Transient heart block. Drug therapy for complete blockade

Complete heart block is a pathology characterized by the termination of conduction from the atria to the ventricles of the organ. As a result, they begin to contract separately, independently of each other, and the heart rhythm is also disturbed.

This condition is considered very dangerous and can be fatal. Therefore, it is important to diagnose heart block in time and start treating it.

Complete blockade can develop in the atrioventricular node, the bundle branch and on the bundle of His. This pathology is acquired or congenital.

In the first case, the blockade develops as a result of the following reasons:

1. Disorders of metabolic processes.
2. Rheumatic fever acute form.
3. Postoperative complications for heart defects.
4. Excess doses medicationsaffecting the speed of the impulses.

The causes of congenital abnormalities include the isolation of the atrioventricular node from the atrial and ventricular myocardium.

Almost all types of blockade arise due to such factors:

• Ischemic disease
• Necrotic processes
• Dystrophy of heart tissue
• Inflammatory process in the myocardium
• Myocarditis
• Cardiosclerosis

Besides, hereditary factor and excessive physical exercise are also the cause of pathology.

The signs of PBS depend on the degree of the disease.

If the blockade is of the first degree, it can proceed even without clinical manifestations. The course of blockade of the second degree is characterized by dizziness, general weakness, pain in the chest. With a complete blockade of the third degree, the patient has the following symptoms:

1. Convulsive state.
2. Pain and heaviness in the left sternum and behind the chest.
3. Cyanosis skin faces.
4. Clouding and loss of consciousness.
5. Decreased heart rate.
6. Sleep disorder.
7. Nausea.
8. Vomiting.
9. Difficulty breathing.

Usually, this condition begins with a temporary cessation of blood circulation. Such an attack is called Morgagni-Adams-Stokes syndrome. In this case, it is necessary to immediately call for medical help, since everything can end in death.

Why is a complete heart block dangerous?

If you ignore the treatment of blockade in the initial stages, such undesirable consequences as an increase in the degree and progression of the disease are possible.

Pathology is dangerous because it can threaten the health and life of the patient. With a complete blockade, the interventricular septum is affected, which leads to the development of such complications:

• Loss of performance.
• Frequent fainting.
• Coronary insufficiency.
• Ventricular fibrillation.

Usually with a complete blockade heavy course sudden death occurs. According to statistics, patients who have a Morgagni-Adams-Stokes attack do not live long - up to three years after the first attack.

Diagnostic methods

First of all, the diagnosis begins with the collection of anamnesis. They definitely do. The blockade may be indicated by a result in which there is no connection between the ectopic and sinus rhythm... Other parameters of ECG interpretation are also taken into account.

In addition, other diagnostic methods may be prescribed:

• Electrophysiological organ diagnostics (transesophageal or intracardiac). This study allows you to establish the level of pathology. Also, using this method, you can determine the indications for cardioimplantation.
• ... With this study, you can determine the degree of blockade, as well as possible reasons its development.

To prepare for the study, it is necessary to exclude psycho-emotional overstrain and physical exertion. It is necessary to stop smoking and drinking alcohol before diagnosis.

Besides instrumental methods research also laboratory tests urine and blood.

To exclude or confirm a hereditary predisposition, you need to do a genetic blood test.

In the case when the patient is diagnosed with complete heart block, the specialist selects the appropriate treatment depending on the severity of the pathology and the location of the pathology.

Treatment of the disease

The choice of treatment methods depends on the location of the blockade and the severity of the pathology. The main objectives of the treatment are:

1. Prevention sudden death from the blockade.
2. Relief of the patient's condition.
3. Elimination of the main symptoms of the disease.
4. Prevention of heart and coronary insufficiency.
5. Can be applied conservative therapy or surgery.

