ECG during a routine examination. But with a complete blockade of the right leg, symptoms are usually observed in a person even in the absence of organic lesions hearts. These include:

• various changes when listening to heart sounds;
• dizziness;
• pre-fainting states and fainting;
• feeling of lack of air;
• dyspnea;
• decrease in working capacity;
• poor exercise tolerance;
• fatigue and weakness;
• sometimes - pain in the heart;
• feeling of interruption in the work of the heart.

In addition, there may be clinical picture corresponding to the underlying disease - both cardiological and covering other organs and systems. The most serious symptoms appear in acute cardiac pathologies - heart failure, myocardial infarction, which are most often accompanied by various heart blocks against the background of ventricular myocardial damage.

Danger and Consequences

It is difficult to predict the prognosis for this disease, since, in fact, it is a symptom of other pathologies. If a patient has an incomplete single-beam block without cardiac or lung diseases, the prognosis is favorable. With regard to the presence of organic lesions of the heart, the prognosis depends entirely on the underlying pathology. As for the danger of BNPG, unpleasant consequences, as a rule, occur with complete blockades. They lead to progressive hemodynamic disorders that can cause such complications:

• stroke - acute ischemia of a part of the brain against the background of a cessation of blood circulation in it;
• chronic heart failure - dysfunction of the heart, leading to malfunctions of the whole organism;
• aggravation of the course of the underlying heart disease;
• the appearance of thrombosis and thromboembolism due to blood clotting.

Complete BNPH is dangerous - with age, if left untreated, it can lead to the development of severe types of arrhythmias - paroxysmal ventricular tachycardia, ventricular fibrillation, which ends in cardiac arrest (the probability of death is highest with a three-beam blockade).

PE, an ischemic stroke, can also lead to death. On average, mortality in the development of blockade against the background of a heart attack is 50% in the first days of pathology. Only an early start of examination and treatment, the fulfillment of all doctor's prescriptions, the elimination or correction of major diseases of the heart and blood vessels can prevent such consequences.

Diagnosis of pathology

Even a therapist, when listening to the heart, can note a change in rhythm, a violation of heart rate. This should prompt a further, more detailed examination to look for the cause and type of heart block. The main diagnostic method is an ECG, which can be used to draw a conclusion about the form of BBB (below are the most common options for blockades):

1. Blockade of the anterior branch of the left NPG. There is a high R wave, a deep S wave, and a deviation of the QRS vector up to the left.
2. Blockade of the posterior branch of the left NPG. The QRS vector is directed up, to the right and forward, there is a high R wave, a deep S wave. Both types of blockades can be accompanied by acute heart failure, myocardial infarction, which should not be forgotten when obtaining such examination results.
3. Blockade of the right NPG. There is a high wide R wave, a broadened S wave, the amplitude is increased. The ventricular QRS complex takes the form of qRS or rSR, widens to 0.12 sec. and more. In addition to acquired causes (anterior myocardial infarction, coronary artery disease), this variant of the development of the disease is characteristic of congenital heart defects and other diseases.
4. Blockade of the left NPG. EOS deviates to the left, or is located horizontally. The QRS is shaped like an extended R wave with a serrated or flattened apex. The width of the ventricular QRS complex is greater than or equal to 0.12 seconds. The condition is characteristic of arterial hypertension, acute myocardial infarction (less often), aortic heart disease.
5. Two-beam blockade (blockade of the right leg and left anterior branch). The QRS complex is expanded over 0.12 sec., the negative T segment, and the RS-T segment is shifted down, the EOS deviates to the left. This change is most characteristic for IHD and other myocardial pathologies.

After identifying these abnormalities on the ECG, the patient is recommended to perform other examinations that will help to detail the information and establish the correct diagnosis:

1. Blood and urine tests to assess electrolyte balance, hormone levels, indicators of autoimmune processes, etc.
2. 24-hour ECG monitoring to detect non-permanent atrial conduction disturbances, arrhythmias, assess the severity of blockades, search for night or exercise blockades.
3. Ultrasound of the heart to establish cardiac causes of heart block, especially organic heart disease.
4. EFI to clarify the data on the disease, when ECG or Holter monitoring does not allow an unambiguous diagnosis.

Methods of treatment

Incomplete single-beam blockades usually do not require any treatment. If there are no cardiac reasons for such disorders, then they are unlikely to progress or be aggravated by other pathologies. Such BNPs almost never turn into complete blockades and are not life threatening. Occasionally, especially against the background of hypertension, progression of the blockade of the right leg and AV blockade of the second or third degree is possible. At the beginning of such processes, the doctor always prescribes prophylactic drug therapy.

