Bundle branch block

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Bundle branch block
File:Left bundle branch block.svg
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Often asymptomatic, may include syncope, palpitations
Complications	Heart failure, arrhythmia
Onset	Can occur at any age, more common in older adults
Duration	Chronic
Types	Left bundle branch block, Right bundle branch block
Causes	Coronary artery disease, hypertension, cardiomyopathy
Risks	Age, hypertension, diabetes mellitus
Diagnosis	Electrocardiogram (ECG)
Differential diagnosis	Myocardial infarction, ventricular hypertrophy
Prevention	N/A
Treatment	Treat underlying cause, pacemaker for severe cases
Medication	N/A
Prognosis	Varies, depends on underlying condition
Frequency	Common in older adults
Deaths	N/A

Bundle Branch Block: An Overview

Bundle branch block refers to a specific type of electrical conduction defect within the heart. This anomaly disrupts the regular propagation of electrical impulses, often culminating in an arrhythmia, or an irregular heartbeat.

ECG trace depicting bundle branch block.

Understanding the Heart's Conduction System

To fully comprehend bundle branch block, one must first grasp the basics of the heart's intrinsic electrical system.

The Electrical Pathway

• Sinoatrial (SA) Node: Often dubbed the heart's natural pacemaker, the SA node initiates the electrical signal.
• Atrioventricular (AV) Node: The signal moves from the atria to the AV node and then travels down the Bundle of His.
• Left and Right Bundle Branches: These pathways ensure the signal reaches the ventricles, enabling them to contract in a synchronized manner.

Pathophysiology of Bundle Branch Block

In bundle branch block, there's a disruption in this typical electrical sequence.

Blocked Conduction

• One or both of the bundle branches become dysfunctional, delaying or halting the transmission of electrical impulses.
• This results in an asynchronous contraction of the ventricles.

Clinical Manifestations

The manifestation of bundle branch block can range from being asymptomatic to producing palpable heart rhythm disturbances.

• ECG Changes: An Electrocardiogram (ECG) will typically showcase distinct changes that point to the presence of a bundle branch block.
• Irregular Heartbeat: Patients might report palpitations or an irregular heartbeat.
• Fatigue: Reduced cardiac efficiency can lead to feelings of tiredness or shortness of breath.

Illustration of the heart's electrical conduction system.

Diagnosis and Management

Identifying and managing bundle branch block is pivotal for ensuring cardiovascular health.

Diagnostic Tools

• Electrocardiogram (ECG): This primary tool measures the heart's electrical activity, revealing the characteristic changes of a bundle branch block.

Management Approaches

• Observation: If the condition is asymptomatic and poses no immediate threat, regular monitoring might be all that's required.
• Pacemaker Implantation: For severe cases that compromise the heart's pumping efficiency, a pacemaker may be implanted to regulate the heart rhythm.
• Medication: Certain medications can be prescribed to manage underlying causes or associated symptoms.

Conclusion

Bundle branch block, while often benign, can be indicative of underlying cardiac conditions. Proper diagnosis and timely intervention can prevent complications and enhance the quality of life for affected individuals.

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