Tone of the sympathetic and parasympathetic system. Diagnosis and symptoms of diseases of the autonomic nervous system

The autonomic or autonomic nervous system is usually contrasted with the anomalous or cerebrospinal nervous system. The latter innervates mainly the sensory organs and organs of movement, i.e., all striated muscles; its innervation is strictly segmental, and the nerve fibers come from the nerve centers ( nerve cell) to the working body without interruptions. The autonomic nervous system innervates primarily smooth muscles, glands and internal organs of the body (circulatory, respiratory, gastrointestinal tract, liver, kidneys, etc.), the innervation is non-segmental and with mandatory breaks. Thus, the main function of the cerebrospinal nervous system is to regulate the relationship between the body and the environment, while the main function of the autonomic nervous system is to regulate the relationships and processes within the body. But it goes without saying that both the cerebrospinal and autonomic nervous systems are only parts of a single whole - the unified nervous system of the body. They are related to each other both morphologically and functionally. Therefore, all organs of our body have double - autonomic and cerebrospinal innervation. In this way, with the indispensable participation of internal secretion, which in turn is closely connected with the autonomic nervous system, the unity and integrity of the entire organism is achieved.

The autonomic nervous system, like the cerebrospinal system, is divided into central and peripheral. The central autonomic nervous system consists of clusters of ganglion cells and fibers - autonomic centers and nuclei, located in various parts of the central cerebrospinal system - in the brain, mainly in the striatum (corpus striatum), in the interstitial, medulla oblongata and spinal cord.

Higher vegetative centers that regulate all major general functions vegetative life of the body, such as: body temperature, metabolism, respiration, blood circulation, etc., are located in the floors of the brain located under each other - in the subcortical nodes, interstitial and medulla oblongata.

The peripheral autonomic nervous system is divided into two divisions: the sympathetic division and the parasympathetic nervous system.

The sympathetic nervous system originates partly in the medulla oblongata, but mainly in the spinal cord - from CVIII to LIII-IV (thoracolumbar subdivision of the autonomic nervous system), and its fibers, after a break in the prevertebral ganglia (border column), extend to all areas of the body, so that sympathetic innervation has, one might say, a universal significance.

The parasympathetic nervous system originates in the midbrain and medulla oblongata - the cranial subdivision (nn. oculomotorius, vagus and glossopharyngeus) and in the sacral part spinal cord- sacral subdivision (n. pelvicus) - The break of parasympathetic fibers occurs either in the plexuses on the surface of the organs, or in the ganglia inside the organs.

Adrenaline has the same effect as stimulation of the sympathetic nervous system, and choline and its derivatives (acetylcholine) cause an effect similar to that of the parasympathetic nervous system. Thus, we can talk about the adrenalinotropy of the sympathetic and cholinotropy of the parasympathetic nervous system. The action of these two parts of the autonomic nervous system is in many cases opposite, which is why they used to talk about their antagonism.

However, this antagonism is not a law. There is no complete antagonism either between the sympathetic and parasympathetic divisions of the autonomic nervous system (the sympathetic nervous system contains cholinergic fibers, and the parasympathetic - adrenalinotropic), nor between the autonomic nervous system as a whole and the animal nervous system. It is much more correct to talk not about antagonism, but about their synergism. The autonomic, actually sympathetic nervous system, having a universal distribution and innervating all organs and tissues of the body, including the sense organs and the central nervous system, is a regulator of their work, changes the conditions of this work, nutritional conditions, etc., and thus plays an adaptive role ) and trophic role.

Broadcast nervous influence or irritation to organs and tissues, as well as from one fiber to another (from preganglionic to postganglionic) occurs through special chemicals, chemical intermediaries or mediators (for the sympathetic nervous system - sympathin, for the parasympathetic, choline or acetylcholine). This fact seems to build a bridge between the nervous and endocrine systems and connects them into one whole. The relationship between the autonomic nervous system and the adrenal glands, the medulla of which develops from the rudiments of the sympathetic ganglia, is especially close. In view of such a close functional connection between the endocrine and autonomic nervous systems, they are often, and not without reason, combined into a single endocrine-autonomic system.

Disturbances of autonomic innervation occur depending on various kinds of endo- or exogenous moments in the direction of increasing or decreasing tone autonomic nervous system, the entire tzaddik or its individual parts. Accordingly, pictures of hyper- or hypoamphotonia, hyper- or hyposympathicotonia, galer- or hypovagotonia develop. The variety of clinical manifestations of disorders of autonomic innervation and the difficulty of their correct assessment are further aggravated by the fact that the same nervous excitation, just as is observed during the action of hormones, causes a different effect depending on the state of reactivity of the working organ and on the physicochemical conditions of its environment .

Symptoms of diseases of the autonomic nervous system
Signs of impaired autonomic innervation are dysfunction of working organs. Naturally, they are very numerous and very diverse in their degree of expression.

The following symptoms from various organs, if there are no special reasons for their occurrence, indicate more or less impaired autonomic innervation in its corresponding parts. Constriction of the pupils and lacrimation, increased salivation and sweating (liquid saliva and sweat), coldness and blueness of the hands and feet (vascular paresis), spasm of the esophagus, dyspepsia (belching, heartburn, nausea, vomiting), stomach cramps (pain), hypersecretion, constipation or diarrhea, spasms of the gallbladder, bradycardia, extrasystole, arterial hypotension, decreased tone of the heart muscle, inability to take a deep breath and fully exhale, attacks such as bronchial asthma, dysuric phenomena, increased tolerance to carbohydrates, eosinophilia - all these are symptoms increased excitability or increased tone of the parasympathetic nervous system, symptoms of vagotonia. Dilation of the pupils and shine of the eyes, decreased tearing and sweating, tachycardia and often hypertension, easy passage of the esophagus, atony of the stomach, the sound of splashing in it, reduced acidity of gastric contents, atony of the large intestine, flatulence, reduced tolerance for carbohydrates - these are the main symptoms of increased tone sympathetic nervous system, symptoms of sympathicotonia.

In clinical patients, these two sets of symptoms are very rarely observed in isolation; usually we see a motley picture of symptoms due to the simultaneous increase or decrease in the excitability of both parts of the autonomic nervous system.

Diagnostics
The pathology of the autonomic nervous system forms an area bordering between internal medicine and neuropathology, and the methodology for studying the autonomic nervous system is described primarily in the course of neuropathology. Therefore, here we will limit ourselves to only pointing out the most commonly used research methods. Of these in in this case Questioning, inspection and palpation are used.

When questioning a patient, in addition to identifying complaints and their nature, special attention should be paid to clarifying the functional state of organs and systems - the so-called additional questioning (according to the questioning scheme outlined above in the General Part).

Examination of the patient can easily establish the presence of autonomic nervous symptoms from the eyes, skin, motor sphere, etc.: the condition of the pupils, the shine of the eyes, protrusion of the eyeballs, dryness or moisture of the skin, changes in its pigmentation, color (acrocyanosis), trembling and etc.

Palpation method the study is used to determine the pulse rate, temperature and humidity of the skin, and also, along with the examination, to establish a number of autonomic nervous reflexes that arise spontaneously and are used for diagnostic purposes, some of which are already described above. Of these, the following can be noted here: 1) viscero-sensory reflex (pain in a certain Hedov area when damaged internal organs); 2) viscero-motor reflex (tension of certain muscles - “muscle protection” under the same conditions); 3) pupillary reflex (dilation of the pupils in response to severe pain or constriction in response to light stimulation); 4) vasomotor reflex (redness or paleness of the skin during various kinds of affects); 5) sweat reflex (profuse, liquid sweat of parasympathetic origin, scanty, thick and cold sweat of sympathetic origin).

Functional research methods. To assess the functional state of the autonomic nervous system, either autonomic nervous, mainly cardiac and skin reflexes artificially evoked according to the principle of dosed load, or studies of the reaction of the autonomic nervous system to certain pharmacological substances are used.

The most common cardiac reflexes are the following:

1) Hering's respiratory-cardiac reflex (Hering), or the so-called respiratory arrhythmia: slowing of the pulse when deep breath and its increase in frequency when exhaling;

2) ocular-heart reflex Dagnini-Aschner (Dagnini-Aschner): slowing of the pulse with pressure on the eyeballs;

3) cervical-cardiac reflex of Czermak: slowing of the pulse when compressed vagus nerve on the neck.

