Cardiopsychoneurosis

cardiopsychoneurosis - this symptom neurogenic nature, arising from exposure to a number of etiological provoking factors, manifested by the appearance of pulse variability and blood pressure indicators cardialgia, respiratory disorders, autonomic disorders, disturbances of the tone of the muscle fibers and the vascular wall, as well as low tolerance to habitualPhysical activity and the impact of stressful situations.

For the first time the diagnosis of "neurocirculatory dystonia" was established in 1948-1950 Savitsky NN.This pathology at the present time has a high incidence rate, and due to a wide variety of clinical manifestations, the establishment of the correct diagnosis requires consultation of the patient with a number of specialists.

In the general structure of the incidence of patients under the supervision of a general practitioner, the "neurocirculatory dystonia syndrome", which is now a separate nosological form, is at least 50% of cases. There is no clear pathogenetic dependence of the onset of neurocirculatory dystonia in people of different age and sex, but a great experience in clinical observation proves the prevalence of adolescent and young patients among all possible age categories.

Neurocirculatory dystonia in children is very rare, being more a "diagnosis of exclusion."

reasons neuro dystonia

Most experts cardiological profile, which is a lot of management and treatment of patients suffering from neuro dystonia in some clinical variants, are unanimous that this pathology is classified polietiologichesky diseases for which detection of inadequate patient kakogo-Or one provoking factor. The unfolded clinical picture develops in humans only with the available set of different etiopathogenetic causes.

About the development of cardiovascular and neurological manifestations in a patient with neurocirculatory dystonia, which are functional in nature, there are many pathogenetic theories. According to the first theory, all the disorders of the structures of the human body, occur as a consequence of the direct effects on the organs of the central nervous system, resulting from fatigue, negative emotions, stress, different variants of the night sleep disturbances, inevitably provoking psychic asthenia.

Damaging effect on the structures of the central nervous system can also have chronic toxic effects, exposure to harmful occupational factors, disruption of the hormonal balance, as well as intoxication effects that occur in chronic and acute infectious diseases. It is predisposing factors, with prolonged exposure which develops moderately pronounced central nervous system that occurs when any form neurocirculatory Dystonia is a genetic predisposition, as well as prolonged irrational hypokinesia.

Adherents of other theories say that the immediate cause, provoking the development of neuro dystonia, is a violation of the functions of the device, which regulates the tone of the vascular wall, and all the other causal factors are background for the primary disease-provoking. This theory is confirmed in a clear dependence of the occurrence of neurocirculatory dystonia in people who have blood relationship in 25% of cases.

Despite the fact that the development of neuro dystonia participate a group of predisposing factors, pathogenetic mechanism of the disease in all situations takes place on a single chain, is in violation of the regulation of hemodynamic system. Disturbances of hemodynamics can be provoked as a violation of the regulatory function of cortical structures of the brain, and vegetative-vascular disorders, which manifest themselves in the dysfunction of the cholinergic and sympathetic-adrenal system. An important role in the development of the mechanism of neurocirculatory dystonia is the emergence of a sympathetic dominant and increased reactivity of the cholinergic system in response to functional disorders of the hypothalamic-pituitary system.

In addition, cardio-visceral mechanisms of regulation, consisting in the appearance of cardiovascular disorders as a result of stimulation of receptors located in all vascular walls, occur in the majority of clinical variants of neurocirculatory dystonia.

All types of disturbances in the regulation of the cardiovascular system negatively affect the metabolic processes taking place in the myocardium, which inevitably leads to dystrophic pathomorphological changes. The course of neurocirculatory changes is aggravated with concomitant disturbance of water-electrolyte, carbohydrate and acid-base metabolism. All of the above mechanisms for the development of neurocirculatory dystonia can be observed in patients who have undergone any surgical operations, childbirth, as well as in persons who have been inactive for a long time.

Symptoms of neurocirculatory dystonia

The fundamental principle of the clinical course of any form of neurocirculatory dystonia is a dissonance between the expressed subjective sensations of the patient and the scarcity of signs revealed by primary objective examination of the patient. To facilitate the diagnosis of this disease, the entire wide range of clinical symptoms is divided into several groups of clinical syndromes.

