Tone of the parasympathetic nervous system. Tone of the autonomic nervous system. In children, vagotonic dysfunction manifests itself

Bradycardia called a heart rhythm disorder in which the heart rate decreases to less than 60 beats per minute ( according to some authors less than 50). This condition is rather a symptom rather than an independent disease. The appearance of bradycardia can accompany a variety of pathologies, including those not directly related to cardiovascular system. Sometimes heart rate ( Heart rate) falls even in the absence of any disease, being natural reaction body to external stimuli.

In medical practice, bradycardia is much less common than tachycardia ( increased heart rate). Most patients do not attach much importance to this symptom. However, with repeated episodes of bradycardia or a severe decrease in heart rate, it is worth making a preventive visit to a general practitioner or cardiologist to rule out more serious problems.

Anatomy and physiology of the heart

The heart cavity is divided into four chambers:

• right atrium;
• right ventricle;
• left atrium;
• left ventricle

The heart wall consists of three layers:

• external - pericardium (its inner layer, which is part of the heart wall, is also called the epicardium);
• average – myocardium;
• internal – endocardium.

The most important properties of the heart are:

• excitability- ability to respond to external stimulus;
• automatism– the ability to contract under the influence of impulses originating in the heart itself ( normally - in the sinus node);
• conductivity– the ability to conduct excitation to other myocardial cells.

In general, the work of the heart is based on alternating cycles of relaxation ( diastole) and abbreviations ( systole). During diastole, a portion of blood enters the atrium through large vessels and fills it. After which systole occurs, and blood from the atrium is ejected into the ventricle, which at this time is in a relaxed state, that is, in diastole, which contributes to its filling. The passage of blood from the atrium to the ventricle occurs through a special valve, which, after filling the ventricle, closes and the ventricular systole cycle occurs. Already from the ventricle, blood is ejected into large vessels that leave the heart. At the exit of the ventricles there are also valves that prevent blood from flowing back from the arteries into the ventricle.

Regulation of the heart is a very complex process. In principle, the heart rate is set by the sinus node, which generates impulses. This, in turn, can be affected by the concentration of certain substances in the blood ( toxins, hormones, microbial particles) or the tone of the nervous system.

Various parts of the nervous system have the following effects on the heart:

• Parasympathetic nervous system, represented by the branches of the vagus nerve, reduces the rhythm of heart contraction. The more impulses supplied to the sinus node along this path, the greater the likelihood of developing bradycardia.
• Sympathetic nervous system increases heart rate. It seems to be opposed to the parasympathetic. Bradycardia can occur when its tone decreases, because then the influence of the vagus nerve will predominate.

Age norms of heart rate

Causes of bradycardia

• good physical fitness;
• hypothermia ( moderate);
• stimulation of reflex zones;
• idiopathic bradycardia;
• age-related bradycardia.

Good physical fitness

Most often, physiological bradycardia is observed in the following athletes:

• runners;
• rowers;
• cyclists;
• football players;
• swimmers.

Hypothermia

Bradycardia in these cases is one of the components of the general protective reaction. Your heart rate will rise again as your body temperature rises. This process is akin to suspended animation ( hibernation) in some animals.

Stimulation of reflex zones

It is possible to artificially induce an attack of bradycardia by stimulating the following zones:

• Eyeballs. With gentle pressure on the eyeballs, the nucleus of the vagus nerve is stimulated, which leads to the appearance of bradycardia. This reflex is called the Aschner-Dagnini reflex or oculocardiac reflex. In healthy adults, pressing on the eyeballs on average reduces heart rate by 8 to 10 beats per minute.
• Bifurcation of the carotid artery. At the site where the carotid artery bifurcates into internal and external, the so-called carotid sinus is located. Massaging this area with your fingers for 3 to 5 minutes will lower your heart rate and blood pressure. The phenomenon is explained by the close location of the vagus nerve and the presence of special receptors in this area. Carotid sinus massage is usually performed on the right side. Sometimes this technique is used in diagnostic or ( less often) for medicinal purposes.