All these reflexes are associated with the tone of the vagus nerve, and a significant slowdown in the pulse under these conditions (for the Aschner and Chermak reflexes by more than 8-10 beats per minute) indicates an increase in the tone of the parasympathetic nervous system.

Of the artificially induced skin reflexes, the most important are:

1) vasomotor skin reflex or dermographismus - a vasomotor response of the skin to mechanical irritation; white, red and edematous dermographism are distinguished: white (vasospasm), red (vasodilation) or raised ridge-like (edema) stripes;

2) pilomotor or hair-muscular reflex - the appearance of so-called goose bumps in response to various irritations, with the main irritant being cold, then mechanical irritation, emotional experiences, etc.; to induce this reflex, they resort to quickly exposing the skin (raising the shirt), applying a damp cold towel or a bubble of cold water to the skin, spraying with ether, etc. A pronounced pilomotor reflex indicates increased excitability of the sympathetic nervous system.

All of the just mentioned methods of studying the autonomic nervous system are characterized by the uncertainty of the results obtained, which is explained by the large variability of the tone of the autonomic nervous system, even in physiological conditions, therefore, these research methods are significant only in a number of other research data.

For pharmacological studies requiring a strictly clinical setting, subcutaneous (or intravenous) injections of atropine, pilocarpine and adrenaline are used. Atropine in an amount of 0.001 under the skin, paralyzing the endings of the vagus nerve, causes dryness of the mucous membranes and skin, redness of the latter, dilation of the pupils, and increased heart rate. Pilocarpine (0.01 subcutaneously), stimulating the endings of the vagus nerve, causes salivation, nausea, vomiting, sweating, and falling blood pressure. Adrenaline (0.001 subcutaneously), stimulating the sympathetic nervous system, causes vasoconstriction (pallor, trembling), increased heart rate, and increased blood pressure.

This is the scheme of the influence of these pharmacological substances on the autonomic nervous system. Depending on the result of the test used, i.e., the greater or lesser severity of the described phenomena, the tone of the corresponding part of the autonomic nervous system is judged. Thus, a weak effect of atropine will indicate an increased tone of the parasympathetic nervous system, a sharp effect will indicate a decreased tone. On the contrary, a sharp effect from the injection of pilocarpine will indicate increased tone, and a weak effect will indicate a decreased tone of the parasympathetic system. Finally, a weak reaction to adrenaline indicates a decreased, and a strong one indicates an increased tone of the sympathetic system.

Main syndromes of autonomic nervous disorders

I. Syndrome of increased excitability of the sympathetic nervous system - sympathicotonia. This syndrome is characterized by the following symptoms:

1) dilated pupils, bright eyes, wide open palpebral fissures;

2) dry skin, pallor, easy appearance"goose bumps";

3) tachycardia, increased blood pressure;

4) rapid, free breathing;

5) dry mouth, decreased secretory and motor ability of the stomach, as well as the intestines (atonic constipation);

6) a tendency to lose weight due to increased metabolism, as well as hyperglycemia and glycosuria.

More or less pronounced sympathicotonia often accompanies a febrile state, manic state, Graves' disease, etc.

II. Syndrome of increased excitability of the parasympathetic nervous system - parasympathicotonia or vagotonia. This syndrome includes the following symptoms:

1) constriction of the pupils, narrowing of the palpebral fissure;

2) cold, damp and cyanotic skin, increased sweating;

3) a tendency to bradycardia, respiratory arrhythmia, a tendency to extrasystole, low blood pressure;

4) slow and constricted breathing, a tendency to night attacks of shortness of breath (suffocation) with difficulty exhaling;

5) salivation, tendency to vomit, increased secretory (hypersecretion) and motor (cardio- and pylorospasm) functions of the stomach and intestines (spastic constipation);

6) tendency to obesity due to slow metabolism; increased absorption of sugar.

Manifestations of vagotonic syndrome are common in depression, shock, and bronchial asthma.

III. The syndrome of increased excitability of both parts of the autonomic nervous system - hyperamphotonia - is characterized by a sharp instability of the autonomic nervous tone and an excessive reaction to irritation from various organs and systems, and the symptoms of sympathetic and vagotonia are very variable, pronounced and often replace each other.

IV. The syndrome of reduced excitability of both parts of the autonomic nervous system - hypoamphotonia - is characterized by weakness and lethargy of all kinds of reactions to irritations. In severe cases of this syndrome, the following picture is observed: increased heart rate and breathing, cold sweat, decreased body temperature, hiccups, nausea, vomiting, drop in blood pressure, i.e., a picture of shock.

In physiology, there is such a thing as cardiac automaticity. This means that the heart contracts under the influence of impulses arising directly within itself, primarily in the sinus node. These are special neuromuscular fibers located in the area where the vena cava flows into right atrium. The sinus node produces a bioelectrical impulse, which spreads further through the atria and reaches the atrioventricular node. This is how the heart muscle contracts. Neurohumoral factors also influence the excitability and conductivity of the myocardium.

Bradycardia can develop in two cases. First of all, a decrease in the activity of the sinus node leads to a decrease in heart rate when it generates few electrical impulses. This bradycardia is called sinus. And there is a situation when the sinus node is working normally, but the electrical impulse cannot fully pass through the conduction paths and the heartbeat slows down.

Causes of physiological bradycardia

Bradycardia is not always a sign of pathology, it can be physiological. Thus, athletes often have a low heart rate. This is the result of constant stress on the heart during long-term training. How to understand whether bradycardia is normal or pathological? A person needs to do active physical exercise. In healthy people, physical activity leads to an intense increase in heart rate. If the excitability and conductivity of the heart is impaired, perform physical exercise accompanied by only a slight increase in heart rate.

In addition, the heartbeat also slows down when the body is hypothermic. This is a compensatory mechanism due to which blood circulation slows down and blood is directed from the skin to the internal organs.

The activity of the sinus node is influenced by the nervous system. The parasympathetic nervous system reduces the heart rate, the sympathetic nervous system increases it. Thus, stimulation of the parasympathetic nervous system leads to a decrease in heart rate. This is a well-known medical phenomenon, which, by the way, many people encounter in life. So, when pressing on the eyes, the vagus nerve (the main nerve of the parasympathetic nervous system) is stimulated. As a result, the heartbeat is briefly reduced by eight to ten beats per minute. The same effect can be achieved by pressing on the carotid sinus area in the neck. Stimulation of the carotid sinus can occur when wearing a tight collar or tie.

Causes of pathological bradycardia

Bradycardia can develop under the influence of a wide variety of factors. The most common causes of pathological bradycardia are:

1. Increased tone of the parasympathetic system;
2. Heart diseases;
3. Hypothyroidism;
4. Taking certain medicines(cardiac glycosides, as well as beta-blockers, calcium channel blockers);
5. Poisoning (FOS, lead, nicotine).

Increased tone of the parasympathetic system

Parasympathetic innervation of the myocardium is carried out by the vagus nerve. When activated, the heartbeat slows down. There are pathological conditions in which irritation of the vagus nerve (its fibers located in the internal organs or nerve nuclei in the brain) is observed.

An increase in the tone of the parasympathetic nervous system is observed in the following diseases:

• Promotion intracranial pressure(against the background of traumatic brain injury, hemorrhagic stroke, cerebral edema);
• Peptic ulcer;
• Neoplasms in the mediastinum;
• Cardiopsychoneurosis;
• Condition after surgery in the head, neck, and mediastinum.

As soon as in this case the factor stimulating the parasympathetic nervous system is eliminated, the heartbeat returns to normal. Doctors define this type of bradycardia as neurogenic.

Heart diseases

Heart diseases (cardiosclerosis, myocardial infarction, myocarditis) lead to the development of certain changes in the myocardium. In this case, the impulse from the sinus node passes much more slowly in the pathologically altered area of ​​the conduction system, which is why the heartbeat slows down.

When a disturbance in the conduction of electrical impulses is localized in the atrioventricular node, they speak of the development of atrioventricular block (AV block).

