Materiały źródłowe

• #1 Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22938-bundle-branch-block

  Bundle branch block (BBB) is a block or disruption to the electrical impulse that contracts your hearts lower chambers. […] Healthcare providers dont always treat bundle branch blocks. But they may treat the underlying health problems that cause the block. […] If you dont have symptoms or underlying conditions, you may not need treatment for bundle branch block. You may need medication to control other issues such as high blood pressure or heart failure symptoms. […] If you have symptoms such as fainting, your provider may suggest a pacemaker. A cardiac electrophysiologist (a subspecialized cardiologist, specifically trained to manage abnormal heart rhythms) places this device under the skin of your chest. Wires connected to your heart help it beat at a steady rate. […] If you have heart failure or dilated cardiomyopathy, your provider may recommend cardiac resynchronization therapy (CRT) using a biventricular pacemaker. This type of pacemaker helps both of your ventricles contract at the same time. CRT can help lessen symptoms such as shortness of breath.

• #2 Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bundle-branch-block.html

  A bundle branch block is either a complete or a partial interruption of the electrical pathways inside the wall of the heart between the two lower chambers (ventricles). […] Usually no treatment is done for bundle branch blocks directly. Your doctor may address the heart disease, if it is present. […] Your doctor may give you additional instructions about how to manage your right bundle branch block and overall heart health. You might need to make lifestyle changes, like losing weight, quitting smoking, or improving your diet. […] Monitor your symptoms carefully. Make sure you see a doctor regularly, even if you don’t have any symptoms. […] Make sure all your doctors know about your bundle branch block.

• #3

  https://www.nursingcenter.com/static.aspx?pageid=1138080

  When part of the heart’s bundle-branch electrical conduction system is blocked, you’ll see changes on several parts of the ECG tracing. This article describes how to recognize left and right bundle-branch blocks (BBBs), hemiblocks, and incomplete BBBs. Most patients with BBBs are asymptomatic unless they have other cardiac problems. The ECG will be your main clue to the electrical problem. All BBBs share some common characteristics: […] The primary leads used to assess BBB are V1 and V6, and most times the diagnosis can be accurately made using only lead V1. This makes bedside determination of BBBs easier because you don’t always need a 12-lead ECG. […] Treatment is directed at the cause of the conduction defect, which can include myocardial infarction (MI) or ischemia, heart failure, pulmonary embolism, or valvular disease.

• #4 Bundle Branch Block 101 – Nursing CE Central

  https://nursingcecentral.com/lessons/bundle-branch-block-101/

  Nursing Consideration of the Patient with Bundle Branch Blocks Management of bundle branch blocks involves identifying and treating underlying causes, such as heart disease or electrolyte imbalances. Patients may require close monitoring for any signs of worsening heart function or arrhythmias. Nurses should educate patients about their condition, medications, and the importance of regular follow-up with their healthcare provider. […] Regular monitoring of the patients heart rhythm and overall cardiac function is also crucial. […] Nurses who are treating patients with LBBB and heart failure need to weigh patients daily and monitor any EKG changes. […] Nurses caring for patients who have received a pacemaker to address a bundle branch block should educate their patients accordingly. Provide patients with a pacemaker with a card that includes their specific units type, serial number, and battery life. Continually assess the patients cardiovascular status, including rate and rhythm, hemodynamic stability, and EKG changes. Its important to monitor respiratory effort, oxygen saturation, and breathing patterns. […] Nurses should provide clear instructions to their patients on what emergent symptoms might arise that warrant immediate care. If patients experience shortness of breath, chest pain, pre-syncope, syncope, or dizziness, immediate medical care is advised.

• #5 Decreased Cardiac Output Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/decreased-cardiac-output-nursing-diagnosis-care-plan/

  Decreased cardiac output related to altered heart rate secondary to bundle branch block as evidenced by ECG changes and chest pain. […] Monitor ECG findings. Bundle Branch Block is an incidental ECG finding and may be asymptomatic. […] Instruct the patient to relax during the chest pain episodes. […] Administer sublingual nitroglycerin every 5 minutes for a maximum of three doses until chest pain is relieved. […] Administer oxygen as indicated. […] Refer to a cardiac rehabilitation program for education and monitored exercise.

