Is your heart's electrical signals also blocked? Let's talk about Bifascicular Block!

Do you sometimes suddenly have blue eyes and feel dizzy ? Or do you feel like your heart is beating too fast or too slow? Maybe someone you know has experienced something like this. Sometimes these can be caused by small disruptions in our heart's electrical system, just like the wiring system in a house. Today, we're going to talk about a special condition in which the electrical signal travels slowly or is interrupted in about two-thirds of the main pathways in the heart's electrical wiring system – that's called (Bifascicular Block) .

What is this (Bifascicular Block)? Let's understand it simply?

Simply put, `(Bifascicular Block)` is a type of heart block. For our heart to work like a pump, it needs to receive electrical signals in an orderly manner. These electrical signals travel along special pathways in the heart. We call these pathways ``bundle branches``. It's like wires in a house needing to turn on the lights.

Imagine that there are three main pathways in our heart that carry these electrical messages. In a ``Bifascicular Block``, the electrical signals travel very slowly or are interrupted in two of these three pathways. "Bi" means "two". "Fascicle" refers to the bundle branches of heart muscle cells. So, when there is a blockage in two of these pathways, the electrical signals are sent a little late to the lower chambers of the heart (the ``ventricles``). This can change the rhythm of the heart and the way it pumps blood.

Doctors call this an “incomplete heart block.” This condition can be caused by congenital heart disease or other heart conditions. Sometimes, symptoms may go away. However, a severe case of Bifascicular Block that causes symptoms may require treatment.

Where are these fascicles located in our heart?

You know that our heart has four main chambers. The two upper chambers are called the atria, and the two lower chambers are called the ventricles. These chambers contract and expand in a controlled manner to pump blood throughout the body.

Bifascicular block affects these lower chambers, or ventricles.

• Right ventricle: This is located on the lower right side of the heart. It is the one that takes blood and sends it to the lungs to pick up oxygen. This right ventricle has only one main electrical pathway (fascicle) – the right bundle branch .
• Left ventricle : This is located on the lower left side of the heart. It is the largest and strongest pumping chamber in the heart. It takes in oxygenated blood and pumps it to the rest of the body through the aorta . The left ventricle has two main electrical pathways: the left anterior fascicle and the left posterior fascicle . Together, these two form the left bundle branch. These further divide into millions of smaller fibers called Purkinje fibers.

What is Heart Block and Bundle Branch Block?

Heart Block occurs when there is a problem with the heart's electrical conduction system. This causes a delay in the transmission of electrical signals between the chambers of the heart. As a result, the chambers of the heart contract out of rhythm. This affects the blood flow through the heart, the heartbeat, and the heart rate.

`(Heart Block)` and `(Atrioventricular Block / AV Block)` are the same condition. `(Bundle Branch Block)` is a type of `(Heart Block).` It occurs when there is a blockage in one of the bundle branches that we talked about.

How does the electrical system in our heart work? It's amazing, isn't it?

Imagine that inside the heart there is a very complex, but very orderly wiring system. Here is the order in which this electrical signal travels:

1. The signal first starts in a special place in the upper atrium of the heart called the SA node. This is the heart's natural pacemaker.

2. This signal then travels through the atria and arrives at another special place called the AV node.

3. After the AV node, the signal enters a pathway called the bundle of His.

4. From there, it divides into the right bundle branch and the left bundle branch, and finally goes to the fine fibers called ``Purkinje fibers`` in the cells ``ventricles``.

5. When this signal is received, the ventricles contract and pump blood. Then the process starts again from the beginning.

All of this happens within a matter of seconds, amazingly enough, isn't it?

Are there types of heart blocks?

Yes, doctors classify these heart blocks (AV blocks) according to their severity:

• First-degree block: This is a slight delay in the electrical signals from the atria to the ventricles. However, this type of block is less likely to cause symptoms and rarely requires treatment.
• Second-degree block: This is where some, but not all, electrical signals are blocked from reaching the cells. This can cause a slow heart rate ( bradycardia ) or an irregular heartbeat (arrhythmia). If this is severe or causes bothersome symptoms, treatment may be needed.
• Third-degree block: This is also called “complete heart block.” Here, there is no connection between the functioning of the atria and ventricles. This means that the upper chambers work as they should, and the lower chambers work as they should. In this condition, a pacemaker must be inserted. If a “bifascicular block” becomes severe, this condition can develop.

Are there different types of Bifascicular Block?

Yes, there are different patterns of `(Bifascicular Block)`. The most common ones are:

• Right bundle branch block and left anterior fascicular block.
• Also, there may be a right bundle branch block and a left posterior fascicular block.
• Sometimes, the left bundle branch can be completely blocked (meaning both the left anterior and posterior fascicles are blocked, but the right bundle branch is intact).

How common is this condition?

Bifascicular Block is found in about 1.5% of people who undergo an ECG . That doesn't mean it's that rare.

Why does this (Bifascicular Block) occur? What are the causes?

Bifascicular Block is often caused by congenital heart disease. This means that a person is born with some changes in the structure of the heart. Sometimes, symptoms of this congenital heart disease may appear later, perhaps in young or middle age. The risk of developing heart blocks also increases with age .

Rarely, this condition can also be caused by a genetic change (gene mutation) that is passed down from family to family. This is called progressive familial heart block. This genetic change can cause scar tissue (fibrosis) or calcium deposits (calcification) in the heart. These changes can also cause heart block.

