Blockade of the legs of the bundle of hys. Blockade of the right leg of the bundle of His: characteristics of the disease, causes, complications and prevention Blockade of the right leg of the bundle

• Can bundle branch block be treated?
• Prevention of heart disease

The blockade of the right leg of the bundle of His is a pathology in which interference is created for the normal passage of the sinus impulse of the conduction system of the heart. As you know, the heart muscle consists of atria and ventricles. Under the influence natural processes contraction occurs, which provides the body with normal blood circulation.

The electrical impulses generated in this system ensure the normal functioning of the heart. Between the atria and ventricles is the so-called atrioventricular node. The impulse, passing through the sinus node, reaches the atrioventricular node, lingers in it for seconds and is directed through the bundles of His. His bundles are muscle fibers. The two parts of these beams are called "legs": left and right.

At healthy person impulses pass through both legs. The blockade of the legs of the bundle of His occurs when the excitation of one of the legs is slower. In this case, conduction disturbance occurs in the cardiac system. Such changes can be a signal of a serious illness or the norm. To establish a diagnosis, it is necessary to undergo an examination. In some cases, such violations may indicate pulmonary pathologies.

What are the reasons for the blockade?

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

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

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

Also, the blockade of the right leg of the bundle of His can develop due to insufficiency of the tricuspid valve. Such a violation may be congenital and be considered as a variant of the norm that does not require treatment. Heart block may be functional. This means that it can occur under certain loads and pass on its own, but this does not pose any danger. The listed reasons are acquired.

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

Back to index

What symptoms are accompanied by pathology?

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

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

In addition to this symptom, you may experience:

The blockade of the legs of the bundle of His can be complete or partial (incomplete), persistent and transient. Even with a complete blockade, there may be no symptoms if there is no serious illnesses hearts. It is possible to detect such violations only with an ECG. Sometimes disorders in the cardiac system are associated with the fact that a person in childhood was ill next to infectious diseases, such as tonsillitis, measles, influenza, scarlet fever. By the time it is discovered, treatment is no longer required.

Back to index

How to be examined for heart block?

If you complain about the work of the heart, you need to visit a cardiologist. With pain in the region of the heart, extrasystole (violation heart rate), shortness of breath, fatigue should consult a doctor. Although such symptoms may be a sign of other diseases not related to the heart, it will be possible to find out only after an examination. To make a diagnosis, you need to do:

• electrocardiogram;
• daily ECG monitoring.

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

Ultrasound (ultrasound examination) allows you to see the work of the heart in real time. This diagnostic method is also available at the present time. Daily monitoring (according to Holter) helps to determine the work of the heart during the day. A special apparatus is attached to the patient's body and fixes any disturbances both during night sleep and during physical activity afternoon. Thanks to such a study, it can be established whether the blockade is passing. When a diary is kept, where the patient enters all his complaints.

- a violation of intracardiac conduction, characterized by a slowdown or complete cessation of the conduction of excitatory impulses along one or more branches of the His bundle. Blockade of the legs of the bundle of His can be detected only with instrumental examination or symptomatically manifested by rhythm disturbances, dizziness, bouts of loss of consciousness. The bundle branch block is diagnosed by electrocardiography. Treatment of the blockade of the legs of the bundle of His is reduced to eliminating the causes of conduction disturbances; in some cases, it may be necessary to install an artificial pacemaker.

General information

Blockade of the legs of the bundle of His is an incomplete or complete violation of the passage of an electrical impulse through the bundles of cells of the conduction system of the heart, leading to a change in the sequence of excitation coverage of the myocardium of the ventricles. In cardiology, the blockade of the legs of the bundle of His is not considered as an independent disease. As a rule, it acts as a consequence and at the same time an electrocardiographic symptom of any independent cardiac pathology. According to the ECG, the blockade of the legs of the bundle of His is diagnosed in 0.6% of people, more often in men; among people older than 60 years, its frequency increases to 1-2%.

The bundle of His is a part of the conduction system of the heart, represented by accumulations of modified muscle fibers. In the interventricular septum, the His bundle is divided into two legs - right and left. In its turn, left leg divides into anterior and posterior branches that descend on both sides of the interventricular septum. The smallest branches of the intraventricular conduction system are the Purkinje fibers, which penetrate the entire heart muscle and are directly connected with the contractile myocardium of the ventricles. Myocardial contraction occurs due to the propagation of electrical impulses originating in the sinus node through the atria to the atrioventricular node, then along the bundle of His and its legs to the Purkinje fibers.

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

Blockade of the legs of the bundle of His can be caused various reasons. Blockade of the right leg of the His bundle occurs in diseases accompanied by overload and hypertrophy of the right ventricle - mitral stenosis, atrial septal defect, tricuspid valve insufficiency, coronary artery disease, cor pulmonale, arterial hypertension, acute myocardial infarction (posterior diaphragmatic or upper apex), etc.

Atherosclerotic cardiosclerosis, aortic valve defects, cardiomyopathy, myocardial infarction, myocarditis, bacterial endocarditis, myocardial dystrophy lead to blockade of the left leg of the bundle of His. Less commonly, bundle branch block develops against a background of pulmonary embolism, hyperkalemia, and intoxication with cardiac glycosides.

