Blockade of the right branch of the fasciculus. Left bundle branch block: causes, characteristic symptoms and treatment methods. Common causes of LPN blockades

The bundle branches are an element of the conduction system of the heart. They are responsible for conducting electrical stimulation through the ventricles of the heart. The bundle of His is divided into a posterior bundle branch and two anterior ones: the left anterior and the left posterior. The posterior branch goes down, it is thicker than the others and is, as it were, a continuation of the common trunk, then first the right and then the left anterior branch is separated from the common trunk (responsible for the anterior-left section of the interventricular septum and the anterolateral wall of the left ventricle). The posterior branch is responsible for the posterior-left section of the interventricular septum and the posterior (lower) wall of the left ventricle. There is a network of anastomoses between the anterior and posterior branches of the left bundle branch.

Based on the structure of the branches of the His bundle, single-bundle, double-bundle and three-bundle blockades are distinguished. With any type of single-fascicle blockade, the QRS complex is slightly expanded, its width remains within the upper limit of normal or slightly increases (0.08 - 0.11 sec.) With right bundle branch block, however, it can be expanded to 0.12 sec. and more.

Causes

Anterior or anterolateral myocardial infarction, cardiosclerosis, diseases accompanied by severe left ventricular hypertrophy ( arterial hypertension, aortic defects heart, mitral valve insufficiency; atrial septal defect, idiopathic calcification of the cardiac conduction system, myocarditis, cardiomyopathy, myocardial dystrophy

Classification

Symptoms

With this pathology, the conduction of excitation along the anterolateral wall of the left ventricle is disrupted. Initially, the left posterior branch of the His bundle excites the interventricular septum and lower parts back wall, and then (after 0.02 s) - the anterolateral wall of the left ventricle (along the anastomoses of the Purkinje fiber system).

Blockade of the anterior branch of the left bundle branch - Cardiac rhythm and conduction disorders

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10.4.3. Block of the anterior branch of the left bundle branch (ALBBB)

Block of the anterior branch of the left bundle branch (ALBBL) is the most common (0.5-4.5%) intraventricular conduction disorder. It most often occurs between the ages of 60 and 68 years.

In acute myocardial infarction, LPVP is observed in 4-18% of cases. According to our data [Reingardene D. 1975], the frequency of blockade of the anterior branch of the left bundle branch in anterior myocardial infarction reached 17%, in posterior myocardial infarction - 1.5%, as a result - among all patients with different localization heart attack - in 9.85%.

Etiology. The most common causes of LPVP are ischemic heart disease (63-85%), hypertonic disease(12-20%) and aortic defects (4-10%). If the cause of LBP is acute myocardial infarction, it is often anterior and transmural. At autopsy or coronary angiography in patients with LPVPL caused by acute myocardial infarction or chronic ischemic heart disease, thrombosis or sudden changes in the anterior descending artery are usually found.

Less commonly, other causes may also cause BPVPL: cardiomyopathy, Lev disease, surgical correction of aortic stenosis, ventricular septal defect, collagenosis (scleroderma, dermatomyositis), atrophic myotopia, progressive muscular dystrophy, Friedreich's ataxia, hyperkalemia, amyloidosis, cardiac sarcoidosis, hemochromatosis, various congenital heart defects, myocarditis, left selective coronary angiography, obesity, diabetes.

Clinical picture. BPVLNPH does not have any specific manifestations. In hemodynamic studies, left ventricular function is usually normal, but after a myocardial infarction it may be reduced.

Diagnostic ECG tests (Fig. 42, B): deviation of the electrical axis to the left; A QRS is greater - 45°; deep wave 5p, m.avF with a tendency to appear in leads Vs, 6; small wave q1, avl with a tendency to decrease or disappear in leads Vs, 6; small wave Hz, in.avF; QRS duration is normal or slightly prolonged, by no more than 0.02 s.

Some authors consider it possible to diagnose LBP with A QRS equal to - 30°. A higher left axis deviation is thought to reflect more extensive damage to the left anterior bundle. An opinion has emerged that it is possible to make a diagnosis of LBP in the absence of qt, avL waves. In these leads, in 8.1-27% of cases with LPVP, the q waves may not be pronounced.

Treatment. Blockade of the anterior branch of the left bundle branch does not require special treatment. If necessary, treat the underlying disease.

The prognosis for LPVP, not associated with organic heart disease, is favorable. In other cases, the prognosis is determined not by the violation of intraventricular conduction itself, but by the course of the underlying disease. BPVL never turns into complete AV block; electrophysiological studies always find H-V interval normal duration. In patients with LBP, a right bundle branch block develops somewhat more often (in 2.4% of cases). LBPBL rarely (0.8%) turns into left bundle branch block. If the LBP appears during an attack of angina, this indicates obstruction of the anterior descending branch and poses a threat of development acute heart attack myocardium.

