ECG with blockade of the left leg of the bundle of His, the causes of the development of pathology, methods of treatment
Blockade of the legs of the beam is a conduction failure in the heart, it is characteristic for it to inhibit or complete blocking in the cardiac muscle of a pulse impulse excitation along one or several branches of the beam His. Such a deviation can be asymptomatic. Diagnosed by medical examination of the patient, sometimes gives itself out as such: failures of palpitations, dizziness, and sometimes loss of consciousness. Diagnosis of the disease occurs by electrocardiography. Therapeutic measures are aimed at eliminating the factors that have become the provocateurs of the disease, it often requires the installation of an artificial heart rate controller.
In a healthy person, the rhythm of the heart is sinusoidal, thanks to it the conductivity of impulses is carried out, which contributes to the contractile action of the myocardium.
The anteroposterior line passes through the interventricular wall, in the middle it divides into three branches: anterior, median branch and posterior branch.
The impulse originates in the right atrium, from which it passes into the atrioventricular zone, where Atrial excitation is formed, then through the left leg it passes into the left ventricular region. Here, deviations in the organization of the impulse and its permeability are manifested.
With blockade of the left leg of the bundle of His (Blin), an absolute or partial inhibition of the passage of the pulse can be traced. The diagnosis is based on an electrocardiogram..
Important! This is not a separate pathology, it develops in other diseases of the heart and blood vessels, therefore, during treatment, the main therapeutic measures should be concentrated on curing the underlying pathology..
The risk of a pathology increases in the elderly, mostly in men, but this does not mean that children are not subject to such deviations.
Blockades are allocated full and partial, with a damaging effect on one or two knives. The complete blockade of the left leg of the bundle is different from the final stop of the pulse transmission. Partial is a delay. At stage 1, the impulses penetrate longer than usual, with the second stage - part of the impulses stop, that is, they pass only partially. These stages are classified as incomplete blockade of the left leg of the bundle. Complete blockade is characterized by an independent ventricular contraction, which entails a decrease in heartbeats: their maximum number does not exceed 40 beats per minute, but 60-80 is necessary.
- Two-beam PPPG
- Forecast and consequences
The following causes are identified that contribute to the formation of the disease:
- Endocarditis, myocarditis (development of rheumatism).
- Heart disease.
- A heart attack.
- Blockage of the pulmonary artery.
- Poisoning of the body with drugs of inhibitors.
- Cardiomyopathy, myocardial dystrophy.
- Hypertrophy of the myocardium.
- Chronic lung disorders (bronchitis, asthma and others).
In children, a blockade of the left leg of the bundle of the Hyis can form due to defects in the heart:additional ventricular chord, prolapse of the left valve and others.
Certain signs of blockade are absent, but there are some discrepancies on the cardiogram.
On the ECG, the complete blockage of the left leg of the fasciculus is determined by discrepancies, when the cardiac axis is shifted to the left, the operation of the pedicle is not observed. This phenomenon can develop after a heart attack and significant deviations in the left ventricular zone. There are complaints of pain, increased heartbeat, malaise, pre-stupor.
The blockade of the anterior branch of the left branch of the bundle of the Hisnia (abbreviated BPVLNPG) in ECG is determined by the following indices:
- Deep S teeth.
- High R. tooth.
- The QRS complex departs from the standard state to the right or to the left.
Characteristic signs are absent, but are capable of manifesting symptoms of a key disease.
The blockade of the posterior branch of the left branch of the bundle is determined by the same deviations, only the QRS deviates from the norm to the side.
Regardless of which side of the branching is affected, certain deviations are considered to be signs on the ECG. There can be no pain in the chest, lack of air.
With incomplete blockade of the left leg of the bundle, the excitation is passed through the minimally damaged branch, as a result of which the atrioventricular block of the 1st or 2nd degree begins to form. At full - impulses can not pass, therefore formation of a blockade of 3 degrees, a ciliary arrhythmia is observed.
As the number of strokes decreases, the body suffers from oxygen starvation, which is manifested by severe dizziness, frequent fainting, and heart rhythm disturbances. Often there is a cardiac arrest and death occurs - this is what the disease is dangerous.
