Bundle branch block - Causes, Symptoms and Treatment .MF .
reasons bundle branch block
legs Symptoms blockade
Diagnosis Treatment of blockade legs Gisa
Complications and prognosis
Sometimes the patient, obtaining the opinion of the ECG from a doctor can hear that his bundle branch block.This may cause some problems in the patient, especially if it is a small child, as children and sometimes there is a blockade.What is it - a disease or a syndrome, if there is a threat to life and health that need to be taken in such a situation, we will look at in this article.
The figure shows the neuro - muscular system of the heart
So, bundle of His - it's part of the heart muscle, which consists of abnormal muscle fibers and includes a trunk and two legs - the left (in the front and rear leg) andright.The barrel is located at the top of septum between the ventricles, and the legs are directed to the right and left ventricles, respectively, breaking into small Purkinje fibers in the thickness of the heart muscle.The function of these structures is to
are the following varieties of the blockade:
- single-beam - the blockade of the right leg;block the front or back of the branches of the left leg;
- two-beam - a blockade of both branches of the left leg;blockade of the right leg with one branch of the left leg;
- Three-beam - the blockade of the right and left legs.
Each of these types of blockade may be complete or incomplete.Also, the blockade may be constant, intermittent (come and go in the process of recording a single ECG), transient (not registered in each electrocardiogram) or alternating (change blockades different legs in the process of recording a single ECG).
reasons bundle branch block
causes a disturbance of conduction within the ventricles are diseases such as:
- congenital and acquired heart defects - stenosis of the aortic and mitral valves, pulmonary artery stenosis, stenosis and coarctation of the aorta, the inadequacy of the aortic valve defectatrial septal
- cardiomyopathy, myocardial dystrophy of different origin - endocrine (hyperthyroidism, diabetes mellitus), exchange (anemia), food (alcohol, obesity), autoimmune (systemic lupus erythematosus, rheumatoid arthritis)
heart disease - cardio as the outcome of manyheart disease, leading to the replacement of the muscle fibers of scar tissue, including atypical muscle fibers
- myocarditis, viral or bacterial origin
- the defeat of the heart with rheumatism - endocarditis, myocarditis
- myocardial infarction
- long-existing hypertension, leading to hypertrophymyocardial
- intoxication cardiac glycosides
- pulmonary embolism
- chronic lung disease (chronic obstructive bronchitis, emphysema, severe asthma), leading to the formation of pulmonary heart - stagnation of blood in the right atrium and ventricle with their hypertrophy and expansion
Doyoung children and adolescents incomplete blockade of the right single-beam may be accompanied by small anomalies of heart development (additional chord in the left ventricle, patent foramen ovale, mitral valve prolapse), and in the absence of organic heart disease is considered to be the norm for this.
One- or two-beam left blockade almost always associated with acquired and not congenital heart disease and can not be regarded as a variant of the norm.
Symptoms branch block
beam single-beam legs right blockade , as a rule, does not manifest itself and detected by chance during the passage of a planned ECG.The presence of such complaints as shortness of breath, pain in the heart, a sense of disruption of the heart, fatigue may be due to the underlying disease that caused the blockade.
When the front or the rear left gemiblokade (one branch) the clinical manifestations are minimal and are caused by the primary disease.
complete blockade left can manifest a sense of palpitations, dizziness, pain in the heart.It can be caused by massive changes in the heart muscle of the left ventricle, such as acute myocardial infarction.
Three-beam blockade called complete or incomplete block in the way of momentum.Incomplete blockade is characterized by a delay of impulses coming to the ventricles and held for several intact fibers and complete - the absence of pulses to the ventricles, and the appearance of them ectopic (located not where it should be) a focus of excitation, thus there is a complete separation of the atria and ventricles, whichreduced in their rhythm with a frequency of 20 - 40 beats per minute.This frequency rate significantly lower than normal and may not provide an adequate ejection of blood into the aorta.Clinically manifested by frequent dizziness, a feeling of disruption in the work of the heart and a tendency to fainting due to a sharp decrease in cerebral blood flow (Morgagni attacks - Edemsa - Stokes).It may lead to life-threatening complications or cause sudden cardiac death.
This conduction disturbances can be detected during standard electrocardiogram.Further tactics of the doctor depends on the type of the detected block.
If there is an incomplete blockade of the right and in the absence of cardiac disease doctor can interpret it as a variant of the physiological norm, and not to appoint additional methods of examination.
two-beam blockade require a more detailed examination of the patient.If the total blockade of the left detected on an electrocardiogram for the first time, it requires immediate hospitalization in a hospital, even if the patient did not complain, as this condition is caused by extensive processes in the myocardium.Prescription of these processes (chronic cardio or acute myocardial infarction, especially painless its shape) is better to find out in a hospital under the supervision of doctors.In addition, the existence of such a blockade on an electrocardiogram ECG camouflage - the criteria for myocardial infarction, so the doctor simply will not be able to confirm or deny a heart attack only by ECG.Continuously there is a complete blockage left with no worsening of the underlying disease does not require inpatient monitoring.
