Causes of complete blockade of the right bundle branch. Left heart block

Patient with characteristic symptoms goes for an ECG and sees the following entry in the results: “Complete blockade of the right bundle branch.” A lot of questions immediately arise: how dangerous is this, what does it lead to. What is this anyway: a disease or a symptom? There is no need to worry too much, the first thing you need to do is figure it out.

Heart - a complex system

The bundle branches are a component of the myocardial conduction system. They are responsible for supplying excitation impulses to the ventricles. The following bundle branches are distinguished:

1. left;
2. right front;
3. the back one is thicker than the others.

Left and right are branches of the rear. The legs are connected to each other by a mesh of anastomoses. The entire bundle has atypical muscle fibers in its structure. The extreme sections of the legs branch and create another element of the heart - Purkinje fibers.

The key task of the bundle is to transmit an electrical impulse to the ventricles from the right atrium. There may be incomplete or complete violation impulse conductivity, both on the right and left legs, and on both simultaneously.

Note! RBBB often does not manifest itself clinically, which means that treatment is not carried out.

The risk of RBBB increases with age. If in young people this phenomenon occurs in 0.6%, then for age group over 55 years of age the average is 2%. Right bundle branch block is more common in men.

Why is it developing?

PNPG blockade is caused various kinds pathological conditions:

• heart defects, including congenital and acquired;
• cardiomyopathy, myocardial dystrophy;
• cardiac ischemia;
• myocarditis of viral and bacterial origin;
• myocardial infarction, cardiosclerosis;
• rheumatic heart disease;
• thromboembolism;
• chronic lung pathologies that provoke a condition such as cor pulmonale;
• underdevelopment of PNPG.

There are other reasons that do not relate to pathological conditions of the myocardium, among them:

• chronic pathologists of the respiratory system, which are accompanied by obstructive processes;
• muscular dystrophy;
• overdose of cardiac glycosides, diuretics and some other medications;
• smoking for a long period;
• alcoholism;
• ANS dysfunction;
• illnesses endocrine systems s;
• diabetes;
• anemia.

His bundle placement

In children, blockade occurs due to minor anomalies of the heart, unclosed oval window, prolapse mitral valve. If there is no organic lesions heart, then this condition is considered normal.

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Classification

BNPG is classified according to different signs. If we consider it from the position of impulse conduction, then it is incomplete when the impulse slows down, but still passes. Complete blockade is the absolute cessation of impulse transmission.

Separation by the number of non-conductive beams:

1. Single-fascicle - the right leg is most often affected, but conduction may disappear only in the left or only in the back.
2. Double-fascicle – covers the branch of the left; one left branch and one right leg.
3. Three-bundle – there is incomplete or complete blockade of the right and left legs.

Classification by types of development:

• Intermittent - during the cardiogram it appears and then disappears.
• Constant – can be traced during the study constantly.
• Transient - blockade of the right bundle branch appears on the ECG from time to time.
• Alternating. This form is characterized by manifestations of blockade either on the right or on the left leg.

Signs

In order to start treatment in a timely manner and not suffer from the consequences, it is important to notice the pathological condition in time. Often RBBB passes without symptoms; single-bundle blocks especially do not “like” to show themselves. These are often detected by chance during a routine ECG. If complete blockade of PNPG occurs, symptoms appear, although generally not accompanied by serious myocardial damage. Among the signs:

1. Atypical heart sounds when listening.
2. Dizziness.
3. Pre-fainting and fainting states.
4. Feeling of lack of air, shortness of breath.
5. Poor tolerance to any stress, rapid fatigue.
6. A rare manifestation is pain in the heart, a feeling of interruptions in the functioning of the organ.

If the blockade is provoked by a disease, then its characteristic manifestations are noted.

ECG blockade back and right legs

Diagnostic techniques

If the listed symptoms appear, it is recommended to go to the doctor for a consultation. Most likely, he will immediately send you for an ECG. If the results of the cardiogram showed incomplete blockade of the right leg, and the patient does not have any other cardiac pathologies, the condition is considered normal. Additional techniques are not prescribed.

If a two-bundle block is detected, a detailed examination is needed. When diagnosing a blockade of two left branches, which is detected for the first time, immediate hospitalization is required. Extensive myocardial pathology reveals itself in a similar way. Often, a two-bundle blockade masks the manifestation of myocardial infarction. If the left blockade is maintained for a long time, hospital treatment no need.