Idiopathic bradycardia

Age-related bradycardia

Bradycardia is usually observed in people after 60–65 years of age and is permanent. In the presence of acquired cardiac pathologies, it may be replaced by attacks of tachycardia. The decrease in heart rate at rest is usually slight ( rarely below 55 – 60 beats per minute). It does not cause any associated symptoms. Thus, age-related bradycardia can be safely attributed to natural processes occurring in the body.

The following diseases and disorders can be the causes of pathological bradycardia:

• taking medications;
• increased tone of the parasympathetic nervous system;
• poisoning;
• some infections;
• heart pathologies.

Taking medications

The most severe attacks of bradycardia can be caused by the following medications:

• quinidine;
• digitalis;
• amisulpride;
• beta blockers;
• calcium channel blockers;
• cardiac glycosides;
• adenosine;
• morphine

Increased tone of the parasympathetic nervous system

The following factors can cause increased tone of the parasympathetic innervation of the heart:

• neuroses;
• traumatic brain injury;
• increased;
• hemorrhagic stroke ( brain hemorrhage) with the formation of a hematoma in the cranial cavity;
• neoplasms in the mediastinum.

Poisoning

Poisoning with the following substances can lead to bradycardia:

• lead and its compounds;
• organophosphates ( including pesticides);
• nicotine and nicotinic acid;
• some drugs.

Hypothyroidism

Hypothyroidism occurs due to diseases of the gland itself or due to a lack of iodine in the body. In the first case, the organ tissue is directly affected. Thyroid cells that should normally produce hormones are replaced by connective tissue. There can be many reasons for this process. Iodine plays a significant role in the formation of the hormone itself in the thyroid gland. It is the main component in the molecule of thyroxine and triiodothyronine. With a lack of iodine, iron increases in size, trying to compensate for the reduced level of hormones with the number of its cells. This condition is called thyrotoxic goiter or myxedema. If it is observed in a patient with bradycardia, we can say for sure that the cause of this symptom is a malfunction of the thyroid gland.

Diseases of the thyroid gland leading to hypothyroidism and bradycardia are:

• congenital disorders in the development of the thyroid gland ( hypoplasia or aplasia);
• previous operations on the thyroid gland;
• ingestion of toxic isotopes of iodine ( including radioactive);
• inflammation of the thyroid gland ( thyroiditis);
• some infections;
• neck injuries;
• autoimmune diseases ( Hashimoto's autoimmune thyroiditis).

With the above diseases, bradycardia will initially appear in the form of frequent attacks, but over time it will be observed constantly. Heart problems are not the only symptom of hypothyroidism. It can also be suspected by other manifestations of the disease.

In parallel with bradycardia, patients with hypothyroidism experience the following symptoms:

• pathological set excess weight;
• poor tolerance to heat and cold;
• menstrual irregularities ( among women);
• deterioration of the central nervous system ( decreased concentration, memory, attentiveness);
• decreased red blood cell levels ( anemia);
• tendency to constipation;
• swelling in the face, tongue, limbs.

Infectious diseases

Infections in which relative bradycardia may be observed are:

• severe sepsis;
• some variants of the course of viral hepatitis.

Heart pathologies

During blockades, impulses are generated at a normal frequency, but do not propagate along the fibers of the conduction system and do not lead to corresponding contractions of the myocardium. Strictly speaking, such blockades are not full-fledged bradycardia, although the pulse and heart rate slow down with them. Typical in these cases are rhythm disturbances ( arrhythmias) when heart contractions occur at different intervals.

Bradycardia and blockade of the conduction system can occur with the following heart pathologies:

• diffuse cardiosclerosis;
• focal cardiosclerosis;

Types of bradycardia

Based on the severity of the symptom, the following types can be distinguished:

• Mild bradycardia. With it, the pulse rate is more than 50 beats per minute. In the absence of other cardiac pathologies, this does not cause any discomfort in the patient and the symptom often goes unnoticed. Mild bradycardia includes most physiological causes that cause a decrease in heart rate. Therefore, there is usually no need for specific treatment for mild bradycardia.
• Moderate bradycardia . Moderate bradycardia is called bradycardia, in which the heart rate is from 40 to 50 beats per minute. In trained or elderly people, it may be a variant of the norm. With this type of bradycardia, various symptoms associated with oxygen starvation of tissues are sometimes observed.
• Severe bradycardia. Severe bradycardia is characterized by a decrease in heart rate below 40 beats per minute, which is most often accompanied by various disorders. In this case, careful diagnosis is required to identify the causes of the slow heart rate and drug treatment as necessary.