Similarly, you should act with more serious types of blockades. Of the drugs, a complex of therapy is selected, which is carried out in courses. It is also necessary to treat the underlying disease. Generally, drug treatment blockade may include the following drugs:

1. Vitamins in injections - thiamine, riboflavin, nicotinic acid and others.
2. Sedatives - motherwort, valerian.
3. Antioxidants - Mexidol, Preductal, Carnitine.
4. Preparations from high blood pressure from different groups (calcium channel blockers, ACE inhibitors, beta-blockers, etc.) - Betaloc, Valsartan, Verapamil, Amlodipine.
5. Drugs against cardiac ischemia, mainly nitrates - Nitroglycerin, Kardiket.
6. Medicines for high cholesterol - Rosuvastin, Simvastatin.
7. Cardiac glycosides and diuretics for heart failure - Digoxin, Lasix.
8. Antiplatelet agents against thrombosis - Cardiomagnyl, Aspirin-Cardio.
9. Medicines for chronic obstruction of the lungs - Pulmicort, Berodual, Beclason.

Currently, several types of surgical interventions have been developed, which are most often recommended for patients with a complete blockade of one branch, or with two- or three-beam blockades. The most commonly used technique is the implantation of a pacemaker, including a temporary one (in case of a heart attack and other acute conditions). With some variants of conduction disturbance, the method of radiofrequency catheter ablation helps. Some patients should also have an cardioverter defibrillator installed, such as those with trifascicular block combined with complete ventricular-atrial block.

In general, a person with blockades without manifestations can lead a normal life, but one should immediately abandon excessive physical exertion, rest more, exclude prolonged stress. Nutrition without fail must be correct, without an abundance of salt and animal fats, sugar. You should give up bad habits, especially smoking. After installing the pacemaker, a person should initially visit a cardiologist every three months, and then once every six months and a year. Some apply folk remedies against heart block. By agreement with the doctor, the following prescriptions from the alternative medicine section are allowed:

1. Combine equally valerian root, rose hips, dandelion roots, calamus roots, grind everything in a coffee grinder. Take a teaspoon of reset, pour 300 ml of boiling water. Drink 100 ml three times a day for 1 month.
2. Connect pharmacy alcohol tinctures hawthorn (50 ml.), valerian (30 ml.), motherwort (40 ml.), calendula (20 ml.), peony (80 ml.), mint (20 ml.). Take 10 drops three times a day after dilution in water for a course of 1 month. With a strong decrease in pressure, the dose is reduced to 5-7 drops.

Preventive measures

To prevent the disease, the following measures are important:

• more rest, sleep;
• eliminate stress and overwork;
• observe the regime of work and rest;
• eat only healthy food, consume more vegetable fiber;
• give up cigarettes, alcohol;
• take all drugs only in recommended doses and under the supervision of a doctor;
• early treatment of all heart diseases.

Are you one of the millions with heart disease?

Have all your attempts to cure hypertension failed?

And have you already thought about drastic measures? It is understandable, because a strong heart is an indicator of health and a reason for pride. In addition, this is at least the longevity of a person. And the fact that a person protected from cardiovascular diseases looks younger - an axiom that does not require proof.

The presented materials are general information and cannot replace the advice of a doctor.

Left heart block

In order to understand what a blockade of the left ventricle of the heart is, you need to know how a healthy human heart works, as well as how its conducting system is organized.

Our heart is made up of ventricles and atria, which contract in turn to supply blood to the entire body. The heart works under the influence of electrical impulses that are produced by its certain structures.

The sinus node is the dominant impulse-generating structure. After an impulse leaves this node, it is conducted to the atria, which are reduced because of this. After it reaches the atrioventricular node. This node is located between the ventricles and atria and is a kind of gate for the eclectic impulse between these two structures. For a fraction of a second, the impulse is delayed in the atrioventricular node. This is necessary so that the blood has time to move from the atria to the ventricles. Then this impulse is carried out along the trunk of the His release, reaching the ventricles, thereby forcing them to contract and pour blood into the general channel.

So, if speaking in simple words, then the blockade of the left ventricle of the His bundle is a conduction disorder in which the electrical impulse stops or slows down.

Blockade of the left ventricle of the heart appears on the background of ischemic or hypertension disease or a number of other cardiovascular diseases.

Classification

The blockade of impulse conduction can occur anywhere in the pedicle, and it can be complete or incomplete. And since the left leg is divided into the back and front, various classification options follow:

The consequences of a complete blockade of the left leg of the bundle of His

The heart is a unique organ that governs itself, i.e. possesses automatism, but, of course, taking into account the needs of the body and not without interference in the work of the nervous and endocrine systems. This organ is not just a muscle bag, which is a pump for pumping blood, the heart is much more complicated than it might seem.