The prognosis of LPVP in acute myocardial infarction, according to our data, is favorable, although opinions on this matter are contradictory. Typically, BPVLPH does not increase the mortality of patients; does not increase the occurrence of cardiac arrhythmias and never progresses to complete AV block. Only heart failure sometimes occurs more often in the group of patients with LBP. LBP does not affect the long-term prognosis.

Blockade of the anterior branch of the left leg - Cardiac arrhythmias (4)

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Etiology. Left anterior branch block (LABB), not accompanied by blockade of other branches, can develop during aging without any signs of specific heart disease. Such a conduction anomaly can occur due to a conduction defect in the PG, ischemia, infarction of the anterior wall of the heart, Chagas disease, sclerodegenerative changes, cardiomyopathy, calcification of the aortic valve leaflets, hyperkalemia, myocarditis, infiltrative and degenerative processes or trauma. In adults, this disorder is usually considered a relatively benign anomaly, however, in one study, patients with LAD who underwent coronary angiography for suspected coronary artery disease had a 50% chance of occlusion (95% or more) of the left anterior descending artery. coronary artery. Sometimes PPVLN is congenital, and its detection in infants often indicates either an ostium primum type atrial septal defect

(usually in combination with LPPN or BPN), or for tricuspid atresia. However, PPN and PPVLN can also be acquired conduction defects in the ostium primum. Block of the anterior branch of the left leg can be observed in 5% of hospitalized patients. Autopsy of the heart of patients with LDL reveals fibrosis in the area of ​​LDL branching. In one study, fibrosis was always observed in the anterior branch, but often involved fibers of the septal and posterior branches.

Clinical signs. Changes associated with blockade of the anterior branch of the left leg are determined by the influence of concomitant diseases. The prognosis for PPVL depends on the age at which the blockage first appeared and on the accompanying cardiac pathology. A significant effect of PPVLN on the prognosis is not noted if the blockade occurs during the aging process (especially in people over 70 years of age) in the absence of obvious heart disease. The probability of its progression to simultaneous blockade of two branches is 7%, and to complete transverse AV block is 3%. In addition, the presence or occurrence of PPVLN does not increase mortality and does not aggravate the course of acute myocardial infarction.

Changes associated with PPVLN often appear in most of the 12 ECG leads (Fig. 5.10; see Tables 5.1 and 5.2). Complexes are most often observed in leads II, III and aVF rS, and in lead I and aVL.- qR. Such deep terminal teeth S in leads II, III and aVF and terminal waves R in lead aVR almost always indicate the presence of anterior branch block even in the presence of complexes QS with infarction of the anterior wall of the heart. In the left chest leads? V4-V6 complexes QRS acquire a biphasic form like R.S. and in the right chest leads, small additional teeth sometimes appear Q. Thus, PPVLN can simulate a lateral or anteroseptal myocardial infarction, and an additional initial r wave in the inferior leads can hide an infarction of the inferior wall of the heart. The cardiac axis is usually between -30° and -90°, but can move into the right upper quadrant on the frontal plane up to an angle of -110°. Prongs R in leads I and aVF with PPVLN tend to increase, so the use of conventional diagnostic criterion left ventricular hypertrophy in these leads is inappropriate. Prongs T in leads I and aVL can be inverted, and in leads II, III and aVL. - directed upward, which sometimes hides the inversion of the teeth T in the inferior leads, due to another pathology. Similarly, the upward direction of the G waves in the left chest leads increases, where the complexes QRS have a biphasic form. Associated tooth changes T and segment ST help differentiate teeth Q in the right chest leads with anteroseptal infarction and teeth Q, sometimes appearing in these leads due to PPVLN. In addition, the teeth Q, caused by infarction, are often wider (> 0.04 s) and flattened.

The development of BPVLN is accompanied by a slight expansion of the complex QRS(on average it increases by 25 ms). The more pronounced the deviation of the heart axis to the left, the greater the expansion of the complex QRS. The delay in the appearance of the deflexion complex in lead aVL on the ECG (more than 50 ms) and the longer (by 10 ms) time of occurrence of the initial deviation in lead aVL compared to lead Ve are also used as a criterion for PPVLN, as well as the displacement of the teeth in the first 0.02 from down and to the right.

Block of the posterior branch of the left leg

Etiology. Left posterior branch block (LPBL) can occur in isolation (without blockade of other branches) as a result of a chronic degenerative or fibrotic process of the specialized ventricular conduction system, hyperkalemia, myocarditis, infiltrative diseases, Chagas disease and, possibly, acute pulmonary heart, as well as due to an ischemic process affecting the posterior branch itself or, possibly, the Purkinje fiber system or the working myocardium, for which the posterior branch usually serves as a specialized pathway.