In addition, ``Bifascicular Block`` can also be caused by damage to the heart. This damage can be:

• Due to a heart attack (myocardial infarction).
• Due to other cardiovascular diseases .
• Due to heart valve disease.
• Due to high potassium levels in the blood (hyperkalemia).

What are the symptoms of a Bifascicular Block? Do you have these too?

Incomplete (first or second degree) heart block may not cause any symptoms. However, when symptoms do occur, the main symptom that many people experience is fainting (syncope). This occurs when the heart rate is too slow (bradycardia) or too slow (arrhythmia) because the blood is not being pumped properly to the body.

Sometimes, a `(Bifascicular Block)` can progress to a complete block (third degree). In that case, symptoms are more likely to occur. It is very important to seek medical advice immediately if you have one or more of the following symptoms:

• Chest pain or tightness (angina).
• Dizziness.
• Constant feeling of extreme fatigue.
• Feeling the heart beating abnormally (heart palpitations).
• Nausea.
• Shortness of breath.

What complications can this cause?

Heart block interferes with the heart's ability to pump blood around the body. A ``Bifascicular Block'' (incomplete block) can sometimes progress to a third-degree (complete) block. When this happens, complications such as:

• Irregular heartbeat (Arrhythmia).
• Heart attack.
• Heart failure.
• Sudden cardiac death / sudden cardiac arrest.

Don't worry! Not everyone will experience these complications. Proper medical advice and treatment can greatly reduce this risk.

How do you accurately diagnose a Bifascicular Block?

The main test to diagnose Bifascicular Block is an ECG. This is also called an EKG. This measures the electrical activity of your heart. It is a very simple, painless test. It takes about 15 minutes.

The doctor will place small stickers (called electrodes) on your chest, arms, and legs. Wires connected to these electrodes are connected to an ECG machine. This machine records your heart's electrical activity as a graph. The electrodes do not send any electricity to your body. Instead, they only measure the electrical activity in your body. By looking at this graph, the doctor can tell if there is any change or blockage in the heart's electrical signal pattern.

Is there treatment? What can be done?

If you have a `(Bifascicular Block)` and you don't have any symptoms, you may not need treatment. However, your doctor will monitor your heart health closely. They may do regular `(ECG)` tests to see if the condition is getting worse and developing into a third-degree (complete) heart block. If that happens, treatment is needed.

But if you have an irregular heartbeat (arrhythmia) or symptoms such as fainting (syncope), your doctor may recommend surgery to implant a pacemaker . There are two types of pacemakers:

• Pacemakers: These send electrical signals to the heart's chambers to keep them beating rhythmically, like giving the heart a little extra help.
• Implantable Cardioverter Defibrillators (ICDs): These work like a pacemaker. In addition, the ICD can detect an irregular heartbeat and correct it by delivering a small electrical shock to the heart. It can also restart the heart in cases of sudden cardiac arrest.

These devices are installed by a cardiologist (electrophysiologist).

Are there ways to prevent Bifascicular Block?

To be honest, there are many factors that can contribute to heart failure that we cannot control, such as congenital heart disease or aging.

However, you can always take steps to maintain and protect your heart health. These include:

• If you smoke, ask for help to quit. Avoid even secondhand smoke.
• Eat a heart-healthy diet and get into the habit of exercising daily.
• Limit alcohol consumption.
• Control heart-damaging conditions such as high blood pressure, diabetes, and high cholesterol.
• Find healthy ways to manage stress.
• Try to maintain a healthy weight.

While these things may not completely prevent the development of `(Bifascicular Block), they will definitely help keep your overall heart health at a good level.

Can we live with this situation? What is the outlook?

Most people with Bifascicular Block do not need treatment. Even if treatment is needed, symptoms usually go away after a pacemaker is inserted.

With proper treatment, the risk of this condition progressing to a complete heart block is very low. In fact, the damage that can be caused by an untreated irregular heartbeat (arrhythmia) is greater than the damage caused by a heart block. Therefore, it is important to seek medical advice at the right time and receive treatment if necessary.

What time should I see a doctor?

If you have one or more of the following symptoms, see a doctor immediately:

• Feeling extremely tired.
• Irregular heartbeat.
• Severe chest pain.
• Difficulty breathing.
• Symptoms of a heart attack (e.g., severe pain in the center of the chest that radiates down the arm).
• Nausea for no reason.

What are the important questions to ask the doctor?

When you go to see the doctor, you can also ask these questions:

• Why did I get this `(Bifascicular Block)`?
• What should I do to reduce my risk of a heart attack or other heart disease?
• Do I need a pacemaker or an ICD?
• What are the risks of having a pacemaker or ICD implanted?
• Should I be concerned about complications? What are the symptoms?

Asking these questions will help you gain a better understanding of your situation and become clearer about what to do next.

Finally, things you need to remember

Bifascicular block is a blockage of two of the three main pathways that carry electrical signals in the heart. This can change the rhythm of the heart and the way it pumps blood. Some people may have no symptoms, while others may experience symptoms such as fainting.

The most important thing is not to panic about this, but to seek proper medical advice. This can be detected with a simple test like an ECG. If necessary, this condition can be successfully controlled with treatments like a pacemaker. Take care of your heart, live a healthy lifestyle, and you can stay healthy!