The structure of the heart and the resulting causes of blockades

In addition to muscles, four cavities, valves, its own coronary vessels, it has a conducting system and two of its centers (pacemaker). From the main center (the pacemaker of the first order), electrical impulses enter the second, and then along the left and right legs of the His bundle they spread to the entire myocardium, which then contracts (and pushes blood out of the heart).

Naturally, if there is a blockade, in this case, a complete blockade of the left leg of the bundle of His. therefore, the impulse cannot spread further, and this leads to a violation of the rhythm and, in general, the work of the whole heart. The reason for this may be myocardial infarction, it should be assumed first of all if the blockade occurred for the first time. Other causes: cardiosclerosis, cardiodystrophy, hypertension, cardiomyopathy, myocarditis, etc.

Consequences of the blockade

Complete blockade of the left leg of the bundle of His leads to a violation of the conduction of an electrical impulse to the left ventricle. But even despite the complete blockade, the impulse still passes, but along bypass routes (anastomoses), and with a delay.

What is the danger of a complete blockade of the left leg of the bundle of His?

Even a complete blockade of the bundle branch can be asymptomatic, and at first does not pose a serious danger to life. However, over time, the condition worsens, ventricular arrhythmia develops, more often one of its types is ventricular paroxysmal tachycardia. It is she who ultimately leads to ventricular fibrillation: a chaotic contraction of the muscle fibers of the myocardium, which is incompatible with life and inevitably leads to death.

Treatment

There is no specific treatment for blockade. With this pathology, treatment is aimed at eliminating the underlying disease, which caused the blockade. As a rule, cardiac glycosides, nitrates, drugs that lower blood pressure are prescribed. If the heart rhythm is not restored, then they resort to surgical intervention: the installation of a pacemaker.

Rehabilitation for cardiac arrhythmias

In addition to the drug therapy of the underlying disease causing the blockade, treatment should include additional non-drug methods related more rehabilitation activities. In general, this tactic is suitable for other causes of left ventricular block. For example, physical therapy. Physical exercises tone not only the whole body, but have a particularly fruitful effect on cardiovascular system, increasing the supply of oxygen and generally reducing the mechanical load on the heart. Simply put, by moving, we help the heart to disperse the blood. Of course strength exercises are not suitable here. Choice: walking and jogging. But in physiotherapy exercises it is very important, especially in case of heart disease, that the load be dosed and adequate to the capabilities of the heart. Otherwise, you can get a negative effect.

Left ventricular block

The heart muscle has special properties compared to other organs of the human body. One of these properties is the conductivity of impulses that occur in special structures of the heart tissue. Sometimes it happens that the impulse is not transmitted by the cells of the heart. Such conditions are called blockades.

The blockade of the left ventricle of the heart or, as it is called in medical practice, the blockade of the left leg of the bundle of His in most cases is only a complication of the disease. Accordingly, if there is a lesion of the right leg of the bundle of His, a blockade of the right ventricle of the heart occurs. Diseases that can lead to blockade occur both in young (heart defects) and in old age (arterial hypertension, ischemic heart conditions, etc.).

For reference

Recently, left ventricular block has been used as a term that has a broader concept than "left leg block". This is due to the mechanism of momentum transfer. The fact is that the left leg of the bundle of His is divided into two legs: anterior and posterior. Sometimes the block occurs at the point of division into the anterior and posterior branches, in such cases, diagnosis by setting the level of the lesion is difficult. As a result, we decided to introduce a broader concept.

Types of blockades

In addition, left ventricular block may be complete or incomplete. Incomplete blockade does not pose any danger to life. Symptoms that are observed with it are weakness, slow pulse (bradycardia). If incomplete blockade is detected on the ECG, the signs of which will be a deviation of the electrical axis of the heart to the left and left ventricular hypertrophy, the main thing is to exclude myocardial infarction, which is very often “masked” in the lines of the cardiogram with incomplete blockade of the left ventricle.

Symptoms and ECG

The main tool in the diagnosis of "blockade ..." is an electrocardiogram, which may look different in the same cases, although it is made on the same device.

Things are very serious with a complete blockade of the left leg of the bundle of His (left ventricular blockade). First, I would like to tell you what happens normally: the left ventricle is “responsible” for the release of oxygenated blood into the aorta. With the failure of the left ventricle, there is a delay or cessation of the release of oxygenated blood, which leads to oxygen starvation of all organs and systems (primarily the brain). Clinically, this is manifested by respiratory disorders (dyspnea), dizziness, drowsiness, a decrease in the rhythm rate to 25 beats / min and, in the end, access to acute heart failure, which can result in death if timely and proper medical care is not provided.