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

Classification of blockades of the legs of the bundle of His

Taking into account anatomical structure bundle of His blockade can be single-beam, two-beam and three-beam. Single-beam blockades include cases of damage to only one leg (branch) of the His bundle: blockade of the right leg, blockade of the left anterior or left posterior branch. Two-beam blockades are a simultaneous defeat of 2 branches of the His bundle: the anterior and posterior branches of the left leg, the right leg and the anterior left branch, the right leg and the posterior left branch. With three-beam blockades, all three branches of the His bundle are affected.

According to the degree of violation of the conduction of the impulse, the blockade of the legs of the bundle of His can be incomplete and complete. With incomplete blockade, the conduction of an impulse along one of the legs of the His bundle is disrupted, while the functioning of the second leg or one of its branches is not impaired. At the same time, excitation of the ventricular myocardium is provided by intact branches, however, it occurs with a delay.

Thus, when slowing down the process of propagation of the impulse along the branches of the bundle of His, there is an incomplete heart block of the 1st degree. In the event that not all impulses reach the ventricles, they speak of an incomplete second-degree heart block. Complete blockade (or blockade of the III degree) is characterized by the absolute impossibility of conducting impulses from the atria to the ventricles, in connection with which the latter begin to contract on their own, at a speed of 20-40 beats. in min.

Bundle blockades can be transient (intermittent) or permanent (irreversible). In some cases, the blockade of the legs of the bundle of His develops only when the heart rate changes (bradycardia, tachycardia).

Characteristics of various options for the blockade of the legs of the bundle of His

Blockades of the legs of the bundle of His do not have independent clinical manifestations; in most cases, they are manifested by symptoms of the underlying disease and specific ECG changes. In some cases, with a decrease in cardiac output, the blockade of the legs of the bundle of His may be accompanied by frequent dizziness, severe bradycardia, and sometimes - attacks of loss of consciousness.

Consider the main clinical options blockade of the legs of the bundle of His.

Blockade of the right leg of the bundle of His

In the case of a complete blockade of the right branch of the His bundle, the impulse conduction and excitation of the myocardium of the right ventricle and the right half of the MZHZHP occur along the contractile muscle fibers from the left ventricle and from the left half of the MZHZHP. With incomplete blockade, there is a slowdown in the conduction of an electrical impulse along the right leg of the His bundle. Sometimes incomplete blockade of the right leg of the bundle of His is detected in practically healthy young people; in this case, it is regarded as a variant of the physiological norm.

ECG signs of a complete blockade of the right leg of the bundle of His are the expansion of the S wave, the increase in amplitude and the expansion of the R wave, the QRS complex has the form qRS with an extension of up to 0.12 sec. and more.

Blockade of the left leg of the bundle of His

With a complete blockade of the left leg of the bundle of His, the excitation wave is not carried out along the stem of the leg until it branches or does not extend simultaneously to both branches of the left leg (two-beam blockade). The excitation wave is transmitted to the myocardium of the left ventricle with a delay from the right half of the MZHZHP and the right ventricle along the Purkinje fibers. On the ECG - EOS deviation to the left, widening of the QRS complex up to 0.12 sec. or more.

At the heart of the blockade of the anterior branch of the left leg of the bundle of His is a violation of the conduction of the impulse to the anterolateral wall of the myocardium of the left ventricle. In this case, after excitation of the MZHZHP and the lower sections of the posterior wall, along the anastomoses of the Purkinje fibers, the excitation wave propagates to the anterolateral wall of the left ventricle from bottom to top.

With the blockade of the posterior branch of the left branch of the bundle of His, the conduction of the impulse to the posterior lower sections of the myocardium of the left ventricle is impaired. The activation wave propagates from the anterior and anterolateral walls of the left ventricle along the Purkinje fibers to the posterior inferior sections of the left ventricle, i.e., from top to bottom.

Incomplete blockade of the left leg of the bundle of His is characterized by a slowdown in the conduction of the impulse along the main left trunk or along both branches of the left leg. In this case, part of the myocardium of the left ventricle is excited by impulses propagating along the right leg.

Two-beam blockade

When the blockade of the right leg of the His bundle is combined with the blockade of the left anterior branch, the propagation of an electrical impulse goes along the posterior branch of the left leg of the His bundle, causing excitation first of the posterior lower sections of the myocardium of the left ventricle, then of its anterolateral sections. Following this, the impulse slowly spreads along the contractile fibers to the myocardium of the right ventricle.

The delay in excitation of the anterolateral wall of the left ventricle and the right ventricle is reflected on the ECG in the form of an expansion of the QRS complex up to 0.12 seconds, a serration of the ascending knee of the S wave, a negative T wave, and EOS deviation to the left.