Electrocardiographic manifestations. When the posterior branch of the left leg is blocked, the cardiac axis usually deviates to the right so that in lead I and (often) in lead aVL, the wave voltage R turns out to be reduced, and the tooth S is negative and has a large amplitude, while in leads II, III and aVF a low-amplitude wave is noted Q and high prong R(see tables 5.1 and 5.2). This picture resembles an infarction of the lower wall or hides an infarction of the lateral wall of the heart. However, some researchers believe that deviation of the cardiac axis to the right is an unusual phenomenon and the diagnosis should be made on the basis of other described changes, including flattening of the initial and final parts of the complex QRS as well as a delay in the onset of the tooth R in deflexion for more than 45 ms in lead aVF. Biphasic complexes are sometimes noted in the left precordial leads, such as V5 and V6 QRS. In lead V1 complex QRS mostly negative, which allows us to exclude RPG. If BPVLN is accompanied by the appearance of a positive complex QRS in lead V1 due to LDBB, the diagnosis of RPH should be excluded only on the basis of clinical findings. If the deviation of the heart axis to the right is the result of positional changes that occur during chronic lung disease, then the teeth R in leads II, III and aVF are low (as is observed with BPVLN) and the voltage of the complexes in most of the 12 leads is, as a rule, reduced. In children and young adults, right axis deviation is often normal, so differentiating between juvenile deviations and changes associated with PLD is difficult.

Prongs T often have a greater upward direction in leads I and aVL, and this tendency may mask pathologically small or slightly inverted waves T, appearing in these leads in the absence of a conduction defect. In patients with PVD, G wave inversion in leads II, III, and aVF is sometimes observed, which may mimic an active or ischemic process in the posterior wall of the heart.

Acute cor pulmonale or anterolateral myocardial infarction can cause changes similar to those observed in PVLN. Thus, for an accurate diagnosis of PVLN, clarification of all clinical correlations and a careful study of other electrocardiographic data are necessary.

Block of the septal branch of the left leg

Etiology. Left septal branch block (LSBLB) has been demonstrated anatomically; most often it is detected in patients with coronary heart disease, especially in the presence of angina and papillary muscle dysfunction. To others etiological factors include diabetes mellitus and hypertrophic cardiomyopathy. Impaired conduction is associated with fibrosis of the septal branch of the LBP.

Clinical signs. Symptoms and signs of PSVLN in patients are determined by the underlying disease. When PSVL is associated with papillary muscle dysfunction, a systolic murmur is often detected.

Electrocardiographic manifestations. The teeth are clearly visible in the right chest leads R, similar to those observed with a “true” infarction of the posterior wall; or possible appearance of teeth Q in the same leads.

Block of the right leg in combination with blockade of the anterior branch of the left leg

Etiology. The main causes of PPN with PPVLN include sclerodegenerative lesions of the specialized conduction system of the ventricles (mainly in older people), coronary heart disease, especially myocardial infarction involving the interventricular septum, as well as hypertension and Chagas disease (in South America). Right bundle branch block with RPVN may occur as a purely congenital anomaly or in association with progressive ophthalmoplegia. There is also a familial form, accompanied by fainting, in which there is a high probability sudden death. This conduction defect may also be due to chest trauma, hyperkalemia, myocarditis, aortic valve disease, cardiomyopathy, or ventricular granulomatous disease such as sarcoidosis. Postmortem examination often reveals fibrosis, calcification, and fatty changes in the central fibrous body, in the PG, the proximal parts of both crura, in the middle part of the PN, and in the fibers of the anterior branch of the FN (3, 10, 22, 174, 175]. Impaired conduction may also occur. as a result of surgical correction of tetralogy of Fallot or VVP.Intracardiac conduction time measurements in the right ventricle indicate that the presence of RVD with RPVN in these conditions indicates damage to the specialized conduction system, whereas the presence of RVD alone reflects only surgery-induced damage to the peripheral fibers of the Purkinje system. PPVLN, which arose as a result of surgery, is a threatening sign and requires implantation of a permanent pacemaker; however, in the absence of signs of permanent or transient blockade of all three branches of the left leg, the prognosis may be favorable even without the use of an artificial pacemaker, at least for several years. In the absence of permanent or transient AV block, there does not appear to be an increase in mortality as in the presence chronic disease coronary arteries, and without it.