Symptoms of bradycardia

A moderate decrease in heart rate does not affect the person’s condition in any way; he feels well and exercises. business as usual. But with a further decrease in heart rate, blood circulation is disrupted. The organs are insufficiently supplied with blood and suffer from a lack of oxygen. The brain is especially sensitive to hypoxia. Therefore, with bradycardia, it is the symptoms of damage to the nervous system that come to the fore.

During attacks of bradycardia, a person experiences dizziness and weakness. Pre-syncope and fainting are also common. The skin is pale. Shortness of breath often develops, usually due to physical exertion.

When the heart rate is less than 40 beats per minute, blood circulation is significantly impaired. With slow blood flow, the myocardium does not receive adequate oxygen. As a result, chest pain occurs. This is a kind of signal from the heart that it does not have enough oxygen.

Diagnostics

In order to identify the cause of bradycardia, it is necessary to undergo an examination. First of all, you should undergo an electrocardiogram. This method is based on the study of the passage of a bioelectric impulse in the heart. Thus, with sinus bradycardia (when the sinus node rarely generates an impulse), there is a decrease in heart rate while maintaining normal sinus rhythm.

The appearance of such signs on the electrocardiogram as increased duration P-Q interval, as well as deformation of the ventricular QRS complex, its loss from the rhythm, larger number atrial contractions than the number of QRS complexes will indicate the presence of AV block in a person.

If bradycardia is observed inconsistently, but in the form of attacks, daily ECG monitoring is indicated. This will provide data on the functioning of the heart for twenty-four hours.

To clarify the diagnosis and identify the cause of bradycardia, the doctor may prescribe the patient to undergo the following tests:

Treatment of bradycardia

Physiological bradycardia does not require any treatment, as does bradycardia that does not affect general well-being. Treatment for pathological bradycardia is started after the cause is determined. The principle of treatment is to influence the root cause, against the background of which the heart rate is normalized.

Drug therapy consists of prescribing medications that increase heart rate. These are medications such as:

The use of these drugs has its own characteristics, and therefore only a doctor can prescribe them.

If hemodynamic disturbances occur (weakness, fatigue, dizziness), the doctor may prescribe tonic medications to the patient: tincture of ginseng, eleutherococcus, caffeine. These drugs speed up your heart rate and increase your blood pressure.

When a person experiences severe bradycardia and heart failure develops against this background, they resort to implanting a pacemaker in the heart. This device independently generates electrical impulses. Stable set heartbeat favors the restoration of adequate hemodynamics.

Grigorova Valeria, medical observer

The information is provided for informational purposes only. Do not self-medicate. At the first sign of disease, consult a doctor. There are contraindications, a doctor's consultation is required. The site may contain content prohibited for viewing by persons under 18 years of age.

FUNCTIONAL STUDY OF THE AUTONOMIC NERVOUS SYSTEM

“A living organism is more than the sum of its parts.” Life processes in individual organs are united by higher regulatory mechanisms into a wonderful whole, full of deep meaning, without which maintaining life would be impossible.

The autonomic nervous system is part of these regulatory mechanisms. In a complex interaction, it is closely related to the endocrine glands and many other regulatory apparatuses of vegetative functions (mineral, vitamin, acid-base balance, etc.), which ensures the integrity and consistency of all functions within the body itself.

In contrast, the central nervous system regulates the active and passive interactions of the body with the outside world, which, through positive and negative impulses arising in the brain, are decisive in the nervous regulation of autonomic functions. At the same time, the interstitial brain is the center of the unified regulation of the most important vegetative processes in the body: blood circulation, respiration, metabolism, blood system, water metabolism and heat regulation.

Bykov, continuing his work on the conditioned reflexes of his great teacher Pavlov, proved that all reflex processes of nervous activity in the body proceed through the mechanism of conditioned reflexes, i.e. through the cerebral cortex, which is capable of establishing time-limited connections with any part of the body and such ensure its adaptation to the constantly changing conditions of the internal and external environment.

With such diverse interconnections, relationships and continuously changing interactions, a number of difficulties are created in conducting functional tests of the autonomic nervous system. The main disadvantage of most of these tests is the lack of sufficient specificity. The action of a given stimulus in one part of the autonomic regulatory mechanism often leads to conjugate oscillations of the entire functional system. Therefore, almost all tests for the study of the autonomic nervous system suffer from certain shortcomings from the very beginning. Thus, the values ​​of blood pressure, blood sugar or pulse rate detected at rest in no way give the right to draw any conclusions about the state of compensatory processes, in relation to which the autonomic nervous system plays a leading role.

In addition, when conducting most functional tests, unilateral loads that are not encountered under normal conditions are used, which are also carried out in an environment (hospital) alien to the actual living conditions of the test subject. Moreover, most of the loads that are related to the profession or work are precisely absent in these samples.

Therefore, one usually has to be content with only a general statement of functional deviations of the autonomic nervous system from the norm. However, this is already valuable. Of great importance is also the ability, with the help of some of these tests, to distinguish organic disorders from purely functional ones.

In the basic regulatory mechanisms of the autonomic nervous system, there is a polarity of two types of influences, which are generally antagonistic: the sympathetic and parasympathetic (vagus nerve) nervous system. Basically, all organs are supplied to the same extent with fibers from both departments. The predominance of the influence of one of the departments is clinically manifested by a number of symptoms, observation of which makes it possible to come to important conclusions regarding the functional state of autonomic regulation.

In the table on page Determination of the type of reactivity using anamnesis, this antagonism of the functions of the sympathetic and parasympathetic nervous system is clearly compared according to the data given by Hoff. Functional antagonism between the sympathetic and parasympathetic nervous systems does not have universal significance, since it is not found in a number of organs and is often absent even in organs with double autonomic innervation.

From among the numerous methods at our disposal for studying the functions of the autonomic nervous system, only a few have been selected and presented below, which have proven themselves in practice and do not require special equipment or high costs.

Carrying out functional tests requires strict adherence to some general rules. In this case it is necessary:

a) Carefully establish initial values ​​by conducting repeated tests on different days, if possible on an empty stomach, with the patient in complete physical and mental rest, without changing the therapeutic regimen (for example, prescribing or stopping treatment affecting the autonomic nervous system).

b) Always carry out tests at the same hours of the day (changes in the nature of autonomic reactions depending on fluctuations in the daily rhythm of physiological functions) and under the same biological state of the body, especially in women.

c) To identify the nervous regulation of autonomic functions, it is not so much static indicators at a given moment (like a cross section), such as, for example, a single measurement of blood pressure or a single determination of blood sugar, that are suitable, but rather systematic observations of changes in a number of indicators in the form of daily, weekly and monthly curves (like a longitudinal section), giving a more complete picture. The most valuable insights can be obtained through stress testing. These loads can be either of a somatic nature (in the form of bending the knees, climbing stairs, exposure to cold and heat, etc., or in the form of using medications), or of a mental nature.

Sympathetic nervous system

Parasympathetic nervous system

Increasing minute volume, enhancing the function of automaticity, conductivity, contractility and excitability

Decrease in cardiac output, inhibition of automatic function, conductivity, contractility and excitability

Increased blood supply to working skeletal muscles.

Increased blood circulation in the coronary and pulmonary arteries, decreased blood supply to the skin and mucous membranes

Decreased blood supply to skeletal muscles

Reduced blood circulation in the coronary and pulmonary arteries, increased blood supply to the skin and mucous membranes

Increased excitability of the respiratory center

Increased tidal volume

Increasing blood supply and blood filling of the lungs

Decreased excitability of the respiratory center

Decreased tidal volume

Decreased blood supply and blood filling to the lungs

Energy consumption, decay processes

Increase metabolism

Increased body temperature

Increased protein breakdown

Tendency towards acidosis

Decrease in K/Ca ratio

Conservation of energy, rest, synthesis processes

Decreased metabolism

Decreased body temperature

Minor protein breakdown

Tendency towards alkalosis

Increasing the K/Ca ratio

Release of blood from the depot

Increase in the number of red blood cells

Sympathetic nervous system

Tendency towards a shift towards myeloid elements in the white blood pattern

Decreased eosinophil count

Accumulation of blood in the depot

Decreased red blood cell count

Parasympathetic nervous system

Tendency towards lymphatic cells in the white blood pattern

Increased number of eosinophils

Closing the entrance (cardia)

Stomach: weakening of tone and inhibition of peristalsis

Inhibition of secretion of the glands of the fundus of the stomach

Small and large intestines: decreased tone and inhibition of peristalsis

Opening the entrance (cardia)

