There are diagnoses in medicine that sound frightening to parents in and of themselves, because they are not heard, and little is known about them to ordinary people. One of these medical verdicts is the right bundle branch block.
About pathology
Before talking about this diagnosis, about what it is, you should clearly understand what part of the body we are talking about. The bundle of His is located in the heart of the child. It is an integral part of the cardiac conduction system and outwardly, in fact, is a bundle, which consists of thin fibers of muscle tissue, but not ordinary, but somewhat modified.
In the interventricular space, in the area of this septum, this bundle branches into two legs - one right and the other left. They branch out into a finer network and connect to the smallest miniature branches called Purkinje fibers. The smallest fibers pass through the entire muscular wall of the organ - the "motor" and connect to the ventricular myocardium.
According to these branches, an electrical impulse passes from both legs to the small fibers, the heart contracts, beats.
Blockade of the bundle of His is thus called complete or partial (incomplete) pathological change in the ability to conduct an electric pulse, as a result of which the ventricular myocardium inconsistently and incorrectly comes into the excitation phase.
Cardiologists do not believe that right or left bundle branch block is a separate anomaly, in the overwhelming majority of blockage - just a symptom of some kind of heart disease, defect. Signs of this blockade are noticeable mainly only on the ECG, the decoding of which shows characteristic changes in the schedule of the interventricular septum and ventricular myocardium. The detection of such a picture is usually accidental, but requires a more detailed study of the state of the child's heart - whether there are any diseases or pathologies.
It is noteworthy that incomplete blockade of the right bundle of His bundle in 5% of cases in children is not an anomaly and is qualified by specialists as a variant of normal, only purely individual, development of the heart of a toddler.
Such children do not have any symptoms and signs of cardiac pathologies, the examination does not show any more violations., except for a minor (incomplete) paradoxical anomaly in conducting electrical impulses of the interventricular septum.
Usually such a problem easily "outgrows" with age. However, in the remaining 95% of cases, when these signs were found on the ECG in the child and the parents were informed about the blockade of the right bundle branch, the child is shown a thorough cardiac examination, which will show what, in fact, to take next.
Why it happens?
The conduction of an electrical impulse in this part of the heart can be disrupted due to various and rather numerous reasons. Most often, according to cardiologists, the leg on the right side is blocked under significant loads and an increase in the size of the right ventricle of the heart.
The ailments in which this becomes possible are numerous: these are mitral stenosis, and congenital and acquired anomalies of the septum, functional insufficiency of the tricuspid valve.
Blocking the functions of the leg on the right side may indicate a so-called cor pulmonale, high blood pressure, as well as the state of acute myocardial infarction.
The reasons for the physiological partial blockade, which would not be interconnected with any heart ailments, are not known to medicine.
What's happening?
When the blockage is complete, the left side of the heart is "taken" to excite the muscle tissue of the right ventricle. So the body tries to bypass the violation.
When the blockage is partial, there is an impulse from the leg on the right side, but it is slow, passing with a delay. This is what the specialist can see on the ECG by the characteristic teeth on the graph.
It should be noted that a violation of the conduction of an electrical impulse can be found at any age - and in newborns, and at 1 year old, and at 6-8 years old, and in adolescence.
How does it manifest?
Much depends on how many bundles are affected and "blocked".
- If only one beam is affected on the right, then there are no symptoms, such a find is a pure coincidence during a planned ECG.
- If the pathology is accompanied by a certain heart disease, then the symptoms will be characteristic of a particular disease. Shortness of breath, cyanosis of the nasolabial triangle, pain in the heart, high and rapid fatigability in a child may be associated not with the blockade as such, but directly with the existing cardiac discomfort.
- If the block on the right is complete, then this is usually accompanied by such signs as a distinct sensation of one's own heart rate, attacks of dizziness.
What to do?
First of all, parents should not be discouraged. The child will be scheduled for a detailed heart examination, and it must be done.
Do not underestimate the most common electrocardiography: ECG gives a fairly accurate idea not only about the presence of a bundle branch block, but also about the possible reasons for this unpleasant phenomenon.
There are several types of such research, each of which can be assigned to a child, if the doctor deems it necessary:
- a study of the work of the heart through the esophagus is carried out;
- conduct a long-term daily ECG study (the mini-recorder is attached to the child's clothes, to the skin, he sleeps with him, eats and tries to lead a normal life for 24 hours).
You will definitely need a qualified consultation with a pediatric cardiologist. Most likely, after such a "find" on the ECG, even if the blockade is physiological, this doctor will put the child on a dispensary. The rest of the actions of parents and doctors will depend on what causes are found.
There is no special treatment for the blockade, regardless of which fibers poorly conduct or do not conduct impulses - the front left legs, the rear right legs, part of the upper branching, etc. The question about treatment can be answered only when the child is given a cardiodiagnosis.
Can be assigned treatment with medications, cardiac glycosides and nitrates, applied drugs to lower your blood pressure.
With complete blockages, especially bilateral ones, at the discretion of cardiac surgeons, it may be necessary to establish electronic pacemaker. With a physiological block, treatment is not required, but the child will need to visit a cardiologist twice a year, do an ECG, which is called dynamic observation. Only a specialist will be able to tell the parents what the changes in the child's cardiogram are talking about and what the resulting sinus tachycardia, passing arrhythmia, etc., can mean.
Complete right branch block is dangerous, because at any time the underlying heart disease can lead to complications. Incomplete forecasts are more favorable.
Child's lifestyle
Separately, I would like to say about how to live on with such a "cardiac device". If the child has no symptoms or signs of heart disease and the blockage is incomplete, the state of health does not suffer in any way, he can continue to lead the usual way of life with the level of physical activity that was familiar to him earlier.
However, when cardiac pathology is detected, much changes in life. Parents should do their best to protect the child from severe stress, anxiety, he must observe the mode of exercise recommended individually by the cardiologist, rest more, be sure to follow the rules of healthy and balanced nutrition.
If a stimulator is installed for a child, then there will be more restrictions: you cannot come close to working electrical devices with the side of the implantation zone, you cannot lean against them, you cannot speak on a mobile phone, pressing it to the ear from the opposite side (in this case, the left).
More information about the right bundle branch block is described in the video below.