When pathological condition it is possible to use the following groups of drugs:

• Sodium channel blockers. Usually Ritmylene, Novocainamide, Enkainid, Quinidine, Giluritmal are used.
• Potassium channel blockers. Commonly prescribed drugs are Sotalol, Nibentan, and Amiodarone.
• ... These drugs include Nadolol, Atenolol, Propranolol, Esmolol, Bisoprolol.
• Antiarrhythmic drugs. Diltiazem or Verapamil may be prescribed by the decision of a specialist.
• With a complete blockade, Adrenaline and Dopamine can be used. Usually drugs help to stabilize hemodynamics.

In addition, the doctor must stop the use of heart drugs in patients, which can provoke the development of undesirable consequences. These include drugs that impair the conduction of the heart.Assign medications only a qualified specialist can. Self-medication can not only exacerbate the problem, but also contribute to the development of further complications.

A more aggressive treatment for pathology is cardiac stimulation. Indications for its appointment are acute heart failure, which is accompanied by edema in the lungs, fainting, decrease, collapse for a reason.

More information you can learn about atrioventricular heart block from the video:

Surgical intervention consists in the implantation of a pacemaker. It is performed with pronounced symptoms of blockade, with other disorders associated with conduction, and an unfavorable prognosis. This method improves the patient's quality of life. However, the lifespan can be increased with constant stimulation of the heart muscle.

When treating a blockade, it is important to restore a normal daily routine and complete, healthy sleep... In addition, it is necessary to normalize the level of fat in the blood. Therefore it is recommended diet food, which consists in limiting the consumption of foods high in cholesterol.

Forecast and preventive measures

Complete blockage has a poor prognosis. Typically, life expectancy in patients with third-degree pathology is greatly reduced. With attacks of Morgagni-Adams-Stokes in case of untimely medical care death is possible.

Blockade, proceeding in the first and second degree, with correct treatment characterized by more favorable outlook... The duration of the loss of working capacity depends on the degree of blockade.

It is possible to increase life expectancy and eliminate signs of pathology with the help of constant stimulation. After implantation, the prognosis is determined depending on the nature of the disease.

When the block is accompanied by a myocardial infarction, the interventricular septum is affected. This condition indicates an unfavorable syndrome.

If the blockade is complicated by heart failure or ventricular fibrillation, then in 90% of cases it ends in death.

To reduce the risk of pathology, it is important to observe the following preventive measures:

1. Carrying out preventive medical examinations.
2. Compliance with all the prescriptions of a specialist.
3. Cardiological studies of people after 40 years.
4. Correct and balanced nutrition.
5. Refusal from bad habits (drinking alcoholic beverages, smoking, using drugs).
6. The use of drugs in the exact dosage, adhering to the recommendations of specialists.
7. A healthy lifestyle that includes exercise.
8. Adequate sleep.

Compliance with these rules will help prevent heart problems as much as possible.

Heart block is a violation of the conduction of electrical impulses in one of its departments. The disease can be either independent or act as a complication in other pathologies. of cardio-vascular system... For a heart block disease, the symptoms, as well as the methods of treatment and diagnosis for each particular type or stage taken will be individual. For a detailed understanding of the principle of the existence of pathology, you need to have an idea of \u200b\u200bhow the movement of electrical impulses through the parts of the heart occurs.

How conduction of electrical impulses is carried out

Electrical impulses appear in the upper part of the right atrium - the place of their origin is called sinus node... Through it, each newly emerging electrical impulse is transmitted to the rest of the atrium. Then, through the atrioventricular node connecting the atria and ventricles (in the medical literature it can be referred to as AB), the impulse spreads to the ventricular section, once in which it branches out to all of its sections. Heart block is a violation of the described process at one of the stages of its implementation.

Classification of the disease

Depending on the area in which the conductivity was broken electrical impulse, heart block can be divided into the following types:

• atrial;
• intra-atrial;
• atrioventricular;
• ventricular.

For these pathologies, experts consider 3 degrees of their manifestation.