Three-bundle block is an indication for immediate hospitalization and detailed examination.

In addition to ECG, other tracking techniques are used:

• Holter mount. Helps identify transient blockade.
• Transesophageal ECG. Due to the fact that the electrode approaches the heart as close as possible, it is possible to determine the blockade if it is not shown by the cardiogram.
• EchoCG - ultrasound of the heart.
• MSCT () is the decisive measure if other methods have given controversial results.

Treatment

With RBBB, specific drug treatment is not necessary, but only if there is no underlying heart disease or other disease. The following groups of drugs are often prescribed:

1. Vitamins. Among them are thiamine, riboflavin, nicotinic acid.
2. Antioxidants.
3. Sedatives of plant origin.
4. Lipid-containing products that help normalize the amount of cholesterol in the blood.
5. In case of development of chronic type of insufficiency - diuretics and glycosides.
6. If hypertension is present, use antihypertensive drugs.
7. For ischemia - ananginal drugs.
8. For inflammation of the membranes of the heart - antibiotics, NSAIDs.

Sometimes drug treatment ineffective to avoid negative consequences surgical intervention is used. The operation consists of installing a pacemaker. Complete blockades often develop in acute phase myocardial infarction, so temporary electrical stimulation is required.

Treatment for RBBB is often necessary

Consequences and complications

The most dangerous consequence this conduction disorder becomes sudden death. This is possible with a complete blockade. As for the less critical consequences, this is the development of heart failure. May occur:

• Acute disorders cerebral circulation, which leads to stroke.
• Worsening of the underlying pathology, which provoked the blockade.
• Thromboembolism due to blood thickening. Blood clots form not only in the heart, but also in other organs and limbs.

Conclusion

Right bundle branch block is not considered dangerous unless it is accompanied by other cardiac pathologies. If there are any, you need to keep the condition under control and regularly undergo an ECG.

More:

ECG with left bundle branch block, causes of pathology, treatment methods

IN last decade the percentage of reported deaths from various heart diseases has increased significantly.

However, not every patient, having heard, for example, such a diagnosis as complete blockade of the left bundle branch, imagines what it is and what methods of treating such a disease exist in modern times. medical practice.

Therefore, this article will answer all your questions.

General characteristics of the disease

Taking into account the natural structure of the His bundle structure, the blockade can be single-bundle or multi-bundle.

In a specific case, this refers to the fact that the pathological process has spread to both branches or reached directly to their branches. This disrupts the normal conduction of the impulse.

As a rule, complete blockade of the left leg is classified as an organic type of damage to a characteristic organ. Electrical signal traveling through right side, has an exciting effect not only on the ventricle located in this area, but also on the septum.

The wave impulse then affects the left ventricle. In this case, the total time of movement of the activation wave increases.

Of course, with the disease in question, conductivity will be observed, but much more slowly and in a roundabout way.

It should be noted that the disease for a long time does not reveal himself at all and initial stage its development does not pose a great threat to human health.

The clinical picture acquires clear outlines only during the period of rapid progression of ventricular arrhythmia (tachycardia).

Attention! If found even minor signs failures in the functioning of the heart, you must immediately contact a cardiologist.

Causes of dangerous deviation

Electrocardiogram (ECG) – enough effective method identifying pathologies of the main human organ. However, even with its help it is very difficult to detect complete LBBB in time. This phenomenon occurs due to long-term asymptomatic anomalous process.

To confirm the doctor’s assumptions, it usually requires the use of other instrumental methods and diagnostic methods:

If the blockade has never been diagnosed before, its occurrence is primarily associated with an acute type of myocardial infarction.

There are also other common reasons for the formation of such a dangerous condition:

The true provoking factor can only be determined by a qualified specialist.

Classic clinical manifestations

During a blockade of the type described, special clinical manifestations occur some time after the onset of the pathology. Moreover, specific changes are easily detected by simply listening to the tones of the patient’s characteristic organ. The patient may report the following warning symptoms:

After all, as you know, the bundle of His consists of a trunk and several legs, and if at least one of its elements functions incorrectly, then the full functioning of the entire conduction system is at risk.