With a combined blockade of the right leg of the His bundle with a blockade of the posterior left branch, the impulse is carried out through the anterior left branch, the anterolateral sections of the myocardium of the left ventricle along the anastomoses to the posterior sections of the left ventricle, and then along the contractile fibers to the right ventricle. The ECG reflects signs of blockade of the left posterior branch and the right leg of the bundle of His, deviation of the EOS to the right. This combination indicates widespread and profound changes in the myocardium.

Trifascicular blockade

Incomplete three-beam blockade is accompanied by the spread of the excitation impulse to the ventricles along the least affected branch of the legs of the bundle of His. At the same time, atrioventricular blockade of the I or II degree is noted.

In the case of a complete three-beam block, the conduction of impulses from the atria to the ventricles becomes impossible (III degree AV block), which leads to separation of the atrial and ventricular rhythms. At the same time, the ventricles contract in their own idioventricular rhythm, characterized by a low frequency and arrhythmia, which can lead to the appearance of atrial fibrillation and asystole of various durations.

The ECG picture with a complete blockade of the legs of the bundle of His corresponds to the signs of AV blockade of one degree or another.

Diagnosis and treatment of bundle branch blockade

The main method for detecting blockade of the legs of the bundle of His is standard electrocardiography and its varieties - transesophageal electrocardiography (TECG), implantation of a pacemaker. With the blockade of the legs of the bundle of His, which proceeds without clinical manifestations, a dynamic observation is carried out.

The prognosis of the blockade of the legs of the bundle of His

The prognosis of bundle branch block in asymptomatic patients is favorable. In the presence of organic pathology of the heart, the prognosis is determined by the underlying disease. In turn, the blockade of the legs of the bundle of His increases both the risk of sudden death in this category of patients and the development of long-term complications.

The progression of the conduction defect, the development of AV blockade, cardiomegaly, hypertension and heart failure increases the likelihood of an unfavorable outcome.

If the conduction of an impulse along special muscle cells in the myocardium, called bundles of His, is disturbed, then a complete or partial blockade of the legs is diagnosed on the ECG. There are no symptoms or patients complain of dizziness, weakness and fainting. For treatment, it is necessary to eliminate the cause (heart attack, sclerosis, heart defects, hypertension), some patients need to install a pacemaker.

📌 Read this article

Bundle of His - what is it in the heart

The bundle of His in the heart is a section of the conduction system. Figuratively, it can be represented as a bundle of electrical wires that pass current. It first goes along the wall between the ventricles, then it is divided into 2 legs, and then the left one further diverges into the anterior, posterior. Gis fiber impulses are received from the atrioventricular junction and transmitted to small Purkinje cells branching in the walls of the ventricles.

What is bundle branch block

Conductive fibers consist of a trunk (located in the septum between the ventricles), right and left branches. The right one descends immediately to the right ventricle, and the left one is previously divided into 2 parts (anterior and posterior), and then passes to the left ventricle. In the future, the legs of the bundle of His in the heart muscle branch out, forming the Purkinje pathways.

The role of the branches of His is to perceive the contraction signal from the sinus and atrioventricular nodes and transmit it to all parts of the ventricular heart muscle. This causes them to contract in the correct rhythm.

If an obstacle occurs in the form of inflammation, necrosis, sclerosis in the myocardium, their work is blocked. If the area of ​​damage is insignificant, then there may be no symptoms; with a complete blockade, contractions occur less frequently than normal. This is due to the conduction of impulses along a roundabout path, which disrupts the synchrony of the work of the heart departments.

Reasons for the development of pathology

The right bundle branch of His (RBB) is damaged by overload and damage to the myocardium of the right ventricle in such cases:

• narrowing of the mitral orifice
• tricuspid valve insufficiency,
• pulmonary hypertension,
• hole in the septum between the atria,
• overdose of cardiac glycosides and beta-blockers.

Parts of the left branch of the His bundle (LBB) are blocked when the myocardium of the left ventricle changes:

• ischemia,
• dystrophic and dishormonal processes,
• hypertrophy in hypertension, aortic malformations, mitral insufficiency,
• bacterial and.

Symptoms in adults and children

Violation of the conduction of the signal along the bundles of His does not have independent clinical signs, as it occurs a second time against the background of an existing disease of the heart or large vessels. If the blockade is partial or only one branch, especially the right one, then the patient may not be aware of it, and such a deviation from the norm can only be detected on the ECG, more often with Holter monitoring.

With complete damage to all 3 branches (PNPG and 2 parts of the left), the volume of blood ejected from the ventricles decreases. In such cases, characteristic symptoms appear:

• dizziness;
• visual impairment;
• fainting spells of Morgagni-Adams-Stokes type;
• bradycardia;
• rhythm breaks,
• labored breathing;
• slowing down of contractions up to a complete stop of the heart.

Types of blockade of His

The legs of Gis can be blocked individually or all at once, also an isolated lesion can be one branch of the left leg, as well as their various combinations. There are periodic or permanent options, on one electrocardiogram, blockade of one, and then the other branch may be noted first.

Right leg

The impulse for the right ventricle comes from the left and along the left side of the septum with complete blockage, its conduction slows down with incomplete blockage. The manifestations are minimal, it can be found in a completely healthy person and not give further complications. If it occurs with cardiac pathology, then shortness of breath and fatigue are usually associated with the underlying disease.

