Cardioneurosis — the psychosomatic disease which arose against the background of failures of activity of the autonomic nervous system under the influence of external factors. It is shown by violations of work of cardiovascular system in the absence of organic changes. Patients complain of kardialny pains, tachycardia, irritability, sleep disorders. Cardioneurosis is diagnosed on the basis of a clinical picture after carrying out the tool and laboratory researches excluding other pathologies. Treatment includes a complex of the actions directed to correction of psychological state and elimination of provocative factors. According to indications appoint medicamentous therapy.
Cardioneurosis — the chronic disease which is followed by disorders of activity of cardiovascular, respiratory, nervous systems, decrease in resistance of an organism to physical activities and stressful situations. In medical practice the state occurs at 30-40% of patients with the symptomatology characteristic of kardialny violations, at 70% of the patients coming to offices of emergency aid with suspicion of a myocardial infarction and other zhizneugrozhayushchy states with a similar clinical picture. Despite considerable prevalence of a disease, exact statistical data on occurrence are absent as patients are quite often mistakenly treated for other neurologic or cardiological pathologies. More often patients aged up to 40 years, mainly female suffer.
Pathology belongs to polietiologichesky diseases therefore definition of the leading reason causes sufficient complexity. Allocate two groups of factors: contributing and directly causing this state. Favorable a background for development of a disease in young people is lability of nervous system, hypersensitivity, tendency to hysterical or depressive reactions, at elderly – TsNS diseases provoking instability of psychoemotional reactions. The role of hereditary predisposition, functional and morphological features of an organism is not excluded: insufficiency of functions of some departments of a brain, individual differences of metabolism. In the presence of a background an etiology can become:
- Psychogenic factors. Development of pathology is promoted by the states or events having pronounced negative emotional coloring. Carry some mental disorders of neurotic level (neurosises, phobias), the endured heavy shocks (natural disasters, accidents, loss of close people), acute and chronic stress, adverse social and economic living conditions to them.
- Unstable hormonal background. More often women owing to an imbalance of sex hormones suffer: estrogen, progesterone. The probability of emergence of symptoms increases during puberty, a climax, pregnancy and childbirth, at the use of hormonal medicines (mainly – oral contraceptives), formation of gormonprodutsiruyushchy tumors. Cardioneurosis can be diagnosed for men in the period of a puberty, in the presence of endocrine frustration.
- Physical, chemical impacts. The disease develops as a result of chronic overfatigue, including at people of brainwork against the background of a hypodynamia. Provocative factors are continuous impacts of vibration, noise, direct sunshine, temperature drops, and also chronic intoxication household poisons, salts of heavy metals, narcotic substances and some groups of medicines, abuse of alcohol and kofeinsoderzhashchy drinks.
- Infectious processes. Mainly lead focal upper respiratory tract infections to cardioneurosis and nervous system: chronic tonsillitis, sinusitis, rinosinusita, pharyngitis, tracheitis, acute respiratory diseases, meningitis, encephalitis, neurosyphilis, neuritis of various localization. Viruses, bacteria, fungi, the elementary can be causative agents of infections.
Continuous complex influence of exogenous and endogenous factors is the reason of an imbalance in the difficult mechanism of regulation of action of the heart, vessels. The coordination role is carried out by a hypothalamus therefore the mismatch of signals of a hypothalamic zone and a cerebral cortex becomes an initial link of pathology. Violation of regulation provokes increase in activity of simpatoadrenalovy and holinergichesky systems, increase in sensitivity of peripheral receptors. All this leads to excess reaction of bodies to TsNS signals, disorders of metabolism that is shown by the reactions inadequate to a situation: tachycardia, at rest, inefficient reductions of heart, violation of a tone of vessels up to a peripheral spasm, increase in arterial pressure. Failures of neurohumoral regulation are more often shown against the background of physical or emotional activity.
The conventional classification of cardioneurosis is absent. In clinical practice division of a course of a disease according to severity taking into account a number of criteria is used: heart rate, existence and frequency of vegetovascular crises, localization and intensity of a pain syndrome, dependence of expressiveness of symptomatology on physical activities. Mark out three severity of pathology:
- Easy current. Working capacity and social activity of the patient are completely kept, insignificant decline in the ability to performance of hard work is noted. Pain behind a breast moderate, develops after psychoemotional or physical activities, paroxysms are absent. Respiratory frustration are practically not reflected in a condition of the patient, violations on the ECG are not found. Medicinal therapy usually is not required.