Cardial symptom complex occurs in 98% of cases and consists in the appearance of unpleasant sensations in the chest in the projection of the supposed location of the heart. A cardiological attack is characterized by characteristic features in the form of a typical localization in the projection of the apex of the heart, aching or thrusting character without signs of irradiation of pain. The occurrence of pain or discomfort in the projection of the heart has no connection with the increase in physical activity of the person, on the contrary, arises against the background of complete well-being. It is impossible to clearly define the duration and severity of the pain syndrome in neurocirculatory dystonia, since each person has an individual threshold of pain sensitivity. To stop the pain, there is no need to take cardiotropic medicines, and to ease the patient's condition, you should use Valocordin or Valerian's tincture.

Hyperkinetic symptom complex is manifested by signs of increased minute heart volume due to an increase in stroke volume and a simultaneous decrease in the overall resistance of peripheral vascular walls. As a result of such hemodynamic changes, the formation of a hyperkinetic type of circulation occurs, as a result of which the work and power of myocardial contraction of the left ventricle of the heart greatly increases. The main pathognomonic symptom of hyperkinetic clinical syndrome is the appearance in the patient of sensations of interruptions in the rhythmic activity of the heart and an increase in the frequency of cardiac contractions. Most often the above mentioned symptoms are described by patients as "frequent changes in rapid heart rate and heartbeat period".This condition adversely affects the quality of life of the patient, however, with physical activity, the above manifestations tend to be leveled independently. The increase in the heart rate is observed during the period of psychoemotional stress and hyperventilation, and in some situations the violation of heart rate regularity can be observed against the background of complete well-being, which fundamentally distinguishes them from a typical attack of angina pectoris. Objective examination of the patient, as a rule, is not accompanied by the discovery of expansion of the boundaries of the heart or sonority of cardiac tones.

Symptomatic complex labile arterial pressure, characterized by transient flow, is a typical manifestation of neurocirculatory dystonia. As a rule, blood pressure figures do not exceed 140/90 mm Hg, and these indices are normalized spontaneously without the use of drug therapy. There are clinical variants of neurocirculatory dystonia, in which, on the contrary, the patient has episodes of a short-term decrease in blood pressure indicators. The above symptoms have a clear dependence on the meteorological conditions.

Respiratory disorders in patients with neurocirculatory dystonia are a typical clinical manifestation. These disorders have nothing to do with the classic version of dyspnea, rather, this condition can be characterized as discomfort in the chest when performing the usual breathing movements. Despite the severity of the patient's complaints, with an objective examination, the doctor can not detect signs of pulmonary pneumotization, which is considered a pathognomonic criterion of neurocirculatory dystonia. Spirographic registration in some situations is accompanied by the discovery of signs of hyperventilation.

The symptom-complex of autonomic disorders consists of a wide range of symptoms, the intensity of which, under equal conditions, can vary greatly in each specific case. Often patients notice an increase in body temperature, which has a permanent character with no signs of subfebrile fluctuation. Patients suffering from neurocirculatory dystonia are concerned about increased sweating and a constant sense of internal chills, regardless of the ambient temperature. Due to the violation of blood circulation at the microcirculatory level, patients tend to develop edematous syndrome, localized in the upper half of the trunk in the morning hours. Skin covers with a long course of the disease acquire acrocyanotic shade, and in most cases there is such a visual symptom as "marble skin".

Asthenoneurotic symptom complex does not differ in specificity and can manifest itself not only with neurocirculatory dystonia, but also with other pathologies. Characteristic signs of this syndrome are manifested in the form of increased weakness, decreased efficiency, anxiety, unreasonable anxiety, irritability and varying degrees of disturbance of night sleep.

To establish the diagnosis of "neurocirculatory dystonia", a prerequisite is the presence of at least three clinical criteria, provided that there are no signs of organic changes in the heart and large vessels confirmed by instrumental diagnostic methods. The main diagnostic criteria for neurocirculatory dystonia are: cardiac syndrome, respiratory dysfunction, lability of blood pressure.

Prolonged course of neurocirculatory dystonia in some cases is accompanied by the development of complications in the form of the appearance of a typical crisis. There are several variants of the crisis course of neurocirculatory dystonia, each of which has its own pathogenetic mechanisms of development.

For the development of sympathic-adrenal crisis, the presence of a psychoemotional component is mandatory. Typical clinical manifestations in this situation are the emergence of a sharp diffuse headache, a feeling of tightness in the chest, difficulty breathing, a sharp chill and cold skin in the distal limbs. A characteristic manifestation of this pathological condition is a short-term increase in body temperature, manifested by a pronounced chill and an internal tremor. In addition to pronounced clinical manifestations, sympathic-adrenal crisis is accompanied by significant psychoemotional disorders of an alarming type.

