Blockade of the legs of the bundle of the Gis - Causes, symptoms and treatment. MF.

Causes of blockade of the bundle's legs
Symptoms of blockade
Diagnosis
Treatment of blockage of the legs of the GIS
Lifestyle
Complications and prognosis of the

Sometimes the patient, after receiving an ECG conclusion from a doctor, can hear that he has a bundle blockade of His. This can cause some questions in the patient, especially when it comes to a small child, since a blockage sometimes occurs in children. What is it - a disease or a syndrome, is there a threat to life and health, what should be done in this situation, we will consider in this article.

The neuromuscular system of the heart

So, the bundle of the Gis is a part of the heart muscle, which consists of atypical muscle fibers and includes a trunk and two legs - the left( its anterior and posterior branches) and the right one. The trunk is located in the upper part of the septum between the ventricles, and the legs are directed to the right and left ventricles respectively, disintegrating into the finest fibers of Purkinje in the thickness of the heart muscle. The function of these structures is reduced to transfer the electrical impulses that appear in the right atrium to the myocardium of the ventricles, causing them to contract in a rhythm corresponding to the rhythm of the atria. If the impulse is partially or completely impaired, the bundle of the bundle of the bundle is developed. This is one of the types of conduction disorders, most often occurring without clinical manifestations and characterized by a complete or partial block in the way of impulses in the ventricles of the heart. It occurs in 6 people out of a thousand, and after 55 years - in 2 people out of a hundred, more often in males.

The following types of blockade stand out:

- one-beam - blockade of the right leg;blockage of the anterior or posterior branch of the left foot;
- two-beam - blockage of both branches of the left leg;blockade of the right leg with one branch of the left leg;
- three-beam - blockade of the right and left legs.

Each of these types of blockade can be complete or incomplete. Also, the blockade can be permanent, intermittent( occurring and disappearing during the recording of one ECG), transient( not recorded on each electrocardiogram), or alternating( changing the blockages of different legs during the recording of one ECG).

Causes of blockade of the bundle of the bundle of the

The following diseases can cause conduction disturbances inside the ventricles:

- congenital and acquired heart diseases - aortic and mitral valve stenosis, pulmonary stenosis, stenosis and coarctation of the aortic aorta, aortic valve deficiency, atrial septal defect
- cardiomyopathy, myocardial dystrophy of various origin - endocrine( thyrotoxicosis, diabetes mellitus), metabolic( anemia), food( alcoholism, obesity), autoimmune( systemic crlupus, rheumatoid arthritis)
- ischemic heart disease
- cardiosclerosis as the outcome of many cardiological diseases, leads to replacement of a part of muscle fibers with scar tissue, including atypical muscle fibers
- myocarditis of viral or bacterial origin
- heart damage in rheumatism -endocarditis, myocarditis
- myocardial infarction
- long-term arterial hypertension that led to myocardial hypertrophy
- cardiac glycoside intoxication
- thromboembolismpulmonary embolism
- chronic lung diseases( chronic obstructive bronchitis, pulmonary emphysema, severe bronchial asthma) leading to the formation of the pulmonary heart - stagnation of blood in the right atrium and ventricle with their hypertrophy and expansion of

. In adolescents and adolescents, the incomplete single-bundle rightblockade of may accompany small cardiac abnormalities( an additional chord in the left ventricle, an open oval window, a mitral valve prolapse), and in the absence of an organicof cardiac disease is considered to be a normal option.

One- or two-beam left blockade of is almost always associated with acquired, not congenital heart diseases and can not be regarded as a variant of the norm.

Symptoms of blockade of the bundle of the bundle of the gid

The right-hand, single-beam blockade of , as a rule, shows no sign of itself and is detected accidentally during the passage of the planned ECG.The presence of such complaints as dyspnea, pain in the heart, a sense of disruption in the heart, increased fatigue, may be due to the underlying disease that caused the blockade.