To others important criterion, by which bradycardia can be classified, is the mechanism of its occurrence. It should not be confused with the causes of this symptom because most of the above causes work through similar mechanisms. This classification is very important for understanding the pathological process and selecting the correct treatment.

From the point of view of the mechanism of occurrence, bradycardia is divided into two types:

• Impulse generation disorder. If the production of a bioelectric impulse is disrupted, they speak of sinus bradycardia. The fact is that this impulse originates in the sinus node, the activity of which largely depends on external innervation. Thus, your heart rate will decrease for reasons unrelated to heart disease. In rare cases, there may be inflammatory processes in the heart, affecting the sinus node. However, during the examination there will always be a characteristic sign. This is the rhythm of contractions. The myocardium contracts at regular intervals, and on the electrocardiogram ( ECG) reflects the timely and consistent contraction of each of the cavities of the heart.
• Impulse conduction disorder. Impaired impulse conduction is almost always caused by pathological processes in the heart muscle itself and the conduction system. There is a blockade of impulse conduction in a certain area ( for example, atrioventricular block or bundle branch block). Then bradycardia will be observed only in that cavity of the heart, the innervation of which was blocked. Situations often arise when, during atrioventricular block, the atria contract normally, and the ventricles contract 2–3 times less often. This greatly disrupts the blood pumping process. Arrhythmias occur and the risk of blood clots increases.

Sometimes bradycardia is also divided into diagnostic sign. Everyone knows that this symptom involves a decrease in heart rate, but heart rate is often measured using the pulse on the radial artery in the wrist. It should be borne in mind that one contraction of the heart does not always lead to one contraction of the artery. Sometimes even the pulsation of the carotid artery in the neck does not correctly reflect the work of the heart. In this regard, we can talk about bradycardia, in which the pulse is slow, but the heart contracts normally ( false bradycardia). The differences are explained by tumors that compress the arteries, arrhythmias, and narrowing of the lumen of blood vessels. The second option is, accordingly, true bradycardia, when the heart rate and pulse in the arteries coincide.

Symptoms of bradycardia

The main symptoms of bradycardia are:

• dizziness;
• inadequate increase in heart rate during exercise;
• pale skin;
• increased fatigue;

Dizziness

Fainting

Inadequate increase in heart rate during exercise

Dyspnea

Weakness

Pale skin

Increased fatigue

Chest pain

Thus, almost all symptoms of bradycardia, one way or another, are associated with oxygen starvation of the body. In most cases, these manifestations of the disease are temporary. However, even episodic attacks of dizziness, and even more so fainting, can greatly worsen the quality of life of patients.

The above symptoms are not typical only for attacks of bradycardia. They can be caused by other, more serious and dangerous pathologies. In this regard, their appearance should be regarded as a reason to visit a doctor.

Diagnosis of bradycardia

Bradycardia itself can be confirmed by the following diagnostic methods:

• auscultation;
• electrocardiography ( ECG);
• phonocardiography.

Auscultation

The big advantage is that this examination simultaneously evaluates the functioning of the heart valves. The doctor has the opportunity to immediately suspect certain diseases and continue the search in the right direction.

Electrocardiography

With sinus bradycardia, the ECG differs little from normal, with the exception of a rarer rhythm. This is easy to notice by calculating the speed of passage of the tape through the electrocardiograph and comparing it with the duration of one cardiac cycle ( distance between the peaks of two identical teeth or waves). It is somewhat more difficult to diagnose blockades in normal sinus rhythm.

The main electrocardiographic signs of atrioventricular block are:

• increasing the duration of the P–Q interval;
• severe deformation of the ventricular QRS complex;
• the number of atrial contractions is always greater than the number of ventricular QRS complexes;
• loss of ventricular QRS complexes from the general rhythm.