Stomach: increased tone and increased peristalsis

Increased secretion of the glands of the fundus of the stomach

Small and large intestines: increased tone and increased peristalsis

Inhibition of insulin production and external secretion

Increased insulin secretion and external secretion

Widening of the palpebral fissure to bulging eyes (exophthalmos)

Narrowing of the palpebral fissure (enophthalmos)

Inhibition of urination, relaxation of the muscle that empties the bladder (m. detrusor)

Increased sphincter tone

Increased urination, increased tone of the muscle that empties the bladder (m. detrusor)

Vasodilation and erection

d) When performing stress tests, you need to pay attention to exact dosage, as well as on the rate of administration of a particular substance, and when repeating or conducting several tests - on a sufficient period of time between them. The reaction to the load must completely subside before starting a new test.

e) For evaluation general condition It is always necessary to conduct several additional studies suitable for clarifying the question posed to the researcher. In essence, almost all functional studies of individual organs, provided that they do not indicate damage to these organs, can also be used as functional tests of the autonomic nervous system.

f) When discussing the results, Wilder's law on initial quantities should be observed. According to this law, a person, even with strict adherence to experimental conditions, does not have a constant, characteristic reaction for a given person to substances acting on the sympathetic and parasympathetic parts of the nervous system. The more active a given organ is, the less its excitability in relation to activating influences and the greater its sensitivity in relation to inhibitory influences. When the initial value of irritation reaches its maximum strength, excitability simultaneously becomes equal to zero, and vice versa.

When functional mobility immediately before excitation exceeds a certain limit, a paradoxical reaction occurs, possibly as a consequence of an antagonistic effect. This corresponds to those patterns that are designated as “restructuring”, “change in functional state”, “antagonistic regulation” and which are, as it were, a protective reaction of the body.

When discussing and assessing the results of tests on the function of the autonomic nervous system, it is recommended to proceed from the division of the initial reactive state according to Birkmeier-Winkler, according to which we distinguish:

a) Increased tone of the sympathetic nervous system, which is a fixation of increased excitation in the sympathetic nervous system (sympathicotonia - sympathicotonic reactive phase of switching of the autonomic nervous system).

Signs: test indicators are very labile, lying above the normal limits of fluctuations, hyper-regulatory (irritable) type under load.

b) A decrease in the tone of the sympathetic nervous system, which often occurs secondary to long-existing sympathicotonia and occurs when the sympathetic nervous system fails and is exhausted (Selie's state of exhaustion).

Signs: the readings of many samples are determined below the normal limits of fluctuation; absence positive reactions after exercise; refractory (rigid) type or even paradoxical reactions; various vegetative functions often do not occur in parallel, but are dissociated.

c) Increased tone of the parasympathetic nervous system, which is expressed in the predominance of vagal innervation. Indicators of tests at rest are determined significantly below the norm, reactions to loads are similar to the type of reactions indicated in section “b”.

Despite this, after exercise there is not lability, but, on the contrary, stability of the ratios (for example, basal metabolism).

d) Amphotonia, which is characterized by the same degree of overstrain of both the sympathetic nervous system and the vagus nerve. However, it is often impossible to clearly distinguish between these states, so in these cases we can only talk about general functional impairment autonomic nervous system in the sense of autonomic dystonia as a reactive state.

Physical and mental signs

Increased tone of the sympathetic nervous system

Increased tone of the parasympathetic nervous system

Decreased tone of the sympathetic nervous system

Not long sleep or insomnia, late falling asleep, restless sleep, disturbing dreams

Deep, long, dreamless sleep; slow transition to wakefulness in the morning

Sleep is possible at any time of the day or night due to exhaustion of nervous activity

General health and ability to work

Variable ratios: relatively good performance, especially in the evening, high but short-term performance

Maximum performance before lunch, rapid decrease in energy. Long-term performance

Performance only for a short period: very rapid fatigue during physical and mental stress

For autonomic disorders caused by physical factors, the greatest performance is in the morning, and in case of vegetative disorders caused by mental issues, in the evening

Intolerance to excessively hot and crowded rooms, extreme cold; tendency to sweating or chilliness, as well as febrile infection

Feeling of heat, increased sensitivity to dry heated air

Chilling, great sensitivity to cold, often low temperature. Patients feel well only in warm rooms

Reduced excitability, but extremely increased sensitivity; need for peace and protection; ideas of depersonalization

Often complaints from the heart (palpitations, feeling of pressure, stabbing, squeezing).

Headaches in the evenings, flickering in the eyes, fog before the eyes, migraines

Feeling of a lump (globus) in the throat, dry mouth, hoarseness, especially when excited

Polyuria, decreased potency or libido, dysmenorrhea or amenorrhea

Cold hands and feet, numbness in the fingers at night, numbness and loss of strength in the hands and feet in the morning

In the foreground, depending on mental stress, complaints from the gastrointestinal tract (burning throat, nausea, cramping pain in the upper abdomen, diarrhea or constipation)

A feeling of tightness in the heart area combined with arrhythmias, especially at night and when lying down

Transient catarrh of the respiratory tract

Absence of potency disorders, sometimes early ejaculation (ejaculatio praecox)

Balance disturbances with darkening of the eyes, rapid visual fatigue. When under strain, rapid fatigue, palpitations and shortness of breath. Feeling of pressure after eating, constipation. Significant potency disorders with weakened libido in both sexes

Picture of functional state and compensatory capabilities of the autonomic nervous system is of practical importance for the doctor. By objectively identifying dysfunctions of the autonomic nervous system, it is possible to make a more correct judgment about patients with complaints who do not have significant changes in the organs, and based on the data of determining the nature of the reactive state, justify the choice of a drug and its dosage.

Effects of the sympathetic and parasympathetic nervous system

45. The main symptoms characteristic of the prevalence of the influences of the sympathetic and parasympathetic departments. “Vagotonia”, “sympathotonia”, “normotonia”.

Vagotonia (obsolete; vagotonia; vago- + Greek tonos tension; synonym parasympathicotonia) - the predominance of the tone of the parasympathetic part of the autonomic nervous system over the tone of its sympathetic part. Manifested by bradycardia, decreased blood pressure, hypoglycemia(, a pathological condition characterized by a decrease in blood glucose concentration below 3.5 mmol/l, peripheral blood below normal, resulting in hypoglycemic syndrome .), hyperhidrosis (increased sweating).

The most common causes of vagotonia development are

• neuroses,
• not rough organic lesions brain,
• stem and hypothalamic disorders.

• cold and damp skin,
• sweating,
• hypersalivation, Hypersalivation (another name is ptyalism) – increased secretion salivary secretion due to increased activity of the salivary glands.
• bradycardia,(Bradycardia- this is a violation of the heart rhythm (arrhythmia) in the direction of reducing the contraction frequency. Normally, the frequency of contractions in adults ranges from (at rest) to 140 (during physical activity) times per minute. A pulse below 60 times per minute is considered rare and such a heart rhythm disorder is called bradycardia.)
• tendency towards orthostatic hypotension is long-term condition, characterized by low blood pressure - less than 100/60 mmHg. due to decreased vascular tone. Previously, the term vegetative-vascular dystonia (VSD) was used for the hypotonic type.
• respiratory arrhythmia,
• tendency to faint.

Patients are slow, phlegmatic, indecisive, prone to depression, and have little endurance.

Vagotonia manifests itself as dysfunction respiratory system, periodic sensations of lack of air and poor tolerance low temperatures. Digestive system disorders may occur - diarrhea or constipation, abdominal pain, various allergic reactions, swelling under the eyes. All these symptoms can appear either periodically or constantly. There are frequent night pains – in the legs and abdomen.

Vagotonia is often accompanied by various cardiovascular disorders. First of all, these are pain in the heart area, low blood pressure or sudden periodic drops in pressure. In this case, the heart has a reduced tone, the number of beats per minute can decrease from 65-70, which is normal for a child, but the physical size of the heart muscle can be increased. In addition, bradyarrhythmia - irregularities in the heart rhythm - can be periodically recorded.

Drug therapy is prescribed in combination with non-drug drugs or if the latter are ineffective.

