Complete blockade of the right bundle of his. What does incomplete blockade of the right leg of the bundle of His mean? Causes of incomplete right blockade

The bundle of His is one of the main components of the cardiac conduction system, which contains nodes, fibers and whole complexes of similar elements. Its function is to transmit an electrical impulse to the ventricles of the heart. But due to interference, conductivity can be impaired, due to which failures occur in the operation of the organ.

The structure of the bundle of His suggests the presence of two front legs and a back one. That branch, which is on the right, has a wide bundle that penetrates into the muscle layers of the right ventricle. To understand what blockade of the right leg of the heart is, it is necessary to consider the features of the changes observed in this case:

  • Throughout the cardiac system, there is a slowdown in the conduction of impulses.
  • The right parts of the organ are excited, affecting the septum present between the ventricles.
  • The unblocked left ventricle is involved in the process, after which the right one is also excited.

Violation of conduction along the right leg of the His bundle can adversely affect the work of the ventricles, as a result of which the time of their excitation changes. As a result, the loss of normal working capacity of the right departments is possible.

Against the background of the development of this pathology, the impulses to the left bundle of His can reach without changes, without spreading to the right leg. Due to such disunity in the work of the parts of the heart, the development of serious pathologies of the organ is possible.

The reasons

Such changes most often occur as a result of structural restructuring of the heart muscle. This may be due to one of the following conditions:

  • various types of heart defects;
  • ischemia;
  • hemochromatosis;

  • heart attack, cardiosclerosis and other heart ailments;
  • cor pulmonale;
  • thromboembolism of the arteries of the lung;
  • amyloidosis;
  • poisoning with medicines or exceeding the recommended doses;
  • hypertension.

In some cases, one of the non-cardiac factors may be the cause of conduction disturbance:

  • systemic connective tissue diseases;
  • water and electrolyte problems;
  • congenital pathologies associated with the conduction function of the heart.

We should not forget about the characteristics of the body. According to statistics, every twentieth patient has a congenital conduction disorder in the right leg, which is the norm.

Symptoms

Complications in diagnosing the disease arise because the violation of the conduction of the right leg of the bundle of His does not have any significant manifestations. The patient simply cannot detect this deviation on his own.

Most often, the disease is detected randomly, during the planned passage of an ECG. However, the patient may have complaints such as pain in the heart, shortness of breath, interruptions in heart rate, severe fatigue, which appear due to the progression of the underlying disease that caused the blockade.

If other sectors are affected, the following symptoms are possible:

  1. Signs of hemiblockade of the posterior or anterior left branch depend on the underlying disease. Usually they are mild and suggest heart pain, shortness of breath, fatigue.
  2. Complete blockade of the left leg of the heart is manifested by dizziness, heart pain, strong heartbeat. The appearance of these symptoms can be caused by extensive changes in the left ventricle, including acute infarction.
  3. Three-beam blockade can be characterized by a complete absence of impulse conduction. Patients experience frequent dizziness, interruptions in the work of the heart, fainting. If adequate treatment is not carried out, then various complications are possible, up to a heart attack.

Features of diagnostics

Any conduction disturbance can be detected during electrocardiography. Based on the results of this procedure, the specialist determines further actions:

  1. If an incomplete right blockade was detected in the absence of other diseases of a cardiological nature, then this can be attributed to the characteristics of the body. Additional research in this case is not assigned.
  2. The detected two-beam blockade will require in-depth diagnostics. If this deviation was not previously observed in the patient, then he needs urgent hospitalization, even if there are no complaints. If the complete left blockade exists for a long time, then hospital treatment is not required.
  3. If a patient has a three-beam blockade, urgent hospitalization is necessary. Here, a full examination will be carried out in a short time in order to determine the further course of treatment.

Treatment methods

This pathology needs to be eliminated only if the patient has a disease that provoked the development of the blockade. In its absence, therapy is not carried out.

For patients suffering from single- or double-beam impedance, drug therapy is chosen, which involves taking the following drugs:

  • antioxidants;
  • vitamins;
  • sedative herbal preparations;
  • means for eliminating arterial hypertension;
  • antibiotics;
  • cardiac glycosides and diuretics.