Anterior branch of the LNPG

The conduction disorder affects the anterior and lateral sides of the left ventricle. Signals are sent to them along the back wall from bottom to top. Most often found in myocardial hypertrophy due to hypertension, congestion in heart defects and myocardiopathy, one of the causes is anterior wall infarction.

back branch

The electrical signal diverges along individual Purkinje fibers from the anterior sections of the left ventricle from top to bottom, reaching the posterior wall late. A heart attack or sclerosis, calcium deposits in the area of ​​conductive fibers lead to a similar condition.

Whole left leg

Partial blockade of one branch gives minimal manifestations, but a complete blockade of LBPH is caused by an extensive infarction or a pronounced inflammatory or dystrophic process that covers the myocardium of the left ventricle. Therefore, with this pathology, cardialgia, dizziness, and arrhythmia are noted.

Complete and incomplete blockade

With a partial blockade, the contraction wave passes with a slight delay, since it reaches the target quickly enough along numerous alternative paths. The rhythm is not disturbed or bradycardia develops, the severity of clinical manifestations depends on the cause that led to the blockade.

Complete blocking is characterized by:

• the impossibility of passing signals to the ventricles;
• the occurrence of foci of excitation in atypical places;
• departments of the heart are reduced in a chaotic rhythm, the pulse rate is from 20 to 40 per minute;
• insufficient release of blood into the arterial network.

Transient blockade of the right leg of the bundle of His

The blockade of the right and left legs of the bundle of His is possible in a permanent, as well as transient form. In the second case, it is also called intermittent. This means that it happens under provoking conditions. For example, it calls:

After the patient goes into a state of rest or the treatment of the underlying disease is successful, the blockade of the leg disappears. A daily cardiogram recording (Holter monitoring) helps to identify a transient slowdown in conduction, and a temporary blockade is often not visible on a regular ECG.

Trifascicular blockade of the legs of the bundle of His

If there is a three-fascicular bundle branch block, then this means that both ventricles receive signals on the most intact of the three branches. They may contract more slowly than normal or at their own pace.

In an incomplete version, this is manifested by dizziness, weakness and shortness of breath during physical exertion, pain in the heart is possible. With further progression, there are interruptions and sensations of tremors in the region of the heart, fainting.

When the signal completely stops passing, then there are bouts of loss of consciousness, blue skin with convulsive twitching of the muscles. Three-beam acute blockade of the bundle of His is the cause of cardiac arrest, with untimely assistance, it ends in the death of the patient.

ECG signs and other diagnostic methods

Most often, a conventional ECG is used, but if there are doubts about the diagnosis, then a transesophageal technique or daily monitoring is additionally prescribed. In order to establish the cause, an examination is carried out using echocardiography, CT and MRI.

Symptoms on the ECG depend on the type and combination of blocked branches:

• Blockade of PNPG - right chest leads Rsr, rSR complexes are detected, they look like the letter M, in the left - S is wider than normal, QRS is more than 0.12 seconds.
• Blockade of LBBB - wide complexes with a serrated apex in the left leads, in the right leads - abnormal complexes, split S.

Blockade of the leg of His in the heart: symptoms in women

Incomplete or temporary blockade of one leg or branch of His in the heart does not show symptoms in women and men. If there is a complete cessation of the movement of impulses, then the rhythm slows down, and the release of blood from the heart decreases. This leads to malnutrition of the organs, but the brain and myocardium suffer the most. The manifestations are:

• darkening in the eyes;
• fainting state;
• rare, non-rhythmic pulse, interruptions;
• difficulty breathing;
• heart attacks.

Often, with a transient blockade at rest, the state is good, but with physical, emotional overstrain, the patient feels a lack of air, there is an attack of dizziness, fainting.

Blockade of the right leg of the bundle of His during pregnancy

If the blockade of the right leg of the bundle of His is detected during pregnancy in a woman who has never suffered from heart disease before, then this is the norm. At a young age, this phenomenon does not cause circulatory disorders and disappears on its own.

Causes associated with cardiac pathology include:

• hypertonic disease,
• angina,
• heart disease.

All of them have characteristic symptoms and EchoCG, ECG and pressure measurements are enough to exclude them. In doubtful cases, Holter cardiogram monitoring, a blood test for rheumatic tests are prescribed.

What is dangerous blockade of the left leg of the bundle of His

The blockade of the left leg of the bundle of His is dangerous when combined with a complete blockade of the right. There is a dissociation of the rhythm of contractions of the chambers of the heart. Against this background, the volume of blood entering the bloodstream from the heart decreases, episodes of loss of consciousness are possible. In a severe case, a complex form of arrhythmia appears and there is even a cardiac arrest of various durations.

If one leg is affected, then the ventricle (right, left, respectively) will receive a bioelectric impulse with a delay, but the contraction will still occur. Therefore, the blockade of only the right (left) leg of the His bundle is not dangerous, but requires therapy for the condition that caused it. With an asymptomatic course, observation, regular annual examinations (ECG, blood tests) are sufficient.

