Blockade of the right and left bundle branch block feet: symptoms, treatment

To bundle branch block is characterized by partial or complete blockage of one or both of two branches. Last - complete bundle branch block, the first - partial.

Such conduction disturbance would be intermittent or continuous. Bundle of His is composed of left and right legs. The first split into two branches: the front and rear. On them are the impulses to the ventricles, then the last cut. Any blocking excitation pulse leads to the development of different kinds of arrhythmias.

BNPG - not a separate independent illness, but a consequence and elektrokardiologicheskoe manifestation of underlying heart disease. Patients with age the percentage of detection of this disorder increases.

What it is?

Bundle branch block - a pathological condition which is broken due to holding of the electric pulse on CBH and LNPG. Consequently, malfunctions occur conducting system.

blockade Causes

Bundle branch block may have various causes.

Right bundle branch block	It arises in cases involving congestion and hypertrophy of the right ventricle - mitral stenosis, atrial septal defect, tricuspid valve, ischemic heart disease, cor pulmonale, hypertension, acute myocardial infarction (or zadnediafragmalnom verhneverhushechnom) and others. insta story viewer
Blockade of the left bundle branch block	lead atherosclerotic kardiosklerosis, malformations of the aortic valve, cardiomyopathy, myocardial infarction, myocarditis, bacterial endocarditis, myocardial dystrophy. Less commonly, bundle branch block develops on the background of pulmonary embolism, hyperkalemia and cardiac glycoside intoxication.

The reasons are two-stream closures typically aortic disease (aortic regurgitation, aortic stenosis) and coarctation of aorta.

Classification

Depending on the number of elements of the bundle of His, which is seen violation of pulse block is:

Single-beam when broken holding pulse on one element with bundle branch blockage:

• right bundle branch block;
• anterior branch of the left bundle branch block;
• the rear branch of the left bundle branch block.

Two-beam when carrying out heart broken pulses of two elements with bundle branch blockade:

• front and rear branches of the left bundle branch block;
• the right leg and the front branch of the left bundle branch block;
• the right leg and the rear branch of the left bundle branch block.
• Three-beam to the embargo on all elements of the bundle of His.

The blockade is complete and incomplete, constant or intermittent (occurs and disappears when one ECG recording) transient (not registered in the ECG), or that the alternating (when the recording of one block different legs ECG).

symptoms

Right bundle branch block is asymptomatic and is the accidental discovery, detected by ECG results of the study during a routine medical examination, baseline medical examination or treatment over the other diseases. Single-beam (front or rear) is also left blockade do not possess clinically significant manifestations.

Blockade of the left bundle branch block has caused the symptoms of her illness, it often:

• reduced tolerance to stress;
• dyspnea on little exertion;
• disruptions of the heart;
• heart attacks;
• pain in the heart;
• change of heart sounds on auscultation [elongate weakened or I tone (in 70% of cases), less commonly (16% cases) - splitting it, splitting tone II (80%)].

Three-beam blockade is the most severe clinical manifestations:

• extremely low heart rate - 20-40 beats / min.;
• sudden shortness of breath at rest;
• disruptions of the heart;
• irregular heartbeat;
• dizziness;
• brief episodes of loss of consciousness;
• cyanosis of the skin.

As it appears bundle branch block on ECG

By ECG signs, characterized by a complete blockade of right bundle branch block, include:

1. Increased QRS complex duration is more than 0.120 seconds.
2. Having extended the deformed tooth in S V4-V6 leads.
3. Having broken into three phases (like the letter "M») QRS in leads V1-V3.

Speaking about the signs of incomplete blockade right bundle branch block, it is worth noting the absence in the ECG complex is pathologically prolonged QRS (or its length normal, or is at upper limit of normal in the range of 0.090 to 0.110 second), but the presence of three-phase assessment on visual form of ventricular complexes.

To complete the visual features (affecting both branches) the blockade of the left leg on the ECG include:

1. Perhaps elongation ventricular complex over 0,120 seconds.
2. Having extended deep teeth S in V4-V6 leads.
3. Having extended and deformed teeth R in lead I, aVL and V5-V6.
4. Absence of Q in the graphs I, V5-V6.

The blockade of the front left leg twigs branch block looks like this:

1. Pronounced deflection axis of the heart to the left side (from -30 to -90 degrees).
2. Ventricular complex normal length.
3. Small barbs R in combination with deep teeth S in the II, III and aVF.
4. Small barbs into I and Q aVL.