1. I degree of the disease is characterized by a slow conduction of electrical impulses. It is easily diagnosed with eCG and does not always require special treatment, but dangerous with the risk of the disease going into a deeper stage.
2. At the next stage, some impulses drop out in some part of the conduction. Patients with II degree heart block periodically feel dizziness, pain in the chest area, rapid fatigue, but sometimes it may not manifest itself symptomatically. The nature of treatment for grade II heart disease differs depending on the location of its occurrence. Usually, an electrocardiogram is not enough to detect and confirm it; in case of suspicion of this diagnosis, the cardiologist can refer the patient for laboratory tests.
3. If an electrical impulse in a particular section does not pass at all, doctors diagnose a heart block III degree... To detect it, in addition to ECG and laboratory research, instrumental will also be required. Patients who are diagnosed with it usually completely lose their ability to work, constantly feel weak and drowsy, often feel a feeling of chest pain, they have a noticeable decrease in heart rate. In some cases, the disease in this form is fraught with sudden death.

Treatment for heart block will vary depending on the degree and type.

Atrial block

Atrial block is caused by a violation of the conduction of electrical impulses in the atrial area. The permanent form of the disease is often confused with bradycardia - a decrease in heart rate, because. clinical picture both pathologies are similar.

The cause of atrial block may be incorrect use of certain antiarrhythmic drugs, as well as medicinesused to lower blood pressure and treat heart failure (in this case, a mandatory consultation with a cardiologist is required to cancel / replace drugs or to adequately select their dosage).

In addition, it is often observed in patients diabetes mellitus with hyperglycemia - elevated level blood glucose. In some cases, this disease is caused by a tumor or occurring in the brain inflammatory processes... Even less often, atrial blockade occurs due to congenital cardiomegaly - an enlargement of the heart to a size significantly exceeding the norm, defects of the mitral and aortic valves, and thyroid disease. She herself can also be congenital or genetic.

The initial stage of atrial block is not considered a serious pathology - people who have it are usually advised to limit themselves to general methods of maintaining health. With II and III degrees of the disease, the cardiologist may prescribe bellataminal, belloid, ephedrine or atropine. With a decrease in the heart rate to 40 beats / min and frequent loss of consciousness, the patient is "implanted" with an implant, which is responsible for generating impulses that determine the heart rate.

Intra atrial block

Intra-atrial block is a delayed or complete absence of an electrical impulse from the right atrium to the left. Called ischemic disease heart and other pathologies of the cardiovascular system. It is rare, and mostly patients over 80 years old suffer from it, but there are cases of atrial blockade in middle-aged patients.

It is not amenable to treatment, but with proper treatment of the diseases that caused its occurrence, it can be completely eradicated from the body or the most favorable course of the disease can be achieved. The exception is complete intra-atrial blockade - it usually occurs several hours before death in patients with serious heart disorders, however, in medical practice, you can also find cases of complete cure of the patient's pathology.

Atrioventricular block

Atrioventricular (AV) or atrioventricular blockade is a delayed or complete cessation of an electrical impulse at the same site of its passage. Patients who have had myocardial infarction, in many cases, have this disease in their medical records. The causes of atrioventricular block can also be a weakening of the heart muscle, heart, coronary artery disease and rheumatoid heart damage, previous diphtheria or other infections. Atrioventricular block is sometimes found in newborns and in some cases is inherited.

I degree atrioventricular block can occur as a normal physiological phenomenon in people who are actively involved in sports (especially in athletes), as well as in young and adolescent years. Potassium salts, cardiac glycosides, cordarone and others medications can provide side effectaccompanied by this violation.

Patients with degree I AV block, which occurred due to myocardial infarction, and at the same time need to take drugs that worsen cardiac conduction, need to insert an endocardial electrode into the ventricle. To prevent the transition of the disease to a deeper stage, persons with a history of myocarditis may be prescribed prednisolone or another drug of the glucocorticoid group. All other carriers of this pathology do not need special treatment.