Phonocardiography

Diagnosis of bradycardia ( especially pronounced and with hemodynamic disturbances) is in no way limited to stating a decrease in heart rate. The doctor must determine whether the decrease in rhythm is a physiological feature of the body or a sign of a more serious pathology. For this purpose it can be assigned wide range various analyzes and surveys that will reflect the structural and functional changes in the heart and other organs or systems.

To clarify the diagnosis, patients with bradycardia may be prescribed the following diagnostic examination methods:

• General and biochemical blood test. This laboratory method can indicate the presence of an inflammatory process in the body and help suspect infection or poisoning.
• General and biochemical urine analysis. It is prescribed for the same reasons as a blood test.
• Blood test for hormones. The most common way to test thyroid hormone levels is to confirm hypothyroidism.
• Echocardiography ( EchoCG). This method is a study of the heart using ultrasound radiation. It gives an idea of ​​the structure of the organ and hemodynamic disorders. It is prescribed without fail in the presence of other symptoms ( along with bradycardia).
• Toxin analysis. For lead or other chemical poisonings, blood, urine, feces, hair, or other body tissue may be tested ( depending on the circumstances under which the poisoning occurred).
• Bacteriological research. Bacteriological examination of blood, urine or feces is necessary to confirm the diagnosis of an infectious disease.

Treatment of bradycardia

The decision to start treatment is made by the general practitioner. The patient himself, due to the lack of proper medical education, cannot unambiguously say whether bradycardia occurs at all ( even if the heart rate is slightly reduced). If the general practitioner has doubts about the causes of this symptom, he sends the patient for examination to a cardiologist. It is this specialist who is most competent in matters of cardiac arrhythmia.

Indications for starting treatment of bradycardia are:

• dizziness, fainting and other symptoms indicating circulatory disorders;
• low blood pressure;
• frequent attacks of bradycardia, causing the patient a feeling of discomfort;
• inability to perform work normally ( temporary disability);
• chronic diseases causing bradycardia;
• decrease in heart rate below 40 beats per minute.

To treat tachycardia, there are the following methods:

• conservative ( medicinal) treatment;
• surgery;
• treatment with folk remedies;
• prevention of complications.

Conservative treatment

Drug treatment for low heart rate should only be prescribed by a specialist with a medical education. The fact is that improper use of heart medications can lead to overdose and severe heart rhythm disturbances. In addition, bradycardia may be a symptom of another disease that the patient himself is not able to recognize. Then drugs that increase heart rate may not help at all or cause a worsening of the condition ( depending on the nature of the pathology). In this regard, drug self-medication is strictly prohibited.

Drugs used to combat bradycardia

If bradycardia is a symptom of another disease, other drugs may be prescribed ( thyroid hormones for hypothyroidism, antibiotics for infectious diseases, etc.). Eliminating the root cause will effectively eliminate the symptom itself.

Surgery

Surgical treatment is also necessary in the presence of tumors or other formations in the mediastinum. In rare cases, it is even necessary to remove tumors directly from the parasympathetic and sympathetic fibers. Typically, after such operations, normal heart rhythm is quickly restored.

In some cases, there is severe persistent bradycardia that leads to heart failure, but its cause is unknown or cannot be corrected. In these cases, surgical treatment will consist of implanting a special pacemaker. This device independently generates electrical impulses and delivers them to the desired points of the myocardium. This way, the lower sinus node rhythm will be suppressed and the heart will begin to pump blood normally. Nowadays, there are many different types of pacemakers that help restore full functionality and eliminate all symptoms associated with abnormal heart rhythms. In each specific case, the pacemaker model is selected individually based on the degree of circulatory impairment and the reasons that caused bradycardia.

