Blockade of legs and branches of the bundle of the Hyis: causes, symptoms, diagnosis, treatment

The blockade of the branch of the bundle of the bundle is a partial or complete violation of the impulse along the leg branch; blockade of the foot - a similar termination of the bundle of the bundle along the whole leg. Both violations are often combined. Usually this does not lead to the development of clinical manifestations, but the presence of any of these disorders indicates a heart attack. The diagnosis is made according to ECG data. There is no need for special treatment.

Blockage of conduction can be the result of various heart diseases, including organic pathology of the organ without any other pathology of the heart.

The blockade of the right leg of the bundle of His may occur in practically healthy people. It can also occur with anterior myocardial infarction, reflecting the marked damage to the myocardium. The first occurrence of blockade of the right leg of the bundle of His is an indication for examination of the pathology of the heart, but often nothing reveals. Transient blockade of the right leg of the bundle can be found in the embolism of the pulmonary artery. Despite the fact that the blockade of the right leg of the bundle of Guis breaks the form of the ventricular complex, it does not cause significant difficulties in the ECG diagnosis of myocardial infarction.

The blockade of the left branch of the bundle is associated with the structural pathology of the heart more often than the blockade of the right leg of the bundle. Blockade of the left leg of the bundle of the Hisnus usually excludes the possibility of using an ECG to diagnose myocardial infarction.

Blockade of the branches involves the involvement of the anterior and posterior branches of the left leg of the bundle. The termination in the anterior branch of the left branch of the Heis bundle is characterized by a moderate elongation of the QRS complex (<120 ms) and a deviation of the QRS axis angle in the negative direction to more than -30 ° (left axis deviation). The blockade of the posterior branch of the left branch of the bundle is characterized by a deviation of the angle in the positive direction to more than + 120 °. The connection between the branch blocks of the branches of the bundle of the bundle with a structural pathology is the same as that of the block of the left leg of the bundle.

Incomplete blockade can be combined with other conduction abnormalities: Blockage of the right bundle of the bundle and blockage of the anterior or posterior branch of the left bundle branch leg (bifascicular block); blockade of the anterior or posterior branch, blockade of the right arm of the bundle of the His and AB blockade of the 1st degree (incorrectly called a three-beam blockade; AB blockade of the first degree usually has a cause at the level of the AV node). Trifascicular block involves a combination of blockade of the right leg of the bundle with a transient transient blockage of the anterior and posterior branches of the left bundle of the bundle, or an alternating block of the left branch of the bundle and a blockade of the right leg of the bundle. The presence of bifascicular or triphasicular blockade after myocardial infarction reflects extensive myocardial damage. Bifascicular blockade does not require special treatment until the moment when the AV blockade of II or III degree appears. True trifascicular blockade is an indication for immediate, and then permanent, pacemaking.

In the event that the complex is elongated (more than 120 ms) but does not have the shape characteristic of the blockade of the left bundle or the left leg of the bundle, a nonspecific blockade of the intraventricular conduction is diagnosed. Disturbances of conduction may occur at the level of Purkinje fibers and be a consequence of slow conduction from the myocyte to the myocyte. Specific treatment is not prescribed.

[1], [2], [3], [4]