• #6 Bundle Branch Block | Cardiology | Bon Secours

  https://www.bonsecours.com/health-care-services/heart-care-cardiology/conditions/bundle-branch-block

  Bundle Branch Block (BBB) occurs when there is a delay or blockage in the hearts electrical conduction system. […] BBB may not have noticeable symptoms or it causes issues like dizziness, fatigue or chest pain. […] Its important to note that BBB is often asymptomatic, meaning it doesnt present with noticeable symptoms, and is only discovered through an ECG thats being used to detect something else. When there are symptoms, they can include: […] BBB usually doesnt require treatment if its asymptomatic. If BBB is symptomatic, medications may be used to control heart rate or rhythm. […] If you experience symptoms like dizziness, fainting or chest pain, you should make an appointment with your primary care physician or cardiologist.

• #7

  https://www.nursingcenter.com/static.aspx?pageid=1138080

  Monitor the patient for advanced heart blocks, such as second-degree atrioventricular (AV) block, type II, or complete heart block, and don’t administer medications that prolong electrical conduction, such as beta-blockers. […] Determining whether a patient with LBBB also has an acute MI can be difficult because the LBBB can distort the ST-segment changes that are used to identify injury on the ECG. However, if LBBB occurs in a patient diagnosed with an acute MI (either by ECG or by cardiac biomarker elevation), the patient has a markedly increased risk of developing third-degree AV block and possibly needing a pacemaker. […] By carefully reviewing selected leads on the bedside ECG monitor, you can garner many clues to the location of a ventricular conduction problem. Combining this information with the patient’s history, condition, and physical assessment lets you anticipate problems and guides treatment options.

• #8 Bundle branch block – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/diagnosis-treatment/drc-20370518

  If you have a right bundle branch block and you’re otherwise healthy, you might not need a full medical checkup. If you have a left bundle branch block, you will need a thorough medical exam. […] Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly.

• #9 Pediatric Right Bundle Branch Block Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/894927-treatment

  The only treatment required for isolated right bundle branch block (RBBB) is periodic follow-up and evaluation. Individuals with RBBB and selected heart disease (untreated or following surgical treatment) may require an annual or biennial electrocardiography (ECG) to evaluate for interval changes. […] Inpatient ECG telemetry may be required if patients with right bundle branch block are at risk for clinically significant arrhythmia (see History and Physical Examination). […] Children with right bundle branch block should be referred to a pediatric cardiologist for careful and complete evaluation. If right bundle branch block is associated with a syndrome, consultation with other appropriate specialists is indicated.

• #10 Right bundle branch block, bifascicular block – Patient Care – EMT City

  https://www.emtcity.com/topic/18476-right-bundle-branch-block-bifascicular-block/

  Bifascicular block is going to show up as a combination of two blocks on the twelve lead. […] Bifascicular blocks are a contraindication of Lidocaine so it is important to be able to determine them. […] A Bifascicular block represents a serious conduction problem for the heart. In a bifascicular block, 2 out of 3 pathways to contract the ventricles in an organized fashion have been blocked. This can compromise myocardial contractility. […] The patient is much sicker than an uncomplicated MI. They may go into complete heart block suddenly and without warning. […] Be prepared to PACE the patient. Be prepared to DEFIBRILLATE the patient. […] I think he may be getting a defib/pacemaker placed in a day or so.

• #11 Bundle Branch Blocks (LBBB, LAFB, RBBB, Trifascicular Block) : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bundle-branch-blocks-lbbb-lafb-rbbb-trifascicular-block/

  Patients with new fascicular blocks are at greater risk of future atrial fibrillation and heart failure, and should therefore be educated on symptoms to look out for and return in case of. […] Patients with new complete or incomplete trifascicular block may require transcutaneous or transvenous pacing in the ED for symptomatic bradycardia, and need to be seen by cardiology and an electrophysiologist for pacemaker implantation. […] Do not give AV nodal blocking agents (ie. atropine) to patients with bifascicular block. These blocks are occurring distal to the AV node so AV nodal blockers will be of little use. […] Trifascicular and bifascicular with intermittent trifascicular block are both class I indications for pacemaker, and require cardiology to see.