Diagnosis of a complete blockade, from an experienced doctor, does not cause any particular difficulties. Everything will be visible on the ECG. Provided that there is no other pathology.

Dangerous states

Complete block and myocardial infarction or complete block and unstable angina are very common. Much more difficult and with the treatment of complete blockades. To date, no special recommendations on this occasion. The main thing is to stop the acute condition, and then prevent recurrences, so to speak, to carry out prevention. Also read about the consequences of a complete blockade of the left bundle branch block.

This condition is stopped in different ways, reaching, in the flesh, to the use of an electric defibrillator. Then, when the condition stabilizes, drug therapy is carried out, drugs that improve the quality of life (beta-blockers, etc.), antiarrhythmic drugs are prescribed.

Prevention

It is advised to follow a diet (often blockades occur against the background of obesity). All this is for the elderly, who, so to speak, have “acquired” diseases. For persons with defects, the most optimal treatment is heart surgery to eliminate the defect. Another direction in treatment is the installation of a pacemaker. In modern conditions, the approach to all patients is individual.

My son has schizophrenia and I am his guardian. He takes haloperidol 3 times, cyclodol 2 times, chlorpromazine 100 mg at night and phenazepam 2 mg at night. On the ECG, a complete blockade of the left leg of the His bundle and an incomplete blockade of the right leg of the His bundle, they write: an overload of the right ventricle is possible. I walk with him on the street, his weight is 84 kg, height is 167 cm. He does not complain about his “heart”. There are "voices" in the head. In September, after September 14, an MSE examination was scheduled for the purpose of rehabilitation for the underlying disease (paranoid schizophrenia, continuously progressive course).

The therapist prescribed asparkam. He is 08.10. 1973 of birth. Need a cardiologist?

Of course I need it. I have a complete blockade of the left leg. They installed a pacemaker. I've had a 26 stimulator since I was 17.

I have a complete blockade of the left leg of the bundle of His. IT IS POSSIBLE TO DO AN OPERATION ON THE UTERINE PROLOSSION. AND THE RECTAL I WANT TO KNOW. AND HOW TO LIVE FURTHER

Incomplete blockade of the left leg of the bundle of His: causes, symptoms and treatment

Absolutely each of us knows that thanks to the work of the heart, the whole organism functions. And when it fails, irreversible health processes begin, especially with late diagnosis and improper treatment.

The danger of this disease lies in the absence of symptoms in the early stages, the edge of the underlying pathology, and it can be detected using an ECG. But if you notice one of the signs indicated in the article, do not postpone a visit to a cardiologist, because this can lead to more serious complications. What is an incomplete blockade of the left leg of the His bundle, how it manifests itself, diagnostic methods and methods of treatment, we will consider with you below.

What is a blockade?

His bundles are altered elements of cardiac tissue that are part of the conduction system of the heart. Excitatory impulses pass through them from the sinus node to the heart muscle. Normally, the main generator of nerve impulses in the heart is the sinus node, from which the trunk goes to the atrioventricular node and is divided into the right and left branches (legs), the so-called bundles of His.

The elements of the right bundle of His, respectively, go to the muscles of the right ventricle, and the left - to the muscles of the left. This ensures synchronous contraction of the right and left parts of the heart. With incomplete blockade, there is a difficulty in the passage of nerve impulses, with complete - their complete cessation.

This leads to a violation of the contractile function of the heart. Groups of causes causing blockades (detailed causes will be discussed below):

1. Cardiac, that is, pathologies from the side of the heart.
2. Drug group of causes (or drug) - as a result of taking certain medications.
3. A group that includes changes in the electrolyte composition of the blood (potassium, sodium, magnesium, phosphorus).
4. A group that combines toxic factors that lead to poisoning of the body and cause conduction blockade in the heart.
5. A group of autonomic disorders (of the autonomic nervous system), it is responsible for controlling the rhythm of the heart.
6. Hormonal causes (diseases of the endocrine organs).
7. A group of causes that cause oxygen starvation of the heart muscle.
8. Idiopathic causes that are not determined by examination of the patient.

Types of blockades

If the electrical discharges of the upper chambers are not transmitted, as they should, to the lower chambers, then a blockade of the legs of the His bundle occurs. This is reflected in the cardiogram.

As a rule, all blockades are divided into 3 main varieties:

• Single-beam - it can affect the right leg, as well as one of the branches of the left process.
• Two-bud - this variety immediately affects both left-sided branches or the right and one of the branches of the left.
• Three-beam - the most serious pathology, in which 3 branches suffer at once.