- Medium-weight current. A considerable part of time symptoms are absent or are poorly expressed, in the period of an aggravation working capacity decreases up to its temporary loss. The pain syndrome expressed, which does not have accurate communication with loadings vascular crises are possible. Tachycardia develops suddenly, pulse rate makes more than 100 beats per minute. Performing medicinal therapy is recommended.
- Heavy current. The resistant diverse symptomatology mentioning several bodies and systems is characteristic. Working capacity is critically reduced or is absent, constant tachycardia, violations of a rhythm, high arterial pressure comes to light. The expressed short wind, hypostases of the lower extremities, sleeplessness is observed. Systematic reception of medicines is necessary.
The symptomatology is variable, considerably differs on expressiveness degree. Displays of a disease are not specific that significantly complicates diagnostics. The beginning is sudden, with a large number of symptoms which intensity depends on a causal factor, the general condition of the patient. After a severe stress cardioneurosis develops sharply, and against the background of an infection or overfatigue — gradually. Patients show complaints to the pains in a breast of various character (which are pricking, burning, holding apart, aching) which duration fluctuates from several seconds to hours or days.
Pain has no accurate localization, can migrate in a scapular zone, a neck, epigastriya, a waist, bodies of a crotch. The pain syndrome usually arises against the background of the physical tension, overfatigue, emotional experiences, alcohol intake, the premenstrual period at women. Intensive pain is followed by alarm, fear, feeling of shortage of air, perspiration, is not stopped by nitroglycerine. Patients can note breath increase, its superficial character, feeling of an incomplete breath, feeling of a lump in a throat. There is a need for fresh air because of which, being in the room, patients try to open windows. Against the background of respiratory violations quite often there is a feeling of the strengthened heartbeat, interruptions in work of body, the pulsation of vessels of a neck is found.
Working capacity decreases, chronic weakness, fatigue increases. Disorders of regulation of a tone of peripheral vessels prove in the form of a headache, dizziness, feeling of a cold snap of extremities. Perhaps temporary increase in arterial pressure to 160/90 mm Hg, increase in body temperature up to 37,5 °C. The picture of vegetative crisis consists of a fever, dizziness, perspiration, feeling of shortage of air, fear. The state usually develops at night, lasts of half an hour till 3 o'clock, comes to an end with a plentiful urination, a liquid chair. Frequency of crises — from one attack a month to 1-2 in a year. Eventually the frequency and intensity of symptoms decrease.
Cardioneurosis seldom provokes serious complications. At a long current the disease leads to violations in mental and social spheres — to morbid depression, phobias, depressive reactions, deterioration of life, activity restriction. In the absence of adequate therapy pathology can negatively affect a condition of heart, the patient's vessels. There are instructions on increase in probability of development of a hypertensive and ischemic disease, different types of arrhythmias that causes morfofunktsionalny changes of a myocardium with violation of his excitability, conductivity, automatism, a sokratimost. The permanent decrease in coronary blood circulation increasing risk of a heart attack becomes a result of the listed processes.
Diagnostic actions are carried out by therapists and cardiologists, at detection of a significant neurotic and functional component in inspection involve the psychiatrist, the psychotherapist, the neurologist. The symptomatology of cardioneurosis is rather obvious, however its similarity with symptoms of other kardialny pathologies demands an exception of organic damages of heart and vessels, other somatic diseases. Complex diagnostics includes:
- Poll, survey. This rather poor, not specific. On cardioneurosis specifies emergence of the first symptoms in young age, their duration, interrelation with irritants. The tremor of fingers, uneasy behavior, pallor or reddening of skin can come to light . At a palpation the increased perspiration, a cold snap of extremities is noted. Often the strengthened pulsation of carotids, morbidity of edges, intercostal intervals is found. The heart sizes at percussion – without changes. Auskultation reveals violations of a rhythm, gives an idea of the frequency of reductions, additional tones and noise. At measurement of arterial pressure its lability is noted, asymmetry on the right and left hand is possible.
