Neurocirculator dystonia (NTsD) – the complex of frustration of cardiovascular system of functional character developing as a result of violations of neuroendocrine regulation. Neurocirculator dystonia has polietiologichesky genesis, is followed by a set various, mainly cardiovascular, the manifestations arising or which are aggravated under the influence of stressful influences differs in a good-quality current and the satisfactory forecast.
Neurocirculator dystonia in literature is sometimes designated by the terms "heart neurosis", "neurocirculator adynamy", "excitable heart". It is accepted to distinguish two types of functional violations of cardiovascular system: vegeto-vascular and neurocirculator dystonia. Vegeto-sosudistaya dystonia unites various displays of vegetative dysfunction which accompany organic defeats nervous, endocrine and other systems. Neurocirculator dystonia is an independent nosological form with the etiology, pathogenesis, symptomatology and the forecast and differs in a number of features from vegetative dysfunction. Distinctive features of neurocirculator dystonia are prevalence among clinical manifestations of cardiovascular symptomatology, the primary and functional nature of violations of vegetative regulation and lack of communication with organic pathology, including, neurosis.
Quite often neurologists, cardiologists, general practitioners should face neurocirculator dystonia. Among patients cardiological and the NTsD therapeutic profile occurs at 30-50% of persons. Neurocirculator dysfunction can develop at different age, but meets at young people more often, mainly the women having it is 2-3 times more often than men. The disease seldom develops at persons more young 15 and 40-45 years are more senior.
Classification of neurocirculator dystonia
In etiologichesky forms allocate essentsialny (constitutional and hereditary), the psychogenic (neurotic), infectious and toxic, disgormonalny, mixed neurocirculator dystonia, and also NTsD of a physical overstrain.
Depending on the leading clinical syndrome on V. P. Nikitin (1962) and N. N. Savitsky's classification (1964) four types of neurocirculator dystonia differ: kardialny (with primary disorder of warm activity), hypotensive (with primary decrease HELL), gipertenzivny (with primary increase HELL), mixed (HELL and warm activity combines violations). On weight of symptomatology allocate easy, average and heavy degrees of neurocirculator dystonia; by current option – phases of an aggravation and remission.
Reasons of development of neurocirculator dystonia
Can lead various factors to development of neurocirculator frustration, however their number does not include organic defeats of endocrine and nervous systems. In the teenage and youthful period neurocirculator dystonia is usually caused by imperfection of the neuroendocrine mechanism of regulation of vegetative processes. Development of NTsD during the prepubertatny and pubertatny periods is promoted by the strengthened mental and physical activities, a social environment.
At persons of any age neurocirculator dystonia can develop against the background of sharp and chronic infections, a sleep debt, overfatigue, a mental trauma, influence of physical and chemical factors (insolation, hot climate, vibration), the wrong diet, physical activity (overloads or a hypodynamia), intoxications, including alcoholic and tobacco. In development of neurocirculator dystonia the periods of hormonal reorganizations of an organism (puberty, abortions, pregnancies, the climacteric period, dysfunction of ovaries) play a role.
At a number of patients hereditary and constitutional predisposition to development of neurocirculator dystonia is observed. Influence of these factors causes dysfunction of neurohumoral control of cardiovascular system where defeat of the gipotalamo-hypophysial structures which are carrying out coordination of these processes acts as the leading pathogenetic link. Violation of neurohumoral control is shown by disorder of functions of the systems providing processes of a homeostasis in an organism: holinergichesky, simpatiko-adrenalovy, kallikreinkininovy, gistaminserotoninovy, etc.
It, in turn, starts the mechanisms leading to violation and multiple changes from carbohydrate, water and electrolytic exchange, an acid-base state, mediator and hormonal systems. In tissues of a myocardium there is an activation of biologically active agents (a histamine, serotonin, kinin, etc.) causing violation of metabolism and development of dystrophy. From the blood circulatory system fluctuations of a vascular tone, spasms of peripheral vessels, microcirculation delay are noted that leads to development of a hypoxia of fabrics.
Having created, pathogenetic mechanisms become autonomous, and neurocirculator dystonia - an independent disease. Any irritants (change of weather conditions, a stress, etc.) cause the pathological reaction causing manifestation of this or that type of neurocirculator dystonia.
Symptoms of neurocirculator dystonia
To the general for all types of neurocirculator dystonia as manifestation serve the nevrozopodobny state which is characterized by fatigue, weakness, frustration of a dream, irritability, decrease in memory, mood and strong-willed qualities, deterioration in concentration of attention which functional circulator disorders of the prevailing character join.
The current of kardialny type of neurocirculator dystonia is shown by a kardialgiya, heartbeat, interruptions in work of heart, sometimes short wind at physical activity; essential changes HELL at the same time are not noted. Tachycardia, respiratory arrhythmia, tachycardia paroxysms, supraventricular premature ventricular contraction, change of warm emission inadequate to loading, can objectively be defined on the ECG – change of a voltage of a tooth of T (high or lowered).
Neurocirculator dystonia on hypotensive type is characterized by the phenomena of chronic vascular insufficiency: decrease systolic HELL less than 100 mm of mercury., chill of feet and brushes, tendency to orthostatic collapses and faints. Also with the NTsD hypotensive type complaints to fatigue, muscular weakness, headaches are typical for patients. Such patients, as a rule, have an asthenic constitution, pale integuments, cold and moist palms.
Tranzitorny increase HELL to 130-140/85-90 mm of mercury is characteristic of gipertenzivny type of neurocirculator dystonia., which in half of cases is not followed by subjective change of health of patients and comes to light on medical examinations. Less often complaints to heartbeat, a headache, fatigue meet. The NTsD Gipertenzivny type according to the characteristics coincides with boundary arterial hypertension.