• #12 Painful left bundle branch block syndrome successfully treated by His-bundle pacing | BMJ Case Reports

  https://casereports.bmj.com/content/15/12/e251071

  Beta-blocker therapy was first attempted. However, the patient could not tolerate it due to a low-resting rate which went to as low as 45 beats per minute after taking only 1.25mg of bisoprolol, and there was only minimal improvement in symptoms. We, therefore, discussed the option of conductive system pacing in the form of His-bundle pacing to abort the LBBB by pacing from a different level in the conductive system, the His-bundle. She then had a successful permanent His-bundle pacemaker. […] Painful LBBB syndrome is defined as intermittent episodes of angina associated with simultaneous LBBB changes on ECG with the absence of flow-limiting coronary artery disease or ischaemia on functional testing. […] With the substantial body of evidence we have nowadays about the benefits of His-bundle pacing in preventing long-term deleterious effects of chronic dyssynchrony from RV pacing only, it has become apparent that His-bundle pacing would be a much better option for long-term treatment of painful LBBB syndrome. […] Recently, His-bundle pacing is a promising treatment strategy that is gaining popularity in treating this condition.

• #13 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  Patients with new-onset LBBB post-TAVR or surgical myomectomy should have continuous telemetry monitoring for at least 48 to 72 hours to detect any episodes of high-grade atrioventricular block or symptomatic bradycardia. […] High-risk patients, especially those with symptomatic conduction abnormalities or evidence of high-grade atrioventricular block, should receive a permanent pacemaker. […] Prompt treatment and regular monitoring of affected individuals can reduce the risk of these complications. […] Patients with LBBB should be educated on the potential seriousness of their condition, symptoms to watch for, and the importance of regular follow-up.

• #14 Right Bundle Branch Block

  https://myhealth.umassmemorial.org/Library/DiseasesConditions/Adult/134,578

  Monitor your symptoms carefully. Make sure you see a healthcare provider regularly, even if you dont have any symptoms. […] Make sure all your healthcare providers know about your right bundle branch block. […] See a healthcare provider right away if you have severe symptoms like chest pain, syncope (fainting), or severe shortness of breath. If you have any new symptoms, plan to see your healthcare provider as soon as possible.

• #15 Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22938-bundle-branch-block

  If you see a new healthcare provider, always tell them that you have a bundle branch block. This information will help them better monitor your heart health and overall wellness. […] Make sure your provider knows about your BBB diagnosis if you have: An exercise stress test, as an LBBB can make diagnosis of certain conditions more difficult. […] You may want to carry a copy of your EKG, so you have it handy if an emergency happens.

• #16 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  Left bundle branch block results when something disrupts the electrical impulse that controls your heartbeat. […] People with heart conditions may need a pacemaker or cardiac resynchronization therapy to manage this condition. […] If you have symptoms such as fainting, your provider may recommend a pacemaker. Pacemakers are typically indicated when you have a conduction abnormality along with a LBBB. […] If you have heart failure, your provider may suggest cardiac resynchronization therapy (CRT). This type of pacemaker helps your ventricles contract at the same time. CRT can help reduce symptoms such as fatigue and shortness of breath. […] If you see a new doctor, always tell them if you have left bundle branch block. This information will help them better monitor your heart health and overall wellness.

• #17 Left Bundle Branch Block

  https://healthinfo.universityhealthsystem.com/Library/Encyclopedia/134,551

  Left bundle branch block is a problem with the hearts electrical wiring (conduction) system. […] In older people with coronary artery disease, left bundle branch block is linked with greater risk of death. This is especially true for people with heart failure. Left bundle branch block is also linked to a greater risk of death after a heart attack. […] Some people with left bundle branch block may need a permanent pacemaker. A pacemaker helps keep the heart beating at the correct rate. This is usually only needed if you are having symptoms or have another conduction problem along with left bundle branch block. […] People with heart failure and left bundle branch block may need cardiac resynchronization therapy or CRT. This is a type of pacemaker therapy that helps the ventricles contract at the same time. CRT can increase the amount of blood that the heart ejects and can improve symptoms of shortness of breath and fatigue. It can improve survival.

• #18 Left Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/l/left-bundle-branch-block.html

  People with heart failure and left bundle branch block may need cardiac resynchronization therapy or CRT. This is a type of pacemaker therapy that helps the ventricles contract at the same time. CRT can increase the amount of blood that the heart ejects and can improve symptoms of shortness of breath and fatigue. It can improve survival. […] Follow your healthcare provider’s instructions carefully. Take all your medicines as prescribed. […] If you have left bundle branch block, see your healthcare provider for monitoring as advised. This is important even if you dont have any symptoms. […] Be aware that some people with left bundle branch block may not require treatment, but others need pacemakers or cardiac resynchronization therapy.