Such clinical picture cannot go unnoticed.

Cases of sudden fatal outcome if the patient was not given first aid.

Occasionally, the ECG shows a slight deviation of the axis of a characteristic organ to the left, which indicates that a person has a blockade, provided that he does not have any concomitant illness.

An effective treatment regimen for the disease

IN specific treatment there is no urgent need for a blockade. As a rule, the fight is aimed at eliminating the underlying disease, which caused the problem in question. The attending physician prescribes the following groups of medications to the patient:

1. Glycosides.
2. Nitrates.
3. Tablets that lower blood pressure.
4. Adrenergic blockers.
5. Antiplatelet agents.

Medicines should be taken strictly according to the doctor's instructions. If after a course of therapy obvious improvements still do not occur, then a decision on surgical intervention is considered.

A pacemaker is surgically installed, which will correct the operation of the “motor” human body. The patient's condition in postoperative period improve data non-drug methods recovery:

Consequences of the disease

It is certainly necessary to treat the disease described. Like any other pathological process, it tends to progress and get worse.

Over a certain period of time, uncontrolled contraction of the heart muscle fibers occurs.

Such a phenomenon is incompatible with life. Therefore, the disease often ends in the death of the patient.

True, with such a frivolous attitude towards health, less frightening complications may arise, including:

Sometimes minor LBP damage is considered normal (mainly in young people). However, only an experienced cardiologist can confirm this fact after conducting a series of examinations.

Scenario for the development of a pathological condition

The forecast for this pathological condition can be very favorable. This is especially true for patients who have not experienced sharp deterioration well-being or severe symptoms at the entire stage of the disease, as well as its therapy.

The acute form of the disease requires immediate hospitalization of the patient. In addition, the underlying disease significantly influences the prognosis, since there is a connection with the organic component of the blockade.

Therapy will also take more time, effort and patience if serious complications have developed.

Getting rid of left bundle branch block various methods, up to the use of a defibrillator. Then a course of effective drug therapy.

True, bringing yourself to a critical state is extremely unwise. Moreover, each patient requires individual approach in the treatment of pathology.

Elderly people are usually advised to adhere to additional measures prevention (for example, do not forget about therapeutic nutrition).

In order to understand what blockade of the left ventricle of the heart is, you need to know how a healthy human heart, as well as how its conducting system is organized.

Our heart consists of ventricles and atria, which contract in turn to provide blood circulation to the entire body. The heart works under the influence of electrical impulses that are produced by its specific structures.

The sinus node is the dominant impulse-generating structure. After the impulse leaves this node, it is carried out to the atria, which contract because of this. Then it reaches the atrioventricular node. This node is located between the ventricles and atria and is a kind of gateway for the eclectic impulse between these two structures. The impulse is delayed for a fraction of a second in the atrioventricular node. This is necessary so that the blood has time to move from the atria to the ventricles. Then this impulse is carried out along the trunk of the His, reaching the ventricles, thereby forcing them to contract and pour blood into the general channel.

So, if we talk in simple words, then left ventricular His bundle block is a conduction disorder in which the electrical impulse stops or slows down.

Blockade of the left ventricle of the heart appears against the background of ischemic or hypertension or a number of other cardiovascular diseases.

Classification

Blockade of impulse conduction can occur anywhere in the leg, and it can be complete or incomplete. And since the left leg is divided into the back and front parts, various classification options arise:

• Complete left ventricular block

Consequences of complete blockade of the left bundle branch

The heart is a unique organ that governs itself, i.e. has automaticity, but, of course, taking into account the needs of the body and not without interfering with the work of the nervous and endocrine systems. This organ is not just a muscle sac, which is a pump for pumping blood; the heart is much more complex than it might seem.

The structure of the heart and the resulting causes of blockades

In addition to the muscles, four cavities, valves, own coronary vessels, it has a conduction system and its two centers (pacemaker). From the main center (the pacemaker of the first order), electrical impulses enter the second, and then along the left and right branches of the His bundle they spread to the entire myocardium, which then contracts (and pushes blood out of the heart).