Treatment should begin with herbal preparations that have the least side effect. Considering the duration of treatment, several medications should not be prescribed at the same time; it is advisable to replace one drug with another.

Sympathotonia (overpriced sympathetic tone) People with sympathicotonia are characterized by temperament, ardor, volatility of mood, excessive affectivity towards pain, and neurotic states. Objectively, more frequent beating and breathing, increased blood pressure, and pallor are determined skin, chill-like hyperkinesis (involuntary movements in various groups muscle).

46.Basic functional tests aimed at diagnosing the prevalence of the influences of the sympathetic and parasympathetic departments

(sympathicotonia; Sympathico- + Greek tonos tension)

the predominance of the tone of the sympathetic part of the autonomic nervous system over the tone of its parasympathetic part.Sympathicotonia – the relative predominance of the tone of the sympathetic part of the autonomic nervous system over the parasympathetic, for example, in melancholic depression, manifested by symptoms such as mydriasis, tachycardia, a tendency to arterial hypertension, dry mucous membranes, pallor of the skin, a tendency to constipation, decreased secretion of tears, etc. ). In psychopathology, symptoms of sympathicotonia are most often accompanied or manifested by melancholy, melancholic and, possibly, hidden depression.

49. The main differences in the mechanism of information processing by the right and left hemispheres of the human brain

The brain consists of two hemispheres, left and right. The cortex of one hemisphere is not connected to the cortex of the other. Information is exchanged between the hemispheres through corpus callosum. If we draw an analogy with a computer, the left hemisphere of the brain functions as a serial processor. Information is processed by the left hemisphere in stages. The right hemisphere works as a parallel processor; it can process a lot of different information simultaneously. Left hemisphere responsible for logic and analysis. It is this that analyzes all the facts and systematizes them. The right hemisphere thinks in images, intuition, fantasies and dreams are in its power.

According to all the laws of general symmetry of the human body, the left and right hemispheres are almost exact mirror images of the other. Both hemispheres are responsible for controlling and controlling the basic movements of the human body and its sensory functions, with the right hemisphere controlling the right side of the human body, and the left hemisphere controlling the left.

There are several types functional organization two hemispheres of the brain:

dominance of the left hemisphere - the verbal and logical nature of cognitive processes, a tendency to abstraction and generalization (left-hemisphere people);

dominance of the right hemisphere - specifically creative thinking, developed imagination (right-hemisphere people);

lack of pronounced dominance of one of the hemispheres (equihemispheric people).

Slightly less than half of people belong to unilaterally represented right-hemisphere and left-hemisphere response types.

50. Manifestations of functional asymmetry of the brain.

Functional asymmetry of the cerebral hemispheres, understood as the participation of the left or right hemispheres of different nature and unequal importance in the implementation of mental function, is not global, but partial in nature. IN various systems the nature of functional asymmetry may be different. As is known, motor, sensory and “mental” asymmetries are distinguished, and each of these asymmetries is divided into many partial types. Within motor asymmetries, manual (manual), foot, oral, oculomotor, etc. can be distinguished. Manual asymmetries are considered to be the leading among motor asymmetries, but other types of motor asymmetries and their connection with manual asymmetries have not yet been sufficiently studied. Sensory forms of asymmetry include visual, auditory, tactile, olfactory, etc. “Mental” forms include asymmetry in the brain organization of speech and other higher mental functions (perceptive, mnestic, intellectual).

Analyzing the relationship of only three types of asymmetries (hand - eye - ear), A.P. Chuprikov and his colleagues identified 8 variants of functional brain asymmetries in the normal population. When taking into account other types of motor and sensory asymmetries, their number should be many times greater.

Thus, there are many variants of normal functional asymmetry of the cerebral hemispheres when assessing even only elementary motor and sensory processes. An even greater variety of asymmetry options will be revealed if the characteristics of all higher mental functions are taken into account. The idea of ​​right-handers (with the dominant right hand) as a homogeneous group of the population is incorrect. Even more complex and homogeneous are the groups of left-handers (with the leading left hand) and ambidextrous people (with the leading both hands).

The real picture of asymmetries and their combinations in normal conditions is very complex. Of course, only “asymmetry profiles” (i.e., certain combinations, patterns of asymmetries of different functions) are very diverse. Their study is one of the most important tasks of modern natural science, including neuropsychology.

Each specific form of functional asymmetry is characterized by a certain degree, measure. Taking into account quantitative indicators, we can talk about strong or weak (motor or sensory) asymmetry. To accurately characterize the severity of a particular asymmetry, some authors use indicators such as the asymmetry coefficient. Therefore, partial characteristics of asymmetry must be supplemented with quantitative data.

Functional asymmetry of the cerebral hemispheres in an adult is a product of the action of biosocial mechanisms. As studies conducted on children have shown, the foundations of the functional specialization of the hemispheres are innate, however, as the child develops, the mechanisms of interhemispheric asymmetry and interhemispheric interaction improve and become more complex. This fact is also noted in the indicators bioelectrical activity brain, and according to experimental psychological indicators, in particular, using the dichotic listening technique. The asymmetry of bioelectrical indicators manifests itself in the motor and sensory areas of the cortex earlier than others, and later in the associative (prefrontal and posterior-parietal-temporal) areas of the cerebral cortex. There is evidence of a decrease in EEG indicators of asymmetry in old age. Thus, there is an ontogenetic and generally age factor, which determines the nature of functional asymmetry.Functional asymmetry of the brain – this is a complex property of the brain, reflecting the difference in the distribution of neuropsychic functions between its right and left hemispheres.

The study of interhemispheric differences has great importance to solve problems in education. According to Joseph Bogen, the current emphasis in the educational system on the acquisition of verbal skills and the development of analytical thinking causes neglect of the development of important non-verbal abilities. And under such conditions, one half of the brain is “starving” and its potential contribution to the development of the individual as a whole is ignored.

According to Springer and Deitch, the study of laterality should be in those directions that relate to dexterity and spatial orientation, it should be an indispensable factor in assessing the school maturity of a child upon entering school. It is important in all cases: educational difficulties, behavioral disorders. It is necessary to carefully study the state of the child’s health, organ functions, motor skills - here the problem of laterality arises - the manifestation of the action and interaction of the cerebral hemispheres.

Research on brain asymmetry has sparked interest in the general problem of right-handedness and left-handedness and has shown differences between left- and right-handed people in terms of brain organization, which allows us to ask a number of questions: what are the significance of these differences, if any, for intelligence and creativity?

What factors primarily determine left-handedness (genes, life experience, minor brain damage)?

The problem of functional asymmetry of the cerebral hemispheres is very complex because differences in the functioning of the left and right hemispheres are masked by redundancy brain activity providing duplication and increasing its reliability.

Vegetative-vascular dystonia (VSD) is a very common disease, which can masquerade as many others, or may have minor clinical manifestations. According to statistics, about 80% of people have one or another VSD symptoms. One third of these people require medical care.

What is the autonomic nervous system?

The autonomic nervous system (ANS) consists of two subsystems - sympathetic and parasympathetic, the joint and coordinated activity of which allows, on the one hand, to maintain the internal constancy of the body (homeostasis), and on the other hand, to adapt to changing environmental conditions. The ANS directs autonomous (consciously uncontrolled) regulatory mechanisms, such as:

• vascular tone (blood pressure);
• heart rate;
• secretion of exocrine and internal secretion glands (sweating, salivation, secretion gastric juice, adrenaline and so on);
• regulation motor activity smooth muscles (intestinal motility, gallbladder, etc.).

Due to various stress factors, chronic lack of sleep, neuroticism and other things, the sympathetic and parasympathetic systems can lose control and begin to work on their own. As a result, a polymorphic clinical picture of vegetative-vascular dystonia appears.

The action of the sympathetic nervous system is realized through the sympatho-adrenal system, the central link of which is catecholamines (adrenaline and norepinephrine). A sharp increase in their concentration (release from the adrenal medulla) leads to sympatho-adrenal crisis (“panic attack”) : tachycardia, rise in blood pressure, fear with subsequent exhaustion of the nervous system.