At II degree of atrioventricular block, patients may feel a slow pulse rate. Short-term cardiac arrest is possible, in which the patient will complain of dizziness and darkening of the eyes. The doctor may recommend installing a pacemaker (or an endocardial electrode in the ventricle) to prevent the progression of the disease to grade III, but this is not always necessary.

Symptoms of III degree atrioventricular heart block: weakness and fatigue, dizziness, short-term loss of consciousness, in which the patient sometimes has involuntary urination or defecation. Blood pressure in this condition, it exceeds normal values.

If a full form the disease appeared as a result of atrial fibrillation, the patient will have only rare heart failure and high blood pressure without other symptoms. III degree of atrioventricular block is the basis for the installation of a pacemaker, with the exception of the congenital nature of the disease and the period of pregnancy. In some situations, a pacemaker can also be installed in pregnant women (for example, in case of hemodynamic disorders).

Ventricular block

Violation of the conduction of an electrical impulse in the ventricular section means that the patient has a corresponding type of heart block. The cause of its occurrence can be:

• congenital;
• high blood pressure;
• pathological lesions of the heart muscle;
• coronary heart disease;
• overdose of cardiac glycosides.

Ventricular block, regardless of its stage, does not require special therapy. To prevent the development of ventricular blockade and its elimination, it is necessary to make every effort to treat the disease that caused it.

This form of pathology, depending on the exact site of localization, can be supplemented by an atrioventricular, including its full stage. This process usually takes about 10 years.

1. Under no circumstances should you self-medicate for cardiovascular disease.
2. Going in for sports, it is absolutely not advisable to immediately take on an increased volume of loads. The opposite rule is also true - for athletes who have already accustomed the heart muscle to heavy loads, it is very dangerous to abruptly stop training.
3. Regardless of the state of health, you should adhere to the principles proper nutrition, the use of excessively salty, spicy and fatty foods should be minimized, especially for people over 40 years old.
4. Patients who already have heart block should promptly inform the cardiologist about any changes in well-being and adverse events when taking prescribed medications.
5. Blood pressure should be checked regularly and if it is long time differ from normal, you should consult a doctor for the appointment of therapy that can support it. Working pressure is a myth. Lack of feeling unwell at high blood pressure does not mean that this or that number on the tonometer, in fact is “ individual norm»For this or that person.
6. A complete cessation of alcohol and smoking is an excellent preventive measure. If you quit on your own bad habits does not work - do not be afraid to seek help from doctors.

Strict prevention can be a full-fledged treatment for the first stages of the disease - it is better to limit yourself to dubious pleasure than to observe unnecessary complications.

If a person has a heart block, why is such a pathology dangerous? This question is often asked by patients to a cardiologist. The first sign developing disease, called "heart block" - this. The heart can beat in slow motion, or even out of rhythm. A similar effect is observed when the passage of electrical signals that control cardiac activity to the controlled organ is impaired, they are simply blocked or slowed down.

A pathological condition in the form of complete or partial blocking of electrical signals to the heart is most often a consequence of old age or the presence of the patient serious diseases hearts.

Fortunately, heart block does not always lead to any complications, but it is quite possible to develop a heart attack or stroke. This pathology is quite diverse. There are three degrees of severity of the blockade, each of which arises in a different way and passes in the same way.

Diagnostics can reveal blockages in various parts of the heart, so examination by a cardiologist should not be too rare and should be carried out on a regular basis to avoid possible undesirable consequences.

What is the danger of the disease?

Why is heart blockage dangerous? First, remember that the heart is the main supplier of oxygen to the body through the blood. Failures in its work lead to instant problems with blood supply and oxygen starvation of organs, which may well lead to frequent dizziness, fainting and other similar unpleasant phenomena. Incomplete heart block leads to a violation correct work atria and ventricles of the heart.

The rhythm of the heart muscle is set by a kind of electrical impulses that originate at the heart wall and penetrate the entire heart. The rhythm is also controlled by these signals.