The course of treatment is selected depending on the underlying disease and the stage of its development. In advanced cases, the blockade can be treated surgically. It involves the installation of a patient pacemaker.

The lifestyle of the patient and the prognosis of the disease

If the patient does not have any heart disease, and the blockade of the right leg of the heart proceeds in his body without complications, then he can lead a normal life with moderate physical activity. In the event that the pathology is caused by another ailment, then the patient should limit stressful situations and loads, eliminate bad habits, and monitor nutrition.

If a pacemaker was installed during the operation, the patient should observe the following precautions:

  • carry a certificate of the owner of the pacemaker;
  • protect the implantation area from exposure to a mobile phone or electrical appliances;
  • once a year to undergo an ECG (or more often if there is a special prescription from a doctor).

Since the blockade of the His bundle is not an independent disease, but is a consequence of other ailments, the prognosis directly depends on the disease that provoked this pathology. Single-beam right blockade without severe heart damage does not pose a danger to human health.

If, as a result of a heart attack, the impulse of the left branch was blocked, then the prognosis is less favorable (mortality is up to 50% with an exacerbation of the disease). Trifascicular pathology also has severe consequences, since against its background the likelihood of asystole increases.

By itself, the blockade of the His bundle is a feature of the body and is not able to affect the patient's quality of life. But with the development of concomitant diseases, the consequences of this pathology can be very deplorable. To avoid trouble, it is necessary to undergo systematic examinations on the ECG.

  • Long-term and stable pathology

Hearing about the diagnosis of an incomplete blockade of the right bundle branch block, many patients grab their hearts and panic. The term "incomplete blockade" refers to a partial violation that occurs during the transmission of electrical impulses in the heart. Cases of detection of incomplete in medical practice are not uncommon. The older a person gets, the more likely they are to develop a partial blockage. In children, this pathology is generally considered as the norm, if in small patients the heart works within the normal range and there are no other heart diseases. When the time of the appearance of a partial blockade coincides with a progressive heart disease, urgent measures must be taken to restore the normal transmission of electrical impulses in the organ as soon as possible.

organic heart disease

When the violation becomes acute, drug therapy is required. But here there is another important point: all the drugs that modern medicine has are able to have a temporary effect, and their treatment of the blockade can lead to unpredictable consequences, among which there is an aggravation of the pathological condition. For the blockade of any of the legs of the bundle of His, a persistent or transient form is characteristic. In the second case, the blockade state can either disappear or appear, but intraventricular conduction will remain the same. There is also an alternating form of partial disruption of the transmission of electrical impulses in the heart, when the state of blockade is observed alternately on one or the other leg. Blockade symptoms are difficult to detect. This is due to two main reasons:

  • most blockades are asymptomatic;
  • the disturbances they cause in the functioning of the heart are characteristic of already existing pathologies of the internal organ.

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Partial violation of the conduction of electrical impulses in the heart

Heart rhythm and heart rate disturbances are common in many heart diseases, but these symptoms are not observed with incomplete blockades.

If the blockade of the His release leg is not partial, patients may complain of dizziness, clouding of consciousness, and the fact that it often becomes difficult for them to breathe. All these are the consequences of a violation of the transmission of cardiac electrical impulses, but they are typical for various pathologies of internal organs, including the lungs.

It is necessary to carry out diagnostics in order to check the condition of the legs of Gis when a person, for no apparent reason, often began to feel increased fatigue and an unreasonable decrease in efficiency.

Important to know: a clinical analysis of blood and urine will not be able to help determine the deviation in the transmission of impulses. To detect a violation, it is necessary to undergo an examination of the hormonal status and Hotler ECG monitoring. The latter method is unique in that it allows you to identify a complete and incomplete violation of the transmission of electrical impulses in the internal organ.

This type of ECG allows doctors to record changes that entail various types of blockades. Differentiation of the clinical symptoms of cardiac pathologies and pathological abnormalities is a rather difficult issue, especially when disorders in the functioning of the internal organ have typical and atypical signs. Holter ECG monitoring makes it possible to determine in each case the clinical symptoms at the time of an attack of blockade.