The parasympathetic nervous system is realized through parasympathetic nerve fibers, the main representative of which is nervus vagus(nervus vagus). The chemical substance that is released at the endings of this nerve is acetylcholine, which causes a decrease in blood pressure and heart rate, increases intestinal motility, constricts the pupils, increases sweating and salivation, and increases the activity of the exocrine and internal secretion glands. Excessive activation of the parasympathetic nervous system leads to vagoinsular crisis , which manifests itself as fainting, " bear disease", abdominal pain, the concentration of insulin in the blood increases, which leads to hypoglycemia (decreased concentration of sugar in the blood), which causes excessive sweating.

Depending on which component of the ANS predominates (sympathetic or parasympathetic), there are three main types of this disease:

1. hypotonic type– the action of the parasympathetic nervous system predominates;
2. hypertensive type– the action of the sympathetic nervous system predominates;
3. normotonic type– there is no predominance of one system or another, but there is their dysfunction.

Symptoms of vegetative-vascular dystonia

Symptoms from the cardiovascular system:

• increased heart rate (tachyarrhythmia);
• decreased heart rate (bradyarrhythmia);
• interruptions in the functioning of the heart, palpitations;
• pain in the heart area;
• increased vascular tone (hypertension);
• decreased vascular tone (hypertension);
• inability to maintain the proper level of blood pressure when necessary, up to the development of fainting;
• due to spasm or vasodilation, both local and general paleness or redness of the skin is possible with a decrease or increase in temperature in this area, respectively.

From the respiratory system shortness of breath may occur.

Gastrointestinal symptoms:

• diarrhea, constipation;
• spasmodic pain;
• irritable bowel syndrome.

Symptoms from the central nervous system:

• apathy;
• hypochondria;
• depression;
• nervousness;
• weather sensitivity;
• changes in body temperature;
• headache;
• insomnia.

Treatment of vegetative-vascular dystonia

Both drug and non-drug methods are used to treat VSD. Moreover, the latter should be given more attention. Non-drug treatment methods include the following.

Compliance healthy image life. It all starts with normalizing your daily routine. In the morning you need to get up at 6-7 o'clock and go to bed at 10-11 o'clock. Thus, your sleep time should be about 8 hours. The human body is accustomed to a diurnal lifestyle and if “daytime” hormones are released during the day, then “nighttime” hormones are released at night. For example, the hormone intermedin, which is responsible for preserving youth, is released from the middle lobe of the pituitary gland from 00:00 to 03:00 am and only if the person is sleeping. If he is awake at this time, then intermedin is not released or not released in large quantities. Of course, this has an impact on health. And for the money that you are paid for night hours on duty, in essence, you are selling your youth.

Sleeping conditions should also be optimal. The room where you sleep should be comfortable for you in terms of temperature, humidity, noise level, and so on. Mattresses, pillows, and bed linen should also not cause inconvenience. It is optimal if they are orthopedic. If you suffer from snoring, you should try to eliminate it, as it can cause the so-called Ondine's curse syndrome or sleep apnea. This is a condition when, due to snoring or other reasons, the sleeping person stops breathing. At the same time, he may not even wake up, but his REM sleep phase is replaced by the superficial sleep phase. And if this happens quite often during the night, then the person simply will not get enough sleep.

You cannot engage in monotonous activities for a long time at work. During breaks, you should switch from mental to physical stress, and vice versa. It is advisable to minimize the time spent working at the computer. The same goes for watching TV. You cannot sit in one position for a long time; periodically you should do gymnastics, stretch your joints and muscles, and do eye exercises.

At work (and in life) you need to try to be less nervous. If you are angry with someone and cannot tell them about it, write what you think about them on paper. You don’t have to give this paper to that person. Some of the accumulated aggression can be burned off in the gym. In this matter, you can also use autogenic training, conversations with a psychotherapist, and familiarization with the relevant psychotherapeutic literature.

Quitting alcohol and smoking is mandatory. These habits reduce the body's reserve abilities and often lead to various ailments. Alcohol can help you get through it stressful situation like anesthesia during surgery. But in general, its use has an adverse effect on life and health. Drinking alcohol does not help combat stress problems; it only displaces them and puts them off for later. And then they come back in even larger volumes and, accordingly, more “anesthetic drugs” are required. But, nevertheless, it is recommended to sometimes drink a glass (50 ml) of expensive high-quality vodka or a glass (250 ml) of good wine a day before meals. This will be useful for those for whom the smell, sight and taste of alcohol does not cause a violent chain reaction.

Smoking is no less harmful to the body, as it keeps it in a state of chronic hypoxia and toxemia (intoxication). Of course, this reduces the body's reserve capabilities. In addition, smoking increases the incidence of respiratory system diseases - from colds to cancer.

Physical education class. Morning exercises tone your body for the whole day, especially if it is combined with hardening. Not only does it wake you up from sleep, but it is also ideal prophylactic from many diseases.

In addition to exercise, you should sign up for some sports section. The best options would be yoga, swimming, race walking, hiking, and the like. You should avoid sports that can create excessive stress on the cardiovascular system (bodybuilding, sprinting), as well as in which it is necessary to make sudden movements with a large amplitude and lowering the head below the abdomen, due to the possibility of fainting.

Nutrition should be rational and balanced. In addition, to improve the conduction of nerve impulses and heart function, you must always consume foods with high content magnesium and potassium. Food should contain a lot of vitamins and others useful substances. The diet should help normalize body weight. For hypertension, it is better to drink soothing teas, and for hypotension, stimulating teas.

Physiotherapy is also used in the treatment of VSD. These procedures may be as follows:

• treatment using laser radiation;
• magnetic therapy;
• electropheresis with various medications on the neck area;
• baths, various showers.

Acupuncture and manual therapy. Depending on the various forms of VSD, chiropractor selects one type of massage or another.

Spa treatment.

Drug treatment of vegetative-vascular dystonia

Treatment of VSD with the help of medications is carried out in case of a sharp deterioration of the condition - crises.

So, during sympathoadrenal crisis, caused by an excess of catecholamines, treatment consists of prescribing medications that block the action of adrenaline and norepinephrine - adrenergic blockers(metoprolol, propranolol, atenolol).

Anxiolytics (tranquilizers) have a sedative and anti-anxiety effect. Their administration stops the sympathoadrenal crisis. The main representatives of this group: phenazepam, diazepam.

During vagoinsular crisis, occurring due to excess acetylcholine, a drug is used that blocks its action - atropine. This is a 0.1% solution, which is administered subcutaneously in 1 ml doses. To maintain blood pressure and heart function at the desired level, use a 1% solution cordiamine. It is administered in an amount of 3 ml intramuscularly. For the same purpose, 1 ml of a 10% solution is injected subcutaneously caffeine.

For severe bronchospasm, inhaled bronchodilators are used: atrovent, salbutomol, berotec, berodual. Intramuscular administration of a 5% ephedrine solution in a volume of 1 ml may help.

Lack of glucose in the blood ( hypoglycemia) is eliminated by intravenous administration. You can administer 20 ml of 40% glucose intravenously as a bolus.

Vestibular disorders (dizziness, nausea, vomiting) treated with intramuscular injection of 2 ml of 5% solution haloperidol.

If saved dizziness, then they are treated with cinnarizine And vinpocetine, who take 1 tablet 3 times a day.

Treatment of vegetative-vascular dystonia in children

Treatment of VSD in children is fundamentally the same as in adults. Crises in children are less common, so treatment will consist of normalizing lifestyle, diet, behavior, habits and other things as described above. Drug therapy is carried out in accordance with the age (body weight) of the child. The drugs used are approved in pediatric practice. As a rule, if VSD appeared in childhood, the risk greatly increases VSD diseases in adulthood. Therefore, for such people, prevention of VSD should be considered throughout life.

Vegetative-vascular dystonia - treatment with folk remedies.

Herbal medicine – treatment of vegetative-vascular dystonia with herbs. This treatment should be given great attention. There are many herbs that can both stimulate the body’s activity and calm its excessive activation.

Treatment of hypertensive type VSD

At hypertensive type VSD uses herbs that have a calming, hypnotic effect on the body. These herbs are not an alternative to drug treatment, but only a significant addition to this treatment. They should be taken only if the symptoms of the disease are mild. They are taken for a long time, about 20-30 days. Moreover, they should be taken no more than the specified period, so that there is no side effects. It is better to use several types of herbs with the same effects, which are used alternately.