The electrical signal travels from the atria to the ventricles through the so-called atrioventricular node, where the atria and ventricles are synchronized. This is how a healthy heart works.

When a pathology occurs, the process of transmitting this signal is disrupted.

If this blockade occurs in the atrioventricular node, the communication between the atrium and ventricles ceases. This pathology is called incomplete heart block.

Taking into account the site of the node where the signal obstruction occurred, an incomplete blockade can be right or left.

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The severity of the blockade of the heart muscle

First-degree (incomplete) pedicle blockade is characterized by partial obstruction of the signal, but not completely blocking it. These changes are clearly visible on the electrocardiogram, where the height of the teeth decreases slightly. If such a blockade is found, the whole heart should be diagnosed, since the blockade may indicate some kind of disease of this organ.

Blockade of this degree can be caused by a number of reasons:

• condition of the vagus nerve;
• myocarditis;
• myocardial infarction;
• deviations of homeostasis in the form of imbalance in water and electrolytes;
• abuse of various cardiac drugs.

Like any dysfunction, blockade of the first degree gives the patient a number of unpleasant symptoms, but does not pose a particular health hazard. No special drastic actions are required from you in this situation, but it is already at this stage to deal with the reason that caused this blockade. The danger of ignoring this pathology can result in its further development in an undesirable direction.

Blockade of the leg of a diseased heart of the second degree (incomplete) is a continuation of the development of the pathology of the first stage. Not all impulses reach their destination, which is reflected in episodic heart rhythm disturbances. On the electrocardiogram, slow contractions alternate with absolutely normal ones. External clinical manifestations can either be completely absent, or appear in a fairly active form:

• dizzy;
• chest pain;
• irregular pulse;
• hypotension;
• blood pressure is lower than usual.

At this stage, a simple cardiogram will most likely not be enough to fully diagnose pedicle blockade. You should turn to more complex diagnostic methods, followed by a thorough analysis of the research results.

Blockade of the left ventricle of the heart (right) of the third degree is characterized by complete obstruction of the signal. The contractions of the ventricles and atria occur completely independently of each other. Such desynchronization has already a pronounced clinical picture:

• dizzy and general lethargy;
• expressed pain in the chest;
• feeling short of breath;
• nausea and vomiting;
• profuse sweating;
• sudden death;
• bradycardia.

The blockade of this severity can be either congenital or acquired. In both cases, the diagnosis of the disease is enough difficult process. To study the problems of the left and right legs of the heart muscle, a whole set of medication and other specific studies is used.

At this stage of the disease, the patient's prospects are very sad. Lack of opportunity full life, during a heart attack, it is necessary to produce artificial ventilation lungs and do chest compressions.

Medicines taken by the patient do not give a long-term effect, therefore, it is completely inappropriate to prescribe any treatment. As a result, upon detection of the first symptoms complete blockade the patient is prescribed constant electrical stimulation of the heart.

That is why, already faced with signs of first-degree heart muscle blockade, you should immediately contact a specialist who will monitor the condition of your disease. The mild severity of symptoms should not mislead you, any deviation in the activity of the heart is extremely dangerous for your health, therefore, consult a doctor as soon as possible if you have observed heart problems.

In order for the heart to supply blood to every cell of the body, it must contract in the correct rhythm and with a frequency of 55-60 to 80-90 beats per minute. The rhythm should be regular, with equal intervals between contractions, because the lack of oxygen carried with the blood, even for more than 30 seconds, can already affect the functioning of cells, and first of all, brain cells. The onset of oxygen starvation (hypoxia) of the brain is especially important for conditions such as heart block.

Blockades of the II and III degrees, complete intraventricular blockade, three-bundle blockade (both of the right and both branches of the left leg of His) almost always occur with organic damage to the heart tissues. Diseases that cause inflammatory or scarring processes in the myocardium include:

Prevention is competent drug treatment of the underlying disease, timely determination of indications for implantation of a pacemaker.

