Many patients are interested in what the blockade of the right bundle of His bundle means, how exactly such a violation manifests itself, what the consequences may be, and also how the diagnosis and treatment are carried out. A similar pathology is associated with a deterioration in the passage of nerve impulses inside the heart.
It may be incomplete and complete. With an incomplete blockade, the possibility of conducting cardiac electrical impulses is lost. Basically, a complete blockade is formed if the lesion area is located in the branching branch of the His bundle.
Features of violation
Blockade of the right leg of the bundle of His is a dangerous disease associated with impaired passage of the heart pulse, which is required for the normal functioning of the heart muscle. Very rarely, such a disorder is diagnosed in young people, since it is mainly observed in the elderly.
Often, the disease occurs in men after 45 years and quite often forms as a result of a previous heart attack. In this case, the partial blockade of the right bundle branch block is predominantly determined. The disease is caused by a deterioration in the flow of an electrical impulse through certain sections of the heart muscle.
Classification
Doctors distinguish several types of blockade of the right leg of the bundle of His, divided by the anatomical structure:
- single beam;
- double beam;
- three-beam.
One-beam defeat is characterized by the fact that only one leg is blocked, and three-beam affect all branches. According to the degree of impulse conduction of impulses, full and partial damage is distinguished.
Incomplete blockade of the right leg of the bundle of His is caused by a violation of the passage of the pulse along only one branch. At the same time, the function of other branches is not violated. Excitation of the ventricles of the myocardium is much slower than normal. When slowing down the process of passing an impulse along the branches of a doctor, heart block 1 degree is isolated. If some leaking impulses reach the ventricular region, then this is a violation of 2 degrees.
At grade 3, a complete blockage occurs, which is determined by the impossibility of the flow of heart pulses into the ventricles. For this reason, they cannot contract on their own.
Complete blockade of the right leg of the bundle of His is caused by a dangerous violation of the conduction of nerve impulses. Often, such a pathology indicates the occurrence of a serious organic myocardial damage. Despite this, for a long time absolutely no dangerous signs are manifested, with the exception of only the symptoms of the underlying cardiological disease.
By the duration of the blockade of the legs can be permanent or transient. In some cases, disorders are characterized by impaired passage of impulses, which begins to develop with changes in heart rate. In particular, it may be bradycardia or tachycardia.
Disease in children
The blockade of the right leg of the bundle of His in a child can form even during fetal development, that is, during the course of pregnancy. However, such a violation can occur against a background of a previously suffered disease of the cardiovascular system.
Basically, in childhood, such a violation is associated with congenital conditions, in particular, such as:
- pseudochord in the left ventricle;
- open oval window;
- mitral valve prolapse.
In the event that no pronounced organic pathologies are detected, blockade of the right leg of the bundle of His in childhood and adolescence can be considered a normal condition, since there can be no critical complications in the work of the cardiovascular system.
Causes of occurrence
Most often, the blockade of the right leg of the bundle of His is diagnosed in people over the age of 45 years, however, such a pathology is very rarely manifested by severe symptoms.
In adults, such a violation is mainly associated with acquired dysfunctions of the heart muscle. Left-sided damage can be associated with various kinds of adverse effects of the internal and external environment, which provokes a malfunction of the tissues of the heart muscle and electrical conductivity. Among the most common causes of blockade of the right bundle branch block in adults, there are such as:
- insufficiency of aortic valves;
- thromboembolism;
- septal defects;
- cardiomyopathy;
- autoimmune disorders;
- heart ischemia;
- cardiosclerosis;
- heart attack;
- chronic course of pathologies of the respiratory system.
Among the reasons, it is also necessary to highlight drug and alcohol intoxication, as well as the use of certain cardiac glycosides. In some cases, the development of the disorder may be due to a genetic predisposition. In this case, the symptomatology is completely absent, and the pathology is detected completely by accident. In addition, dangerous lesions and injuries of the sternum, malignant neoplasms, as well as previous operations in this area can lead to the development of complete or incomplete blockade of the right leg of the bundle of His.
In some cases, infectious diseases, in particular such as typhoid and syphilis, can provoke a violation. Hormonal disorders can also be a predisposing factor.
Main symptoms
Signs of blockade of the right leg of the bundle of His are expressed in the form of a deterioration in the necessary electrical conductivity or there may be no symptoms. Basically, such a pathology is detected quite by accident during the diagnosis of other diseases. Usually, the presence of a problem is determined by conducting an electrocardiogram. With complete blockade of the right leg of the bundle of His, signs such as:
- dizziness;
- dyspnea;
- decreased performance;
- heart rhythm disturbance;
- general weakness;
- lack of air;
- panic attacks;
- fainting
- increase in pressure.
It is worth noting that there are many different manifestations that may be signs of a complete blockade. In some cases, it is quite difficult to determine what exactly provoked the occurrence of the violation.
Three-beam blockade is often manifested by very dangerous signs, up to a complete cardiac arrest, which requires urgent hospitalization and solving the issue of surgery.