In turn, LBBB can occur in several scenarios:

• blockade occurs in a certain part of the trunk up to the branching border;
• the stem part is completely affected before it branches;
• the blockade affects the process on both sides after branching;
• both peripheral parts of the left process are blocked;
• scattered changes in the middle muscle layer of the heart.

Incomplete blockade of the left leg of the bundle of His - characteristic

Under incomplete blockade is meant a violation of the conduction of an electrical signal along one of the branches of the left leg. To determine which part suffers, the electrographic deviation of the total vector of the electrodynamic force of the heart is evaluated at the position of the recording electrodes on the right upper and left lower extremities.

If there is a pronounced deviation of the total vector of the electrodynamic force of the heart to the left, then a blockade of the anterior branch is diagnosed, and if a pronounced rightogram is observed, then this indicates a lesion of the posterior branch.

Incomplete LBBB usually does not cause serious clinical abnormalities and no abnormalities are observed when listening to the patient. And if an incomplete blockade of the right leg is found, then the condition can be regarded as corresponding to the physiological norm and an additional examination in this case is completely optional.

The blockade of the left leg of the bundle of His (or LBBB) is a pathology, which may be based on damage to the heart apparatus at different levels. For example, the left leg in the trunk of the bundle of His may be affected. Or the main trunk of the left leg before branching.

The anterior and posterior branches of the leg can be affected at one moment after the end of the place of their release from the body of the main trunk. The left good half of the septum between the ventricles is also damaged, along with this, both branches of the pedicle are involved in the process.

The circumstance may also lie in pronounced diffuse transformations of the myocardium in the peripheral branches of the posterior and anterior branches. With LBBB, the passage of excitation to the myocardium of the left ventricle along the left leg is difficult.

It is carried out by an unusual method, as a result of which the QRS complex is widened, and the direction of repolarization in the left ventricle changes. We will not consider this in detail, this is a task for hearty experts. Consider some of the features of this disease.

Damage to the leg can be the result of fibrous processes, which are associated with coronary sclerosis and less often with limited myocarditis (syphilitic, rheumatic, diphtheria, infectious). It is very rare, but not uncommon, that the blockade appears with a completely healthy heart.

Complete and incomplete blockade of the left leg of the bundle of His is not uncommon. If it comes to complete, excitation at first covers only the septum between the ventricles, and not the entire ventricle entirely. Incomplete blockade begins with violations of electrolyte metabolism, or an overdose of drugs, or various kinds of intoxication.

As a result, the normal conduction of the cardiac system is disturbed, and the full excitation of the left section does not occur. It is possible to diagnose this violation using a simple electrocardiogram; when deciphering, transformations will be visible.

If the blockade has spread to only one leg, then no, it is not life-threatening, despite the fact that there is certainly nothing good in this.

Many modern cardiologists are sure that this deviation has already ceased to be a deviation in those cases, at a time when it is not the result of other heart diseases. The complete blockage of both legs is terrible, in such cases it is required to implant a pacemaker.

Causes

The causes of pathology include:

• Atherosclerotic cardiosclerosis - replacement of part of the heart muscle with connective tissue.
• Aortic valve defects. Such a defect leads to the expansion and increase in the size of the left half of the heart, which disrupts the conduction of nerve impulses in this part of the heart.
• Cardiomyopathy, myocardial dystrophy, bacterial endocarditis are diseases characterized by damage to the myocardium (heart muscle) and with it Purkinje fibers (the smallest cells in the conduction system of the heart).

Types of incomplete blockade of the left side of the bundle of His:

• at the level of the left leg in the very trunk of the beam;
• blockade occurring in the left leg until it is divided;
• difficulty in conducting an impulse in both branches after their separation;
• a variant when the spread of the lesion to half of the interventricular septum in its left part joins the previous type;
• blockade at the level of the extreme, smallest branches of the branches of the left leg.

An important role in the occurrence of this disorder is played by drug intoxication of the body. In this case, poisoning with diuretics, cardiac glycosides, sympathomimetic drugs is observed.

Sometimes the development of blockade leads to excessive consumption of alcoholic beverages, smoking, and taking drugs. Also, the appearance of this disease may be the result of deviations in the electrolyte balance of the body.

The development of blockade of the His bundle leads to a deficiency of magnesium, a lack or an excessive amount of potassium. Also, the cause of the development of the blockade may be the appearance of thyrotoxicosis.

