Bundle Branch Block Sleep Apnea
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Etiology Congestive Heart Failure
There are numerous causes for systolic heart failure, but the most common is related to coronary artery disease and prior myocardial infarctions. This entity is termed an ischemic cardiomyopathy and accounts for nearly half of systolic heart failure cases in the United States.
Dilated cardiomyopathy is the second leading cause of systolic HF. This can be idiopathic , a viral cardiomyopathy, peripartum and hypertensive heart disease . These include doxorubicin therapy, stress-induced , alcohol-related, selenium or thiamine deficiency, tachycardia-mediated, giant cell arteritis, hyperthyroidism, cocaine use, obstructive sleep apnea and familial cardiomyopathies.
The third leading cause of systolic HF is valvular heart disease. This includes aortic valve stenosis, aortic valve regurgitation, mitral valve stenosis and mitral regurgitation. In many developing nations, the most common cause of systolic HF is Chagas disease, which is related to Trypanosoma cruzi and transmitted by triatomine bugs.
Recall that right heart failure and diastolic heart failure are different entities from the left-sided systolic heart failure reviewed here. The most common cause of right HF is pressure overload related to left HF. Diastolic HF is most commonly caused by hypertension as a part of hypertensive heart disease. Aging of the heart contributes to diastolic HF as well.
What Are The Symptoms
Left bundle branch block often doesnt cause any symptoms. In fact, some people have it for years and never know they have the condition.
For others, however, a delay in the arrival of electrical impulses to the hearts left ventricle can cause syncope , due to unusual heart rhythms that affect blood pressure.
Some people might also experience something called presyncope. This involves feeling like youre about to faint, but never actually fainting.
Other symptoms can include fatigue and shortness of breath.
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Pathophysiology Congestive Heart Failure
Congestive HF results in the activation of multiple compensatory mechanisms in an attempt to increase cardiac output. These frequently work in the short term however, the long-term effects can be detrimental to the heart via negative remodeling. The two primary mechanisms considered the neurohormonal response are activation of the sympathetic nervous system and activation of the renin-angiotensin-aldosterone system. Medical therapy is aimed at reducing the activity of these two systems. A third compensatory response occurs via B-type natriuretic peptide and A-type natriuretic peptide. See the summary image below.
When the carotid baroreceptors sense a low blood pressure, one response is to activate the SNS. This increases epinephrine and norepinephrine levels, which act to increase heart rate, contractility and afterload via peripheral vasoconstriction. In the short term, this will work to increase cardiac output and relieve HF symptoms however, chronically this has deleterious effects and causes further left ventricular systolic decline. Beta-blockers are the primary therapy to reduce this SNS activation.
Endothelin has negative effects in regards to remodeling and vasoconstriction however, clinical trials of endothelin inhibitors have never shown a benefit, and thus its role remains unclear.
Sleep Apneas Effects On The Cardiovascular System
The repetitive pauses in breathing that characterize sleep apnea can stress and potentially damage not only the heart, but the whole cardiovascular system. While researchers are continuing to learn about the ways in which sleep apnea affects the cardiovascular system and contributes to heart disease, several biological pathways have been suggested.
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What Causes Left Bundle Branch Block
Left bundle branch block can be caused by several different heart conditions.
For example, a heart attack can damage your heart tissue, making it harder for your heart to conduct electrical impulses. This can result in bundle branch block at either the right or left ventricle. A new left bundle branch block should warrant work-up for a prior heart attack.
Other conditions that can cause a left bundle branch block include:
- heart infection
- weakened, enlarged, or stiffened heart muscle
Sometimes, however, left bundle branch block can happen without any underlying heart condition. Its not known why this happens, but its most often seen in older adults.
When To See A Doctor
Given the significant health consequences of untreated sleep apnea, its important to know when its time to reach out to a doctor. Common signs and symptoms of sleep apnea include:
- Frequent, loud snoring or gasping during sleep
- Reduced breathing or pauses in breathing during sleep
- Daytime sleepiness and fatigue
- Difficulty maintaining attention and concentration
- Dry mouth or headaches when waking
- Sexual dysfunction or decreased libido
- Waking up often at night to urinate
Primary care doctors or specialists are all good resources if youre concerned about having sleep apnea. Diagnostic tests for sleep apnea often include a comprehensive sleep evaluation and polysomnography to diagnose or rule out this serious condition.