Diagnostics
You can establish a diagnosis of blockade of the right leg of the bundle of His on an ECG (electrocardiogram). During the study, the change in ventricular complexes is determined. Due to the fact that such a violation often occurs against the background of a slightly altered myocardium, one can determine on the electrocardiogram (ECG) the blockade of the right bundle branch block, as well as other conduction anomalies.
Sometimes other research methods may be used, in particular, such as:
- echocardiographic examination;
- Holter monitoring;
- laboratory blood tests;
- intracardiac electrophysiological examination.
Complete blockade does not require specific therapy, since it is itself safe for the patient’s health. It is only necessary to treat the underlying heart disease, which caused the development of conduction disturbance of the electric pulse.
Treatment features
Therapeutic measures consist, first of all, in eliminating the disease that led to the onset of blockade. It is worth noting that specific therapy does not exist. For example, congenital heart defects can be treated with surgery. If the patient suffers from angina pectoris, heart failure and hypertension, then therapy is prescribed by the use of cardiac glycosides, antihypertensives and antiarrhythmic drugs.
For some young people, such a blockade is considered normal, so treatment is not prescribed. A doctor can recommend only dynamic monitoring and periodic consultation with a cardiologist. Depending on the underlying disease established during the examination, the patient needs constant monitoring and treatment by a general practitioner or cardiologist. Observation implies an assessment of the dynamics of ongoing changes on the electrocardiogram and correction of the prescribed therapy.
Drug therapy
A universal remedy for eliminating violations has not yet been developed. Basically, therapy is aimed at eliminating the existing symptoms, as well as at preventing the development of complications. In the presence of a pronounced clinical picture, the doctor prescribes such drugs as:
- antioxidants;
- antihypertensive drugs;
- diuretics;
- vitamins;
- sedatives;
- anticholinergic drugs;
- cardiac glycosides.
A prerequisite for the full restoration of the required electrical conductivity of the heart muscle with complete blockade is the use of vitamin complexes. To normalize the structure of the affected tissue, the use of antioxidants is required. These drugs include Mexidol, Carnitine, Ubiquinone.
In the case of vivid signs of hypertension, antihypertensive drugs are prescribed. These include ACE inhibitors, in particular, such as Perindopril or Lisinopril. In addition, calcium channel antagonists may be prescribed, but it is not recommended to use them with a reduced heart rate.
With the development of a dangerous disorder against the background of ischemia, the doctor mainly prescribes anti-anginal drugs, including nitrates. These include "Isoket", "Nitroglycerin", "Cardiket". In the case of detecting signs of heart failure and to prevent the occurrence of dangerous complications, cardiac glycosides and diuretics are prescribed. In addition, you need to lower cholesterol and eliminate atherosclerotic plaques.
In the presence of an inflammatory process that affects the muscle tissue of the heart, the use of antibiotics and anti-inflammatory drugs is required. In particular, Diclofenac, Penicillin, Nimesulide are actively used. Sedatives are mainly used as additional support.
Surgical intervention
In the case of ineffectiveness of drug therapy, as well as with constant fainting or the occurrence of malignant processes, surgery is prescribed. With a complicated course of the disease, the doctor may prescribe the implantation of a pacemaker.
In the event that the blockade proceeds without obvious clinical signs, dynamic monitoring and periodic examination are indicated.
Lifestyle
If the patient's well-being is quite satisfactory and there are no dangerous consequences and complications, then he may well lead a familiar lifestyle, without limiting physical exertion. There are also no other contraindications. When leaking two- and three-beam blockades, compliance with such recommendations as:
- restriction of psychoemotional and physical stress;
- proper nutrition;
- frequent rest;
- smoking cessation and alcohol consumption.
With proper observance of all the doctor's recommendations, the patient's health can be significantly normalized.
Possible complications
With the occurrence of such a disease, it is necessary to know the danger of blocking the right leg of the bundle of His in order to prevent the occurrence of unpleasant consequences in a timely manner. Among the main complications, it is necessary to highlight such as:
- acute cerebrovascular accident;
- aggravation of the course of the main pathology;
- thromboembolism with a thickening of blood.
The most dangerous consequence of the blockade of the right bundle branch block is sudden death. A similar complication can be with complete blockade.
Forecast and Prevention
Prevention of the occurrence of pathology boils down to timely treatment of diseases that could provoke the development of a disorder. In addition, you must systematically visit a medical institution, as well as comply with absolutely all the instructions and recommendations of the attending physician. This is especially true for people who have been diagnosed with heart and vascular diseases.
The general prognosis of the pathology depends on the cause that provoked the formation of blockade of the bundle of His. With a right-sided violation in the absence of pulmonary and cardiac disorders, the prognosis is quite good. A complete blockade that occurs with necrotization of myocardial cells leads to very serious consequences. Mortality in this case reaches fifty percent. Three-beam blockades also have a poor prognosis, since there is a high probability of the formation of asystole and the subsequent death of the patient.