The causes of damage to the anterior and posterior branches of this part of the organ can differ significantly. So, the following factors most often lead to problems in the work of the anterior branch:

• anterior infarction;
• arterial hypertension;
• aortic valve disease;
• cardiosclerosis;
• mitral insufficiency.

Also, the blockade of the anterior branch of the left leg may be the result of a violation of the integrity of the septum between the atria. It often leads to cardiomyopathy and calcium salt deposits.

Often the cause of the deviation lies in the inflammatory process that affects the heart muscle. Violation of the posterior branch develops under the influence of such factors:

• atherosclerosis;
• infarction, which differs in posterior localization;
• deposition of calcium salts;
• myocarditis.

In more rare cases, a two-beam blockade can be detected - in this case, both the anterior and posterior branches of the organ suffer.

Significant changes in the hormonal background, due to certain external influences, are also additional causes of the blockade of the left leg of the His bundle.

The most common etiological factors that can largely influence the occurrence of the first signs of blockade include the following:

1. Poisoning of the patient's body with a large amount of residues of drugs that were used in the treatment of concomitant heart diseases. These include various types of diuretics, symptomatic and cardiac glycosides;
2. Abuse of bad habits that adversely affect the entire human heart system. It can be alcoholism, the use of narcotic drugs, smoking;
3. thyrotoxicosis;
4. Insufficient amount of certain substances in the body. These are potassium, magnesium, which are responsible for the electrolytic balance in the body. Their significant amount, as well as some of their lack, affect the balance in the work of the cardiac system.

As a result of the above situations, the anteroposterior bundle loses its rhythm of work, ventricular contractions pass regardless of the receipt and conduction of impulses through the tissues of the pedicle.

Anterior branch block

With the blockade of the anterior branch of the left leg of the bundle of His, uniform violations are determined regardless of the location of the lesion. This is due to the fact that the reaction of the excitable structure does not reach the upper sections of the anterior wall of the left lower chamber of the heart.

Therefore, using standard electrocardiography, it is impossible to accurately determine the place subject to blockade.

With BPVLNPG, excitation in the right lower cardiac chamber occurs in a standard way. In the lower left chamber, the reaction of the excitable structure propagates in stages.

First, it passes along the posterior branch of the left leg, and then spreads to the upper parts of the left-sided lower chamber.

This deviation can be detected against the background of a number of cardiac pathologies:

• chronic myocardial damage, which is based on pathological processes in the system of coronary arteries, and this especially applies to the anterior wall of the left-sided lower chamber;
• ischemic necrosis of the myocardium of the anterior wall of the left-sided lower chamber;
• inflammation of the heart muscle;
• significant thickening of the wall of the left ventricle;
• pathological expansion of the left lower chamber of the heart, caused by insufficiency of the aortic valve;
• primary isolated sclerosis and calcium deposition in the walls of the conducting system;
• congenital heart defects.

According to statistics, LBBB appears over the age of 50 in 1.25% of male patients. And in most cases, this indicator is the only sign of a developing pathology in the muscular middle layer of the heart.

Posterior branch block

With the blockade of the posterior branch of the left leg of the bundle of His, serious conduction disturbances occur in the posterior branch, which can proceed with different indicators. The same deviations are noted on the ECG, which are difficult to differentiate using standard electrocardiography.

This condition develops in pathologies similar to those in BPVLNPG:

• insufficiency of blood supply to the myocardium;
• atherosclerosis of the coronary arteries;
• necrosis of a portion of the myocardium affecting the left ventricle;
• inflammation and other changes in the heart muscle caused by a variety of reasons;
• deposition of calcium and degeneration of tissues into a solid connective tissue.

If we talk about the blockade of the anterior branch, then in electrocardiography this is a fairly well-studied section. And the defeat of the posterior branch gives non-specific signs, and this section is still under development. It is impossible to diagnose a lesion of the posterior branch only on the basis of the results of a standard cardiogram.

As a rule, for clarification, you need to resort to additional diagnostic methods. In any case, any of the above blockades is detected during a full examination and the specialist, if necessary, will prescribe additional studies before making an accurate diagnosis.

Symptoms

Single-beam blockade is asymptomatic, it is detected by an ECG. Such signs of a violation as constant fatigue, pain in the sternum, shortness of breath, in this case, are caused by a disease that caused a violation of electrical conductivity.

Signs of blockade of the left leg of the anterior or posterior branch are also not felt by the patient. The blockade of the left complete gives such symptoms as: dizziness, pain in the heart, strong heartbeat. The symptoms are caused by severe changes in the left ventricular muscle (myocardial infarction).

Incomplete blockade of the left leg of the bundle of His three-beam is characterized by the following features:

• interruptions in the work of the heart;
• constant fainting caused by oxygen starvation of the brain;
• dizziness.