Indispensable conditions for the effective implementation of the diagnosis are the simultaneous recording of the patient's sensations and monitoring of clinical symptoms. This information is of particular value in determining the cause of disturbances in the transmission of electrical impulses by doctors.

Classical ECG is also widely used to diagnose blockades. To perform a traditional ECG, the transesophageal method is used. It is one of the most informative ways. During such a diagnosis, sinus arrhythmia is also determined, which is characteristic of an incomplete blockade of the right leg of the His bundle.

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Who is at risk?

Various types of blockades of the right leg, as medical statistics show, most often occur in men. Blockades of the left leg, on the contrary, are most characteristic of women aged 50 to 70 years who suffer from hypertension. The older the person, the more likely it is that the violation in the transmission of cardiac impulses that has appeared in him will have a complete form. In children, incomplete blockades of the right leg are not uncommon, but this deviation does not pose a danger to the health of the child when he does not have cardiac pathology, disorders in the functioning of the cardiovascular system and respiratory organs. Even if incomplete blockade is asymptomatic, it affects the functioning of the ventricles. Therefore, when predicting the development of any type of blockade, the state of the ventricular tissues is taken into account without fail.

There is a whole list of diseases that can provoke the occurrence of an incomplete blockade of the right leg of the Gis launch. Complete and incomplete forms of the disorder can be congenital and acquired. Is blockade inherited? Controversial question. Today it is generally accepted that it is not transmitted, but the predisposition to problems with the transmission of electrical impulses in the internal organ can still be inherited. To provoke the occurrence of an incomplete blockade of the right leg are capable of:

  • congenital and acquired heart defects;
  • ischemic disease;
  • stenosis;
  • heart failure;
  • myocardial infarction.

An overdose of the use of drugs entails various disorders in the functioning of internal organs, kidney and liver failure. In medical practice, it is not uncommon for drugs used against arrhythmia to cause a complete and partial disruption of the transmission of electrical impulses in the heart.

Lung pathologies also have an effect on the heart. If a person is diagnosed with, for example, pulmonary hypertension, it is likely that it will cause a complete or incomplete form of leg block. Acute myocardial infarction and cardiosclerosis are fertile ground for disturbances in the conduction of electrical impulses. Tricuspid valve insufficiency and right ventricular hypertrophy can lead to a similar result. The general state of the body and destructive changes in the functioning of internal organs are closely interconnected. When the balance of electrolytes is disturbed in the body, conditions are created for the occurrence of blockades of the legs of the bundle of His.

- a violation of intracardiac conduction, characterized by a slowdown or complete cessation of the conduction of excitation impulses along one or more branches of the His bundle. The blockade of the legs of the bundle of His can be detected only with an instrumental examination or be symptomatic of rhythm disturbances, dizziness, bouts of loss of consciousness. The bundle branch block is diagnosed by electrocardiography. Treatment of the blockade of the legs of the bundle of His is reduced to eliminating the causes of conduction disturbances; in some cases, it may be necessary to install an artificial pacemaker.

General information

Blockade of the legs of the bundle of His is an incomplete or complete violation of the passage of an electrical impulse through the bundles of cells of the conduction system of the heart, leading to a change in the sequence of excitation coverage of the myocardium of the ventricles. In cardiology, the blockade of the legs of the bundle of His is not considered as an independent disease. As a rule, it acts as a consequence and at the same time an electrocardiographic symptom of any independent cardiac pathology. According to the ECG, the blockade of the legs of the bundle of His is diagnosed in 0.6% of people, more often in men; among people older than 60 years, its frequency increases to 1-2%.

The bundle of His is a part of the conduction system of the heart, represented by accumulations of modified muscle fibers. In the interventricular septum, the His bundle is divided into two legs - right and left. In turn, the left leg is divided into anterior and posterior branches, which descend on both sides of the interventricular septum. The smallest branches of the intraventricular conduction system are the Purkinje fibers, which penetrate the entire heart muscle and are directly connected with the contractile myocardium of the ventricles. Myocardial contractions occur due to the propagation of electrical impulses originating in the sinus node through the atria to the atrioventricular node, then along the bundle of His and its legs to the Purkinje fibers.