Here are the main representatives of herbs with soothing and hypnotic effect: valerian, lemon balm, St. John's wort, motherwort, chamomile, hops, linden, mint, clover, dill, blackberries, strawberries and some others.

Valerian is one of the best herbs this series, which also has no contraindications. It is best to use valerian tincture, which is taken 15 ml (1 tablespoon) 2 times a day. This treatment lasts one week, then a break is taken for 2 weeks.

Motherwort can significantly lower blood pressure, so it should be used with caution.

Mint and lemon balm are used in the form of teas and tinctures. Long-term use is not recommended, as it can have a negative effect on the human reproductive system.

Treatment of hypotonic type of VSD

For the hypotonic type of VSD, herbs are used that increase the tone of the body and, in particular, the cardiovascular system. Such herbs include: ginseng, eleutherococcus, coffee, black and green tea.

Ginseng is an adaptogen. Tincture from its root is taken 20 drops 30 minutes before meals. It should be taken in the first half of the day to prevent insomnia. Ginseng not only stimulates the nervous and cardiovascular systems, but also increases potency. Treatment with ginseng should not be continued for too long, otherwise depletion may occur.

Eleutherococcus is also an adaptogen. It selectively stimulates the functioning of the nervous system, improves the transmission of nerve impulses. Take it in the same way as ginseng: in the first half of the day, 30 minutes before meals, 30 drops. The course of treatment is 15-20 days.

Collection of herbs for the treatment of VSD

Make a mixture of the following herbs: marsh cudweed(30 gr.), astragalus wooliflora (40 gr.), horsetail (40 gr.), sweet clover (40 gr.) Make a decoction from the mixture and take 15 - 30 ml (1-2 tablespoons) for 1- 2 months.

Video: VSD, panic attacks. Occurrence and treatment.

Vagotonia (vagotonic VSD, dysfunction): what it is, causes, signs and manifestations, treatment

Vagotonia (parasympathicotonia) is a complex condition provoked by excessive tone of the vagus nerve, which regulates the activity of internal organs, endocrine glands, and blood vessels. It is not an independent disease and has several dozen symptoms, which makes its diagnosis difficult, but established vagotonia is undoubtedly a reason for observation and, in many cases, appropriate treatment.

Vagotonia is extremely common among children and adolescents. According to statistics, more than half of children with non-infectious pathology They come to the pediatrician with exactly this problem. Adults are also increasingly faced with vagotonia. The reason for this is the decreasing physical activity of the population, unhealthy lifestyle, high levels of stress, excessive physical and emotional stress at work and at home.

Many symptoms of vagotonia are similar to serious illnesses heart, lungs, endocrine system, but they are functional in nature, although over time and without appropriate correction they threaten to develop into somatic pathology and severe psychical deviations, therefore, vagotonia is always a reason to consult a doctor.

The diagnosis and treatment of this condition is carried out by therapists, neurologists, endocrinologists, gastroenterologists - depending on the prevailing symptoms.

In many cases, vagotonia is a diagnosis of exclusion, that is, the patient is fully examined, no organic changes are found in the heart, lungs, or brain, but the symptoms of bradycardia, hypotension, and dyspeptic disorders continue to bother. In such cases there is no doubt about the presence of dysfunction of the autonomic nervous system.

Autonomic dysfunction, or a broader concept that includes a disorder of the autonomic nervous system as a whole, and vagotonia is a common case of it, one of its varieties, so in the diagnosis the patient may see “VVD of the vagotonic type.” This means that the reason for everything is the vagus nerve, which is not “working” quite correctly.

Causes of vagotonia

hypertonicity of the vagus nerve - the cause of vagotonia

The vagus nerve (paired) goes from the brain to the thoracic and abdominal cavity. It carries not only motor and sensory fibers, but also vegetative ones, which provide impulses to the lungs, digestive system, glands, and heart. An increase in its tone provokes a spasm of smooth muscles, increased motor activity of the intestines and stomach, and a slowdown in heartbeat, which is what is observed with vagotonia.

There is no single cause that causes vagotonic disorders. As a rule, this is a whole complex of unfavorable factors affecting a person simultaneously. In a number of cases, hereditary predisposition and constitutional features have been noted, which “result” in vagotonia under the influence of external causes.

Women are susceptible to vagotonia several times more than the male population. The disorder may first appear in childhood or adolescence, and by the age of 20-40 it will acquire the character of a persistent and pronounced disorder. According to some reports, signs of vagotonia are found in more than half of all people on the planet.

Most probable reasons vagotonic syndrome are considered:

• Head injuries, concussions, intrauterine and birth injuries;
• Raise ;
• Emotional overload, stress, strong and prolonged experiences;
• Functional disorders of the digestive and respiratory organs;
• The presence of chronic foci of infection;
• Metabolic disorders;
• Heredity;
• Change of climatic zones;
• Age - children, adolescents, menopausal women.

Vagotonia in children is associated with the natural immaturity of some elements of nervous regulation, rapid physical growth and hormonal changes during adolescence, and in women it is often provoked by pregnancy and childbirth, and the onset of menopause. These conditions are not a disease, they are natural, but they can manifest themselves in a variety of ways.

Manifestations of vagotonic syndrome

VSD of the vagotonic type has a very diverse symptomatology, which leads the patient to search for all sorts of causes of disorders, suspicion of the presence of severe organic pathology of internal organs, and depressive disorders.

the predominance of the parasympathetic nervous system over the sympathetic one is a characteristic sign of the vagotonic type of VSD (= parasympathicotonia)

Heterogeneous signs of vagotonia, which do not fit into a single pathological process, force doctors to repeatedly examine patients in order to exclude somatic pathology. Some patients are treated by a psychotherapist, but continue to suffer from dysfunction of the digestive system, bradycardia, etc., others manage to get rid of some subjective symptoms, but apathy and panic attacks They don’t even allow me to live in peace.

In this regard, in patients with probable hypotension, all complaints should be carefully weighed, correlating them with objective examination data, in order to avoid overdiagnosis of somatic pathology and incorrect treatment prescriptions.

Vagotonia can be of varying degrees of severity - from mild to severe. With the flow they release:

1. Paroxysmal form, when symptoms appear in attacks due to stress, exacerbation of a chronic infection, overwork or lack of sleep;
2. Constant;
3. Hidden.

Depending on the systems affected in the pathological process, there are generalized form of VSD of the vagotonic type (disorders of many organ systems), systemic when complaints are limited to one of the organ systems, and localized(local) - concerned about the dysfunction of one organ.

The most characteristic symptoms of vagotonia are:

In addition to the above, patients with VSD of the vagotonic type also experience other symptoms - poor tolerance to heat and cold, chilliness, severe sweating, fluctuations in body temperature towards its decrease, itchy skin and a tendency to allergies, runny nose without an obvious infectious cause, overweight body with decreased appetite, weather dependence and deterioration of well-being due to sudden changes in weather conditions.

The most common symptoms of vagotonic syndrome are weakness, hypotension, bradycardia, shortness of breath, non-localized pain in the abdomen and chest, dizziness and decreased resistance to any type of stress, and fatigue. Vagotonia is accompanied by sleep disturbances - patients have difficulty falling asleep, sleep restlessly, or suffer from insomnia, but are drowsy during the day.

In adults and children with vagotonia, the appearance: the skin becomes pale or even cyanotic, the extremities are often cold to the touch, severe sweating is bothersome, weight increases with a small amount of food consumed.

A typical vagotonic person is apathetic, indecisive, unsure of himself, prone to self-examination, listens sensitively to the extremely varied symptoms of VSD and strives to visit as many doctors as possible, often trying to convince them of the presence of a terrible and incurable illness. The vagotonic person describes his complaints quite colorfully, paying maximum attention to each manifestation. Fear of a serious illness and constant search for it lead to deep depressive disorders and even suicidal tendencies.

Vagotonics quickly get tired, lack initiative, are extremely sensitive to criticism from others, and at the same time tend to plunge into a state of daydreaming and are highly personal. inner experiences, which further complicates their social adaptation, training, and work activity.

Often changes in character and psycho-emotional status come to the fore among other manifestations of vagotonia. Patients experience difficulty remembering any information, especially specific facts, while imaginative thinking remains quite good.

Many find it difficult to work both mentally and physically due to a constant feeling of fatigue and weakness, and drowsiness during the daytime. Subjective discomfort can lead to serious neurosis and neurasthenia, irritability, causeless mood swings, tearfulness and incontinence.

