Stephen J. Schueler, M.D.

Overview Symptoms Evaluation EP studies Treatment pacemaker specialist Home Care diet pulse checks taking control warning signs Underlying Cause complete block left anterior hemiblock left posterior hemiblock Types Anatomy

Left Bundle Branch Block Home Care

Home care for left bundle branch block may include:

  • Stop smoking
  • Avoid exposure to secondary smoke
  • Eat a healthy heart diet:
    • Limit your intake of fat to 30% of your total calories.
    • 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
    • Low cholesterol diet.
    • Low salt diet.
    • Eat foods rich in omega-3 fats
  • If you have been prescribed medications to control high cholesterol, so not skip doses.
  • Follow an exercise plan developed with your doctor
  • Weight loss if you are overweight.
  • Take any prescribed heart medications as directed:
    • Don't skip doses of your heart medication.
    • Avoid running out of your prescribed heart medications.
    • Don't stop your medication when you feel better.
    • Talk to your doctor before stopping your heart medication if you feel worse.
    • Be aware of potential drug side effects.
  • Learn how to take your blood pressure.
  • Check your blood pressure every day:
    • Keep a log of your results.
  • If you have diabetes:
  • Learn how to take your own pulse.
    • Notify your doctor if your heart rate is high or irregular
  • Control chronic stress and anxiety
  • Let your doctor know if you are suffering from severe or prolonged depression.
  • Avoid alcohol, or drink alcohol in moderation:
    • For men: no more than 2 alcoholic beverages per day
    • For women: no more than 1 alcoholic beverage per day

Left Bundle Branch Block Diet

It is important to follow a healthy diet if you have left bundle branch block.

A healthy diet for people with heart disease includes:

  • Limit total fat intake to no more than 20 to 25% of your total calories:
    • Less than 7% of the day's total calories from saturated fat.
    • Up to 10% of the day's total calories from polyunsaturated fat.
    • Up to 20% of the day's total calories from monounsaturated fat
  • Less than 200 milligrams of dietary cholesterol a day.
  • Just enough calories to achieve and maintain a healthy weight. (You may want to ask your doctor or registered dietitian what is a reasonable calorie level for you.)
  • Reduced salt to 2 grams per day.
  • Plenty of fresh fruit and vegetables
  • Limiting iron intake: too much iron can increase atherosclerosis
  • More complex carbohydrates, such as starch and fiber. Whole grains and brown rice are good fiber sources. Other sources include:
    • Fruits
    • Vegetables
    • Bran
    • Barley
    • Oats
    • Legumes

Check with your doctor about supplementing your diet with B vitamins. Some people may benefit from these supplements.

Left Bundle Branch Block Pulse Checks

If you have left bundle branch block, it is important to learn how monitor your pulse at home.

How to Take Your Pulse
The pulse can be determined in a number of locations, but the neck and the wrist are usually best.

Using the flat of your index and middle fingers, position your fingers over the artery. Press firmly without excessive pressure or rubbing.

Locations for Taking a Pulse

  • Carotid Artery: to either side of the thyroid cartilage (Adam's apple) and just in front of the large muscle in the neck (Sternocleidomastoid muscle) you will feel the pulsations. Check only one side at a time. See carotid sinus hypersensitivity for additional information.
  • Brachial Artery: located in the elbow crease, on the inner aspect of the biceps tendon (tighten up your biceps muscle and then palpate adjacent to it). The brachial artery is an excellent location for assessing the pulse in smaller children and infants.
  • Radial Artery: located on the underside of the wrist, on the thumb-side. This is a first choice for pulse measurement by many individuals (and health professionals), due to accessibility.
  • Femoral Artery: located on either side of the groin in the midline, this large vessel carries oxygenated blood to the lower extremities. It normally produces a strong pulse that can be easily felt in the upper (middle) inguinal area. Palpating the femoral pulse must be done when the patient is lying flat (supine). Although the location is not as easily accessible, it is commonly used by physicians when assessing a critically ill patient, who may be in shock or cardiac arrest.
  • Posterior Tibial Artery: located just under and slightly behind (posterior) the inner prominence (medial malleolus) of the ankle. Although not typically useful in routine pulse measurement, the posterior tibial pulse is often used to assess the extent of blood flow to the lower extremities. Those individuals with peripheral vascular disease may show diminished, or absent, posterior tibial pulsations.

Interpreting Pulse Results
Count the number of pulsations for 10 seconds. Multiply this number by six. This will give you the number of heartbeats per minute.

When measuring your pulse you should notice not only the rate (beats/minute), but the rhythm. Is it steady and regular or are there extra beats? You may also notice that the pulse rate varies with breathing. Normally, the pulse rate will increase slightly on inhalation and decrease on the exhalation of air. This variation is known as a respiratory-dependent arrhythmia and is usually more obvious in smaller children.

Normal Values for Resting Pulse
Age RangeAverage Beats Per Minute
Newborns125-135
1 month120-130
6 months120-130
1-2 years110-120
2-3 years100-110
4-5 years95-105
6-8 years90-100
10-12 years85-95
14 years75-85
Adults60-85
Athletes40-60

Report all extra beats, or abnormally rapid heart rates, to your doctor. Any irregular pulse, palpitations, or rapid pulse that is associated with symptoms (e.g. chest pain, breathing difficulty, fainting, lightheadedness, dizziness, sweating, and nausea) may be an emergency and should be evaluated right away.

Left Bundle Branch Block Taking Control

The successful treatment of left bundle branch block requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Left Bundle Branch Block Warning Signs

Notify your doctor if you have left bundle branch block and any of the following:

Continue to Left Bundle Branch Block Underlying Cause

Last Updated: Nov 3, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Left Bundle Branch Block References
  1. Guerrero M, Harjai K, Stone GW, Brodie B, Cox D, Boura J, Grines L, O'Neill W, Grines C. Comparison of the prognostic effect of left versus right versus no bundle branch block on presenting electrocardiogram in acute myocardial infarction patients treated with primary angioplasty in the primary angioplasty in myocardial infarction trials. Am J Cardiol. 2005 Aug 15;96(4):482-8. [16098297]
  2. Lee SJ, McCulloch C, Mangat I, Foster E, De Marco T, Saxon LA. Isolated bundle branch block and left ventricular dysfunction. J Card Fail. 2003 Apr;9(2):87-92. [12751128]
  3. Nguyen K, Cigarroa JE, Lange RA, Hillis LD, Keeley EC. Presence and extent of angiographic coronary narrowing in patients with left bundle branch block. Am J Cardiol. 2004 Jun 1;93(11):1426-7, A10. [15165932]
  4. Reuben AD, Mann CJ. Simplifying thrombolysis decisions in patients with left bundle branch block. Emerg Med J. 2005 Sep;22(9):617-20. [16113178]
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