- Electrocardiography. The technique gives the chance to estimate the frequency, character of a rhythm, to find premature ventricular contraction, arrhythmia, violations of intracardial conductivity, to exclude organic damage (myocardium ischemia, damage of a cardiac muscle by toxic agents). When carrying out the ECG with a change veloergometriya on a tape at neurosis of heart correlate with decrease in working capacity, increase of symptomatology.
- Echocardiography. The research is applied to an exception of defeat of valves, organic anomalies of heart (additional chords, cavities in ventricles). The size of cameras, thickness of their walls which at cardioneurosis usually meet standard is estimated. At persons with a heavy course of disease decrease in warm emission, the general speed of work of heart fibers is possible that demonstrates violation of sokratitelny function of a myocardium.
- Laboratory researches. In clinical and biochemical blood test the increased level of leukocytes, SOE, S-jet protein, ostrofazny factors is not found that allows to exclude rheumatoid fever and other immunopathologies. Levels of maintenance of ALT, nuclear heating plant, a myoglobin, troponin as markers of injury of a myocardium are important. Change of a physiological ratio of electrolytes is necessary for differential diagnosis of arrhythmia.
The diagnosis is exposed with certain criteria: durations of preservation of symptomatology, communication with a characteristic provocative factor, expressiveness of a psychoemotional component, absence of somatic pathologies. Differential diagnosis of cardioneurosis is carried out with diseases which give a similar clinical picture with the leading symptom in the form of pain behind a breast: an ischemic disease, myocarditis, a myocardial infarction, stratified aorta aneurism, pleurisy. Differentiation with pathologies with frequent irradiation of pain in a thorax is carried out: hepatic colic, sharp pancreatitis, stomach ulcer. Special attention is paid to an exception of rheumatic damages of heart, valvate system.
Treatment of cardioneurosis
Because of changeable intensity of symptoms, their big variability the correct purpose of medical actions represents a difficult task. At easy and moderate severity perhaps out-patient treatment, at heavy cardioneurosis hospitalization is shown. Preference is given to etiologichesky or pathogenetic therapy in combination with symptomatic means, the all-strengthening actions. Considering features of cardioneurosis, in its treatment allocate a number of the directions:
- Psychotherapy. Regardless of other provocative factors pathology demands correction of psychological state. Cognitive and behavioural therapy, hypnosis, relaxation methods is used. The complex of actions is directed to decrease in sensation of fear, despair, helplessness, belief of the patient in groundlessness of his fears. Explain to the patient an essence of symptoms, high quality of a disease, help to create a position of active participation in treatment process.
- Psychotropic drugs. In cases when mental violations gain long character or do not give in to not medicinal correction, during stay in a hospital and after an extract appoint psychotropic drugs. To the forefront there is an application of medicines of a phytogenesis (a valerian, a motherwort), at their inefficiency pass to neuroleptics, antidepressants, tranquilizers.
- Medicamentous therapy. At the diagnosed infection to application antibiotics, antiviral medicines, polyvitamins are obligatory. At endocrine violations appoint hormonal means. At a medium-weight course of disease therapy is supplemented with adrenoblokator, pulsurezhayushchy medicines.
- Physical therapy. Physiotherapeutic techniques strengthen action of medicines that in some cases allows to lower a dosage, to accelerate recovery, to normalize work of the central nervous system. LFK, reflexotherapy, an electrophoresis, an electrodream, a hydromassage is applied. The respiratory syndrome demands additional purpose of respiratory gymnastics.
Forecast and prevention
For cardioneurosis development of heavy complications, on condition of timely complex therapy the forecast favorable is uncharacteristic. The pronounced clinical symptomatology worsens quality of life of patients that demands constant observation and holding medical actions. Prevention includes maintaining a healthy lifestyle, an exception of addictions, moderate physical activity according to age and the state of health, healthy nutrition, timely treatment of infectious diseases. An important point is correction of a hormonal background at women, especially in the period of a climax. Whenever possible it is necessary to avoid excessive physical, mental and emotional activities, stressful situations.