Three-beam incomplete blockade leads to a sudden lethal outcome.

Diagnosis of violation of the electronic conductivity of the bundle of His

A cardiogram shows a problem with electrical conductivity. The right incomplete blockade, in the absence of clinical symptoms and concomitant diseases, is considered the norm and additional examinations are not carried out.

ECG signs of a two-beam blockade serve as a reason for hospitalization of the patient, since there is a danger of developing serious conditions. The revealed blockade of the His bundle on the ECG, the three-beam also requires immediate hospitalization, followed by a surgical operation.

How to see the problem with the electrical conductivity of the bundle of His on the cardiogram. Signs of blockade of the right leg:

• Rsr or rSR complexes in V 1, V2 (right leads).
• Wide S wave in V5, V6 (left leads).
• QRS complex greater than 0.11 s.

Signs of impaired conduction of the left leg:

• left leads V5, V6, I do not have a Q wave;
• ventricular complexes are deformed;
• the top of the R wave is split;
• right leads V1, V2, III are characterized by a deformed top of the S wave, the width of the complex is more than 0.11 s.

Differences of the three-beam blockade:

• all signs of left and right;
• drawing of the cardiogram shows an atrioventricular blockade.

Incomplete left bundle branch block on ECG

LBBB can be caused by damage at various levels:

1. The defeat of the left leg in the trunk of the bundle of His;
2. The defeat of the main trunk of the left leg before its branching;
3. Simultaneous defeat of the anterior and posterior branches of the left leg after their isolation from the main trunk of the left leg;
4. The defeat of the left half of the interventricular septum with the involvement of both branches of the left leg in the process;
5. The presence of pronounced diffuse changes in the myocardium of the peripheral branches of the anterior and posterior branches of the left leg.

Despite the above options, as a result, with LBBB, excitation cannot pass in the usual way along the left leg to the myocardium of the left ventricle - excitation is carried out in an unusual way.

What causes a slowdown in the passage of excitation through the ventricles, as evidenced by the widening of the QRS complex and a change in the direction of repolarization in the left ventricle:

• in the left chest leads, the QRS complex is represented by a wide tooth RV5,V6 with a notch;
• in the right chest assignments the QRS complex like rS, QS with a wide and deep tooth of SV1, V2 is registered.

It should be borne in mind that with the blockade of the left leg of the bundle of His:

1. Arousal stage 1:
   • the left ventricle and the left part of the interventricular septum are not excited;
   • excitation along the right leg is transmitted in the usual way and causes excitation of the right half of the interventricular septum (the vector is directed to the V6 electrode);
   • at the same time, excitation of the right ventricle begins (the vector is directed to the V1 electrode);
   • excitation from the right half of the interventricular septum passes to the left and flows slowly;
   • as a result, the total EMF vector is directed to the V6 electrode, since the total thickness of the interventricular septum significantly exceeds the mass of the right ventricle: the beginning of the RV6 wave and the QV1 or rSV1 wave are recorded (this is due to the fact that at the beginning of the electrical systole the vector of the right ventricle is close to the V1 electrode, which sometimes allows a small rV1 to be recorded).
2. Excitation stage 2: this is the final excitation of the interventricular septum, flowing from right to left: further descent of the SV1 waves (QSV1) and the rise of RV6 are recorded.
3. Arousal stage 3:
   • due to excitation of the left ventricle, which goes in an unusual way and proceeds slowly;
   • a further descent of the SV1 (QSV1) waves and a further rise of the RV6 are recorded, with a notch usually observed on the RV6 tooth, located on the ascending knee (there are several options for explaining this phenomenon, such as;
   • the presence of a small time interval between stages 2 and 3;
   • the predominance of the vector of the final excitation of the interventricular septum over the vector of the initial excitation of the left ventricle;
   • different interaction of the interventricular septal vector and the left ventricular vector). Due to the slow propagation of excitation, a widening of the QRS complex is noted.
4. The process of repolarization begins in the right ventricle and spreads from the epicardium to the endocardium (the vector is directed to the V1 electrode).

The process of repolarization in the left ventricle is associated with delayed depolarization, and spreads from the endocardium to the epicardium. As a result, the repolarization vector of the left ventricle has the same direction as the right one - to the V1 electrode (registration of positive TV1, the ST segment in this lead is located above the isoline.