Naturally, if there is a blockade, in this case a complete blockade of the left bundle branch. therefore, the impulse cannot spread further, and this leads to disruption of the rhythm and, in general, the work of the entire heart. The reason for this may be myocardial infarction; it should be assumed first of all if the blockade occurred for the first time. Other causes: cardiosclerosis, cardiac dystrophy, hypertonic disease, cardiomyopathy, myocarditis, etc.

Consequences of the blockade

Complete blockade of the left bundle branch leads to disruption of the conduction of electrical impulses to the left ventricle. But even despite the complete blockade, the impulse still passes, but along bypass routes (anastomoses), and with a delay.

What is the danger of complete blockade of the left bundle branch?

Even a complete bundle branch block may be asymptomatic and may not initially pose a serious threat to life. However, over time, the condition worsens and develops ventricular arrhythmia, more often one of its types is ventricular paroxysmal tachycardia. It is this that ultimately leads to ventricular fibrillation: random contraction of myocardial muscle fibers, which is incompatible with life and inevitably leads to death.

Treatment

There is no specific treatment for blockade. With this pathology, treatment is aimed at eliminating the underlying disease, which caused the blockade. As a rule, cardiac glycosides, nitrates, and blood pressure-lowering drugs are prescribed. If the heart rhythm does not recover, then they resort to surgery: installing a pacemaker.

Rehabilitation for cardiac arrhythmia

In addition to drug therapy for the underlying disease causing the blockade, treatment should include additional non-drug methods that relate more rehabilitation measures. In general, this tactic is suitable for other causes of left ventricular block. For example, physical therapy. Physical exercise They tone not only the entire body, but have a particularly beneficial effect on the cardiovascular system, increasing the supply of oxygen and generally reducing the mechanical load on the heart. Simply put, by moving, we help the heart accelerate blood. Of course, strength exercises are not suitable here. Choices: Walking or jogging. But in physical therapy It is very important, especially in case of heart disease, that the load is dosed and adequate to the capabilities of the heart. Otherwise, you may get a negative effect.

Left ventricular block

The heart muscle has special properties compared to other organs of the human body. One of these properties is the conductivity of impulses that arise in special structures of the cardiac tissue. Sometimes it happens that the impulse is not transmitted by the heart cells. Such conditions are called blockades.

Block of the left ventricle of the heart or, as it is called in medical practice, block of the left bundle branch in most cases is only a complication of the disease. Accordingly, if there is damage to the right bundle branch, blockage of the right ventricle of the heart occurs. Diseases that can lead to blockade occur both in young people (heart defects) and in old age ( arterial hypertension, ischemic heart conditions, etc.).

For reference

Recently, left ventricular block has been used as a term that has a broader concept than “left bundle branch block.” This is due to the mechanism of impulse transmission. The fact is that the left bundle branch is divided into two legs: anterior and posterior. Sometimes the block occurs at the site of division into the anterior and posterior branches; in such cases, diagnosis by establishing the level of the lesion is difficult. As a result, they decided to introduce a more extensive concept.

Types of blockades

In addition, blockade of the left ventricle can be complete or incomplete. An incomplete blockade does not pose any danger to life. The symptoms that are observed with it are weakness, slow pulse (bradycardia). If detected on an ECG, it is not complete blockade, the signs of which will be deviation electrical axis heart to the left and left ventricular hypertrophy, the main thing is to exclude myocardial infarction, which is very often “masked” in the lines of the cardiogram with incomplete blockade of the left ventricle.

Symptoms and ECG

The main tool in diagnosing “blockade...” is an electrocardiogram, which may look different in the same cases, although it was done on the same device.

Things are very serious with complete blockade of the left bundle branch (left ventricular block). First, I would like to tell you what happens normally: the left ventricle is “responsible” for releasing oxygenated blood into the aorta. When the left ventricle fails, the ejection of oxygenated blood is delayed or stopped, leading to oxygen starvation all organs and systems (primarily the brain). Clinically, this is manifested by breathing disorders (shortness of breath), dizziness, drowsiness, a decrease in heart rate to 25 beats/min and, in the end, acute heart failure, which can result in death if timely and correct medical care is not provided.

Diagnosing a complete blockade with an experienced doctor does not pose any particular difficulties. Everything will be visible on the ECG. Provided there is no other pathology.