Causes of the blockade of the legs of the bundle of His

The blockade of the legs of the bundle of His can be caused by various reasons. Blockade of the right leg of the His bundle occurs in diseases accompanied by overload and hypertrophy of the right ventricle - mitral stenosis, atrial septal defect, tricuspid valve insufficiency, coronary artery disease, cor pulmonale, arterial hypertension, acute myocardial infarction (posterior diaphragmatic or upper apex), etc.

Atherosclerotic cardiosclerosis, aortic valve defects, cardiomyopathy, myocardial infarction, myocarditis, bacterial endocarditis, myocardial dystrophy lead to blockade of the left leg of the bundle of His. Less commonly, bundle branch block develops against a background of pulmonary embolism, hyperkalemia, and intoxication with cardiac glycosides.

The causes of bifascicular blocks are usually aortic defects (aortic insufficiency, aortic stenosis) and aortic coarctation.

Classification of blockades of the legs of the bundle of His

Given the anatomical structure of the bundle of His, blockades can be single-beam, two-beam and three-beam. Single-beam blockades include cases of damage to only one leg (branch) of the His bundle: blockade of the right leg, blockade of the left anterior or left posterior branch. Two-beam blockades are a simultaneous defeat of 2 branches of the His bundle: the anterior and posterior branches of the left leg, the right leg and the anterior left branch, the right leg and the posterior left branch. With three-beam blockades, all three branches of the His bundle are affected.

According to the degree of violation of the conduction of the impulse, the blockade of the legs of the bundle of His can be incomplete and complete. With an incomplete blockade, the conduction of an impulse along one of the legs of the His bundle is disrupted, while the functioning of the second leg or one of its branches is not impaired. At the same time, excitation of the ventricular myocardium is provided by intact branches, however, it occurs with a delay.

Thus, when slowing down the process of propagation of the impulse along the branches of the bundle of His, there is an incomplete heart block of the 1st degree. In the event that not all impulses reach the ventricles, they speak of an incomplete second-degree heart block. Complete blockade (or blockade of the III degree) is characterized by the absolute impossibility of conducting impulses from the atria to the ventricles, in connection with which the latter begin to contract on their own, at a speed of 20-40 beats. in min.

Bundle blockades can be transient (intermittent) or permanent (irreversible). In some cases, the blockade of the legs of the bundle of His develops only when the heart rate changes (bradycardia, tachycardia).

Characteristics of various options for the blockade of the legs of the bundle of His

Blockade of the legs of the bundle of His does not have independent clinical manifestations; in most cases, they are manifested by symptoms of the underlying disease and specific ECG changes. In some cases, with a decrease in cardiac output, the blockade of the legs of the bundle of His may be accompanied by frequent dizziness, severe bradycardia, and sometimes - attacks of loss of consciousness.

Consider the main clinical options for the blockade of the legs of the bundle of His.

Blockade of the right leg of the bundle of His

In the case of a complete blockade of the right branch of the His bundle, the impulse conduction and excitation of the myocardium of the right ventricle and the right half of the MZHZHP occur along the contractile muscle fibers from the left ventricle and from the left half of the MZHZHP. With incomplete blockade, there is a slowdown in the conduction of an electrical impulse along the right leg of the His bundle. Sometimes incomplete blockade of the right leg of the bundle of His is detected in practically healthy young people; in this case, it is regarded as a variant of the physiological norm.

ECG signs of a complete blockade of the right leg of the bundle of His are the expansion of the S wave, the increase in amplitude and the expansion of the R wave, the QRS complex has the form qRS with an extension of up to 0.12 seconds. and more.

Blockade of the left leg of the bundle of His

With a complete blockade of the left leg of the bundle of His, the excitation wave is not carried out along the stem of the leg until it branches or does not extend simultaneously to both branches of the left leg (two-beam blockade). The excitation wave is transmitted to the myocardium of the left ventricle with a delay from the right half of the MZHZHP and the right ventricle along the Purkinje fibers. On the ECG - EOS deviation to the left, widening of the QRS complex up to 0.12 sec. or more.