Forecast

The prognosis for blockade I degree in the absence of organic heart damage is favorable.
For complete blockages, the prognosis is determined by the nature of the underlying disease, the degree of dysfunction of the heart and the stage of chronic heart failure. The frequency and number of seizures of MES are not predictors of mortality, that is, they do not affect the prognosis - in some patients, seizures may occur frequently, while in others, a single seizure in a lifetime can be fatal.

Prognosis for patients in acute period myocardial infarction, complicated by the development of a complete left or right blockade bundle of His, extremely unfavorable.

Physician therapist Sazykina O.Yu.

Heart block - irregularities in the rhythm of contractions occurring due to problems with the passage nerve impulses through the conducting system of the heart.

An electrical impulse is created in the sinus node, spreads to the atria, then to the ventricles through the atrioventricular node. This is the conduction system of the heart muscle.

The etiology of the development of pathology includes both congenital and acquired heart diseases, medication, heredity.

A list of diseases that can cause the development of the blockade:

• heart attack;
• metastases;
• tumors;
• fibrosis;
• lev-Lenegra disease;
• coronary heart disease;
• myocarditis;
• cardiomyopathy;
• atherosclerosis;
• diabetes;
• vegetative vascular dystonia (VVD);
• vasculitis;
• autoimmune diseases;
• damage to the atrioventricular node;
• hypertension;
• heart defects;
• endocrine disorders;
• problems with gastrointestinal tract (for example, with vomiting);
• breathing disorders (eg apnea);
• drug intoxication.

And there are also other factors that can provoke conduction dysfunctions - a lack of trace elements that affect the heart, excessive physical exertion, frequent stress, and taking narcotic drugs.

Possible varieties

There are several classifications of heart block:

Classification	Kinds
By localization	Sinoatrial (failures during the transition of the impulse from the sinus node to the atria)
	Atrial (atrial dysfunction)
	Atrioventricular (obstruction or abnormalities at the level of the atrioventricular node)
By the time of existence	Constant
	Intermittent or transient (passes with attacks)
By severity	1st degree (passability is not violated, but is carried out with a delay)
	2nd degree (impulses pass, but only partially, this means that some impulses do not reach parts of the conducting system)
	3rd degree (complete heart block, that is, impulses are not conducted completely, which causes a drop in the heart rate)
By manifestations	Asymptomatic (most often, it is observed with damage to the bundle of His. And also blockades of the first and second degree are detected only after an ECG)
	With the manifestation of symptoms (with the third degree of impulse patency, the symptoms appear brightly)
By the effect on health	Physiological (pathology of the first degree occurs and is considered the norm in a certain circle of people, for example, in athletes or children / adolescents with minor cardiac abnormalities)
	Pathological (characterized by damage to the conducting system at some level, leading to a deterioration in the patient's condition)

Degrees and their symptoms

In total, three degrees are distinguished, one of which is divided into three types - 1st, 2nd (3 options are distinguished in it: mobitz 1, mobitz 2, high-degree blockade) and 3rd.

1st degree

At the first severity of cardioblockade, the passage of the impulse through the conducting system is not disturbed, but it is carried out with a delay (with the sinoatrial - the impulse slows down when passing from the sinus node to the atria, with the atrial one - failures occur in the right or left atria, with the atrioventricular - on the atrioventricular node).

Symptoms are not observed, the disease does not manifest itself in any way and is often discovered by chance during a planned ECG procedure.

2nd degree, 1st type

It is characterized by a gradual deterioration in conductivity, reaching the complete cessation of the arrival of pulses in the sections of the conducting system and subsequent recovery.

In the first type, symptoms may be absent or manifest as a slight, rare increase or decrease in heart rate.