Dangerous conditions

Very common is complete blockade and myocardial infarction or complete blockade and unstable angina. It is much more difficult to treat complete blockades. To date no special recommendations on this occasion. The main thing is to stop acute condition, and then prevent recurrences, so to speak, carry out prevention. Also read about the consequences of a complete block of the left bundle branch.

This condition can be cured in different ways, including the use of an electric defibrillator. Then, when the condition has stabilized, drug therapy is carried out, drugs that improve the quality of life (beta blockers, etc.), and antiarrhythmic drugs are prescribed.

Prevention

It is advised to follow a diet (blockades often occur due to obesity). All this is for older people who have, so to speak, “acquired” diseases. For people with defects, the most optimal treatment method is heart surgery to eliminate the defect. Another direction in treatment is the installation of a pacemaker. IN modern conditions The approach to all patients is individual.

• Functions of the cardiac bundle of His
• Symptoms of blockage
• Forecasts for the development of the disorder
• Causes of occurrence and development of leg blockade
• Treatment of right bundle branch block

The bundle is located in the thickness of the muscular septum located between the ventricles of the organ.
In the structure of the beam, the right and left leg. Through these structures, the excitation impulse spreads to the right or left ventricle of the organ. Disruption of nerve impulse conduction in medicine is called bundle branch block. Leg blockade can have varying degrees. An incomplete degree of blocking implies a partially slowed passage of the excitatory impulse, and a complete degree of blocking is characterized by a complete cessation of the passage of the excitatory nerve impulse through the structures of the legs.

In medicine, blockade of the right and left legs or both at the same time is distinguished - it all depends on the localization of the site of origin and development of the disorder. Quite often in early age blocking of the right leg develops almost without significant visible reasons, most often such blocking is incomplete and is not associated with other diseases. Outwardly, such a blockade does not manifest itself in any way and can be considered one of the normal variants.

The difference between complete blocking of the right leg is that excitation interventricular septum and the exciting impulse is carried out along individual fibers of muscle tissue from the left part of the septum and the left cardiac ventricle.

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Symptoms of blockage

Isolated incomplete blocking of the right bundle branch has no connections with other disorders and ailments occurring in the human body, which leads to the fact that this type of cardiac dysfunction does not have characteristic external symptoms. This type of violation is usually detected by chance during routine inspections.

When a blockade occurs caused by other pathologies developing in the body, the presence of symptoms of the primary disease that caused the blockage is observed. The blockade itself has no signs and is detected only during an ultrasound scan of the organs. chest, during listening or when taking an ECG. The blockade is not always permanent; it can come and go. Tachydependent isolation of the right leg occurs, which disappears after the heart rate returns to normal.

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Forecasts for the development of the disorder

The isolated form of the disease that develops in humans most often has sufficient good prognosis for a cure. Isolation of the right leg almost never transforms into the atrioventricular form. However, this type of development of the disorder is observed only if the disorder is caused by the presence of a serious illness.

Isolation of the right bundle branch, which develops under the influence of arterial hypertension or ischemic disease, significantly worsens the prognosis for the development of the disorder. Blockade that occurs during development acute form heart attack, most often does not affect the course of the underlying disease. Most researchers believe that mortality in the development of RBBB increases only with the development of transmural extensive heart attack. The main danger that comes from the blockade is obtaining distorted electrocardiogram results. This situation does not allow the use of an ECG to detect myocardial infarction.

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Causes of occurrence and development of leg blockade

The occurrence of blockade of the right bundle branch is usually associated with the occurrence of congenital anomalies. The most common anomalies that contribute to blocking are the following:

• underdevelopment of the right fascicle segment;
• defect of intracardiac septa between the atria and ventricles of the heart;
• development of pulmonary stenosis.

The occurrence of blockage of the right leg is caused by the development of certain ailments in the body. The main ailments and factors influencing the development of the blockade are the following:

• hypertonic disease;
• development acute heart attack, most often transmural, consisting in the formation of necrosis of all layers of cardiac muscle tissue;
• chest injury due to blunt trauma;
• cardiac ischemia;
• medical surgery carried out in the cardiac region;
• progressive development of muscle fiber dystrophy;
• functional and structural changes cardiac myocardium- cardiomyopathy;
• increased concentration of potassium ions in the bloodstream - hyperkalemia;
• toxicosis caused by certain cardiac medications.

