cardiopsychoneurosis - it is a symptom of neurogenic nature, arising from the impact of a number of aetiological provoking factors, manifested in the appearance of the instability of the pulse and blood pressure, false angina, respiratory disorders, vegetative disorders,Abuse tone and muscle fibers of the vessel wall, and low tolerance to usual physical activity and exposure to stressful situations.
first diagnosis "cardiopsychoneurosis" was established in the years 1948-1950 Savitsky NNThis pathology is at the present time has a high morbidity rate, and due to the wide variety of clinical manifestations of the establishment of the correct diagnosis of the patient requires a consultation from a variety of specialists.
In general morbidity of patients under the supervision of a general practitioner, "neurocirculatory dystonia syndrome," which is now a separate nosology form is at least 50% of the cases.There is no clear pathogenetic depending appearance neurocirculator
cardiopsychoneurosis in children is rare, as most "diagnosis of exclusion".
reasons neurocirculatory dystonia
Most experts cardiology, with which is the management and treatment of patients suffering neurocirculatory dystonia in some clinical variants, united in the opinion that this pathology is classified polietiologichesky diseases for which development is insufficient detectionthe patient has any one provoking factor.Expanded clinical picture develops in a person only when the available set of different etiopathogenetic factors.
about the development of cardiovascular and neurological manifestations in patients with dystonia neurocirculatory wearing functional nature, there are many pathogenic theories.According to the first theory, all the disorders of the structures of the human organism, occur as a consequence of the direct effects on the organs of the central nervous system, resulting from fatigue, negative emotions, stress, different options to sleep at night, inevitably provoking psychic asthenia.
damaging effect on the structure of the central nervous system and may cause chronic toxic effects, the impact of harmful occupational factors, hormonal imbalance, as well as the impact of intoxication, which occurs in chronic and acute infectious diseases.Contributing factors, long-term exposure who develop moderately pronounced central nervous system that occurs in any form neurocirculatory dystonia, a genetic predisposition, as well as long-term unsustainable hypokinesia.
adherents of other theories say that the immediate cause, provoking the development neurocirculatory 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 the background for the primary disease-provoking.This theory is confirmed by the appearance of clear dependence neurocirculatory dystonia in people with kinship in 25% of cases.
Despite the fact that the development of dystonia neurocirculatory participate a group of predisposing factors, the pathogenetic mechanism of the disease in all situations takes place on a single chain, is in violation of the regulation of hemodynamic system.Hemodynamic disorders can be triggered as a violation of the regulatory function of the cortical brain structures, and vegetative-vascular disorders that are manifested in the dysfunction of the cholinergic and sympathetic-adrenal system.An important role in the development of a mechanism neurocirculatory dystonia plays a dominant appearance of the sympathetic and increased reactivity of the cholinergic system in response to the functional disorders of the hypothalamic-pituitary system.
Besides cardio-visceral regulation mechanisms, is the appearance of disorders of the cardiovascular system as a result of stimulation of receptors located all vascular walls, are in most clinical variants neurocirculatory dystonia.
All kinds of dysregulation of the cardiovascular system have a negative impact on the metabolic processes in the myocardium, which inevitably leads to dystrophic pathological changes.Current neurocirculatory changes compounded by the concomitant violations of water-electrolyte, carbohydrate and acid-base metabolism.All of these mechanisms of neurocirculatory dystonia may occur in patients who have had any surgery, childbirth, as well as parties for a long time are inactive.
symptoms of dystonia neurocirculatory
fundamental principle of the clinical course of any form neurocirculatory dystonia is a dissonance between the expressed subjective sensations of the patient and scant signs revealed by the primary objective examination of the patient.To facilitate the diagnosis of this disease the broad spectrum of clinical signs is divided into several groups of clinical syndromes.
Kardialgichesky syndrome occurs in 98% of cases and is the appearance of discomfort in the chest in the projection of the alleged location of the heart.Kardialgichesky attack different characteristic features of a typical localization projected apex of the heart, aching or stabbing nature with no signs of irradiation of pain.The appearance of pain or discomfort in the projection of the heart has no connection with the increase in physical activity, in contrast, occurs against a background of well-being.Clearly define the duration and severity of pain in the dystonia neurocirculatory impossible, as each person has an individual pain threshold.For the relief of pain there is no need to take cardiotropic drugs, and to facilitate the patient's condition should be used Valocordin or tincture Valerian.
hyperkinetic syndrome show signs of increased cardiac output due to an increase in stroke volume and a simultaneous decrease in total peripheral resistance of the vascular walls.As a result of hemodynamic changes is the formation of hyperkinetic circulation type, resulting in significantly increased performance and power reduction of left ventricular myocardium of the heart.The main pathognomonic symptom of hyperkinetic syndrome is the occurrence of clinical patient experiences interruptions in the rhythmic activity of the heart and increased heart rate.In most cases the above symptoms patients describe as a "frequent change of heart palpitations and periods of fading heart."This condition affects the quality of life of the patient, but in physical activity above symptoms tend to self-leveled.Increased heart rate observed during the psychological and emotional stress and hyperventilation, and in some situations, violation of the regularity of heartbeats can be seen against the background of well-being, which distinguishes them from typical angina attack.An objective examination of the patient, as a rule, is not accompanied by the detection of extending the boundaries of the heart or heart sounds sonority.