2nd degree, 2nd type

The second type is characterized by a sudden cessation of patency in sections of the conducting system. The blockade of the impulse provokes pauses between those impulses that reach from the sinus node to the ventricles and legs of the His bundle and terminal branches. After a pause, conduction improves, but does not completely return to normal and continues to be slowed down.

The second degree of the second type is expressed by the following symptoms:

• violations in the frequency of myocardial contractions;
• feeling of sinking heart;
• arrhythmia (may be expressed by tachycardia - increased heart rate, or bradycardia, bradyarrhythmia - decrease);
• feeling of weakness in the body;
• rapid onset of fatigue;
• dizziness and headaches;
• vision problems (the appearance of circles before the eyes or flies);
• fainting or darkening before the eyes;
• chest pain rarely occurs.

2nd degree, high-grade blockade

A special and rather rare species is high-grade. In this case, out of four impulses formed in the sinus node, only one passes through the atrioventricular node (there is also a period of one transmitted impulse in five / six formed).

The symptomatology resembles the second type of the 2nd degree. Bradycardia is pronounced.

3rd degree

It is characterized by the complete cessation of the output of an electrical impulse (in the case of sinoatrial blockade) or the termination of conduction between the sinus node and the right atrium (atrial) or through the atrioventricular node (atrioventricular or transverse).

The symptoms are similar in course to the second type of the 2nd degree, but they also have their own features:

• the frequency of myocardial contractions decreases;
• there are pains in the heart;
• there are swelling, shortness of breath;
• physical activity is hard (or not at all).

Classification by degree is not applied. In this case, topical classification is relevant, distinguishing the course of pathology by damage to the elements of the His bundle.

Unilateral conduction disturbances:

Bilateral conduction disturbances:

Non-specific blockade of terminal branches (focal) - usually patients have symptoms of the disease-cause that caused the blockade of the His bundles. The pathology of this type of specific symptoms (with the exception of high-grade) does not have.

Diagnostic methods

Diagnostics begins with taking anamnesis, listening to tones, identifying comorbidities and studying possible impact heredity.

If there is a suspicion of a blockade, the patient is sent for an ECG (electrocardiography) - this is the main diagnostic method this disease... The procedure is performed to register the electric fields generated during the work of the heart. The assessment of the patient's condition occurs according to the graph, on which the teeth are marked, reflecting the various processes taking place in the heart. There are six waves in total (P, Q, R, S, T, U) and their derivatives (PQ, QRS, ST).

With blockade, the graph shows deviations from the norm in the P and Q waves, and their derivatives.

Different types of pathology appear on the cardiogram in different ways:

• sinoatrial is not reflected in the ECG graph. Indirectly, pathology is indicated by an increase in the RR interval (designation of the heart rate) two times compared to the previous one and the absence of a P wave (designation of atrial contraction) at the time of pause;
• The 1st degree of atrioventricular blockade is expressed by a change in the PQ interval (designation of an electrical impulse when passing through the atrioventricular node). An increase is considered a deviation from the norm. 2nd degree - the absence on the graph of the Q wave (denotes the contraction of the ventricles) and the QRS derivative (assessment of the uniformity of ventricular contractions). There may be an increase in the PQ interval. 3rd degree - there is a noticeable difference in frequencies between the P wave and the QRS complex.
• blockade of the legs and branches of the His bundle - the QRS derivative expands when the P wave is normal.

In transient types of pathology, the ECG cannot always fix deviations from the norm, therefore, additional methods diagnosis:

