neurocirculatory dystonia

neurocirculatory dystonia (Cardiopsychoneurosis )

Cardiopsychoneurosis (NDC) - a set of disorders of the cardiovascular system of a functional nature, which develops as a result of violations of the neuroendocrine regulation. Cardiopsychoneurosis polietiologichesky genesis is accompanied by a variety of, mainly cardiovascular diseases, symptoms, caused or aggravated under the influence of stress effects, different benign course and a satisfactory outcome.

Cardiopsychoneurosis (neurocirculatory dystonia)
    Classification of neuro dystonia
    The causes of neuro dystonia
    Neuro symptoms of dystonia
    Diagnosis of neuro dystonia
    Neuro treatment of dystonia
    The prognosis of neuro dystonia
    Prevention neuro dystonia

Cardiopsychoneurosis in literature is sometimes described by the term "cardiac neurosis", "neuro-circulatory asthenia," "excitable heart." Taken to distinguish between two types of functional disorders of the cardiovascular system: vegetative-vascular and neuro-circulatory dystonia. Vegetative-vascular dystonia together various manifestations of autonomic dysfunction that come with organic lesions of the nervous, endocrine and other systems. Cardiopsychoneurosis an independent nosological form with its etiology, pathogenesis, symptoms and prognosis and has a number of features of autonomic dysfunction. Distinctive features of neuro dystonia is the prevalence of clinical manifestations of cardiovascular symptoms, primary-functional nature of the disturbances of autonomic regulation and lack of communication with organic pathology, including neurosis.

With neuro dystonia often face neurologists , cardiologists , general practitioners. Among patients and therapeutic cardiology NDC occurs in 30-50% of individuals. Neurocirculatory dysfunction may develop at different ages, but is more common in young people, mainly women, suffering from it 2-3 times more often than men. The disease rarely occurs in people younger than 15 and older than 40-45 years.

Classification of neuro dystonia

On the etiological forms of essential release (constitutional-hereditary), psychogenic (neurotic), infectious-toxic, dishormonal mixed cardiopsychoneurosis and NDC physical stress.

Depending on the leading clinical syndrome classification V.P.Nikitina (1962) and N.N.Savitskogo (1964) distinguishes four types of neuro dystonia: cardiac (with a primary disorder of cardiac activity), hypotensive (with the decrease of blood pressure), hypertensive ( with primary elevated blood pressure), mixed (combined disturbance of blood pressure and cardiac activity).

On the severity of symptoms distinguish mild, moderate and severe neuro dystonia, the variant of flow - the phase of exacerbation and remission.

The causes of neuro dystonia

By the development of neuro disorders can cause a variety of factors, but these do not include organic lesions of the endocrine and nervous systems.

In adolescence and early period cardiopsychoneurosis usually due to imperfections in the neuroendocrine mechanism of regulation of autonomic processes. NDC development in prepubertal and pubertal periods contribute to enhanced mental and physical activities, social environment.

Individuals of any age can develop cardiopsychoneurosis against acute and chronic infections , lack of sleep, fatigue, trauma, exposure to physical and chemical factors (sun exposure, hot weather, vibration), improper diet, physical activity (or inactivity overload), intoxication, including alcohol and tobacco. In the development of neuro dystonia serve as periods of hormonal changes the body (puberty, abortion , pregnancy, menopause , ovarian dysfunction ).

A number of patients have a hereditary-constitutional predisposition to the development of neuro dystonia.

The impact of these factors causes dysfunction neurohumoral control of the cardiovascular system, where as the leading pathogenetic mechanisms protruding lesions of the hypothalamic-pituitary structures responsible for the coordination of these processes. Violation of neurohumoral control disorder manifested systems functions, ensuring the processes of homeostasis in the body: cholinergic sympathetic-adrenal, kallikreinkininovoy, gistaminserotoninovoy etc.

This in turn triggers the mechanisms leading to disruption and multiple changes of the carbohydrate, water and electrolyte metabolism, acid-base balance, neurotransmitter and hormonal systems.

In the myocardial tissue is activation of biologically active substances (histamine, serotonin, kinins, etc.), causing the development of metabolic disorders and malnutrition. On the part of the circulatory system are marked variations in vascular tone, peripheral vascular spasm, slowing of microcirculation, leading to the development of tissue hypoxia.

Once formed, the pathogenetic mechanisms become autonomous and cardiopsychoneurosis - a separate disease. Any stimuli (weather changes, stress, etc.) cause pathological reaction, for expression of a type neuro dystonia.

Neuro symptoms of dystonia

Common to all types of neuro dystonia is a manifestation of neurosis-a condition characterized by fatigue, weakness, insomnia, irritability, memory loss, mood and willpower, the deterioration of concentration, joined functional circulatory disorder is predominant.

During cardiac type neuro dystonia manifested false angina, palpitations, disruptions of the heart, sometimes shortness of breath during physical activity, significant changes in blood pressure is not observed. Can be determined objectively tachycardia , respiratory arrhythmia , paroxysmal tachycardia, supraventricular arrhythmias, inadequate cardiac output load change, the ECG - changing voltage of the T wave (high or reduced).

Cardiopsychoneurosis hypertensive type is characterized by the phenomena of chronic vascular insufficiency: a decrease in systolic blood pressure less than 100 mm Hg. Art., chilliness feet and hands, prone to orthostatic collapse and fainting. And for patients with hypertensive type NDC typical complaints of fatigue, muscle weakness, headaches . Such patients usually have asthenic physique, pale skin, cold and wet hands.