The vagoinsular crisis with neurocirculatory dystonia is accompanied by the appearance of a sensation of interruptions in rhythmic cardiac activity, a decrease in blood pressure and a decrease in the pulse. In addition to the violation of the heart, the patient develops manifestations of respiratory failure. The pathognomonic symptom of the vagoinsular crisis is various variants of bowel disturbance, manifested in the development of flatulence, the urge to defecate and pain along the thick part of the intestine.

Each of the pathogenetic variants of the crisis course of neurocirculatory dystonia can occur in varying degrees of severity. The duration of the crisis, not exceeding 15 minutes with predominance of one clinical syndrome, implies a slight degree of severity. The moderate crisis with neurocirculatory dystonia lasts at least 1 hour, after which the patient has a long period of asthenia. Severe degree of the crisis course of neurocirculatory dystonia is subject to inpatient treatment, since in this pathology there is a high risk of developing severe complications. In some situations, the course of the crisis is accompanied by a pronounced patient health disorder, but these changes are transient in most cases.

Neurocirculatory dystonia by hypertonic type

The leading clinical symptom of the hypertensive variant of neurocirculatory dystonia is a different degree of increase in arterial pressure, mainly systolic, with a normal level of diastolic component or a slight increase in it. During the onset of the unfolded clinical picture, patients notice an intense headache that does not have a clear localization, dizziness, double vision of objects.

Objective examination of the patient allows to determine the pronounced white dermographism, increased moisture of the skin in the projection of the distal limbs. Against the background of high blood pressure, the pulse rate rarely changes, but in some cases there may be some lability in the heart rate. The permanent variant of the hypertensive type of neurocirculatory dystonia differs by a slow increase in clinical manifestations without marked progression of the disease. Paroxysmal as a form has a very negative effect on the patient's well-being, since it is characterized by rapid development of clinical symptoms and frequent periods of exacerbations.

This pathology should first of all be differentiated from the classical variant of hypertensive disease in the stage of initial manifestations. The main difference between neurocirculatory dystonia, which proceeds according to the hypertonic type, is a complete absence of signs of changes in the vessels of the fundus, an isolated increase only in the systolic pressure index and absence of expansion of the left ventricle during echocardiography.

A good therapeutic effect in the hypertensive version of neurocirculatory dystonia is the application of a course of electrophoresis using a 5% solution of potassium bromide in combination with a 1% solution of Euphyllin with an effect on the collar zone.

Neurocirculatory dystonia in mixed type

A mixed clinical variant of the course of neurocirculatory dystonia is characterized by sharp changes in arterial vascular pressure indices both upward and downward. In some situations, these changes in blood pressure may have a clear correlation with respect to time of day. This type of course of neurocirculatory dystonia combines the manifestations of the hypertonic and hypotonic variant simultaneously, so the spectrum of clinical manifestations in this pathology is quite wide. During the interictal period, a patient with a mixed type of neurocirculatory dystonia, as a rule, does not notice any impairment of well-being.

Despite the wavy course of the disease, consisting of frequent periods of remission and exacerbations, a significant disorder of the patient's health with a mixed version of neurocirculatory dystonia is not observed.

Neurocirculatory dystonia in cardiac type

This clinical variant of the course of neurocirculatory dystonia is considered the most common and the main symptomatic complex is the appearance of pathological changes in the activity of the heart. The pronounced cardialgic syndrome is not characterized by a single type of pain syndrome, therefore the diagnosis of dystonia is extremely difficult. In addition to nonspecific pain syndrome, the heart projection shows a different degree of its severity, which has a clear dependence on the individual level of the patient's pain sensitivity.

Nonspecific manifestations of the cardiac variant of neurocirculatory dystonia are asthenoneurotic and psychoneurological syndromes, which in most cases aggravate the course of the disease.

As a prophylactic treatment of the cardialgic variant of neurocirculatory dystonia, the method of physiotherapy "electrosleep" with a course of at least 15 sessions with a frequency of 10 Hz lasting 30 minutes proved to be a good one.

Neurocirculatory dystonia by hypotonic type

A hypotonic variant of the course of neurocirculatory dystonia occurs with an increased tone of parasympathetic nervous system structures and is accompanied by a predominance of symptoms of vascular insufficiency. Lowering of peripheral arterial pressure arises as a result of reduced total resistance of peripheral vessels.