With incomplete blockade of the left leg, excitation can pass, but somewhat slowly. In incomplete RBBB, the QRS complex is shaped like a left bundle branch block, but the QRS width is less than 0.12 s:

• In chest leads V1, V2, the QRS complex has the form rS, QS.
• The STV1,V2 segment can be located on or above the isoline, the TV1,V2 wave is usually positive.
• In the chest leads V5, V6, an ECG is recorded that looks like an R wave (qV5, V6 is absent).
• The STV5,V6 segment can be located on the isoline or below it, the TV5,V6 prong can be of any shape.

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

Additional diagnostic procedures

Additional measures include:

• Daily ECG monitoring is necessary to detect a transient form of the disease that manifests itself at different times of the day.
• Electrocardiographic studies of the esophagus are necessary for the diagnosis of arrhythmias.
• A heart echo is performed to detect organic pathologies in the structure of the heart and to assess the state of the myocardium.
• MRI is prescribed in case of controversial issues in the diagnosis.

The most effective is considered to be an electrocardiogram and emission tomography - these research methods make it possible to make an accurate pre-diagnosis, to identify the main causes of this cardiac pathology.

Thanks to such a diagnostic study, it becomes possible to determine the most effective method of therapeutic action.

Therapeutic measures

Treatment of this condition is based on comparing the results of the ECG and ECG with normal heart rate. Since bundle block is not recognized as an independent heart disease, this condition usually accompanies a specific heart disease or several diseases.

Therefore, treatment is necessarily directed first of all to the elimination of the root causes of this condition. And the methods of treatment of primary cardiac lesions are determined both by the disease itself and by its degree of development, manifestations and the general condition of the patient's body.

The following methods of influence can be attributed to the most effective:

1. With the root cause of the blockade of the His bundle of heart failure, broad-spectrum cardiac glycosides will often be prescribed, as well as nitroglycerin, antihypertensive drugs that stabilize the heart and its rhythm in the first place;
2. Immune preparations aimed at stimulating the body's defenses and increasing the degree of its resistance to various diseases, including heart disease.

The most popular today is a broad-spectrum drug called "Transfer Factor Cardio": the absence of side effects, a quick effect on the heart muscle and stimulation of the immune system are the main manifestations of taking the drug;

However, it should be borne in mind that there is no universal therapy for blockade of the tissues of the bundle of His; the main focus of the therapeutic effect in this case should be considered the treatment of the underlying disease of the cardiac system with parallel maintenance of the patient's condition.

This pathology has an unpleasant probable consequence if the main treatment is insufficient: a blockade of this type can go on to a complete blockade of the heart and its atria, which has a poor prognosis for the patient and in this situation requires immediate special medical intervention.

There is no specific treatment for patients who have experienced cardiac conduction disorders. Patients in whom blockade of the left leg of the bundle of His was found, drug therapy is not indicated.

Symptomatic treatment of the underlying pathology with one-, two-beam blockade includes such medicines:

• Vitamins (nicotinic acid, thiamine, riboflavin).
• Sedatives (valerian tincture, motherwort, sage).
• Antioxidants (Preductal, Carnitine).
• Antihypertensive drugs, the action of which is aimed at the treatment of hypertension (beta-blockers, ACE inhibitors, calcium channel antagonists).
• Antiplatelet agents that prevent the appearance of blood clots (Aspirin, Cardiomagnyl).
• Medicines used to treat coronary artery disease (Izoket, Nitroglycerin).
• Medicines that normalize the level of cholesterol in the blood (Simvastatin).
• Tablets and injections for the treatment of pathologies that are the root cause of the appearance of "cor pulmonale".
• Diuretics (indicated in patients with heart failure).
• Non-hormonal agents and antibiotics for the treatment of inflammation of the myocardial membranes (Diclofenac, Penicillin, etc.)

Surgical intervention for dysfunctions of electrical conduction involves the installation of a pacemaker for the patient. Complete blockade (right or left), acting as a consequence of acute infarction, requires temporary stimulation of the myocardium using an electrode.

Three-beam blockade, accompanied by attacks of loss of consciousness and a rare rhythm of ventricular contraction, is considered the basis for constant electrical stimulation of the myocardium. The patient is implanted with a cardioverter.

1. A patient who is not bothered by cardiac symptoms and does not suffer from chronic diseases is well tolerated by normal conditions of life associated with stress.

Three-beam and two-beam blockade will require restriction of physical activity. Such patients should not work hard and be in a stressful state. Diet and food composition are very important.

To prevent the development of blockades and other cardiovascular pathologies, it is recommended to follow the general rules:

• prolonged sleep;
• active lifestyle;
• lack of self-treatment;
• quitting smoking and alcohol;
• balanced nutrition according to the regimen;
• exclusion of stress and nervous shocks;
• regular diagnosis and treatment of heart disease.