At the heart of the blockade of the anterior branch of the left leg of the bundle of His is a violation of the conduction of the impulse to the anterolateral wall of the myocardium of the left ventricle. In this case, after excitation of the MZHZHP and the lower sections of the posterior wall, along the anastomoses of the Purkinje fibers, the excitation wave propagates to the anterolateral wall of the left ventricle from bottom to top.

With the blockade of the posterior branch of the left branch of the bundle of His, the conduction of the impulse to the posterior lower sections of the myocardium of the left ventricle is impaired. The activation wave propagates from the anterior and anterolateral walls of the left ventricle along the Purkinje fibers to the posterior inferior sections of the left ventricle, i.e., from top to bottom.

Incomplete blockade of the left leg of the bundle of His is characterized by a slowdown in the conduction of the impulse along the main left trunk or along both branches of the left leg. In this case, part of the myocardium of the left ventricle is excited by impulses propagating along the right leg.

Two-beam blockade

When the blockade of the right leg of the bundle of His is combined with the blockade of the left anterior branch, the propagation of an electrical impulse goes along the posterior branch of the left leg of the bundle of His, causing excitation first of the posterior lower sections of the myocardium of the left ventricle, then of its anterolateral sections. Following this, the impulse slowly spreads along the contractile fibers to the myocardium of the right ventricle.

The delay in excitation of the anterolateral wall of the left ventricle and the right ventricle is reflected on the ECG in the form of an expansion of the QRS complex up to 0.12 seconds, a serration of the ascending knee of the S wave, a negative T wave, and EOS deviation to the left.

With a combined blockade of the right leg of the His bundle with a blockade of the posterior left branch, the impulse is carried out through the anterior left branch, the anterolateral sections of the myocardium of the left ventricle along the anastomoses to the posterior sections of the left ventricle, and then along the contractile fibers to the right ventricle. The ECG reflects signs of blockade of the left posterior branch and the right leg of the bundle of His, deviation of the EOS to the right. This combination indicates widespread and profound changes in the myocardium.

Trifascicular blockade

Incomplete three-beam blockade is accompanied by the spread of the excitation impulse to the ventricles along the least affected branch of the legs of the bundle of His. At the same time, atrioventricular blockade of the I or II degree is noted.

In the case of a complete three-beam block, the conduction of impulses from the atria to the ventricles becomes impossible (III degree AV block), which leads to separation of the atrial and ventricular rhythms. At the same time, the ventricles contract in their own idioventricular rhythm, characterized by a low frequency and arrhythmia, which can lead to the appearance of atrial fibrillation and asystole of various durations.

The ECG picture with a complete blockade of the legs of the bundle of His corresponds to the signs of AV blockade of one degree or another.

Diagnosis and treatment of bundle branch blockade

The main method for detecting blockade of the legs of the bundle of His is standard electrocardiography and its varieties - transesophageal electrocardiography (TECG), implantation of a pacemaker. With the blockade of the legs of the bundle of His, which proceeds without clinical manifestations, a dynamic observation is carried out.

The prognosis of the blockade of the legs of the bundle of His

The prognosis of bundle branch block in asymptomatic patients is favorable. In the presence of organic pathology of the heart, the prognosis is determined by the underlying disease. In turn, the blockade of the legs of the bundle of His increases both the risk of sudden death in this category of patients and the development of long-term complications.

The progression of the conduction defect, the development of AV blockade, cardiomegaly, hypertension and heart failure increases the likelihood of an unfavorable outcome.

cardiac surgeon

Higher education:

cardiac surgeon

Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBSU)

Level of education - Specialist

Additional education:

Certification cycle for the program "Clinical Cardiology"

Moscow Medical Academy. THEM. Sechenov


When undergoing a routine examination, a person may accidentally find out that an incomplete blockade of the right bundle of His bundle was found on the ECG. Below we will try to tell in the most detail about whether it poses a danger to health and whether it is worth being treated.

The bundles of His are an important part of the cardiac conduction system. They are formed from special muscle fibers of the heart, which have the unique property of conducting impulses. Thanks to these nerve impulses, the heart is able to contract.