Clinical symptom

neurocirculatory dystonia hypotonic type accompanied by the manifestation of brain symptoms as severe weakness of disability, a sharp drop in blood pressure indicators in the translation of the body horizontal position in the standing position. In some situations, a marked decrease in pressure is accompanied by the development of an orthostatic fainting, which is of a short duration.

Treatment neuro dystonia

cardiopsychoneurosis belongs to the category of diseases in which the causal treatment is not applied focus, since in most cases the cause of its occurrence can not be determined. However, elimination of the factors provoking the development of neurocirculatory crises greatly facilitates the condition of patients and improves their quality of life. These factors include the harmful effects of adverse environmental conditions, negative emotions. The key to the success of therapeutic measures in neurocirculatory dystonia is the moral and psychological mood of the patient, so special attention should be given to psychotherapeutic methods of behavior correction.

All drugs used as a treatment for patients with neuro dystonia belong to the category of empirical: Group tranquilizers( Sibazon in a daily dose of 10 mg orally, Nozepam in a daily dose of 20 mg orally), neuroleptics( Sonapaks in a daily dose of 0.025 g p.o.), sedativesPreparations( Corvalol 15 drops once a day).

As a reduction in the effect of increased activity of the sympathetic-adrenal system, preparations of the group of B-adrenoblockers should be used. The most effective these drugs have in relation to the relief of sympathic-tonic crises and cardiac syndrome. However, it should be taken into account that B-adrenoblockers are absolutely contraindicated in bradyarrhythmic states and low blood pressure figures. The drug of choice in this situation is Pyroxane in a single dose of 0.015 g orally or intramuscularly in a dose of 1 ml of a 1% solution.

The presence of signs of a vagoinsular crisis in the patient is an indication for the use of Atropine sulfate 0.25 mg in combination with Dimedrol 1 ml intramuscularly. In a situation when a crisis occurs with hyperventilation symptoms, the patient must enter sibazona 0.5% solution in a volume of 2 ml intramuscularly in combination with a calcium chloride 10% solution of 5 ml of intravenously.

The use of nootropic drugs is pathogenetically justified for all variants of neurocirculatory dystonia, since the drugs of this group are able to improve energy processes in the structures of the brain and intracerebral circulation, to positively influence the intellectual and mnestic abilities. A good clinical effect has Nootropil even in oral form, in a daily dose of 1.2 g

To apply drugs tserebroangioprotektornogo steps necessary condition is the presence of symptoms in patients angiodistonicheskih headaches( Vinpocetine in a daily dose of 0.005 g p.o.).

Due to the fact that the majority of patients suffering from neurocirculatory dystonia differ in their meteosensitivity, it is recommended to use the course of adaptogens to prevent the development of clinical manifestations of the disease. As adaptogens are used preparations of plant origin, capable of exerting a tonic effect on the structures of the brain, vascular walls and on all organs of the human body. In connection with a positive indirect effect on metabolic processes occurring in the human body, adaptogens improve the body's resistance to negative environmental influences and stress. As an adaptogenic agent for neurocirculatory dystonia, the most commonly used tincture of Eleutherococcus is a long course or tincture of Ginseng. When prescribing preparations of an adaptogenic pharmacological group, it should be taken into account that these drugs can increase blood pressure, which is an absolute indication for stopping the drug. These drugs should not be used in the hypertensive version of the course of neurocirculatory dystonia for the same reason.

Separately, we should mention the use of physiotherapeutic procedures, which in most cases are effective in preventing the development of neurocirculatory crises and have a beneficial effect on the activity of the structures of the central nervous system. The greatest application was found in such techniques as massage of the collar region, electrosleep, carbon dioxide bath and circular contrast shower.

As non-drug therapies for neurocirculatory disorders, therapeutic gymnastics are most important, contributing to the increase of exercise tolerance and favorably affecting the patient's mental health.

Due to the fact that neurocirculatory dystonia is not under any circumstances accompanied by the development of organic damage to organs and systems of the human body, the outcome of the disease is usually favorable. The only exception is the crisis variants of the course of neurocirculatory dystonia, which negatively affect the patient's quality of life and performance.

Neurocirculatory dystonia, like no other pathology, is well amenable to correction using folk medicine, the action of which is aimed at normalizing the activity of the nervous system.