For hypertensive type neuro dystonia characterized by transient increase in blood pressure to 130-140/85-90 mm Hg. Art., which half the time is not accompanied by changes in subjective well-being of patients and detected on physical examination. Less frequent complaints of palpitations, headache, fatigue. Hypertensive type NDC in performance coincides with the boundary of arterial hypertension .

Mild neuro dystonia is characterized by moderately severe symptoms that occur only in connection with psycho-overload. Disabled patients maintained, there may be a slight decrease in physical endurance, drug therapy is not indicated.

At moderate neuro dystonia are multi symptoms, decreased physical performance by more than 50%. Reduction or temporary disability requires use of drug therapy.

In severe forms of dystonia neuro long lasting and multiple clinical symptoms, sudden decrease or loss of earning capacity, requiring hospital treatment of patients.

Diagnosis of neuro dystonia

Malospetsifichnost neuro symptoms of dystonia is difficult to diagnose and requires careful verification of the diagnosis.

Supporting diagnostic criteria based on neuro dystonia patient's complaints may serve as symptoms traced for 1-2 months: false angina, palpitations, feeling short of breath, precordial pulsation in the field or in the vessels of the neck, weakness, fatigue, neurotic symptoms (irritability, anxiety , insomnia ), dizziness , cold and wet limbs. For neuro dystonia characterized multiplicity of complaints that have a clear link with stress or periods of hormonal changes, illness with periods of remissions and exacerbations, but no tendency to progression.

By the criteria of significant physical presence NDCs are erratic heart rhythm with a tendency to tachycardia, which appears spontaneously or inadequate situation, labile blood pressure, presence of respiratory arrhythmia (tachypnea, dyspnea), hyperalgesia in the heart.

On ECG in patients may register tachycardia, arrhythmia, pacemaker migration (21.3%), arrhythmias (8.8%), paroxysmal tachycardia and atrial fibrillation (3%), negative T waves in two or more leads (39.4 %).

Informative methods for diagnosis of dystonia are neuro-diagnostic ECG test with a load .

• Physiological test with hyperventilation implies a for 30-40 minutes forced breaths followed by ECG recordings and comparing it with the original. Positive samples indicating NDC is increased heart rate by 50-100% and the appearance of the ECG negative T waves or increase their amplitude.
• Tilt test provides ECG in the supine position, and then after 10 to 15 minutes of standing. Positive results of the sample are the same changes as in the sample with hyperventilation found at the NDC in 52% of patients.
• Drug test (with β-blockers, potassium) are aimed at distinguishing neuro dystonia and organic heart disease. ECG-registration is carried out after 40-60 minutes after taking 60-80 mg of β-blockers (obzidan, inderal, Inderal), or 6 g of potassium chloride. In organic kardiopatologiyah ( myocarditis , coronary artery disease , myocardial hypertrophy) recorded positive T waves, the NDC - negative T waves.

During cycle ergometry determined typical neuro dystonia reduced exercise capacity, that is, patients with neuro dystonia can do less weight than a healthy person of the same age and sex.
Laboratory data indicate an increase in the activity of sympathetic-adrenal system: in response to the load in the blood is inadequate increase in noradrenaline, adrenaline, metabolites, lactic acid.

Neuro treatment of dystonia

In the treatment of neuro dystonia extremely important place occupied by non-drug activities to increase the adaptive capacity of the organism to changing conditions. When NDC shown holding tempering procedures, sports (athletics, swimming), rational psihiterapiya, normalization of work and leisure.

Positive impact on the training of the system of regulation of autonomic function has balneotherapy , physiotherapy ( therapeutic showers and baths, electric sleep , reflexology , electrophoresis with bromine, magnesium, Novocain), physical therapy , spa treatment.

Sleep disturbances, irritability, sedation can assign medicines: motherwort, valerian valokordin, tranquilizers (nozepama etc.).

For the treatment of neuro dystonia of hypertensive cardiac and type shown receiving β-blockers (atenolol, Inderal, trazikora), eliminates tachycardia, hypertension, false angina, as well as products that will improve the metabolism of the heart muscle (riboksina, preparations of potassium, B vitamins).

When neuro dystonia of hypertensive type with the presence of fatigue and postural disorders prescribed tincture of ginseng (lemongrass, Aralia), caffeine.

The prognosis of neuro dystonia

During any type of neuro dystonia does not cause the development of cardiomegaly, heart failure or life-threatening arrhythmias and conduction. In adolescence, with early treatment or cure itself comes complete recovery. With age, the prognosis for complete recovery of neuro dystonia decreases. Reduction or temporary disability may occur during exacerbations.

Hypertensive patients with type neuro dystonia are at risk for hypertension , with any type of NDC in relation to lipid metabolism can not exclude the risk of atherosclerosis and coronary artery disease.

Prevention neuro dystonia

Prevention issues neuro dystonia go beyond purely medical measures. Prevention includes proper physical, mental and adolescent health education, increase their self-esteem and social adjustment. The role of health promotion, exercise, avoid smoking and drinking alcohol.

Medical prevention neuro dystonia include combating focal infections, stress factors, hormonal regulation in women in menopause.