• #19 Right Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507872/

  Right bundle branch block is usually asymptomatic and is typically found incidentally on ECG. […] Generally, the isolated presence of a right bundle branch block is asymptomatic and does not require further evaluation or treatment. In the setting of heart failure with a low ventricular ejection fraction in combination with a right bundle branch block, cardiac resynchronization therapy is indicated. […] ECGS are regularly done in clinical practice and sometimes the primary care provider, nurse practitioner and the internist may come across a patient with a RBBB. In isolation and in an asymptomatic patient, RBBB is benign. However, the patient should be referred to a cardiologist to ensure that he or she has no heart disease. In patients with CHF and RBBB, cardiac resynchronization therapy is indicated.

• #20 CoxHealth | Right Bundle Branch Block

  https://www.coxhealth.com/condition/right-bundle-branch-block/

  Right bundle branch block affects the hearts conducting system. The right branch of this conducting system is blocked or partially blocked. This causes the right ventricle to contract a little later than it should. […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. People without any symptoms do, however, need careful evaluation at the time of diagnosis. […] Some people with right bundle branch block may ultimately need a permanent pacemaker, but this is rare. It is usually only necessary when a person has another conduction problem and right bundle branch block. […] Your healthcare provider may give you additional instructions about how to manage your right bundle branch block and overall heart health. You might need to make lifestyle changes such as losing weight, quitting smoking, or eating a healthier diet. You’ll likely also need to:

• #20 CoxHealth | Right Bundle Branch Block

  https://www.coxhealth.com/condition/right-bundle-branch-block/

  Monitor your symptoms carefully. Make sure you see a healthcare provider regularly, even if you dont have any symptoms. […] Follow your healthcare provider’s instructions carefully. Take all your medicines as prescribed. […] If you have right bundle branch block, see your healthcare provider for follow-up monitoring as advised. This is important even if you dont have any symptoms. […] Tell your healthcare provider if you have severe symptoms or if your symptoms get worse.

• #21 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block. […] Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #22 Bundle branch block – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/diagnosis-treatment/drc-20370518

  If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #23 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  LBBB is a predictor of worse outcomes in patients with heart failure, including recurrent hospitalization and mortality. […] The presence of LBBB in different cardiomyopathies confers adverse outcomes. […] Regular monitoring and appropriate management, including the potential use of therapies like cardiac resynchronization therapy, are key to improving outcomes in patients with LBBB. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. […] Standard medical therapy for heart failure should be initiated and optimized as tolerated. […] Cardiac resynchronization therapy (CRT) is indicated in patients with sinus rhythm, NYHA functional class II, III, or ambulatory IV heart failure despite optimal medical therapy, an LVEF of 35% or less, QRS duration greater than or equal to 150 ms with LBBB morphology, and a meaningful expected survival longer than 1 year.

• #24 Left Bundle Branch Block

  https://healthlibrary.uwmedicine.org/Library/DiseasesConditions/Adult/134,551

  Left bundle branch block affects the hearts electrical conduction system. When you have left bundle branch block, the left branch of this conducting system is partially or completely blocked. This causes the left ventricle to contract a little later than it should. […] Follow your health care provider’s instructions carefully. Take all your medicines as prescribed. […] If you have left bundle branch block, see your health care provider for monitoring as advised. This is important even if you dont have any symptoms. […] Be aware that some people with left bundle branch block may not require treatment. But others need pacemakers or cardiac resynchronization therapy. […] Monitor your symptoms carefully. Make sure you see your health care provider regularly, even if you dont have any symptoms.

• #25 Right Bundle Branch Block

  https://johnshopkinshealthcare.staywellsolutionsonline.com/Library/DiseasesConditions/Adult/134,578

  Right bundle branch block comes from a problem with the hearts ability to conduct electrical signals. It usually doesnt cause symptoms unless you have some other heart condition. […] Right bundle branch block is rare in healthy young people. It happens more often in older people. This may be due to the normal changes in the heart’s conduction system that occurs with age. […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] Your healthcare provider may give you additional instructions about how to manage your right bundle branch block and overall heart health. You might need to make lifestyle changes such as losing weight, quitting smoking, or eating a healthier diet. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

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