The blockade of the rear branches of the left leg Gisa looks:

1. Pronounced deflection axis of the heart to the right side (from +120 to +180 degrees).
2. Ventricular complex normal length.
3. Small barbs Q in combination with a high amplitude teeth R II, III and aVF.
4. Small barbs R in I and aVL.

In identifying in the ECG signs discussed above, under appropriate description of the blockade of legs, the doctor is required to identify the root cause this arrhythmia and diagnoses in accordance with state guidelines and considers itself a manifestation of the blockade disease.

Effects

Bundle branch block requires timely diagnosis, because if left untreated, the disease causes serious consequences, sometimes incompatible with the patient's life. Among them are:

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

should regularly undergo prophylactic medical examination in order to prevent these complications. When cardiac pain, breathlessness and other signs of disease, treatment specialist should be immediate.

Treatment with bundle branch block

Treatment depends on the type of pathology and ECG parameters during diagnosis. Special treatment in the defeat of the right leg more often than not required. In this case, the patient is recommended to comply with measures aimed at the prevention of disease complications.

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

• quenched, pour cold water;
• adequately respond to stress;
• enter into the diet of teas, including anti-anxiety herbs (valerian, motherwort, elderberry, linden, nettle, oregano);
• abandon the heavy physical work, training power sports;
• observe proper diet, to refuse products that increase cholesterol levels in the blood;
• eliminate greasy, spicy, fried, smoked food, mayonnaise, sauces, marinades, ketchups.

Specific pharmacological treatment of conduction disturbances there. Patients with right bundle branch block in the absence of underlying disease, the treatment is not needed. Patients with one- or two-beam blockade to treat the underlying disease following groups of drugs may be administered:

• antioxidants - ubiquinone, carnitine, mexidol preduktal;
• Vitamins - Thiamin (vitamin B1) with lipoic acid, riboflavin (vitamin B2), niacin (vitamin PP);
• sedative drugs of plant origin (St. John's wort, motherwort, valerian, sage);
• antiplatelet agents for the prevention of thrombus formation in the heart and blood vessels - aspirin, cardiomagnil, thrombotic Ass;
• lipid-lowering drugs to normalize cholesterol - statins (rosuvastatin, atorvastatin, simvastatin);
• anianginalnye drugs for the treatment of coronary heart disease - nitrates short and long-acting (nitroglycerin, izoket, kardiket, monocinque);
• drugs for the treatment of diseases of respiratory system, caused the development of the "lung" of the heart - inhaled agonists and glucocorticosteroids (berotek, Flomax, Flomax, Beclason);
• antihypertensives for treating hypertension - ACE inhibitors (perindopril, lisinopril) receptor antagonists angiotenzinogenu II (losartan, valsartan), beta - blockers (bisoprolol, atenolol), a calcium channel antagonists (amlodipine, verapamil). The latter two groups should be used with caution, because it reduces the heart rate;
• antibiotics, non-steroidal anti-inflammatory drugs in inflammation of the heart membranes - penicillin; nimesulide, diclofenac;
• diuretics and cardiac glycosides in the development of chronic heart failure - indapamide diuver, lasix; strofantin, digoxin.

Furthermore medication, surgical treatment is used blockade, which is to install the patient pacemaker (ECS). Complete blockade of right, particularly in combination with the left gemiblokadoy (blockade of one branch of the left leg), and the full blockade of the left, developed in the acute period of infarction infarction (10 - 14 days), are an indication for temporary pacing electrode by administration through a central vein, right ventricle.

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

Forecast

In conclusion, it must be said that the bundle branch block blockade is not a disease, and heart disease symptoms that can manifest itself clinically or be detected on an electrocardiogram. 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 one or another of the blockade.

If the patient has the right single-beam blockage and no heart disease and lung function, we can talk about a favorable outcome.

Poor prognosis in the case of a total 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 Three-beam blockage likely to develop asystole and prognosis is also unfavorable.

prevention

Preventive measures include:

• avoidance of stressful situations;
• avoiding alcohol and tobacco use;
• day regimen, a full and restful sleep;
• refusal to fried, canned and spicy food;
• Only medications prescribed by a physician and under his supervision;
• eating foods with a high content of fiber: fresh fruit, vegetables, herbs;
• Timely diagnosis and treatment of diseases of all organs, not just the heart;
• mandatory consultation with a doctor at the onset of symptoms.

If the operation to install a pacemaker, one should eliminate the influence on him of electrical appliances, mobile phone was held. When the disease it is crucial to visit your doctor to assess the condition of the heart and the patient's general state of health.