Clinical signs. An objective examination of RPN with PPVLN may reveal the same changes in heart murmurs that are observed in isolated RBP, i.e., widening of the second heart sound. Phonocardiogram, recording of pulsation in carotid artery and cardiogram show the late onset and slow development of the phase of expulsion of blood from the ventricles. In short, the objective findings are consistent with the etiology of the disease. The rate of progression of chronic RPN from RPLN to higher degree AV block is 10% or more in patients followed for various periods of time and 19% at 5-year follow-up. In the presence of organic disease heart rate of progression to AV block is more high degrees varies from 14 to 100%. RFS with PPVLN occurring during an acute anterior septal infarction significantly changes the prognosis of patient survival after the acute phase, especially if the interval H-V increased in the histogram. Complete AV block may develop, and since simultaneous blockade of two branches indicates damage to a large area of ​​the myocardium, the likelihood of cardiogenic shock in such patients is higher than without blockade of two branches. The use of an artificial transvenous pacemaker may not affect the survival of patients with acute anterior septal infarction complicated by RPN with LBP. However, most cardiologists recommend using a temporary transvenous pacemaker in this situation, even if RBP was observed before the infarction. If blockade of two branches precedes acute myocardial infarction, the mortality rate within the first year is 65%, although sudden death is unlikely. If the intraventricular conduction defect does not disappear and especially if short-term episodes of AV block II or III degree, then a permanent pacemaker can prolong the patient's life. These recommendations are also applicable (to a lesser extent) in the case of the development of LPN or isolated LPN (without LPN); in the case of acute myocardial infarction, accompanied by isolated RPVLN or RPVLN without right leg block, they are probably unacceptable.

The prognosis for asymptomatic outpatients with chronic LPN and PPVLN is favorable, while hospitalized patients with similar disorders have high risk sudden death or development of complete AV block, especially if the intervals H-Q significantly increased. Although there is a definite correlation between increasing intervals P-R and long intervals I- Q, with PPN with PPVLN, most intervals H-Q accompanied by normal intervals P-R. In patients with PPN, PPVLN and long intervals H-Q the likelihood of having more serious heart disease with the addition of cardiomegaly and heart failure is higher than in patients with normal intervals H-Q. There is no reliable evidence that the implantation of pacemakers in patients with chronic LPN and LBP changes the risk of sudden death (except in cases of second degree AV block). For example, the cause of death in many patients with Chagas disease and bundle branch block is ventricular fibrillation rather than AV block. In patients with PPN and PPVN without cardiac symptoms, the development H-Q-second degree blockade with frequent atrial stimulation or during anesthesia is hardly possible if such blockade has not been observed before; However, one case of transient AV block occurring during intubation in a 44-year-old patient with RPN and LPN was described. One group of researchers reported a 12% 3-year mortality rate due to cardiovascular disease in patients with bibranch block. Other investigators have shown that the likelihood of sudden death in patients with LPN, PPVL, and prolonged intervals H-Q decreases with the use of permanent pacemakers, whereas, according to a group that noted a high incidence of sudden death (10% during the first year, 13% during the second and 16% during the third) in patients with chronic blockade of two branches, death

Rice. 5.11. Electrocardiogram in 12 leads (A): in each lead, two P-waves are conducted and one P-wave is blocked. (Bigeminy is best seen in the recordings shown in fragment B.)

Fragment A: the first of each pair of QRS complexes has signs of right bundle branch block (RBB) with left anterior branch block (LABB). The second of each pair of QRS complexes indicates LRBB with left posterior branch block (LPBB). Q waves of both complexes in the right precordial leads indicate anteroseptal myocardial infarction. However, in the leads

II, III and aVL. Q waves are present in only the second of each pair of beats, suggesting that the LPVN mimics posteroinferior wall infarction or that the LPVN may obscure this pathology. So, here there is a constant BPBB and a 3:1 block in the anterior and posterior branches of the left leg, but not simultaneous, but with a shift in one cycle, which causes an alteration of the QRS shape and 3:2 AV block.

in the cases described, it was caused by ventricular fibrillation rather than AV block.

Electrocardiographic manifestations. Right bundle branch block and RPVN change the shape of the complexes differently QRS and teeth T, which sometimes overlap each other (Fig. 5.11; see Tables 5.1 and 5.2). In leads I and aVL. usually marked by a high tooth T S, a small tooth Q may or may not be present. Low-amplitude waves are usually observed in leads II and aVF R and deep, widened teeth S. In lead II, and sometimes in leads II and aVF, a low-amplitude wave is detected R, as well as deep and widened prong S or deep tooth S and terminal flattened tooth R. Prongs T in leads I, aVL, and sometimes in leads II, III and aVF are often more directed upward, which may hide small or inverted waves T, which may be present in some places. In lead V1, and sometimes in leads V2 and V3, a terminal flattened wave is noted R. Wave inversion often occurs in these leads T, which sometimes mimics anteroseptal ischemia. The right chest leads may also show a small wave Q, as well as a tall, widened and flattened tooth R or R's inverted tooth T; in this case, the diagnosis of recent anteroseptal myocardial infarction is excluded based on other clinical or electrocardiographic findings, such as the presence of narrow waves only Q or disappearance of BPN and BPVLN simultaneously with anterior septal teeth Q and inversion of the G wave. The ventricular complexes in the left chest leads are biphasic with flattened terminal teeth S. Heart axis in the frontal plane, determined based on wave voltage R And S, deviated to the left.