Is the blockade of the left leg of the bundle of His treated?

The blockade of the left leg of the His bundle is treated, but for this it is necessary to identify and eliminate the disease that caused it, and there is no special therapy only for the blockade. Since this condition is not a disease, but only a symptom of it, the main diagnosis in a patient is:

• valve defect;
• septal defect;
• cardiosclerosis postinfarction, postmyocarditis;
• calcification;
• cardiomyopathy (viral, diabetes, hormonal disorders, gout, allergic, toxic, alcoholic).

Therefore, drugs are used that are needed in each specific case - reducing pressure, dilating blood vessels, improving myocardial nutrition, anti-inflammatory.

Treatment of bundle branch block

The underlying disease is being treated, vitamins, Coenzyme Q, Thiotriazolin, Mildronate are prescribed to improve the blood supply to the myocardium. Pressure reduction is carried out with angiotensin-converting enzyme blockers (Lisinopril, Kapoten), beta-blockers and calcium antagonists are avoided, as they slow down conduction in the myocardium.

Indications for the installation of a pacemaker (artificial source of rhythm or cardioverter):

• blockade of 3 beams,
• complete block for signals from the atrium,
• the rhythm of contractions is below 40 per minute,
• bouts of loss of consciousness.

If the blockade of the legs occurred in acute stage heart attack, there is a complete blockade of the LNPG, PNPG with one branch of the left, then temporary cardiac stimulation is recommended. To do this, an electrode is inserted into the right ventricle through the central vein.

If there are no clinical manifestations, then patients are shown observation by a cardiologist and periodic monitoring of the ECG.

Watch the video about the blockade of the right leg of the bundle of His:

What is the dangerous condition

Complete blockage of electrical impulses increases the risk of cardiac arrest and can cause a sudden stop of contractions with a fatal outcome. Morgagni-Adams-Stokes attacks, which occur when the blood supply to the brain is interrupted, can also be life-threatening, especially if the patient is driving a vehicle or other complex mechanisms at this time.

Complications of the blockade of the legs of His include:

• attacks of tachycardia of ventricular origin,
• and ventricular flutter
• circulatory failure,
• thromboembolism.

Prognosis for the patient

If the blockade is detected by chance during an ECG examination, there are no signs of a circulatory deficit internal organs the prognosis for these patients is good. This may be a variant of the structure of the heart, no treatment is required.

An unfavorable outcome of the blockade is observed in patients with extensive infarction, uncompensated defects, massive myocardial dystrophy. It should be noted that the blockade that frolics in such situations is a sign of the negative dynamics of the disease, it increases the risk of complications and death.

Lifestyle when a problem is identified

If the examination did not reveal abnormalities, and there are only ECG signs of blockade, then the patient is recommended to maintain physical activity in the same volumes as healthy people.

With the development of conduction disorders in patients with a cardiological profile, the load is limited, but not completely canceled. Stress, overwork, excess animal fats in the diet, smoking and alcohol abuse have a negative effect on the course of the disease.

After installing a pacemaker, devices with an electromagnetic field, security detectors in supermarkets and airports, and high-voltage electrical lines should be avoided. Using mobile phone you need to keep it on the right side.

The blockade of the legs of the bundle of His is not a separate disease, but a sign of a violation of the conduction of the contraction signal through the heart muscle. Partial blockades of PNPG and 1 branch of the left are asymptomatic. With a complete blockage of 3 branches or the occurrence of a similar violation on the background of a heart attack, sudden cardiac arrest may occur. Treatment of the underlying disease is prescribed, with fainting attacks, the installation of a pacemaker is indicated.

Read also

The complex conduction system of the heart has many functions. Its structure, in which there are nodes, fibers, departments, as well as other elements, helps in the overall work of the heart and the entire hematopoietic system in the body.

Blockade of the legs of the bundle of His (BNPG) is a violation of intracardiac conduction due to damage to the bundle of His. Diagnosis of pathology is carried out during instrumental research by taking an electrocardiogram. The disease manifests itself with heart rhythm disturbances, dizziness, and the development of syncope.

What is bundle branch block?

Blockade of the legs of the bundle of His is a partial / complete violation of the passage of an electrical impulse through the conduction system of the heart. In cardiological practice, it is not distinguished into an independent disease, but is considered as a sign of an existing heart disease. It is found in 0.6% of the population, much more often in men. The frequency of diagnosis increases with age.

Reference! The ICD-10 code depends on the area of ​​damage.

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

There are a lot of factors that provoke the development of the condition.

The causes of RBBB (blockade of the right leg of the bundle of His) are:

• hypertonic disease;
• pathological expansion of the right parts of the heart;
• cardiac ischemia;
• sarcoidosis;

Causes of LBBB (left bundle branch block):

• heart attack;
• myocarditis;
• endocarditis;
• cardiosclerosis;
• calcification.

Important! Narrowing/absolute closure of the aorta and other aortic malformations become the provoking factor of two-beam blockades.