Complete right bundle branch block, what is it? This condition is diagnostic sign some diseases of cardio-vascular system. Pathology is detected during an ECG. The presence of RBBB does not always contribute to worsening general condition body.

The causes of pathological changes in the heart muscle are previously suffered infectious diseases- sore throat, scarlet fever, chicken pox. Treatment of disorders that arose in childhood is not required in adulthood. The examination reveals only residual effects myocardial dysfunction not detected in time.

Oxygen and nutrients tissues are obtained through blood, the circulation of which is controlled by the heart muscle. Its rhythmic contractions occur autonomously. Transmission of signals that stimulate contractile activity, is carried out through a conducting system called the bundle of His.

It is located in the tissues of the septum that separates the left ventricle from the right. The system consists of two legs through which impulses are transmitted to the heart walls. A nerve conduction disorder is called a bundle branch block. The disease may have various degrees expressiveness. When its form is incomplete, the conduction of impulses slows down, but does not stop. Complete blockade is characterized by the cessation of signals entering the tissues of the left or right ventricle.

The lesion may affect the entire beam or half of it. It all depends on the speed of development of the disorder and the place of its occurrence. In children, RBBB may appear for no apparent reason. It does not contribute to the deterioration of the general condition and is physiological.

Complete blockade differs in that the excitation of the interventricular septum and signal transmission are carried out using the fibers of the muscle tissue of the left ventricle.

How does this pathology manifest itself?

Isolated right bundle branch block is not associated with other pathological processes in the body, therefore this form of the disease severe symptoms does not have. As a rule, it is detected during a routine medical examination. With secondary blockade of PNPG, signs of the underlying disease come to the fore. There are no typical manifestations of bundle branch conduction disorder.

Reveal pathological changes in the heart muscle can be done using chest ultrasound or ECG. In some cases, the blockade occurs periodically. There are also arrhythmic forms of pathology that occur when heart rate. After the heart rate normalizes, the signs of blockade disappear.

The isolated form of the disease has a favorable prognosis. It extremely rarely turns into atrioventricular. However, a similar development of pathology is observed when it occurs against the background of congenital heart defects. Blockade that develops when arterial hypertension or ischemic heart disease, has a less favorable prognosis.

The disruption of His bundle conduction that accompanies the development of acute infarction does not affect the course of the underlying disease. The risk of death increases significantly when a large transmural infarction occurs. The main danger of the blockade is the possibility of influencing the ECG results, which is why the underlying disease is often detected untimely.

What is a bundle block and what causes it? The development of this pathology is facilitated by congenital defects, the most common of which are: ventricular septal defects, underdevelopment of the right bundle branch, pulmonary stenosis.

Acquired forms of pathology develop against the background of acute and chronic diseases: arterial hypertension, acute heart attack, chest trauma, coronary artery disease. The blockade may be a complication surgical intervention into the heart muscle dystrophic changes V muscle fibers, dysfunction of the myocardium, intoxication of the body with potassium ions, long-term use heart medications.

Methods of treating pathology

This disorder can be diagnosed in the presence of heart disease. For this reason, treatment begins only after the complications caused by them are identified and eliminated. Termination of conduction of the right bundle branch does not have typical manifestations; its idiopathic forms are found extremely rarely.

The main diseases leading to the development of blockade are: ischemia, arterial hypertension, chronic intoxication of the body, myocardial infarction. It is with their elimination that treatment must begin. Violation of the processes of excitation transmission indicates the presence of serious pathologies localized in muscle tissue right ventricle and interventricular septum.

For treatment hypertensive forms blockades are used antihypertensive drugs, venotonics, cardiac glycosides. Constant monitoring required blood pressure, compliance special diet. Alcohol, fatty and fried foods should be excluded from the diet.

The amount of salt consumed should be reduced to 3 g per day. Medicines should be taken only as prescribed by a doctor. In case of heart rhythm disturbances, antiarrhythmic drugs are used. Longer and complex treatment requires ischemic disease and myocardial infarction.

If the blockade of the right bundle branch is caused by congenital defects, it is indicated surgery. After completing the course drug therapy or undergoing surgery, the patient must be under constant supervision of a cardiologist.

The effectiveness of treatment is assessed through regular ECG; if necessary, one or another drug is replaced or excluded from the therapeutic regimen.