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Treatments For Right Bundle Branch Block
If one was to only have isolated RBBB, the only treatment required would be periodically scheduled follow-up visits and evaluations to ensure the condition does not exacerbate or pose serious threat to your health.
1. Regular Electrocardiogram
If one has RBBB that is caused by heart disease, he may be required to undergo a biennial or annual ECG to assess the change in intervals. This can help health care professionals to see whether the condition is improving or exacerbating, as well as check for other abnormalities in the rhythm of the heart.
If RBBB is caused by another underlying problem, treating the problem should be of most importance. This can involve medication to lessen the severity of heart disease or medication that works to reduce high blood pressure.
3. Implanting a Pacemaker
After the assessment from a medical professional, the installation of a pacemaker may be advised. This is generally the case for those with RBBB and a history of fainting. This device can provide electrical impulses to the heart when required via the two wires connecting to the heart on the right side.
4. Cardiac Resynchronization
Cardiac resynchronization, also called biventricular pacing, is very similar to a pacemaker, except a third wire connects the device to the left side of the heart. This allows the inserted device to synchronize both sides of the heart and ensure correct rhythm.
When Do You Need Medical Treatment?
Electrocardiographic Associations Seen With Obstructive Sleep Apnea
Sushilkumar Satish Gupta
1Fellow, Department of Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
2Fellow, Department of Cardiology, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
3Attending, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
4Fellow, Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
5Attending, Department of Pulmonary and Critical Care, Maimonides Medical Center, Brooklyn, New York, USA
6Chairman, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
7Attending, Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
8Director, Department of Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
Obstructive sleep apnea is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. The incidence of OSA from population-based studies has ranged from 4.9% to 15% . OSA can be diagnosed through polysomnography. During polysomnography oronasal airflows were measured. We used oronasal thermal sensor to identify apneas and nasal pressure transducer to identify hypopneas. The Wisconsin Sleep Cohort Study determined the prevalence of OSA to be 9% in females and 24% in men in a random sample of 602 middle aged state employees in Wisconsin .
3. Statistical Analysis
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The Effects Of Experimental Sleep Apnea On Cardiac And Respiratory Functions In 6 And 18 Month Old Dystrophic Mice
- Milind R. Chaudhari ,
Contributed equally to this work with: Milind R. Chaudhari, Gaspar A. Farkas
Current address: Department of Medicine, and Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, United States of America
Affiliations Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, United States of America, Department of Medicine, University at Buffalo, Buffalo, New York, United States of America, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, United States of America
- James A. Fallavollita,
Affiliations Department of Medicine, University at Buffalo, Buffalo, New York, United States of America, Center for Research in Cardiovascular Medicine, University at Buffalo, Buffalo, New York, United States of America, VA Western New York Healthcare System at Buffalo, Buffalo, New York, United States of America
The Efficiency Of The Heartbeat
With either right or left bundle branch block, the heart’s two ventricles are being stimulated in sequence instead of simultaneously. This loss of normal coordination between the two ventricles can reduce the efficiency of the heartbeat.
However, the reduction in the heart’s efficiency is probably less important in right bundle branch block. So, for instance, the use of cardiac resynchronization therapy may not be as helpful in people with right bundle branch block, even if they have heart failure.
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Coronary Artery Disease And Heart Attack
Coronary artery disease is the result of a process called atherosclerosis . It is the most common cause of heart attack and involves the buildup of cholesterol in the arteries, with inflammation and injury in the cells of the blood vessels. The arteries narrow and become brittle. Heart failure in such cases most often results from a pumping defect in the left side of the heart. But both sides can be affected.
People often survive heart attacks. But many eventually develop heart failure from the damage the attack does to the heart muscles.
I Am Under A Great Deal Of Stress Every Day Is It Possible That I Have Been Walking Around With Broken Heart Syndrome And Did Not Even Know It
Broken heart syndrome appears to be a condition that comes on suddenly and resolves quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. If your symptoms are chronic, it is unlikely that you have broken heart syndrome.
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The Effect Of Continuous Positive Airway Pressure Treatment On P
Received Date: Oct 23, 2017 / Accepted Date: Nov 14, 2017 / Published Date: Nov 16, 2017
Citation: Sabri S, Adnan KU. The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome. Curr Res Cardiol 2017 4:61-64.
This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License , which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact
Right Bundle Branch Block
- Shortness of breath
LBBB can make it difficult for your doctor to diagnose other heart conditions. These include:
Left ventricular hypertrophy . A condition where the walls of your heartÃ¢s left pumping chamber become thick.