Method	Description
24-hour heart rate monitoring (Holter)	The sensors of the ECG apparatus are installed on the patient's chest and measurements last throughout the day. This method helps to clarify the severity of the pathology, the nature of its occurrence and the factors that influenced it.
Electrophysiological examination of the heart (EPI)	Through the esophagus - before the procedure, an electrocardiogram is made and the pressure is measured (they are carried out to understand that the EFI did not provoke a heart failure). Further, a probe with an electrode at the end is inserted through the nose or mouth (through the mouth the procedure is performed much less often). The electrode emits light impulses to stimulate the myocardium. During stimulation, an electrogram is removed and, after removing the probe, it is analyzed.
	Intracardial - before the procedure, the readings of the ECG (cardiogram) and tonometer must be taken. The patient is administered anesthetics and pain relievers. After that, the vein is punctured and a catheter with five electrodes at the end is inserted through it and passed to the patient's mouth. After the stimulation, the obtained data are analyzed. Both types of research are carried out when the usual ECG does not give a reliable answer and does not allow us to accurately establish the nature of the violations.
	EchoCG through chest - carried out in the same way as ultrasound. The patient lies down on the couch, reveals upper part torso and the transducer is installed on the chest.
	EchoCG through the esophagus - the procedure is carried out in case of difficulties in the diagnosis of the first method. Both types of echocardiography are used to identify the causes of the blockade directly related to the work of the heart.

Treatment method

Periodic and chronic blockade is treated based on the severity of its course:

• incomplete blockade of the first degree and second degree of the first type are asymptomatic and requires only observation and routine examinations. It is possible to identify it in cases of planned ECGs, but even then the person is only observed by a doctor in order to prevent the worsening of the course. For pathology caused by other heart diseases, a pacemaker may be installed.
• at the 2nd degree of the second type, constant stimulation with an external pacemaker is carried out. If the cause is not heredity, but the factors in the development of pathology were acquired diseases, medicines, drugs, early stages it can be cured by arresting the original problem. If there is a suspicion of the possibility of the transition of pathology to the stage of complete blockade, a permanent pacemaker is installed.
• 3rd degree therapy is aimed at alleviating the condition and is reduced to preventing cardiac arrest, therefore, a pacemaker is always installed. Complete relief at this stage is impossible.

The greatest risk to the patient's life is represented by rapidly progressive blockages and high-grade blockages. With this course, heart failure and blood flow disturbances are observed.

Treatment is carried out surgically and always urgently:

• the patient is stimulated by an external cardiac pacemaker;
• an operation is performed to install a pacemaker.

The following drugs are used during the operation:

• Atropine.
• Dopamine.
• Adrenalin.
• Theophylline.

During treatment, drug therapy is used (if the pathology was provoked by intoxication, the intake of the drugs that affected this should be discontinued):

• beta adrenostimulants;
• m-anticholinergics;
• sympathomimetics (in this moment, the funds are not used, as they are dangerous big amount side effects).

Also, for the treatment, certain nutrition of the patient is important. Foods are added to the diet, which include trace elements that affect the work of the heart.

For instance:

• dried fruits (especially dried apricots - contains potassium and magnesium);
• fruits and berries (bananas, avocados, currants - contain calcium, sodium, iron, potassium and magnesium);
• vegetables (cucumbers, spinach - B vitamins, calcium, iron, magnesium, potassium);
• seafood.

The provision of emergency care is carried out only by specialists. If you suspect a blockade or the onset of an attack, you need to give the person horizontal position and call an ambulance. It is worth giving any medications with caution if they are not prescribed by a doctor for the purpose of treating this pathology. The patient may die from taking the wrong medication.

Why is this pathology dangerous?

Heart block on initial stages may not carry any consequences for the body, but cases of complete blockade may threaten:

• heart failure;
• disorders of cerebral circulation;
• ischemia and heart attack;
• arrhythmogenic shock;
• disability;
• pathologies of internal organs;
• lethal outcome.

Forecast

Partially, heart block is treatable, namely some of its types, but in many respects a positive outcome is predetermined by the reasons that provoked the pathology and factors that influenced its further development.

The most unfavorable prognosis for the third degree of severity of the course of the disease - there is a high probability of acquiring disability and death. Increases the chances of life surgical intervention and the installation of a pacemaker to help improve the patient's condition.

Prevention is timely treatment diseases that can develop into a blockade or cause it, routine checks of the heart and contacting doctors at the first suspicion of a deterioration.