In addition to the previously discussed reasons, BNPG can be provoked by:

• cardiopathology - rheumatism, heart failure, etc.;
• change in the level of electrolytes;
• prolonged intake, in particular;
• influence of toxic components;
• diseases of endocrine origin, for example, high blood sugar;
• a constant lack of oxygen in the body, caused, in particular, by asthma.

Characteristics and symptoms of each type of BBB

Each of the varieties has its own signs and clinic.

Right bundle branch block (abbreviated RBBB)

The causes of focal RBBB are directly dependent on the existing form of conduction disturbance. The background for the primary blockade are:

• taking antiarrhythmics of classes 1A and 1C;
• deviations in electrolyte balance;
• injury to the area chest;
• the formation of blood clots in the lumen of the pulmonary artery;
• myocarditis, etc.

Important! RBBB is a typical complication that accompanies the postinfarction condition. Especially if the changes affected the right ventricle of the heart or the back wall.

RBBB accompanies the following diseases:

• valve system defects;
• organic lesions of myocardial cells.

In about 20% of all diagnosed cases, it is not possible to identify the true cause of the development of the condition.

Left bundle branch block (LBBB)

A characteristic of the complete blockade of LBB is the absence of the spread of excitation to the point of divergence of the stem. The occurrence of a two-beam blockade is not ruled out, both branches are excluded from the process.

NBPNPG (incomplete blockade of the right leg of the bundle of His) accompanies slow impulse conduction. Excitation of the myocardial cells of the left ventricle occurs due to impulses passing through the right branch of the His bundle.

Symptoms of the blockade of the anterior branch of the left leg of the bundle of His (BPVLNPG)

The state of blockade of PVLNPG in most cases proceeds unnoticed by the patient. Diagnosed by chance, during the removal of a cardiogram. ECG signs are the shift of the electrical axis of the QRS to the left and the appearance of pronounced R (up) and S (down) waves.

Very rarely, the condition is accompanied by the development of arrhythmia, but is considered as a characteristic clinical symptom she shouldn't.

Blockade of the posterior branch of the left leg of the bundle of His (BZVLNPG)

In the case of a complete blockade of the zone of participation in the processes of excitation, it does not accept. Any characteristics missing.

Two-beam BNPG

With a two-beam form, excitation of the posterior-lower zone of the myocardium of the left ventricle occurs first. Then the spread to the anterolateral sections and further, to the tissue of the myocardium of the right ventricle is fixed.

Pathology is clearly visible on the ECG and is expressed in the expansion of the QRS complex and some other changes.

Important! Diagnosis of combined blockade indicates serious changes in the myocardium.

Tribundle BNPG

With an incomplete form, the transmission of the exciting impulse is carried out along a less damaged branch and is accompanied by the development of the first / second degree.

With a complete blockade, the passage of excitatory impulses along the path "atrium - ventricle" is completely stopped. This is expressed in the disunity of rhythms. The contraction of the ventricles takes place in the idioventricular arrhythmic mode, which acts as an asystole.

Symptoms of bundle branch block

Most blockade cases are completely asymptomatic. In particular, this applies to incomplete single-beam blockade. The condition is diagnosed quite by accident during the period of the planned removal of the cardiogram of the heart.

But the clinical symptoms of a complete blockade of the right leg are recorded in the patient even when the signs organic damage his heart was not found. Signs of pathology are:

• changes in the work of the heart muscle;
• development of dizziness;
• syncope and pre-syncope;
• intolerance to physical activity;
• increased fatigue, general weakness;
• soreness in the region of the heart and a feeling of interruptions in its work.

development is not excluded clinical picture reflecting the underlying pathology. This can be a cardiological profile, and diseases of other organs and systems.

Severe symptoms accompany such complex cardiopathologies:

• heart failure;

They are accompanied by the development different forms heart blockade with lesions of the myocardium of the ventricles.

Blockade of the right leg of the bundle of His in children

The child has pathological condition can be formed during fetal development, i.e. during a woman's pregnancy. But it can also be acquired against the background of a previous disease of the cardiovascular system.

Causes can be:

• insufficient blood supply - the oxygen starvation caused by it can cause the development of myocardial ischemia;
• the death of the His bundle - the state of hypoxia can provoke the death of myocardial cells and their replacement with non-functional scar tissue;
• heart failure;
• pathologies of the heart muscle due to its organic damage;
• abnormal structure of the heart - violations of intrauterine development;
• inflammation of myocardial tissue;
• surgical operations on the heart;
• autoimmune pathology - capable of provoking malfunctions in the work of the myocardium;
• pathological increase in blood pressure - in childhood can cause changes in the structure of the heart, in particular, provoke the development of LVH (), which is accompanied by a violation of its functionality.

The causes of congenital blockade are:

• multifocal lesion of connective tissues in a pregnant woman;
• insulin-dependent form of diabetes;
• abnormal development of the right leg of the bundle of His;
• violation in the structure of the partitions in the heart cavity.

The condition may develop as a result closed injury hearts. It could be:

• a blow to the chest during a fall or push;
• incorrectly performed medical manipulations during cardiac surgery.