The diagnosis of “incomplete blockade of the right bundle branch” is often found in medical practice. Often, a disorder is detected on an ECG during a preventive medical examination or when a patient seeks medical help. Most patients panic when they receive a conclusion that they have this pathology. What is the disease in question, and what is its danger to the human body?

General information

The His bundle is a collection of conducting cells whose activity ensures the transmission of electrical impulses from the right atrium to the ventricular myocardium. In the interventricular septum, this formation is divided into the right leg and the left, which is also divided into anterior and posterior branches.

If for any reason the conduction of the impulse is partially or completely disrupted, then a bundle branch block occurs. This pathology is characterized by an asymptomatic course and complete or partial blocking of impulse transmission to the ventricles of the heart.

There are three clinical variants of the disease in question:

• single-bundle blocks affecting the right leg, or the anterior or posterior branch of the left leg;
• two-bundle – damage to both branches of the left leg, or the right leg together with one of the branches of the left;
• three-bundle – both legs are blocked. Depending on the degree of disruption of the transmission of electrical impulses, the blockade can be complete or incomplete. Depending on the course of the disease, there are three forms of blockades: transient, persistent, alternating.

One of the common cardiac conduction disorders is blockade of the anterior branch of the left bundle branch (symbol: LBP). The pathological condition is facilitated by the location of this branch, which is located in the projection of the aortic valve ring, due to the persistent impact high pressure inside the ventricles, and valve disease.

Right leg block is the second most common; it is not associated with any cardiac pathology. Most rarely, patients experience blockade of the posterior branch of the left bundle branch.

Features of the disease

Partial blockage contributes to disruption of the transmission of electrical impulses in only one leg. Cardiac conduction slows down. Incomplete blockade of the right bundle branch is a partial failure of the transmission of nerve impulses to the ventricles of the heart. Sometimes a similar phenomenon is found in young, relatively healthy people. In this situation, it is a variant of the physiological norm.

It is worth remembering that incomplete blockade of the left bundle branch is considered a more dangerous type of disease. It causes the development of heart failure and atrioventricular impulse failures.

The analyzed disease is more often observed in males. While women over 50 years old are characterized by blockade of the left leg of the heart. Slowing of cardiac conduction is often observed in children. This deviation does not pose a threat to the child’s health if he does not have heart disease or activity disorder circulatory system and respiratory organs.

Despite the asymptomatic course of the pathology, it affects the activity of the ventricles. Therefore, when predicting the formation of any form of blockage, it is necessary to take into account the state of the ventricular tissues.

Causes of pathology

There are many known diseases that can cause the development of incomplete and complete blockade of the right bundle branch. Today it is generally accepted that the condition in question is not hereditary, but a predisposition to cardiac conduction problems can still be transmitted at the genetic level.

The following factors can provoke the development of a pathological process inside the ventricles:

• heart defects and tumors;
• myocarditis and endocarditis;
• blockage of one pulmonary artery (PE);
• cardiosclerosis;
• intense enlargement of the myocardium due to chronic hypertension;
• respiratory diseases causing the formation of a “pulmonary” heart;
• myocardial infarction;
• presence of bad habits;
• constant stress.

Often, slow impulse transmission occurs due to drug poisoning caused by an overdose of certain medicines. There are many cases where the antiarrhythmic drugs used caused partial or complete disruption of the conduction of electrical impulses to a characteristic organ.

A bundle branch block is formed as a result of overexcitation of the vagus nerve caused by intense exercise during training or during physical work. Surgical interventions, which are used to eliminate cardiac pathologies, also lead to the formation of a blockade.

Observable symptoms

In most cases, there are no symptoms of incomplete blocking at all; this problem can only be identified using an ECG.

The presence of shortness of breath, periodic pain in the chest, cardiac arrhythmia - this is caused by a disease that leads to a violation of cardiac conduction. Therefore, first of all, it is necessary to treat the diseases that caused the development of this problem.

Unlike partial, complete blockade of the left bundle branch is expressed by similar symptoms:

• dizziness;
• weakness;
• periodic fainting;
• pain in the heart area;
• interruptions in cardiac activity;
• headache;
• feeling of heartbeat.

The above symptoms indicate the presence of serious chronic diseases, the treatment of which cannot be delayed.

