Incomplete blockade of the right bundle branch leg
author: cardiologist Merter M.V.
Incomplete blockade of the right leg of the bundle of His (abbreviated as NBPPG) is a partial violation of the patency of the electric pulse through the right leg of the bundle.
This incomplete blockade refers to conduction abnormalities at the ventricular level of the heart, thus referring to intraventricular blockages. In some cases, this phenomenon can be detected in young, practically healthy people, which is a variant of a physiologically normal state. Given that the blockage of any of the legs of the bundle of His expressed conductivity disorder, there is a need to examine the patient to identify and treat the disease that caused this violation.
The causes of NBPV are classified into congenital and acquired.
1. In the Born :
· Incomplete development of the PPPG segment;
· Stenosis of the mouth of the LA;
· Lenegre disease, which is usually detected in children born to mothers with type 2 diabetes;
· M.Lev disease;
· Other AMS that lead to RV overload.
2. Purchased :
Chronic obstructive airways disease;
Dull trauma of the chest;
· Various tumor processes;
Progressive muscular dystrophy;
· Electrolyte disorders (hyperkalemia);
· Intoxication with drugs of quinidine, digitalis, novocaineamide less often - cardiac glycosides, beta - adrenoblockers;
· Diseases accompanied by a lesion of the right ventricle (pulmonary heart, insufficiency of the 3-fold valve, mitral stenosis, high LH) or left ventricle of the heart (chronic ischemic heart disease, cardiosclerosis, acute myocarditis, myocarditis of various etiologies, hypertensive heart).
· Hypertrophy of the prostate.
The mechanism of development.
As a result of the development of incomplete blockade, there is a slowdown in the pulse of the heart system, leading to the fact that physiologically correct excitation of its right divisions does not occur.
Clinical evaluation of NBPPG.
At the moment it is known that, despite the serious reasons causing this pathology of the conduct, this blockade usually proceeds quite benignly. In addition, if there is an isolated NBPPH, that is, if there are no organic disorders in the myocardium, the process is rarely able to go into a complete blockade. A small number of researchers believe that the transition to the degree of a complete blockade can be achieved only by joining another serious pathology, which in any case would lead to this disruption of the conduct.
Isolated NBPPG usually has no external manifestations and, as a rule, is an accidental finding when recording ECG, conducted for completely different reasons.
In the remaining cases, the symptoms of the underlying disease, which are found in the auscultation, will be present, and since the NBPVH itself does not have symptoms, it is detected on the basis of the main ECG disease.
The diagnosis of incomplete blockade at the level of the right leg is revealed only on the basis of the ECG study. When decoding ECG in patients with NBPN, the terminal tooth S in the leads on the left (I, aVL, V5 and V6) is found; tooth R ' in V1, as well as in V2 (but may not be present). ECG with hypertrophy of the prostate is characterized by the presence of a deviation of the cardiac axis to the right, a narrower QRS complex, and the appearance of QR, QRS or RS complexes in V1 . In patients with NBPN, the duration of the QRS complex may be within the normal range, but most often is 0.9 to 0.11 seconds. There is also usually a positive prong T that is directed opposite to the anomalous S- wave in the leads on the left, and sometimes it can be opposite to the R ' tooth and is inverted again in the pectoral leads on the right.
Therapeutic measures at NBPPG are to treat the disease that caused the development of this pathological condition. That is, specific therapy of the blockade itself is not carried out. So, for example, the UPU are subject to prompt correction in a cardiosurgical clinic. If the patient has signs of heart failure, stenocardia, hypertension, then it is necessary to carry out drug therapy using the appropriate classes of drugs and first aid in cardiac arrhythmia before examination by a cardiologist. It should be noted that sometimes this option is considered normal for young people, so treatment is not prescribed. Supervision in the dynamics and examination of a cardiologist is recommended.
According to the identified underlying disease, the patient needs dynamic observation and specific therapy with a physician-therapist or cardiologist. The observation provides for an assessment of the changes in the ECG in the dynamics and correction of the performed drug therapy on the basis of clinical and laboratory studies.
Prognosis and complications.
In young people without the presence of any pathology of the heart of an organic nature, the prognosis is quite favorable. At present, it is known that isolated BPNGH has no tendency to transition to a full atrial - ventricular (atrioventricular) blockade.