Primary symptoms are:

• loss of consciousness and fainting;
• bouts of dizziness;
• periodic development of bronchospasm;
• fatigue and unexplained weakness;
• heart attack;
• oxygen starvation of brain cells;
• lagging behind in general development;
• enlargement of the left ventricle and atrium;
• angina attacks;
• heart defects.

Diagnostics

Diagnosis of pathology in patients in adulthood and childhood is based on instrumental tests and analyzes. It:

• general and biochemical analysis blood;
• examination of the patient's urine;
• establishing hormonal status - helps in determining the causes of the disease, not associated with a violation of the functionality of the heart and blood vessels;
• removal of an electrocardiogram - helps to obtain a description of the existing deviations and determine the form of the blockade;
• Holter (daily) monitoring - helps to identify existing conduction disorders;
• taking an ECG after stimulating the myocardium with an electrical impulse;
• EchoCG - used to determine the root cause of the blockade.

Deciphering the results obtained is within the competence of a specialized specialist and helps him choose the necessary treatment.

Treatment for blockade of the legs of the bundle of His

There is no specific treatment for the pathology. Since BNPH is only a symptom, doctors treat the underlying disease that caused the development of the blockade.

If the condition was provoked by hypertension, angina pectoris or heart failure, then the treatment protocol for the patient is to take the following drugs:

• funds from the group of nitrates;
• cardiac glycosides;
• drugs that stabilize blood pressure.

It is recommended to treat the condition by installing a pacemaker in the formation of AV blocks.

In the case of an asymptomatic course, the patient is prescribed dispensary observation.

Lifestyle with blockade of the bundle of His

If the patient's well-being is not overshadowed by the development of clinical manifestations of a pathological cardiac condition, he can live in his usual mode, without limiting physical activity. There are no other contraindications.

When identifying two- and three-beam blockades, the following recommendations must be observed:

• limitation of physical and psycho-emotional stress;
• frequent rest;
• proper nutrition;
• quitting smoking and alcohol.

If a pacemaker is installed, the patient must carry the EKS owner card with him. In addition, during a conversation cell phone The tube should be applied not to the left, but to the right ear.

A control ECG is taken once a year. The procedure may be performed more frequently if the attending physician sees the need.

Complications

Complications of any of the types of blockade can be:

• ventricular fibrillation - cardiac arrhythmia, characterized by asynchronous contraction of the ventricles;
• complete .

Complete blockade of the leg of His is capable of provoking such complications of the underlying disease:

• the development of heart failure - the inability of the body to provide adequate blood supply to the body;
• blockage of the lumen of the vessel by detached particles of a blood clot.

Prevention of the formation of pathology is reduced to the timely elimination of diseases, systematic visits medical institution implementation of all prescribed recommendations. This is especially important for people with diagnosed diseases of the heart and vascular system.

Forecast

As a result, it should be noted that the blockade of the His bundle is only a symptomatic sign of cardiac pathology, but not a disease at all. It is detected during the removal of a cardiogram or on the basis of a patient survey.

The general prognosis of the condition largely depends on the root cause, i.e., the disease that acted as the provoking factor for this disorder.

• With a single-beam right-sided blockade in the absence of cardiac and pulmonary complications, the prognosis is good.
• Complete blockade of the left leg in conjunction with necrotizing myocardial cells receives poor prognosis from physicians. Mortality in the acute period reaches 50%.
• Three-beam blockades also have unfavorable outcome predictions. There is a high probability of asystole formation and subsequent death of the patient.

The blockade of the legs of the bundle of His is a pathological cardiac condition that requires medical supervision. That is why, with the development of unpleasant symptoms, it is recommended to get medical advice.

Complete blockade of the right leg of the heart is a rare pathological process in the human body. It is not a separate disease, but becomes an auxiliary symptom that is detected during the removal of electrocardiography. Although the symptom is a danger to health, complaints from the patient about bad feeling are absent.

The most common blockade is provoked infectious diseases transferred in childhood. Among them stand out:

• measles;
• flu;
• chickenpox;
• angina;
• scarlet fever.

During the examination of the patient, the doctor reveals residual manifestations of disorders in the activity of the heart muscle, which were not diagnosed in time. However, these myocardial changes, which appeared in childhood, no longer require treatment in adulthood.

• All information on the site is for informational purposes and is NOT a guide to action!
• Give you an ACCURATE DIAGNOSIS only DOCTOR!
• We kindly ask you DO NOT self-medicate, but book an appointment with a specialist!
• Health to you and your loved ones!

On the other hand, it is very important to diagnose pathological changes in the functioning of the heart muscle in childhood, in order to avoid complications in adulthood. Therefore, pediatricians are required to be attentive to patients and take heart problems seriously.

Functions of the cardiac bundle of His

Every organ in human body It needs oxygen to function properly, which it receives from the blood. Blood circulation is maintained due to the ability of the heart to contract autonomously in a strictly defined rhythm.

The nerve impulses that cause the muscle fibers of the heart to contract are transmitted along the conduction system in the organ. One of the important sections along its length is the bundle of His. This element is located in the thickness of the muscular septum, which is located between the left and right ventricles.