On the other hand, in relatively healthy people there is no need to treat incomplete right bundle branch block. This is regarded as a normal condition.

Diagnosis of the disease

Without diagnostics, it is impossible to begin full treatment of the blockade. When a significant number of ventricular contractions are lost, their number decreases. This phenomenon can be observed both with partial and complete violation. If impulse obstruction is suspected, the doctor prescribes ECG studies and blood hormone levels.

When the bundle branches are partially blocked, the ECG shows that the electrical impulse travels at a slow pace. A wave is recorded demonstrating atrial contraction, but a wave of ventricular contraction is absent. When an incomplete block of PNPG is detected, the ECG shows small notches on the S wave, and changes are noticeable on the right side.

The duration of the QRS complex in patients with partial obstruction of nerve impulses may remain within normal limits, but in most cases it is 0.9–1.1 seconds.

To identify the presence of diseases that can cause partial obstruction of electrical impulses, the cardiologist additionally prescribes these research methods:

• general blood and urine tests;
• biochemical blood test;
• Ultrasound of the heart;
• in severe diagnostic cases, computed tomography or magnetic resonance imaging is used;
• transesophageal electrocardiography;
• 24-hour ECG monitoring is used to identify transient disorders.

Based on the results of tests and consultations with a cardiac surgeon, an accurate diagnosis is made, allowing competent therapy to be prescribed.

Treatment of the pathological condition

Therapy for the pathology in question consists of treating diseases that contribute to the development of RBBB and LBBB. Special treatment for partial impulse obstruction itself is not required. For example, patients with congenital heart defects need surgical intervention. For patients with signs of heart disease, drug therapy is provided, including:

• taking natural sedatives;
• B vitamins;
• blood thinners;
• taking antioxidants;
• means that normalize blood pressure;
• For heart failure, diuretics are prescribed.

To combat the development of cor pulmonale due to bronchopulmonary problems, glucocorticosteroids are used. In case of inflammation of the membranes of the heart, antibacterial agents are prescribed.

Complete bundle branch block requires surgical intervention, which consists of installing a pacemaker. A person with ECS must protect himself from being in proximity to electrical appliances.

In young people, the analyzed variant of blockade is regarded as normal, so the doctor does not prescribe therapy. A dynamic examination and observation by a cardiologist is recommended. Since the analyzed pathology does not require conservative treatment, care must be taken to reduce the likelihood of partial blockage progressing to more severe forms.

Emerging symptoms may signal the development of the disease, so they should not be ignored. When do they arise? discomfort caused by a pathological condition, you must perform the following actions:

• if dizziness occurs, you should take a lying or sitting position;
• you need to perform simple breathing exercises: take a deep breath, hold your breath as you enter, then exhale all the air.

It is useful to use infusions of hawthorn flowers and fruits. An alcohol or water tincture of lily of the valley helps to cope with the disease.

Lifestyle and prevention

If the bundle branch block occurs without any symptoms, then you are allowed to lead your daily life. However, you should give up intense exercise and bad habits, reduce the negative impact of stress, and get more rest. It is necessary that the duration of sleep is more than 8 hours a day. The diet should be balanced and not contain large quantity salt, sugar, animal fat. Carry out reception medicines only in recommended doses under medical supervision.

A person should be observed by a cardiologist and undergo an ECG annually. If the patient has a pacemaker installed, the first visit to an arrhythmologist and cardiac surgeon will occur 3 months after discharge, the next one – after six months. Further visits to the treating specialist will take place 2 times a year.

This is what a pacemaker looks like connected to the heart.

Complications

The prognosis is favorable for young people who do not have organic heart disease. Often, blockage of the right leg of the heart does not pose such a threat as blockage of the left. But still, the pathological condition can have consequences.

The complication develops in the form ventricular tachycardia. The pathology manifests itself as an accelerated heartbeat. It often causes severe consequences. There is a risk of ventricular fibrillation; if it is not properly treated, the patient may die.

To avoid serious consequences, you should undergo periodic examination by a cardiologist. Self-medication is strictly prohibited.

Incomplete right bundle branch block is a fairly common diagnosis after an ECG. Many may not even suspect that there are problems with their heart. This pathology is early stages can be asymptomatic, this is the insidiousness of the disease.

The causes of the disease in the modern world can be many factors. The older a person is, the greater the likelihood of having malfunctions in the conduction system of the heart, and for children this may be the norm if they do not have other signs and complications. But in neither case nor in the other can this disease be ignored.

If you are faced with a problem such as incomplete blockade of the right bundle branch, do not panic; timely treatment will give positive result. In this article we will tell you what this disease is, what the symptoms and treatment methods may be.