Three-beam blockage is an indication for emergency hospitalization for a more complete examination and a decision on the treatment of cardiac surgery.
signs of the blockade on the ECG are:
- blockade of the right leg.The right leads (V 1, V2) M - shaped complexes Rsr type or RSR, to the left leads (V5, V6) S wave wide, jagged, QRS complex with more than 0.12
- blockade of the left leg.The left leads (V5, V6, I,) broadened deformed ventricular complexes without Q wave the split-vertex wave R, on the right leads (V1, V2, III,) deformed complexes with split-vertex wave S, the width of the complex of more than 0.12 to
- Three-beam block - signs of the right and left blockades, signs of atrioventricular block I, II, III degree.
From additional methods of examination in the clinic or in the department of cardiology patient can be assigned to routine diagnostic methods - the general blood tests, urine tests, blood chemistry, as well as:
- ECG monitoring is indicated for the detection of transient blockade during the day.
- Transesophageal electrocardiography help diagnose arrhythmias during normal ECG uninformative
- Ehokadiografiya diagnoses organic heart disease, assess ejection fraction, myocardial contractility.
- heart MSCT (multislice computed tomography) or MRI of the heart (the magnetic - resonance imaging) may be indicated in the disputed and diagnostically unclear cases to detect heart disease.
Treatment branch block
beam legs specific medication given no conduction abnormalities.Patients with right bundle branch block in the absence of underlying disease, treatment is not needed.Patients with one- or two-beam blockage for the treatment of the underlying disease can be assigned to the following groups of drugs:
- vitamins - thiamin (vitamin B1) with lipoic acid, riboflavin (vitamin B2), niacin (vitamin PP)
- antioxidants - ubiquinone,carnitine, mexidol preduktal
- sedative drugs of plant origin (St. John's wort, motherwort, valerian, sage)
- antihypertensive agents to treat hypertension - ACE inhibitor (perindopril, lisinopril) receptor antagonists angiotenzinogenu II (losartan, valsartan), a beta -blockers (bisoprolol, atenolol), a calcium channel antagonist (amlodipine, verapamil).The latter two groups should be administered with caution as reduced heart rate
- anianginalnye drugs for the treatment of coronary heart disease - nitrates short and long-acting (nitroglycerin, izoket, kardiket, monocinque)
- 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)
- diuretics and cardiac glycosides in the development of chronic heart failure - indapamide, diuver, lasix;strofantin, digoxin
- drugs to treat diseases of respiratory system, caused the development of "pulmonary" heart - agonists and inhaled corticosteroids (berotek, Flomax, Flomax, Beclason)
- antibiotics, nonsteroidal anti-inflammatory drugs in inflammation of the heart membranes - penicillin;nimesulide, diclofenac
Besides medication, applied surgical treatment of the blockade, which is to install a pacemaker patient (ECS).Full right block, especially in combination with the left gemiblokadoy (blockage of one branch of the left leg), and the total left block, developed in the acute phase of myocardial infarction (10 - 14 days), is an indication for temporary pacing by introducing the electrode through a central vein in the rightventricle.Three-beam with a complete blockade atrio - ventricular block, rare rhythm of ventricular contractions and seizures Morgagni - Edemsa - Stokes (loss of consciousness seizures) is an indication for permanent pacing (implantation of an artificial pacemaker or cardioverter - defibrillator).
Lifestyle at blockade bundle branch block
patient with the blockade of the right leg without clinical manifestations and without heart disease can live a healthy life with the usual physical activity.In the presence of underlying disease that caused the two-beam or Three-beam blockade is necessary to limit the burden and stress, get plenty of rest, eat right, get rid of bad habits.
When installing the pacemaker patient must always carry with them the card holder pacemaker, avoid close exposure to electrical and mobile phone on the implantation area.For example, do not lean against the TV, talk on the phone, pressed it to his ear on the opposite side, to have a hair dryer or electric shaver no closer than 10 cm from the area of implantation.
patient should visit the doctor once a year to undergo an electrocardiogram, or more frequently, if ordered by your doctor.When installing the pacemaker first visit to the doctor - heart surgeon and arrhythmology after discharge will take place over three months, then six months, then twice a year.
Complications Complications include paroxysmal ventricular tachycardia, ventricular fibrillation, asystole (cessation of cardiac activity - sudden cardiac death).Complications of underlying disease in a patient with a blockage can be acute and chronic heart failure, thromboembolic complications (pulmonary embolism, stroke).
prevention of complications is timely inspection, regular visits to the doctor and the implementation of all its provisions, especially for patients with heart and vascular diseases.
summarize all that is written, we can say that the bundle branch block is not a disease, but a symptom of heart disease, which is either detected on an electrocardiogram, or clinically manifested.To know what the consequences may be in the form of a blockade must be considered that the outlook depends on the disease, which led to the development of the block.
In single-beam right blockade and absence of cardiac or pulmonary disease prognosis.When total blockade of the left leg on the background of the development of myocardial infarction unfavorable prognosis, since mortality rates as high as 40 - 50% in the acute phase of a heart attack.Forecast Three-beam blockade also unfavorable, as is more likely the development of asystole.
therapists Sazykina OJ