Treatment with folk remedies

The following recipes are used in the treatment of bradycardia with folk remedies:

• Infusion of immortelle. 20 g of dried flowers are poured into 0.5 liters of boiling water. Infusion lasts several hours in a dark place. Take this remedy 20 drops 2 – 3 times a day. It is not recommended to take it after 19.00.
• Tatar decoction. 100 g of dry baskets are poured with 1 liter of boiling water. The mixture continues to simmer over low heat for 10 – 15 minutes. Infusion lasts about 30 minutes. After this, the broth is filtered and cooled. You need to take it 1 tablespoon before meals.
• Infusion of Chinese lemongrass. Fresh fruits are poured with alcohol at a rate of 1 to 10. After this, the alcohol tincture should stand for at least a day in a dark place. The product is added to tea ( approximately 1 teaspoon of tincture per cup of tea or boiled water). You can add sugar or honey to taste. The tincture is taken 2 – 3 times a day.
• Yarrow decoction. For a glass of boiling water you need 20 g of dry herb. Usually the product is prepared in 0.5 - 1 liter quantities at once. The mixture is simmered over low heat for 8 - 10 minutes. Then it is infused and gradually cooled for 1 - 1.5 hours. Take a decoction of 2 - 3 teaspoons several times a day.

Prevention of complications

Particular attention is paid to diet in the prevention of complications. The fact is that certain nutrients in various foods can affect heart function to varying degrees. The importance of this method of prevention should not be underestimated, since non-compliance with the diet sometimes nullifies even the entire course of drug treatment.

In the diet, patients with bradycardia should adhere to the following principles:

• limiting the consumption of animal fats ( especially pork);
• giving up alcohol;
• reduction in calorie intake ( up to 1500 – 2500 Kcal per day depending on the work performed);
• limited water and salt intake ( only on special instructions from the attending physician);
• eating nuts and other plant products, rich in fatty acids.

Consequences of bradycardia

Most often, patients with bradycardia encounter the following problems:

• heart failure;
• blood clot formation;
• chronic attacks of bradycardia.

Heart failure

Blood clots

Blood clots formed in the heart can enter almost any vessel, leading to its blockage. In this regard, a number of serious complications can develop - from extensive myocardial infarction to ischemic stroke. Patients with bradycardia in whom blood clots are suspected are referred for echocardiography to assess the risk of complications. After this, specific treatment is prescribed with drugs that prevent blood clotting. Implantation of a pacemaker remains a last resort measure to prevent blood clots. A correctly set rhythm will prevent blood stagnation in the ventricle.

Chronic attacks of bradycardia

In an adult, the normal heart rate is between 65-80 beats per minute. A decrease in heart rate of less than 60 beats per minute is called bradycardia. There are many reasons leading to bradycardia, which only a doctor can determine in a person.

Regulation of heart activity

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 the 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, physical exercise is accompanied by only a slight increase in heart rate.

In addition, the heartbeat also slows down during the body. 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. Taking certain medications (cardiac glycosides, as well as beta-blockers, calcium channel blockers);
4. (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. Exist pathological conditions, in which there is irritation of the vagus nerve (its fibers located in internal organs, or nerve nuclei in the brain).

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

• (against the background of traumatic brain injury, hemorrhagic stroke, cerebral edema);
• 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, 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 goes about his usual activities. 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 weakness. Also characteristic are pre-fainting states and. 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 go through. 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 an increase in the duration of the P-Q interval, as well as deformation of the ventricular QRS complex, its loss from the rhythm, a greater number of atrial contractions than the number of QRS complexes will indicate the presence of AV blockade in a person.

If bradycardia is observed inconsistently, but in the form of attacks, it 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:

1. Echocardiography;
2. Determination of blood content;
3. Toxin analysis.

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:

• Izadrin;
• Atropine;
• Isoprenaline;
• Euphilin.

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 tonics to the patient. medicines: ginseng tincture, 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. A stable preset heart rhythm favors the restoration of adequate hemodynamics.

Grigorova Valeria, medical observer

The autonomic (autonomic) nervous system regulates all internal processes of the body: functions internal organs and systems, glands, circulatory and lymphatic vessels, smooth and partially striated muscles, sensory organs. It ensures homeostasis of the body, i.e. the relative dynamic constancy of the internal environment and the stability of its basic physiological functions (blood circulation, respiration, digestion, thermoregulation, metabolism, excretion, reproduction, etc.). In addition, the autonomic nervous system performs an adaptation-trophic function - regulation of metabolism in relation to environmental conditions.