If the NBPH occurred against the background of ischemic heart disease or hypertension, the prognosis worsens, the probability of a lethal outcome increases almost threefold. Also, the prognosis of this pathology worsens heart failure and cardiomegaly. However, it should be noted that the prognosis for NBPVPG is always better than when the patient has an incomplete blockade of the left leg of the bundle of His. On the consequences of a complete blockade of the left leg of the bundle of His, read the article of a rehabilitation physician.
Altaf Ali Naushad: Could you list the EKG criteria for Trifascicular block? i understand there can be several different combinations of individual blocks. Ty!
elGuiriWTF: What are the complications of having a RBBB? Is it reversible/fixable? I was first diagnosed RBBB with 80-100ms and then in a course of 6 months progressed to a 120ms (right on the verge between complete and incomplete) and I am quite worried. I have none of the etimologies and the block just randomly appeared when I was 15 (I never had it when I was smaller because of other EKGs). I am nearly 18 now. Getting checked again in Jan 24th.
Zaid Mousa: I find it strange that Ventricular Depolarization in V1 would be Negative rather than Positive. Does LV still have a stronger vector than RV during LBBB, just that the whole process is prolonged?
Jelena Rakus: I thought I will never understand EKG before I watched your videos! Thank you so much! you are much better than any book! Very helpful! <3
KarenCHS2008: Hi there, I'm a junior off-service resident on my first internal medicine/cardiology block of the year. I really appreciate the video. The clearest explanation of Bundle Branch Blocks that I've found. Thanks, and I will definitely recommend to my junior colleagues!
truhustla2: I actually like the perspective you used. It was useful to reinforce the perspective of looking at CTs.
author: cardiologist Makarenkova T.Yu.
Sinoatrial blockade is a pathology of the conduction system of the heart, characterized by impaired conduction of the pulse going from the sinus node to the atria.
author: doctor Pyataeva Margarita
Despite a huge number of methods for diagnosing heart disease, one of the most accessible and informative studies is still electrocardiography. The ECG makes it possible to detect not only and not so much myocardial infarction, as well as changes or disturbances in the conductivity of the electrical pulse in the heart, and not always these changes are accompanied by complaints from the patient. An example of such a pathology is atrioventricular blockade of the 2nd degree.
author: doctor Bobyleva Т.R.
Heart bypass surgery, or aorto-coronary bypass surgery, is being used more and more often. The operation is performed with ischemic heart disease, in the case of a significant blockage of blood vessels that directly feed the heart muscle.
author: doctor Subbota AA
Conduction through the sinoatrial connection in the heart can be disrupted for various reasons. It can be of several degrees, each of which has a different effect on the patient's well-being. The lightest degree of this blockade is the 1st degree. This is the initial and minimal damage to the conduction system in the heart, namely, its sinoatrial connection.
author: doctor Pyataeva Margarita
When we get cold with endless sneezing and coughing, almost everyone knows how to act. Someone makes a lime blossom by grandmother's recipe, and someone goes to the pharmacy for the usual paracetamol or a brand new miracle drug. However, many ordinary people are completely lost when the heart is at the sight of an ailment.
author: doctor Pyataeva Margarita
The attending physician appointed you an electrocardiogram: a squeaking apparatus, a whole heap of wires with suction cups and a long tape covered with mysterious curves, as a result. What do these teeth and knolls say?
In a nutshell, unfortunately, the technique of decoding the ECG will not tell. However, it is possible and necessary to understand the causes and significance of those changes that the specialist will identify. For example, if it is an inconvenient abbreviation - PBSCH, also known as a complete blockade of the right leg of the bundle.
author: physician-rehabilitologist Maslak AA
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author: cardiologist Makarenkova T.Yu.
The blockade of the right bundle of the bundle is a pathological abnormality in the work of the conduction system of the heart, in which the electrical impulse going from the atrioventricular node to the right ventricle is slowed or absent. There are complete and partial blockade of the right leg of the village of Gis.
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Author: ambulance doctor Deryushev A.N.
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author: doctor Mikhailovskaya Oksana
Wolff-Parkinson-White syndrome is a condition characterized by a premature contraction of one of the ventricles of the heart, a tendency for supraventricular tachycardia (rapid heart rate), and the appearance of atrial fibrillation and flutter. This is due to the fact that in the heart there are additional nerve conduction beams that can directly conduct excitation from the atria to the ventricles.
author: doctor Li V.V.
The bundle of His can be described as a collection of cardiac cells, which is divided into two parts (legs): the right and left. It is located behind the atrioventricular node. The left leg has its branches, which are connected by an anastomosis. The legs, reaching the myocardium of the ventricles, are divided into bundles of the leading cardiac cells, also called Purkinje fibers.