Vagotonia can occur chronically, when the symptoms are constantly disturbing, but crises with sudden sharp deterioration well-being. A mild crisis lasts about a quarter of an hour and is characterized by one symptom - sweating, bradycardia, fainting. Crisis moderate severity longer, takes up to 20 minutes and is accompanied by various manifestations - dizziness, pain in the heart, decreased pressure, freezing of the heart or slowdown of its work, abdominal pain, diarrhea, etc. Severe crises occur with pronounced vegetative symptoms affecting many organs , convulsions and loss of consciousness are possible. After a severe attack, the patient feels exhausted, weak, and apathetic for the next few days.

In children, vagotonic dysfunction manifests itself:

1. Pallor, cyanosis of the peripheral parts of the body;
2. Increased sweating and swelling;
3. Allergic mood;
4. Chilliness and sensitivity to changes in weather.

Among the complaints of children with VSD of the hypotonic type, shortness of breath, a feeling of lack of air, and weakness predominate. These symptoms are especially pronounced in the presence of obstructive bronchitis and frequent respiratory infections.

Vagotonic children suffer poor appetite, nausea, abdominal pain, spasms in the esophagus, pharynx. Babies in the first year of life are prone to regurgitation; the first few years are bothered by constipation and diarrhea for no apparent reason. With age, stool normalizes, but abdominal pain may persist into adolescence.

Pediatricians consider vagotonia with low blood pressure to be an independent pathology that manifests itself by the age of 8-9 years of a child’s life. Among the complaints of such children are pain in the head, in the heart area, and fatigue. Increased levels of anxiety, inattention, poor memory and sleep problems were also noted.

Vagotonia affects the general and intellectual development of a child who is overweight, does not tolerate sports well, and therefore does not engage in them. Constant fatigue and the lack of adequate sleep make learning and assimilation of information difficult, the child may fall behind the program at school, and there is no talk of attending additional classes and sections.

Vagotonic dysfunction has no clear definition diagnostic criteria, including those established using objective research methods. The ECG in such patients shows bradycardia, even severe forms cannot be excluded. An ultrasound examination can detect dilated chambers of the heart due to a decrease in its tone. General and biochemical studies of blood and hormonal status usually do not show obvious deviations from the norm.

Ways to combat vagotonia

Treatment of vagotonia includes a number of non-drug measures that can independently help cope with the disorder. If they are ineffective or severe autonomic dysfunction Medications are prescribed depending on the predominant symptom.

Treatment of vagotonia should be long-term, comprehensive and individually selected in accordance with age, complaints, and concomitant pathology. The mental and emotional characteristics of the patient, personality type and degree of intellectual development must be taken into account.

The main directions in the correction of vagotonic disorders are:

• Normalization of regime, nutrition, physical activity;
• Medication support;
• Treatment concomitant pathology and chronic foci of infection.

The first thing the doctor will do is recommend normalizing your routine: sleep should be at least 10 hours, walks 2-3 hours a day (especially important for children), work and rest should alternate, watching TV and working on the computer should be limited as much as possible.

Physical exercise- an obligatory component of treatment for both children and adults. Gymnastics, water procedures, visiting the pool and even simple walking are useful. For vagotonic children, pine and radon baths and douses, which increase overall vascular tone, have a good effect. Doctors do not recommend group or traumatic sports.

Nutrition patients with vagotonia should be complete, rich in vitamins and minerals. If you have hypotension, you cannot limit the amount you drink; tea and coffee, chocolate, cereals, and legumes are recommended. Pediatricians advise giving children honey, juices or compotes made from raisins, rose hips, sea buckthorn, and viburnum at night.

The most important measure in the correction of autonomic dysfunction is considered psychotherapy, and individual work with a psychologist or psychotherapist brings greater results than group classes, due to the peculiarities of the emotional response of vagotonic people.

Among non-drug methods of normalization autonomic function - physiotherapy: electrophoresis with a solution of mesatone or caffeine with a tendency to hypotension and bradycardia. Massage of the calf muscles, hands, back and neck helps combat low blood pressure. Good effect gives acupuncture.

When the correct regimen, nutrition, and sports do not bring the desired result, drug therapy is prescribed:

When treating vagotonia, it is important that the chosen regimen is individual, taking into account the manifestations of the disorder in a particular patient and the characteristics of his emotional response. Children need the support and help of their parents, who, in turn, must trust their doctors and create the most calm environment possible at home.

Vagotonia is not yet a disease, but in the absence of proper attention it risks turning into a serious pathology - angina pectoris, cholelithiasis, depression and even stroke, so such patients should not be left without attention. Vagotonics should know that in most cases it is enough to normalize the regime, nutrition and exercise, eliminating stress and anxiety, in order autonomic tone returned to normal.

Normally, the sympathetic and parasympathetic nervous systems are constantly in an active state, and the magnitude of this basal activity is defined as the sympathetic and parasympathetic tone of the autonomic nervous system. It allows one system to both increase and decrease the activity of the innervated organ. An example of this could be the effect of the tone of the sympathetic centers on the contraction of smooth muscles of arterioles of systemic vessels. With basal tone, the frequency of nerve impulses in the sympathetic fibers innervating the vessels (arterioles) is 0-2 impulses per second. Gradual stimulation of nerve fibers with a frequency of 3-10 impulses/s leads to a significant decrease in the diameter of arterioles and an increase in vascular resistance. And, conversely, when the frequency of stimulation decreases, the arterioles relax, and the peripheral hydrostatic resistance of the vessels drops sharply (Fig. 5.5). Sympathetic tone supports the long-term secretion of adrenaline and norepinephrine by the adrenal glands, which increases significantly during extreme exposure to the body and decreases at rest.

At rest, the tone of the parasympathetic fibers of the vagus on the heart predominates. During physical activity, a reflex decrease in parasympathetic tone leads to an increase in the frequency and force of heart contraction. An important role is played by the parasympathetic basal tone in the digestive canal to maintain the condition of the smooth muscles of the stomach, its reflex relaxation when food arrives, and propulsive motor movements during its evacuation.

Usually the tone of the sympathetic and parasympathetic centers is balanced, although at rest the tone of some parasympathetic centers is slightly greater.

Cholinergic influences The ANS, which is inherent in the parasympathetic system, stimulates the function of the secretory glands digestive tract, reduce the heart rate at rest and during sleep. Intestinal motility increases, the tone of the sphincters of the digestive canal weakens, gallbladder and the smooth muscles of the bronchi contract. The indicated effects on effector organs associated with co-

RICE. 5

rest or processes of digestion and absorption of nutrients are sometimes called anabolic or trophotropic effects (Table 5.1).

Adrenergic influences of the ANS are characteristic of the sympathetic system, the activity of which increases significantly in extreme situations, physical work, and stress.

TABLE 5.1. The influence of the sympathetic and parasympathetic systems on the functions of various organs and structures of the body

and pain factors, in the cold, with a lack of oxygen. In these conditions, the frequency and force of heart contraction increases, the smooth muscles of the systemic vessels contract, which leads to an increase in blood pressure. At the same time, the function of the digestive tract is inhibited, which contributes to the redistribution of blood circulation to adequately meet the metabolic needs of functioning structures. This type of adrenergic effects is called catabolic, or ergotropic. Increased performance based on growth metabolic processes, L. A. Orbeli defined it as an adaptive-trophic function of the sympathetic nervous system, which ensures the body’s adaptive reactions to extreme factors. Usually there is a unity of cholinergic and noradrenergic effects on the visceral systems. An example of this would be an increase in cholinergic influences on heart rate in athletes at rest, which is a consequence of long-term physical activity, in which adrenergic effects on the strength and frequency of heart contraction continue. However, at rest, a decrease in the heart rate contributes to trophic effects and an increase in reserve, which helps the body's adaptive reactions during physical activity.

The unity of regulation with the participation of the metasympathetic system can be traced precisely in the gastrointestinal tract - in the intestines, where local reflex influences contribute to digestion, promotion, and absorption in the section where the chyme is located. At the same time, the body's general adaptive reactions when exposed to stress factors can either stimulate the motor function of the gastrointestinal tract through parasympathetic influences, or suppress it through sympathetic action.