The term "autonomic nervous system" reflects the control of involuntary functions of the body. The autonomic nervous system is dependent on the higher centers of the nervous system. There is a close anatomical and functional relationship between the autonomic and somatic parts of the nervous system. Autonomic nerve conductors pass through the cranial and spinal nerves.

The main morphological unit of the autonomic nervous system, like the somatic one, is the neuron, and the main functional unit is the reflex arc. The autonomic nervous system has a central (cells and fibers located in the brain and spinal cord) and peripheral (all its other formations) sections. There are also sympathetic and parasympathetic parts. Their main difference lies in the characteristics of functional innervation and is determined by their attitude to drugs that affect the autonomic nervous system. The sympathetic part is excited by adrenaline, and the parasympathetic part by acetylcholine. Ergotamine has an inhibitory effect on the sympathetic part, and atropine has an inhibitory effect on the parasympathetic part.

The sympathetic part of the autonomic nervous system.

Its central formations are located in the cerebral cortex, hypothalamic nuclei, brain stem, reticular formation, and also in the spinal cord (in the lateral horns). The cortical representation has not been sufficiently clarified. From the cells of the lateral horns of the spinal cord at the level from CVIII to LII, the peripheral formations of the sympathetic part begin. The axons of these cells are directed as part of the anterior roots and, having separated from them, form a connecting branch that approaches the nodes of the sympathetic trunk.

This is where some of the fibers end. From the cells of the nodes of the sympathetic trunk, the axons of the second neurons begin, which again approach the spinal nerves and end in the corresponding segments. The fibers that pass through the nodes of the sympathetic trunk, without interruption, approach the intermediate nodes located between the innervated organ and the spinal cord. From the intermediate nodes, the axons of the second neurons begin, heading to the innervated organs. The sympathetic trunk is located along the lateral surface of the spine and mainly has 24 pairs of sympathetic nodes: 3 cervical, 12 thoracic, 5 lumbar, 4 sacral. Thus, from the axons of the cells of the upper cervical sympathetic node, the sympathetic plexus of the carotid artery is formed, from the lower - the upper cardiac nerve, forming the sympathetic plexus in the heart (it serves to conduct acceleration impulses to the myocardium). The aorta, lungs, bronchi, and abdominal organs are innervated from the thoracic nodes, and the pelvic organs from the lumbar nodes.

Parasympathetic part of the autonomic nervous system.

Its formations begin from the cerebral cortex, although the cortical representation, as well as the sympathetic part, has not been sufficiently elucidated (mainly the limbic-reticular complex).

There are mesencephalic and bulbar sections in the brain and sacral sections in the spinal cord. The mesencephalic section includes cells of the cranial nerves: III pair – accessory nucleus of Yakubovich (paired, parvocellular), innervating the muscle that constricts the pupil; Perlia's nucleus (unpaired parvocellular) innervates the ciliary muscle involved in accommodation. The bulbar section makes up the superior and inferior salivary nuclei (VII and IX pairs); X pair - vegetative nucleus, innervating the heart, bronchi, gastrointestinal tract, its digestive glands, and other internal organs. The sacral section is represented by cells in segments SIII-SV, the axons of which form the pelvic nerve innervating genitourinary organs and rectum.

Features of autonomic innervation.

All organs are influenced by both the sympathetic and parasympathetic parts of the autonomic nervous system. The parasympathetic part is more ancient. As a result of its activity, stable states of organs and homeostasis are created. The sympathetic part modifies these states (i.e., the functional abilities of the organs) in relation to the function performed. Both parts function in close cooperation. However, there may be a functional predominance of one part over the other. When the tone of the parasympathetic part predominates, a state of parasympathotonia develops, while the sympathetic part develops sympathotonia. Parasympathotonia is characteristic of the sleep state, sympathotonia is characteristic of affective states (fear, anger, etc.).