There are only two such bundles in the heart - left and right. They depart from a common trunk, which lies in the interventricular septum. Further, the legs of Gis go each to its own ventricle. Passing deep into the walls of the ventricles, the legs branch into numerous small Purkinje fibers. Each of these fibers conducts nerve impulses to the heart cells, as a result of which they are all able to contract almost synchronously.

Sometimes the conduction of an impulse along the branches of His is disturbed, it can slow down, or even disappear altogether. Then there is a complete or partial blockade of the legs. As a rule, such a conduction disorder does not manifest itself in any way and is an accidental finding on a planned electrocardiogram.

Classification

The blockade of the legs of the bundle of His is complete and incomplete. Intermittent blockade is also distinguished - on the same ECG tape, sections of blockade and normal conduction alternate, alternating blockade - the presence on the ECG of a combined blockade of the right and left legs, and permanent.

The reasons

The conduction of nerve impulses along the conducting cardiac pathways can be disturbed in various diseases and pathological changes. The most common diseases that cause blockade of RBBB are:

  1. Congenital and acquired cardiac anomalies and defects;
  2. Myocardial dystrophy;
  3. Cardiomyopathy caused by diabetes mellitus, alcoholism, obesity, thyrotoxicosis, anemia, any systemic autoimmune diseases;
  4. Poisoning with drugs, more often with cardiac glycosides;
  5. Inflammatory diseases of the myocardium;
  6. Myocardial hypertrophy caused by any reasons;
  7. Heart diseases accompanied by the process of cardiosclerosis. At the same time, myocardiocytes are gradually replaced by scar cells;
  8. The occurrence of thrombosis in the system of branches of the pulmonary artery;
  9. All lung diseases capable of chronicity. They lead to a constant stagnation of blood in the arterial pulmonary circulation, and an increase in the cavities of the right heart. Most often these are chronic bronchitis, asthma and emphysema;

It is worth remembering that the blockade of the right leg of the bundle of His is characteristic of young males, can occur in a healthy heart and does not further affect the life prognosis.

In children and adolescents, such a blockade occurs more often against the background of minor congenital anomalies of the heart. It is considered the norm if the studies have excluded any damage to the heart muscle and defects.

Symptoms

The vast majority of young people who have a blockade of the right leg have absolutely no symptoms of the disease. These are strong and healthy people. The presence of such an unexpected find does not affect health and life expectancy. The situation is different for older patients. In older people, the blockade of the right leg of the His bundle for the first time is associated with a number of diseases. These are organic lesions of the heart muscle, and all kinds of chronic diseases of the respiratory system. In rare cases, blockade occurs due to the presence of systemic autoimmune diseases. In such cases, it is necessary to treat the disease that caused the pathology.

Symptoms of such diseases are typical. This is shortness of breath, a feeling of interruptions in the heart, fatigue, pain and a feeling of discomfort in the region of the heart. Such manifestations are very serious, indicating dangerous chronic diseases that need to be treated.

On the other hand, incomplete blockade of the right leg of the bundle of His against the background of full health does not require treatment at all. It can even be considered a variant of the norm.

If electrocardiographic methods revealed, in addition to the blockade of the right leg of the bundle of His, also the blockade of the left leg, it is worth undergoing an additional examination. Bifascicular blockade does not occur in healthy people, it cannot be regarded as a normal condition.

The blockade of the left leg occurs against the background of diseases that affect the myocardium. On the other hand, blockade of the right leg occurs with myocardial disease in older people. So an additional medical examination should be subjected to all people who have reached the age of 55 in the presence of a violation of cardiac conduction.

It is not difficult to diagnose the presence of a blockade of the right bundle of His bundle in a person. It is enough to conduct an electrocardiographic study. Any doctor, not necessarily a cardiologist, can see the characteristic signs of blockade on the tape. The ECG shows the type of blockade - complete or incomplete.