With the front or rear left hemiblock ( one of the branches), the clinical manifestations are also minimal and are caused by the underlying disease.

Complete left blockade of may be manifested by palpitation, dizziness, pain in the heart. It can be caused by massive changes in the left ventricular heart muscle, for example, with acute myocardial infarction.

Three-beam blockade of is caused by a full or incomplete block in the path of the impulse. Incomplete blockade is characterized by a delay in impulses arriving at the ventricles and carried out through several intact fibers, and complete blockade by the absence of impulses to the ventricles and the appearance in them of an ectopic( located where not necessary) foci of excitation, with complete separation of the atria and ventricles that occurshrink in their rhythm with a frequency of 20 - 40 beats per minute. This frequency of contractions is much lower than normal and can not provide adequate discharge of blood into the aorta. Clinically manifested by frequent dizziness, a sense of disruption in the work of the heart and a tendency to fainting due to a sharp decline in cerebral blood flow( attacks Morganya - Edessa - Stokes).May lead to the development of life-threatening complications or cause sudden cardiac death.

Diagnosis of

This conduction disturbance can be detected by standard electrocardiography. Further tactics of the doctor depends on the type of blockade identified.

If the incomplete right blockade is detected and in the absence of cardiological diseases, the physician may regard this as a variant of the physiological norm and do not prescribe additional examination methods.

Two-beam blockages require more detailed examination of the patient. If a complete left blockade is detected on the ECG for the first time in life, then an immediate hospitalization is required, even if the patient does not complain, since this condition is due to extensive processes in the myocardium. The age of these processes( chronic cardiosclerosis or acute myocardial infarction, especially its painless form) is better to find out in a hospital under the supervision of doctors. In addition, manifestations of such a blockade on the ECG mask ECG - the criteria for myocardial infarction, so the doctor simply can not confirm or refute the infarction only on a cardiogram. A long-term complete left blockade in the absence of a worsening of the course of the underlying disease does not require a stationary observation.

Three-beam blockade is an indication for emergency admission to a hospital for a more complete examination and resolution of the issue of cardiac surgery.

Signs of blockade on the ECG are:

- blockade of the right leg. In the right leads( V 1, V 2) M-shaped complexes of the type Rsr or rSR, in the left leads( V5, V6) the tooth S is wide, jagged, the QRS complex is greater than 0.12 with the

-block of the left leg. In the left leads( V5, V6, I,) the broadened deformed ventricular complexes without the Q tooth with the split apex of the tooth R, in the right leads( V1, V2, III,) the deformed complexes with the split vertex of the S wave, the width of the complex is more than 0.12 with

-three-beam blockade - signs of right and left blockades, signs of atrioventricular blockade of I, II, III degrees.

Of the additional methods of examination in a polyclinic or in a cardiology department, routine diagnostic methods can be prescribed to the patient-general blood tests, urine tests, biochemical blood tests, and:

• Daily monitoring of the ECG is indicated to detect a transient blockade within 24 hours.
• Transesophageal electrocardiography helps to diagnose rhythm disturbances in case of uninformative normal ECG
• Echocardiography diagnoses organic cardiac pathology, evaluates ejection fraction, myocardial contractility.
• MSCT of the heart( multispiral computed tomography) or MRI of the heart( magnetic resonance imaging) can be shown in controversial and diagnostically unclear cases for the detection of heart disease.