IN clinical settings Conditions are possible in which the activity of individual organs or systems of the body is disrupted as a result of the predominance of the tone of one of the parts of the autonomic nervous system. Parasympathotonic crises manifest themselves bronchial asthma, urticaria, Quincke's edema, vasomotor rhinitis, motion sickness; sympathotonic - vascular spasm in the form of symmetrical acroasphyxia, migraine, intermittent claudication, Raynaud's disease, transient form hypertension, cardiovascular crises in hypothalamic syndrome, ganglion lesions. The integration of autonomic and somatic functions is carried out by the cerebral cortex, hypothalamus and reticular formation.

Suprasegmental division of the autonomic nervous system. (Limbic-reticular complex.)

All activities of the autonomic nervous system are controlled and regulated by the cortical parts of the nervous system (limbic region: parahippocampal and cingulate gyri). The limbic system is understood as a number of cortical and subcortical structures that are closely interconnected and have a common development and function. The limbic system also includes formations olfactory pathways located at the base of the brain, septum pellucidum, vaulted gyrus, cortex of the posterior orbital surface of the frontal lobe, hippocampus, dentate gyrus. Subcortical structures limbic system: caudate nucleus, putamen, amygdala, anterior tubercle of the thalamus, hypothalamus, frenulus nucleus.

The limbic system is a complex interweaving of ascending and descending pathways, closely related to reticular formation. Irritation of the limbic system leads to the mobilization of both sympathetic and parasympathetic mechanisms, which has corresponding autonomic manifestations. A pronounced autonomic effect occurs when the anterior parts of the limbic system are irritated, in particular the orbital cortex, amygdala and cingulate gyrus. In this case, salivation, changes in breathing, increased intestinal motility, urination, defecation, etc. appear. The rhythm of sleep and wakefulness is also regulated by the limbic system. In addition, this system is the center of emotions and the neural substrate of memory. The limbic-reticular complex is under the control of the frontal cortex.

In the suprasegmental section of the v.n.s. There are ergotropic and trophotropic systems (devices). Division into sympathetic and parasympathetic parts in the suprasegmental part of the v.s. impossible. Ergotropic devices (systems) provide adaptation to environmental conditions. Trophotropic ones are responsible for ensuring homeostatic balance and the course of anabolic processes.

Autonomic innervation of the eye.

The autonomic innervation of the eye provides dilation or contraction of the pupil (mm. dilatator et sphincter pupillae), accommodation (m. ciliaris), a certain position of the eyeball in the orbit (m. orbitalis) and partially elevation upper eyelid(smooth muscle - m. tarsalis superior). - The sphincter of the pupil and the ciliary muscle, which serves for accommodation, are innervated parasympathetic nerves, the rest are sympathetic. Due to the simultaneous action of sympathetic and parasympathetic innervation, the loss of one of the influences leads to the predominance of the other.

The nuclei of parasympathetic innervation are located at the level of the superior colliculi, they are part of the third pair of cranial nerves (Yakubovich-Edinger-Westphal nuclei) - for the sphincter of the pupil and the Perlia nucleus - for the ciliary muscle. Fibers from these nuclei go as part of the III pair and then enter the ganglion ciliarae, from where the posttanglionic fibers to the m.m. originate. sphincter pupillae et ciliaris.

The nuclei of sympathetic innervation are located in the lateral horns of the spinal cord at the level of the Ce-Th segments. Fibers from these cells are sent to the border trunk, the upper cervical ganglion and then through the plexuses of the internal carotid, vertebral and basilar arteries to the corresponding muscles (mm. tarsalis, orbitalis et dilatator pupillae).

As a result of damage to the Yakubovich-Edinger-Westphal nuclei or the fibers coming from them, paralysis of the sphincter of the pupil occurs, while the pupil dilates due to the predominance of sympathetic influences (mydriasis). If the nucleus of Perlia or the fibers coming from it are damaged, accommodation is disrupted.
Damage to the ciliospinal center or the fibers coming from it leads to constriction of the pupil (miosis) due to the predominance of parasympathetic influences, to retraction of the eyeball (enophthalmos) and slight drooping of the upper eyelid. This triad of symptoms - miosis, enophthalmos and narrowing of the palpebral fissure - is called Bernard-Horner syndrome. With this syndrome, depigmentation of the iris is sometimes also observed. Bernard-Horner syndrome is most often caused by damage to the lateral horns of the spinal cord at the level of Ce-Th, the upper cervical parts of the borderline sympathetic trunk or the sympathetic plexus of the carotid artery, less often by a violation of the central influences on the ciliospinal center (hypothalamus, brain stem).