At the reception the therapist discovers failures in the number of cuts, which is the reason for a thorough examination of the patient. ECG with blockade of the left leg of the bundle of the Hisnus is the main diagnostic method, according to the received data, conclusions are drawn.
- The blockade of the anterior branch of the left branch of the bundle of His on the ECG is represented by an intense S-wave, the QRS-complex moves to the left and upwards.
- The posterior branch is characterized by the displacement of the QRS complex upwards, forward to the right, deep tooth S, high R.
Attention! When examining the results of analyzes, one must not forget that both violations are accompanied by myocardial infarction or heart failure..
- Blockade of the right leg is characterized by an enlarged and high tooth R, an enlarged tooth S. Provocators can serve as myocardial infarction, ischemia, congenital heart defects and other pathologies.
- The left leg is characterized by a deviation of the cardiac axis from the left or horizontally. The tooth R is enlarged, and the peak is acute and flat. More often it indicates hypertension, but sometimes it can characterize a heart attack.
- The blockade of the right leg and left anterior branch is characterized by a deviation of the cardiac axis to the left side, the RS-T section leaves downwards. This often indicates concomitant ischemia or other cardiovascular diseases.
After studying the data of the electrocardiogram, the patient is referred for analysis so that the diagnosis can be reliably diagnosed:
- Continuous recording of an electrocardiogram for a day or longer for a cardiovascular device. It makes it possible to determine violations of all kinds of conductivity, since they can differ at different time intervals, and to identify a transient blockade.
- Electrophysiological research (EFI) is appointed as an additional method in case of doubt.
- Blood test.
- Analysis of urine.
The last two analyzes make it possible to determine the equilibrium of electrolytes, the hormonal level, the presence of autoimmune reactions.
To determine the concomitant diseases, the following diagnostic measures are carried out:
- Echocardiography (EchoCG).
- Magnetic resonance imaging.
- Multispiral computed tomography.
- Positron-emission tomography (PET).
For the diagnosis of pathology, the child uses the same methods as in adults.
Incomplete blockade of the left leg of the bundle of Hisb usually does not need treatment. More often, such a violation does not have serious causes of occurrence and does not pass into neglected stages, therefore it is not dangerous for a person. Only occasionally, under elevated pressure, they are able to pass to the second or third degree, in such situations, the specialist prescribes the patient medication for prophylactic purposes.
Approximately the same happens when observing more serious blockades. The doctor determines complex therapy. Primary treatment is directed to the main pathology, which became a provoker of this phenomenon. Most often the following measures are assigned:
- Vitamins in injections - Nicotinic acid, Thiamine, Riboflavin and others. Introduced intravenously or intramuscularly.
- Soothing drugs (Valeriana, Motherwort).
- Antioxidant preparations (Preductal, Picture and others).
- Means, which lower the pressure (Amlodipine, Valsartan, Verapamil).
- Means for the prevention of ischemia (Nitroglycerin).
- Drugs for lowering cholesterol in the blood (Rosuvastin, Simvastin).
- Glycosides and diuretics (Lasix, Digostin) - with heart failure.
- Antithrombotic agents (Cardiomagnet).
Therapy is prescribed by the attending physician based on each individual case. Surgical methods of treatment are often necessary. Such therapy is necessary with two three-beam blockades and a complete one of the branches. The installation of pacemakers (permanent or temporary) is widespread. Sometimes the doctor considers it rational to conduct radiofrequency catheter ablation - a minimally invasive technique with the introduction of a catheter. It is possible to install a cardioverter-defibrillator, which causes the heart muscle to contract.
Most often during blockades a person can live an everyday life, but it is necessary to eliminate physical and emotional overstrain. Doctors recommend doing gymnastics, relaxing and walking outdoors. Provide a healthy diet, use unsalted and low-fat food, to refrain from bad habits, with more harm to nicotine..
Important! After the pacemaker is installed, it is necessary to visit the specialist 3 months later, then 6 months, and in the absence of any problems - once a year..
Forecast and consequences
With partial blockade and absence of serious impairment, no close consequences occur, especially if the patient follows all the recommendations of a specialist. Forecasts in such cases are favorable.
With full and three-beam blockade, the prediction is not so positive, as it often ends with the patient's death... .