The bundle of His has a special structure in which two legs stand out - left and right. Nerve impulses pass through them, rushing to one of the heart ventricles. If the nerve conduction of the impulse is disturbed, they speak of a pathology, which doctors call the blockade of the legs of the bundle of His.

This pathology in different cases is expressed stronger or weaker. Incomplete heart block is characterized by a partial difficulty in the passage of the excitatory impulse, complete is diagnosed when the passage of the impulse through the structures of the legs of the heart stops.

Depending on the localization of the violation, blockade of one leg is distinguished - right or left, as well as both at the same time. Very often in childhood blockades are formed for no apparent reason.

In most cases, such a blockade is incomplete, it is in no way connected with any diseases. The pathological process develops asymptomatically. In addition, sometimes it can even be considered a variant of the norm.

If there is a complete blockage of the right leg of the heart, then in this case the nerve impulse is conducted through individual muscle fibers, starting from the left ventricle and the left side of the septum between the ventricles.

Symptoms

Incomplete blockade of the right leg of the heart of an isolated type is in no way associated with current disorders of the internal organs and diseases. In this regard, the pathology proceeds without pronounced signs and is therefore difficult to diagnose. Violation is detected most often by chance during a routine inspection.

With complete blockage of the right leg of the heart, there are signs of primary diseases against which this disorder develops, including:

• dyspnea;
• heartache;
• severe fatigue;
• malfunctions of the heart.

However, the blockade itself in this case is asymptomatic, and is diagnosed exclusively by ultrasound of the chest or during an ECG or listening.

A complete blockage of the left bundle branch can be identified by other symptoms, including:

• dizziness;
• cardiopalmus;
• chest pain.

A characteristic feature of the blockade is that it does not have a permanent character, so it can occur suddenly, but often disappears over time. For example, with a tachycardia form of the disease, the violation is eliminated when the heart rate returns to normal.

With a three-beam blockade, complete or incomplete isolation is also formed along the path of the nerve impulse. With incomplete blockade, impulses are blocked that are conducted to the ventricles along intact fibers.

With a complete three-beam blockade, the impulses do not pass at all. In this case, an ectopic focus of excitation appears in the cardiac ventricles. The work of the atria and ventricles is completely disconnected, and the frequency of heart beats per minute slows down to 20-40. This indicator is significantly below the norm, which indicates that a full release of blood into the aorta is impossible.

This type of blockade is accompanied by fainting caused by difficulty in blood circulation in the brain and concomitant oxygen starvation organ. There may also be sensations of failures in the functioning of the heart, dizziness. In such cases, the risk of sudden death increases.

Development forecasts

The prognosis for cure worsens if there is arterial hypertension or ischemia. However, acute infarction most often does not have a significant effect on the development of blockade. The probability of a lethal outcome increases in the presence of a transmural extensive infarction.

An unfavorable prognosis with complete blockade is taken out if myocardial infarction is present. In this case, 40-50 patients out of 100 die. Also, a low chance of cure is observed with a three-beam block, as this increases the risk of asystole.

The reasons

The reasons for the formation of the blockade of the right leg of the heart are usually multiple congenital anomalies:

• unformed segment of the right bundle;
• pulmonary stenosis;
• septal defect within the heart.

Complete blockade of the right leg of the bundle of His is formed due to certain diseases. Their list is quite extensive:

• hypertension;
• cardiomyopathy;
• acute form of a heart attack;
• ischemic disease;
• blunt chest trauma;
• heart surgery;
• dystrophic changes in muscle fibers;
• hyperkalemia;
• intoxication with cardiac drugs;
• changes in the functionality and structure of the myocardium.

Treatment of blockade of the right leg of the heart

When blocking the legs of the bundle of His, there are no specific signs, and disorders are usually diagnosed incidentally during scheduled examinations. In this regard, it is possible to identify violations only by the presence of concomitant heart diseases. Accordingly, the treatment of blockage of the right leg of the heart begins with the elimination of the negative impact of these diseases on the body.

There are 4 main diseases, against which a blockage in the bundle of His develops:

• ischemic disease;
• arterial hypertension;
• chronic intoxication;
• right ventricular infarction.

Before the immediate elimination of the consequences that arise due to the blocking of the bundle of His bundle, the primary disease that provoked the development of the pathology should be cured.

The very fact of the presence of a blockage of the legs of the heart indicates the presence of significant disorders in the organ. They are localized in the muscles of the right ventricle or in the septum between the ventricles.

At the end of the full course of treatment or after surgery, the patient should continue to be monitored by physicians and cardiologists. Specialists will monitor all changes. If such a need arises, they will adjust the methods of therapy in time.

Effects

However, all Negative consequences in most cases, they develop due to the fact that the patient ignores the recommendations of the doctor. Therefore, in order to save yourself from various risks, it is necessary to undergo a medical examination in a timely manner and appear for an examination with your doctor.

It is especially important to consult a doctor for those patients who are currently being treated. cardiovascular system. When the first dangerous symptoms it is important to immediately go to the hospital, without postponing the examination for later. The consequences may be irreversible.