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

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

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

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

The bundle branches are the conducting element of the cardiac system, responsible for conducting electrical signals through the ventricles of the heart. The bundle of His consists of three separate parts:

• posterior bundle branch;
• right anterior and left anterior limb of His.

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

In addition, this violation can only occur when:

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

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

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

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

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

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

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

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

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

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

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

Such diseases include heart defects (congenital, in which there is an excessive load on the right ventricle, defects of the septa between the atria and ventricles), mitral stenosis, coronary heart disease, acute conditions (heart attack), arterial hypertension and cardiosclerosis.

The causative factors for the development of an incomplete type of blockade are intoxication or overdose medicines(from the group of digitalis, adrenergic blockers), disturbances in electrolyte metabolism. Due to the development of the blockade, the conduction of impulses through the heart system slows down, which leads to the fact that physiological, full excitation of the right sections does not occur.

The diagnosis of blockade separately at the level of the right leg can only be established on the basis of an electrocardiographic study. At ECG decoding Changes in the QRS complex are detected (expansion and jaggedness of its terminal part), while the duration of the complex itself is usually increased.

In the chest leads, the R wave will be enlarged and jagged, the ST segment will be lowered. What congenital causes exist:

• violations of the interatrial septum;
• congenital heart defects that overload the right ventricle;
• M.Lev disease (unexplained etymology);
• ventricular septal defects;
• Legere's disease (cardiac conduction disorders in children);
• arterial stenosis of pulmonary vessels;
• underdevelopment of the right bundle branch.

Acquired reasons:

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

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

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

Who is at risk

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

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

In children, incomplete blockades of the right leg are not uncommon, but this deviation does not pose a danger to the child’s health if he does not have cardiac pathology or disturbances in the functioning of the cardiovascular system and respiratory organs.

Even if incomplete blockade is asymptomatic, it affects the functioning of the ventricles. Therefore, when predicting the development of any type of blockade, the condition of the ventricular tissues is certainly taken into account.

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

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

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

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

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

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

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

When the violation becomes acute, it is required drug therapy. But there is another important point here: all the drugs that the modern medicine, are capable of producing a temporary effect, and treatment of the blockade with them can lead to unpredictable consequences, including aggravation of the pathological condition.

Blockade of any of the bundle branches is characterized by a persistent or transient form. In the second case, the state of blockade can either disappear or appear, but intraventricular conduction will remain the same.

There is also an alternating form of partial disruption of the transmission of electrical impulses in the heart, when the state of blockade is observed alternately on one or the other leg. Symptoms of blockades are quite difficult to detect. This is due to two main reasons:

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

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

If the blockade of the branch of His is not partial, patients may complain of dizziness, clouding of consciousness, and that it often becomes difficult for them to breathe. All these are consequences of impaired transmission of cardiac electrical impulses, but they are typical for various pathologies internal organs, including the lungs.

It is necessary to carry out diagnostics to check the condition of the legs of His when a person, for no apparent reason, begins to often feel increased fatigue and causeless decrease in performance.

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

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

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

This information is of particular value when doctors determine the cause of disturbances in the transmission of electrical impulses. Classical ECG is also widely used to diagnose blockades. To perform a traditional ECG, the transesophageal method is used.

It is one of the most informative ways. During such a diagnosis, sinus arrhythmia, characteristic of incomplete blockade of the right bundle branch, is also determined.

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

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

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

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

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

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

Clinically, incomplete blockade of the right branch of the His bundle does not manifest itself in any way. In most cases, pathology is detected by chance during a routine preventive electrocardiographic examination.

Due to the fact that disturbances in impulse conduction inside the ventricles most often occur against the background organic damage heart, patients with this pathology may present “cardiological” complaints, such as:

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

In some rare situations, incomplete blockade of the right side of His can be accompanied by a decrease in heart rate to 55-60 beats per minute or lower, which is due to the redistribution of the excitation wave along the conduction system of the heart and the relative activation of Purkinje fibers, which transmit impulses from the branches of His to the cardiomyocytes themselves.

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

Isolated incomplete blockade of the right bundle branch does not manifest itself in any way and, as a rule, is an accidental finding during an ECG for completely different reasons, for example, during a routine medical examination or a medical examination before conscription into the army.

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

The only option in which one can suspect the presence of a blockade before electrocardiography is the usual auscultation of the heart, or listening to it with a phonendoscope. The doctor may suspect this by ear if there is a splitting of tones that is not felt by the patient.

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

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

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

If the blockade of the leg occurs against the background of a cardiac disease, then an intracardiac electrophysiological study is performed. Its main task is to determine whether there are indications for placement (implantation) of a permanent pacemaker.

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

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

Cardiogram changes

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

ECG signs of incomplete right bundle branch block:

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

With this disorder, there is a slowdown in the conduction of the excitation impulse along the right bundle branch. Incomplete blockade of PNPG on the ECG is often diagnosed in absolutely healthy young people. In such cases, changes are considered as a physiological norm.