Examination methods

Additionally, in order to identify diseases that can cause cardiac conduction disorders, the doctor may prescribe other examination methods:

  • general clinical blood and urine tests;
  • blood chemistry;
  • daily Holter monitoring of the electrocardiogram of the heart is prescribed in order to identify transient disorders;
  • transesophageal electrocardiography is a very accurate research method, and therefore can be prescribed as an additional diagnostic method;
  • echocardiography - one of the most popular methods for studying the heart muscle, shows organic cardiac pathology, the degree of myocardial contractility, gives an accurate assessment of the cardiac output fraction;
  • with an unclear diagnosis, it is possible to prescribe multislice computed tomography (CT) or, if the appropriate equipment is available, magnetic resonance imaging (MRI) of the heart.

Treatment

To the delight of patients who find out that they have some kind of partial or complete blockade of RBBB, treatment for this condition is not required. However, such patients should, if possible, completely stop smoking, so as not to cause an increase in the load on the right side of the heart. Children with such diagnoses should be prescribed a course of vitamins, provide good nutrition with a full range of essential amino acids, adequate food coloration. Similar ECG manifestations in children and adolescents are often associated with a mismatch in the growth rate of the body and the development of the heart muscle. Often in children, when repeating the ECG after some time, such a violation may no longer be repeated.

Girls with this diagnosis should not worry about complications during pregnancy. Incomplete blockade of the bundle of His bundle is not a contraindication for pregnancy, it is not capable of causing unwanted symptoms. Young people with right bundle branch block are allowed to serve in the military.

Athletes do not need to wonder if they should continue to play sports. Such a condition is not a contraindication for performing any physical activity. The prognosis for this condition is favorable if the patient has no signs of other diseases. Without treatment with such a diagnosis, patients live the same quality and long life as the rest.

A very insidious disease is the incomplete blockade of PNPG (the right leg of the bundle of His). Firstly, in many cases, such a feature of the development of the heart muscle is taken as a variant of the norm and does not require treatment. But there are also cases when pathology poses a danger to human life. Here, a complete diagnosis is already being carried out and treatment is prescribed, in some cases it may even be surgery.

What it is

Before we get acquainted with the pathology, it is necessary to make a small digression and find out some points that will relate to the structure and functional features. So it will be easier to understand the essence of the pathology of interest to us.

The bundle of His refers to the accumulation of nerve fibers that enter the structure of the heart. These fibers are essential for conducting impulses to the ventricles. The main trunk of this bundle is divided into two branches. They are called legs. There are left and right legs, along which impulses are conducted to the left and right ventricles, respectively. Blockade can be found on one of these legs, and may be present on two at once. So far, we are only interested in the right leg, or rather, the blockade, which can disrupt its conductive ability.

Incomplete blockade of the right leg of the bundle of His or NBPNPG is characterized by disturbances in the processes of conducting impulses that are sent along this branch. For the second leg, such violations are not typical, it regularly performs its function. There are two degrees of development of this disease:

  • the first degree manifests itself in the form of a slowdown in the process of transmitting an excitation impulse, while all impulses are transmitted regularly, but with a lag;
  • the second degree is characterized by the transmission of not all impulses, some come out of the atria, some of them do not reach the right branch with incomplete blockade of the right leg of the His bundle to the ventricles.
  • There is also a third degree. It means complete blockade. In this state, not a single impulse that leaves the atria reaches the ventricles. In such a situation, the contraction of the ventricles is carried out independently, and their number does not exceed 30 per minute.

Causes of pathology

There are several reasons that can cause the onset of the disease. They can be congenital or acquired. It is the cause that has become the trigger for the development of pathology that must be identified and eliminated. The main reasons are the following points:

  • heart valve disease;
  • hypertension.

The list of congenital causes, which in most cases become factors in the development of an incomplete blockade of the His bundle in a child, is as follows:

  • stenosis of the mouth of the pulmonary artery;
  • structural deviations in the interatrial septum;
  • changes in the development of the PNG segment;
  • inferiority of the interventricular septum;
  • , as a result of the development of which congestion of the right ventricle may occur.


The acquired factors include the following:

  • obstructive pathologies of the respiratory tract, which have developed into a chronic form;
  • neoplasms in the heart muscle;
  • blunt trauma attributable to the chest;
  • muscular dystrophy, prone to progression;
  • an overdose of certain medications that can have such an effect on the heart;
  • prone to negative change;
  • hyperkalemia.