Easy degree of neurocirculator dystonia is characterized by moderately expressed symptoms arising only in connection with psychoemotional overloads. Working ability of patients is kept, insignificant decrease in physical endurance can be observed; medicinal therapy is not shown.
At neurocirculator dystonia of average weight plurality of symptoms, decrease in physical working capacity more than for 50% is noted. Decrease or temporary disability demands purpose of medicamentous therapy. At heavy displays of neurocirculator dystonia the resistant and multiple clinical symptoms, sharp decrease or disabilities demanding hospitalization of patients are observed.
Diagnosis of neurocirculator dystonia
Low-specificity of symptoms of neurocirculator dystonia complicates diagnostics and demands careful verification of the diagnosis.
As the confirming diagnostic criteria of neurocirculator dystonia on the basis of complaints of the patient the symptoms which are traced for 1-2 months can serve: kardialgiya, heartbeat, feeling of shortage of air, a pulsation in prekordialny area or in the field of neck vessels, weakness, increased fatigue, neurotic manifestations (irritability, uneasiness, a sleep disorder), dizziness, cold and moist extremities. Plurality of the complaints having accurate communication with stressful situations or the periods of hormonal reorganizations, course of a disease with the periods of remissions and aggravations, but without tendency to progressing is characteristic of neurocirculator dystonia.
Treat an unstable rhythm of heart with tendency to the tachycardia developing spontaneously or inadequately situations, lability HELL, existence of respiratory arrhythmias reliable fizikalny criteria of existence of NTsD (, ), a giperalgeziya in heart. On the ECG at patients tachycardia, arrhythmia, migration of the driver of a rhythm (21,3%), premature ventricular contraction (8,8%), paroksizmalny tachycardia and vibrating arrhythmia (3%), a negative tooth of T in two and more assignments (39,4%) can be registered.
As informative methods of diagnostics at neurocirculator dystonia serve diagnostic ECGs tests with loading.
- Physiological test with a hyperventilation assumes performance within 30-40 minutes of the forced breaths and exhalations with the subsequent registration of the ECG and its comparison with initial. The positive test indicating NTsD is increase of pulse for 50-100% and emergence for the ECG of negative teeth of T or increase in their amplitude.
- Orthostatic test provides registration of the ECG in a prone position, and then after 10-15-minute standing. As positive results of test serve the same changes as well as at test with a hyperventilation, noted at NTsD at 52% of patients.
- Medicinal tests (with β-adrenoblokator, potassium) are directed to distinction of neurocirculator dystonia and organic diseases of heart. ECG registration is carried out 40-60 minutes later after reception of 60-80 mg of β-adrenoblokator (an obzidan, an inderal, an anaprilin) or 6 g of potassium of chloride. At organic cardiopathologies (myocarditis, IBS, a myocardium hypertrophy) the positive tooth of T is registered, at NTsD – the T tooth negative.
When carrying out a veloergometriya decrease in tolerance, typical for neurocirculator dystonia, to loading is defined, i.e. the patient with neurocirculator dystonia is capable to execute smaller loading, than a healthy face of the same age and a floor. Laboratory data indicate increase in activity of simpatiko-adrenalovy system: in response to loading in blood inadequate increase in level of noradrenaline, adrenaline, metabolites, lactic acid is observed.
Treatment of neurocirculator dystonia
In treatment of neurocirculator dystonia the extremely important place is taken by the non-drug actions designed to raise adaptive opportunities of an organism to the changing conditions. At NTsD holding the tempering procedures, sports occupations (track and field athletics, swimming), a rational psikhiterapiya, normalization of a work-rest schedule is shown.
Positive impact on a training of system of regulation of vegetative functions is exerted by a balneoterapiya, physical therapy (medical souls and bathtubs, an electrodream, reflexotherapy, an electrophoresis with bromine, magnesium, novocaine), to LFK, sanatorium treatment. At sleep disorders, irritability purpose of sedative medicines is possible: motherwort, valerian, tranquilizers (oxazepam, etc.).
For treatment of neurocirculator dystonia on kardialny and gipertenzivny type reception of the β-adrenoblokator (an atenolol, propranolol, an oksprenolol) liquidating tachycardia, hypertensia, a kardialgiya and also the medicines improving metabolism of a cardiac muscle is shown (inosine, medicines of potassium, group B vitamins). At neurocirculator dystonia on hypotensive type with existence of an adynamy and orthostatic frustration appoint ginseng tincture (a magnolia vine, an araliya), caffeine.
The forecast at neurocirculator dystonia
The current of any types of neurocirculator dystonia does not cause development of a kardiomegaliya, heart failure or life-threatening violations of a rhythm and conductivity. At teenage age at timely therapy or self-healing there comes the absolute recovery. With age the forecast for full treatment of neurocirculator dystonia decreases. Decrease or temporary disability can be observed during the periods of aggravations.
Patients with gipertenzivny type of neurocirculator dystonia enter into risk group on a hypertension; at any NTsD type in connection with violations of lipidic exchange the probability of development of atherosclerosis and IBS is not excluded.
Prevention of neurocirculator dystonia
Questions of prevention of neurocirculator dystonia are beyond especially medical actions. Prevention includes the correct physical, mental and hygienic training of teenagers, increase in their self-assessment and social adaptation. The role of promotion of a healthy lifestyle, sports activities, exceptions of smoking and alcohol intake is big.
Medical prevention of neurocirculator dystonia includes fight against focal infections, stressful factors, regulation of a hormonal background at women in the climacteric period.