Always tell a new doctor if youÃ¢ve been diagnosed with LBBB. This well help them do a better job of spotting changes in your heart. For example, if you have LHV, your doctor may need to do a stress test with medicine instead of exercise.
ItÃ¢s also a good idea to carry a copy of your EKG that shows you have LBBB in case of an emergency, like a heart attack. That way, the doctors and nurses know and can give you the right treatment.
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Overview Of Right Bundle Branch Block
Right bundle branch block is an abnormal pattern that is seen on the electrocardiogram , which indicates that the hearts electrical impulse is not being distributed normally across the ventricles. Specifically, right bundle branch block means that the electrical stimulation of the right ventricle is being delayed.
Treating Sleep Apnea To Reduce The Risk Of Heart Disease
Talking to a doctor about sleep apnea is an important step that anyone can take to protect their heart health. If a person is diagnosed with sleep apnea, treatments are often effective. Treatment for sleep apnea depends on the type of sleep apnea detected and may include:
- Lifestyle changes: Doctors may begin by informing patients about lifestyle changes that may reduce the severity of this condition. Weight loss, exercise, limiting alcohol, quitting smoking, and even changing your sleeping position may be helpful.
- Positive airway pressure devices: PAP devices pump air through the airway, preventing the upper airway from collapsing during sleep.
- Mouthpieces and oral appliances: Oral appliances reduce disordered breathing by changing the position of the jaw, tongue, or other part of the body thats constricting the airway.
- Mouth and throat exercises: Depending on the cause of a persons sleep apnea, special exercises of the mouth and throat may help tone these muscles, making them less likely to interfere with breathing during sleep.
- Surgery: Surgery for sleep apnea may involve changing parts of the body that cause airway constriction or implanting devices that causes tightening of the muscles around the airway.
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Prevalence Of Bradycardic Arrhythmias In Sleep Apnoea
In the early days of sleep research it was thought that heart block , sinus arrest, or sinoatrial block were frequent findings in patients with sleep apnoea. Tilkian and co-workers reported that more than 50% of patients with sleep apnoea develop episodes of heart block during sleep. In 400 patients studied by Guilleminault et al bradycardic arrhythmias were reported in almost 18% of the patients and later studies found heart block in 913% of patients with sleep apnoea., Due to ventricular asystoles of up to 13 seconds in duration it was hypothesised that heart block might lead to an increased mortality risk in these patients. A recent publication challenged previous results in that no increased prevalence of bradycardic arrhythmias was seen in patients with sleep apnoea compared with those without sleep apnoea.
To examine these seemingly discrepant results further we performed Holter monitoring in 239 consecutive patients diagnosed as having sleep apnoea using a validated ambulatory recording device based on the measurement of heart rate, Sao2, snoring sound, and body position. Episodes of second and third degree atrioventricular block and/or sinus arrest of more than two seconds in duration occurred in 17 of the 239 patients. There was no significant difference in age between patients with and without heart block 50.7 versus 52.1 years), but those with heart block were significantly more obese versus 30.7 ).
What Are The Bundle Branches
Normally, your heart beats in a nice, regular fashion. The heartbeat starts in the upper chambers of the heart in an area called the SA node. The impulse then moves to the AV node. The AV node is an area of tissue that carries the impulse through the Bundle of His and then splits into two wire-like branches . The branches carry the impulse to the Purkinje fibers, which are located in the muscular walls of the ventricles, and cause them to contract.
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Indications For A Pacemaker
Right bundle branch block, by itself, does not require treatment with a permanent pacemaker. However, in some people, right bundle branch block is just one manifestation of a more general problem with the hearts electrical conduction system.
In such cases, a pacemaker may eventually be required if sick sinus syndrome or heart block should develop.
Sleep Apnea Obesity And Heart Disease
Research suggests that obesity may play an important role in the development of both sleep apnea and heart disease. It is important to keep in mind that sleep apnea alone, with or without obesity, can increase the risk for heart disease. Sleep apnea and obesity independently increase the risk of health conditions that negatively affect heart health, like hypertension , unhealthy cholesterol levels, and diabetes.
Obesity is a common cause of sleep apnea, often related to increased deposits of fat in the neck that narrow or block the upper airway during sleep. Researchers have found that even a 10% increase in body weight increases the risk of OSA by six-fold. While 60 to 90% of people with sleep apnea also have obesity, only around 30% of people diagnosed with obesity have sleep apnea.
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