In this article, we will consider such a pathology as incomplete blockade of the right leg of the bundle of His. This is a partial violation of the conductivity of electrical impulses in the heart. This disease is usually asymptomatic, but indicate organic damage to the heart and affect the outcome of the underlying ailment. The diagnosis is based on the results of an electrocardiographic study. Incomplete blockade of the right leg of the bundle of His occurs in one and a half to two point four tenths of a percent of cases, and with age, these indicators only increase. Among all types of blockade in frequency, this pathology takes second place.
Etiology of its occurrence
The cause can be heart defects, coronary heart disease and an overdose of anti-arrhythmia drugs, pulmonary heart, mitral valve stenosis , pulmonary hypertension, tricuspid heart valve insufficiency, acute myocardial infarction, myocarditis, cardiosclerosis, hypertensive heart, imbalance of electrolytes in the body and right ventricular hypertrophy. Quite rarely, incomplete blockade of the right leg of the bundle of His is diagnosed in healthy young people. In such cases, we are talking about a variant of the norm.
Incomplete blockade of the right leg of the bundle of His is the cause of a slowdown in the transmission of both sinus and ectopic pulses along it. And this, in turn, leads to a sharp change in the sequence of excitation of some of the parts of the ventricles or the entire ventricle completely.
Incomplete blockade of the right bundle branch block: symptoms
In most cases, this pathology does not cause any noticeable symptoms, since the rhythm and frequency of the heart does not change.
Diagnosis of this pathology, as mentioned above, is based on data obtained using electrocardiographic studies.
Here is a list of the signs visible on it:
- The duration of the QRS complex is slightly increased, up to nine to eleven hundredths of a second.
- In the first and V6 leads, the S wave is slightly expanded, and on the right thoracic V1 lead, the QRS complex is rSr, or rsR.
Incomplete blockade of the right bundle branch block: treatment
A long and stable existing pathology often does not require any treatment. But in those situations when its appearance coincides in time with an exacerbation of cardiac pathology, timely therapy is of great importance for the normalization of cardiac conduction. If the blockades of both legs are interleaved, temporary pacemaker is indicated, provided that the duration of the HV interval is longer than 80-100 milliseconds. All elderly patients with such conduction disorders are subject to mandatory hospitalization. In acute disorders and the absence of contraindications, drug therapy can be used, while not forgetting the inconstancy and unreliability of the effect of such drugs on this pathology. In the best case, you can count on a temporary effect.
The following drugs are used to treat:
- Anticholinergics that reduce vagal influences, for example 0.1% atropine per milliliter intravenously and 0.2% platifillin also one milliliter per cutaneous or intravenous, but in this case it must be administered on 5% glucose, with a volume of 500 milliliters.
- Drugs that enhance the effect of sympathy on the cardiac conduction system, for example, 5% ephedrine, one milliliter intramuscularly, subcutaneously, or intravenously, 0.2% norepinephrine, in a volume of 1 ml, administered on glucose, or 0.05% alupent, from half to one cube, administered both intramuscularly and intravenously, or 0.1% isadrine, in the amount of one milliliter.
- Glucocorticosteroid hormones, such as hydrocortisone, are also used, at the rate of up to 200 mg per day.
- To reduce the potassium content, it is advisable to use 1% lasix in the amount of one milliliter.
The prognosis of this disease is quite favorable, but, given the danger of exacerbating various concomitant cardiological ailments, it is necessary to take its treatment very seriously.