In most cases, the disease is detected accidentally during a physical examination, listening to the heart (auscultation) and electrocardiography. Incomplete right bundle branch block is rarely accompanied by clinical manifestations.

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

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

Therapeutic measures for incomplete blockade consist in treating the disease that is the cause of the blockade. That is, there is no specific therapy for the blockade itself; it is necessary to treat the underlying disease.

For example, birth defects in modern conditions, it can be operated on in a cardiac surgery clinic (if there are appropriate indications for this). If the patient suffers from heart failure, angina pectoris, hypertension, therapy is carried out with cardiac glycosides, antiarrhythmics, and antihypertensive drugs.

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

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

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

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

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

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

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

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

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

1. Ramson (bear onion). Wild garlic bulbs contain ascorbic acid(natural analogue of aspirin), allicin, healing mineral salts And essential oils, as well as sugars that normalize the activity of the heart muscle.

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

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

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

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

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

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

To prepare a water tincture, you will need a teaspoon of herbs per 200 ml of boiling water. Dosage – a teaspoon three times a day (pi atrial fibrillation the dosage can be increased to 1 tablespoon 3 times a day).

To prepare an alcohol tincture, you will need 20g of spreading jaundice herb and 100 ml of alcohol. The mixture is infused in a dark place for 2 weeks, after which it must be filtered.

Dosage – 10 drops 3 times a day before meals (you can wash the drops down with water). Continue treatment for 6-10 months to obtain a stable, long-term effect.

3. Common hazel. Hazel will calm you down nervous system, will enhance the effectiveness of treatment of heart diseases and prevent serious pathologies in the ventricles.

We recommend making tea from this plant. To do this, you will need a tablespoon of hazel bark or leaves (dry crushed) and a glass of boiling water. Leave the mixture for 20 minutes, then take 100 ml twice a day.

4. Sedum is caustic. IN folk medicine Treatment with preparations from the herb sedum is popular.

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

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

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

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

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

Recipe: Brew a teaspoon of dry herb cudweed in a glass of boiling water and leave for half an hour. Take 3-4 tablespoons of infusion 4 times a day 20 minutes before meals. People with heart problems are also recommended to take wine made from cucumber.

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

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

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

Brew a tablespoon of this mixture with 0.5 liters of boiling water in a thermos, close the lid and leave for at least an hour. Every time 15 minutes before meals, drink half a glass of this drink. The course of treatment is from one month to a year (depending on the patient’s condition).

In an ancient French herbal medicine reference book we found the following recipe:

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

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

The following collection provides an excellent therapeutic effect:

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

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

Incomplete blockade of the right bundle branch in itself does not pose a significant danger to the life and health of the patient. In the vast majority of cases, the pathology is not accompanied by any symptoms and is detected incidentally during a routine electrocardiographic study.

In this regard, incomplete RBBB does not require specific treatment. However, taking into account the fact that incomplete blockade of the right bundle branch often develops against the background of existing heart disease, it is natural to expect that it will have some effect on the course of the underlying pathology.

Indeed, studies confirm that RBBB worsens the course of cardiac diseases and increases the risk of cardiovascular complications and mortality in the coming years after its development.

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

How dangerous is incomplete right bundle branch block? The prognosis for this condition is not determined by this formulation of the diagnosis. As mentioned above, the degree of development of the underlying disease is decisive, as well as the presence of the risk of developing complete atrioventricular block (in which the atria and ventricles can each contract in their own rhythm, disorganized).

It is the latter fact that can lead to the development of ventricular arrhythmias. It should be noted that the blockade, especially incomplete, does not automatically mean the presence of arrhythmia. It’s just that, in the presence of predisposing and unfavorable factors, this can happen, and then the blockade of the leg, albeit incomplete, can increase the risk of sudden cardiac death.

Thus, the probability of a complete atrioventricular block in individuals with partial conduction disorders of the bundle branches is 1% per year.

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

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

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

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

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

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

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

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

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

As for service in the armed forces, then, as we remember, in the absence of a clear interpretation, the entire emphasis is on “impairment of function.” In this case, given the absence of pronounced organic damage and the asymptomatic course, such a young man will be drafted into the army in category B-4, that is, “fit with minor restrictions.”

This actually means that he is unsuitable for the elite units of the RF Armed Forces, that is, where it is more or less prestigious to serve. As a result, he will be sent somewhere to the infantry, or to the signal troops, where, naturally, no restrictions will be observed, since the “automatic” determination of the type of troops will already serve as a guarantee that such restrictions have already been made.

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

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

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

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

Do not ignore cases if they appear:

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

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