Treatment for blockade of the bundle of the bundle of the gums

There is no specific drug treatment for this conduction disorder. Patients with blockade of the right leg of the bundle of His in the absence of the underlying disease, do not need treatment. Patients with one- or two-beam blockade for the treatment of the underlying disease can be assigned the following groups of drugs:

- vitamins - thiamine( vitamin B1) with lipoic acid, riboflavin( vitamin B2), nicotinic acid( vitamin PP)
- antioxidants - ubiquinone, carnitine, mexidol, preductal
- herbal sedatives( St. John's wort, motherwort, valerian, sage)
- antihypertensive drugs for the treatment of arterial hypertension - ACE inhibitors( perindopril, lisinopril), antagonists of angiotensinogen II receptors( losartan, valsartan), beta-adrenoblockers( bisoprolol, atenolol), calcium channel antagonists( amlodipine,verapamil).The last two groups should be administered with caution, as they reduce the heart rate
- anianginal drugs for the treatment of coronary heart disease - short and long-acting nitrates( nitroglycerin, isoket, cardioket, monochinke)
- antiplatelet agents for preventing thrombosis in the heart and in the vessels -aspirin, cardiomagnesium, trombo Ass
- lipid-lowering drugs for normalizing cholesterol-statins( rosuvastatin, atorvastatin, simvastatin)
- diuretics and cardiaclikozidy in the development of chronic heart failure - indapamide diuver, lasix;strofantin, digoxin
- preparations for the treatment of bronchopulmonary system diseases that caused the development of pulmonary heart - inhalation adrenomimetics and glucocorticosteroids( berotek, berodual, spiriva, беклазон)
- antibiotics, nonsteroidal anti-inflammatory drugs in inflammation of the heart membranes - penicillin;nimesulide, diclofenac

In addition to medication, a surgical method of blockade treatment is used, which consists in the installation of an electrocardiostimulator( ECS) to the patient. The complete right blockade, especially in combination with the left hemiblockade( blockage of one branch of the left leg), and the complete left blockade that developed in the acute period of myocardial infarction( 10-14 days), is an indication for temporary pacing by inserting the electrode through the central vein into the rightventricle. A three - beam blockade with a full atrioventricular block, a rare rhythm of ventricular contractions and with attacks of Morgani - Edessa Stokes( loss of consciousness) is an indication for permanent electrocardiostimulation( implantation of an artificial pacemaker or cardioverter - defibrillator).

Lifestyle with blockade of the bundle of the GIAS

Patient with right leg blockade without clinical manifestations and without heart disease can lead a healthy lifestyle with the usual physical exertion. In the presence of the underlying disease that caused a two-beam or three-beam blockade, you need to limit the stress and stress, rest more, eat properly, get rid of bad habits.

When installing the ECS the patient should always carry a card of the pacemaker owner, avoid the close impact of electrical appliances and mobile phone on the implantation area. For example, do not lean against the TV, talk on the phone, pressing it to your ear on the opposite side, have a hair dryer or electric shaver no closer than 10 cm from the implantation area.

The patient should visit the doctor once a year for ECG transmission or more often if this is prescribed by the attending physician. When the ECS is installed, the first visit to the doctor - cardiosurgeon and arrhythmologist after discharge will take place in three months, then in six months, then twice a year.

Complications of

Complications include paroxysmal ventricular tachycardia, ventricular fibrillation, asystole( cessation of cardiac activity - sudden cardiac death).Complications of the underlying disease in a patient with blockade can be acute and chronic heart failure, thromboembolic complications( pulmonary embolism, stroke).

Prevention of complications is the timely examination, regular visits to the doctor and the fulfillment of all his prescriptions, especially for patients with heart and vascular disease.

Forecast

Summing up everything written, it can be said that the blockade of the bundle of His is not a disease, but a symptom of heart disease, which either appears on the ECG, or manifests itself clinically. In order to know what consequences may occur in this or that type of blockade, it is necessary to take into account that the prognosis depends on the disease that led to the development of the block.

With a single-bundle right blockade and no cardiac or pulmonary pathology, the prognosis is favorable. With the development of a complete block of the left leg against a background of myocardial infarction, the forecast is unfavorable, since the mortality rate reaches 40-50% in the acute period of the infarction. The prognosis of the three-beam blockade is also unfavorable, as the likelihood of developing asystole increases.

Doctor therapist Sazykina O.Yu.