Symptom labile blood pressure, wherein transient current, is a typical manifestation of neurocirculatory dystonia.As a rule, the numbers of blood pressure does not exceed 140/90 mm Hg indicators, and these indicators are normalized spontaneously without the use of medication.There are clinical variants neurocirculatory dystonia, in which, on the contrary, patients experienced episodes of the short-term decrease in blood pressure.The above mentioned symptoms are clearly dependent on meteorological conditions.
Respiratory disorders in patients suffering from dystonia neurocirculatory are typical clinical manifestations.These disorders have nothing to do with the classic version of shortness of breath, probably, this condition can be described as chest discomfort when performing usual respiratory movements.Despite the severity of the patient's complaints, an objective examination of the doctor fails to detect signs of lung pnevmotizatsii is considered pathognomonic criterion neurocirculatory dystonia.Spirographic registration in some cases accompanied by the detection of signs of hyperventilation.
Symptom autonomic disorders consists of a wide range of symptoms, intensity under the same conditions can be very different in each case.Most patients notice an increase in body temperature of a permanent character without signs of hesitation on the low-grade type.Patients suffering neurocirculatory dystonia, worried about excessive sweating and the constant feeling of inner chill, regardless of ambient temperature.As a result of violation of circulation of blood in the microcirculatory level, there is a tendency for patients to develop edema syndrome localized in the upper half of the body in the morning.The skin in the long course of the disease become akrotsianotichny shade, and in most cases there is a visual symptom as "the marble skin."
asthenoneurotic symptom is different specificity and can manifest itself not only in neurocirculatory dystonia and in other pathologies.The characteristic features of this syndrome are manifested in the form of increased weakness, decreased performance, anxiety, groundless anxiety, irritability, and varying degrees of sleep at night.
for diagnosis "cardiopsychoneurosis" necessary condition is the presence of at least three clinical criteria in the complete absence of signs of organic changes of heart and great vessels, confirmed by instrumental methods of diagnosis.The main diagnostic criteria neurocirculatory dystonia are: kardialgichesky syndrome, respiratory dysfunction, blood pressure lability.
Long neurocirculatory for dystonia in some cases accompanied by the development of complications in the form of the appearance of a typical crisis.There are several options during krizovoe neurocirculatory dystonia, each of which has its own pathogenetic mechanisms of development.
for the development of sympathetic-adrenal crisis necessarily requires the presence of mental and emotional component.Typical clinical manifestations of this situation is the emergence of sharp diffuse headaches, tightness in the chest, difficulty breathing movements, sudden chills and cooling of the skin in the distal extremities.A typical manifestation of the disease state is a transient increase in body temperature, manifested severe chills and internal tremor.In addition to the clinical manifestations sympathoadrenal crisis accompanied by significant psycho-emotional disorders such as anxiety.
vagoinsulyarnyh crisis when neurocirculatory dystonia is accompanied by a feeling of disruption in rhythmic heart activity, reduced blood pressure and slowing heart rate.In addition to disorders of the heart, the patient develops symptoms of respiratory failure.Pathognomonic symptom vagoinsulyarnyh crisis are various options for disorders of the intestines, which manifests itself in the development of flatulence, fecal urgency, and pain along the large intestine.
Each of pathogenic variants of crisis course neurocirculatory dystonia may occur in varying degrees of severity.The duration of a crisis, not to exceed 15 minutes, with a predominance of the clinical syndrome, it involves mild.Medium heavy crisis during neurocirculatory dystonia lasts at least 1 hour, after which the patient has a long period of asthenia.Severe crisis course neurocirculatory dystonia to be hospital treatment, since this disease are at high risk of serious complications.In some situations during krizovoe accompanied by a pronounced disorder of the patient, but these changes in most cases are transient in nature.
cardiopsychoneurosis of hypertensive type
leading clinical symptom of a hypertensive variant neurocirculatory dystonia is a different degree of increase in blood pressure, especially systolic, under normal diastolic component or his minor increase.During the onset of expanded clinical patients reported intense headache, which has no clear localization, dizziness, double vision objects before his eyes.
objective examination of the patient to determine the expression white dermographism, high humidity of the skin in the projection of the distal extremities.Against the background of high blood pressure heart rate rarely changes, but in some cases there may be some lability of heart rate.Permanent current version of hypertensive type neurocirculatory dystonia characterized by slow growth without the expressed clinical manifestations of disease progression.Paroxysmal also form an extremely negative impact on the health of the patient, as is characterized by the rapid development of clinical symptoms and frequent periods of exacerbation.
This pathology must first be differentiated from the classic version of hypertensive disease in the stage of initial symptoms.The main difference neurocirculatory dystonia flowing of hypertensive type, is the complete absence of evidence of changes in retinal vessels, increasing only isolated systolic pressure and the lack of expansion of the left ventricle at echocardiography.
good therapeutic effect for hypertensive variant of dystonia has neurocirculatory application rate electrophoresis using a 5% solution of potassium bromide in combination with a 1% solution of aminophylline with exposure to the collar area.
cardiopsychoneurosis mixed type
mixed clinical variants neurocirculatory dystonia is characterized by sharp changes of arterial vascular pressure in an upward and a significant reduction.In some situations, these changes in blood pressure may have a clear correlation with respect to time of day.This type of flow neurocirculatory dystonia combines manifestations of hypertonic and hypotonic variants simultaneously, so the spectrum of clinical manifestations of this pathology is quite wide.In the interictal period, patients with mixed neurocirculatory dystonia usually not noted violations being.
Despite the fluctuating course of the disease, consisting of frequent periods of remission and relapse, a significant health disorder patient with mixed variant neurocirculatory dystonia is observed.