Observed symptoms

The big problem of this pathology is the almost complete absence of signs of incomplete blockade of the right leg of the bundle of His. The person feels well and does not even suspect that there is a problem in the heart. To identify the problem, you need to undergo an ECG or listen to the work of the myocardium. So it turns out that the detection of pathology is carried out by chance. The manifestation has only a complete blockade.

In children, incomplete blockade of the right leg of the bundle of His also does not manifest itself in any way. This condition is detected by chance, and in rare cases, treatment is prescribed. If the child is healthy, then NBBB is considered a variant of the normal structure of the heart. You can live your whole life, but never know about the presence of this pathology.

The solution to the problem of timely detection of a disease that does not have severe symptoms is regular examination and treatment of existing diseases. In this case, it will be possible to identify NBBB at the earliest stage and prevent the development of complications, which we will talk about later.

Diagnosis of the disease

To diagnose an incomplete blockade of the right bundle branch block, doctors resort to various techniques. Diagnostic methods are selected taking into account many factors that are analyzed by the doctor on an individual basis. But for the most part, a single plan is used:

  • initial examination and analysis of complaints;
  • followed by a cardiogram by means of an ECG;
  • in some cases, to identify NBPBPG, an examination using one of the varieties of the electrocardiogram (TPEKG, daily monitoring, rhythmocardiography) may be required;
  • to detect organic neoplasms, echocardiography, MRI or PET of the heart muscle is performed.


Whatever the diagnostic plan is chosen, it must be strictly adhered to and all procedures must be completed without delay. Delay can result in serious complications that will cause great harm to the body.

Treatment tactics

After obtaining data on the state of a person as a result of diagnosing an incomplete blockade of the right leg of the bundle of His, an effective treatment is required. The primary goal of treatment is to eliminate the disease that caused the development of the blockade. Treatment, which will be directed specifically to the blockade, is not provided.

That is why it is so important to conduct a qualitative examination, the results of which will make it possible to establish an accurate diagnosis and identify the underlying disease. Otherwise, all further treatment will be ineffective and may even be harmful to health.

Congenital diseases are eliminated by surgery. Serious indications must be present for the appointment of such a method of treatment. Many of the diseases that cause NBBB are amenable to medical treatment. Antihypertensive drugs, antiarrhythmic drugs and cardiac glycosides may be prescribed.

In some cases, NBBBB is a variant of the norm. Usually such situations are typical for young people. There is no treatment here. Instead of therapy, it is recommended to conduct dynamic monitoring and regular examination by a cardiologist.

Possible Complications

Although incomplete blockade of RBBB is not a dangerous pathology in itself, it can cause the development of serious complications. This is the insidiousness of this disease. A list of possible and most common complications is presented below:

  • ventricular fibrillation;
  • development of heart failure;
  • cardiac arrest, which leads to death;
  • complications of already present diseases that caused the development of NBBB;
  • disturbances in the processes of saturation with blood of the brain;
  • thrombus formation;
  • tachycardia of paroxysmal type;
  • various ;
  • the development of a complete blockade or even atrioventricular.

Each of these conditions is potentially dangerous and can pose a serious threat to human life. Therefore, the prescribed treatment must be taken seriously. It is important to follow all recommendations, including those related to lifestyle changes.

Lifestyle and prevention

It is quite possible to reduce the likelihood of developing NRBBB. You just need to follow simple rules of prevention and adjust your lifestyle. This will be within the power of everyone to do. The rules are simple:

  • normalizing the mode of work and rest, ensuring prolonged sleep;
  • balanced and rational nutrition every day;
  • rejection that saturate the body with toxic substances;
  • refusal of self-treatment, taking any medication to coordinate with the doctor;
  • timely diagnosis of cardiovascular diseases at the initial manifestations of symptoms;
  • reduction of stress factors.


Many diseases of the cardiovascular system can be prevented, because they arise from an unhealthy lifestyle, frequent stress, ignoring symptoms and self-medication. And NBBB, as it has already become known, develops against the background of a number of cardiovascular pathologies. Be attentive to your health, take care of your heart, blood vessels and avoid stress whenever possible. It is easier to prevent any disease than to deal with its further treatment and eliminate the complications that have appeared.

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