Irritation of these parts can cause exophthalmos and mydriasis.
To assess the autonomic innervation of the eye, pupillary reactions are determined. The direct and concomitant reactions of the pupils to light, as well as the pupillary reactions to convergence and accommodation, are examined. When identifying exophthalmos or enophthalmos, the state of the endocrine system and family characteristics of the facial structure should be taken into account.

Autonomic innervation of the bladder.

The bladder has dual autonomic (sympathetic and parasympathetic) innervation. The spinal parasympathetic center is located in the lateral horns of the spinal cord at the level of segments S2-S4. From it, parasympathetic fibers go as part of the pelvic nerves and innervate the smooth muscles of the bladder, mainly the detrusor.

Parasympathetic innervation ensures contraction of the detrusor and relaxation of the sphincter, i.e. it is responsible for emptying the bladder. Sympathetic innervation is carried out by fibers from the lateral horns of the spinal cord (segments T11-T12 and L1-L2), then they pass as part of the hypogastric nerves (nn. hypogastrici) to the internal sphincter of the bladder. Sympathetic stimulation leads to contraction of the sphincter and relaxation of the detrusor of the bladder, i.e., it inhibits its emptying. It is believed that lesions of sympathetic fibers do not lead to urinary disorders. It is assumed that the efferent fibers of the bladder are represented only by parasympathetic fibers.

Excitation of this section leads to relaxation of the sphincter and contraction of the detrusor of the bladder. Urinary problems may include urinary retention or incontinence. Urinary retention develops as a result of sphincter spasm, weakness of the bladder detrusor, or as a result of a bilateral disruption of the organ’s communication with the cortical centers. If the bladder is full, urine may be released in drops under pressure - paradoxical ischuria. With bilateral damage to the corticospinal influences, temporary urinary retention occurs. Then it usually gives way to incontinence, which occurs automatically (involuntary periodic urinary incontinence). There is an imperative urge to urinate. When the spinal centers are damaged, true urinary incontinence develops. It is characterized by the constant release of urine in drops as it enters the bladder. Since some of the urine accumulates in the bladder, cystitis develops and an ascending infection of the urinary tract occurs.

Autonomic innervation of the head.

Sympathetic fibers innervating the face, head and neck begin from cells located in the lateral horns of the spinal cord (CVIII - ThIII). Most of the fibers are interrupted in the superior cervical sympathetic ganglion, and a smaller part is directed to the external and internal carotid arteries and forms periarterial sympathetic plexuses on them. They are joined by postganglionic fibers coming from the middle and lower cervical sympathetic nodes. In small nodules (cellular accumulations) located in the periarterial plexuses of the branches of the external carotid artery, fibers that are not interrupted in the nodes of the sympathetic trunk end. The remaining fibers are interrupted in the facial ganglia: ciliary, pterygopalatine, sublingual, submandibular and auricular. Postganglionic fibers from these nodes, as well as fibers from the cells of the superior and other cervical sympathetic nodes, go either as part of the cranial nerves or directly to the tissue formations of the face and head.

In addition to the efferent, there is afferent sympathetic innervation. Afferent sympathetic fibers from the head and neck are directed to the periarterial plexuses of the branches of the common carotid artery, pass through the cervical nodes of the sympathetic trunk, partially contacting their cells, and through the connecting branches they approach the spinal nodes.

Parasympathetic fibers are formed by the axons of the stem parasympathetic nuclei and are directed mainly to the five autonomic ganglia of the face, in which they are interrupted. A smaller part is directed to the parasympathetic accumulations of cells of the periarterial plexuses, where they are also interrupted, and postganglionic fibers go as part of the cranial nerves or periarterial plexuses. Front and middle departments the hypothalamic region, through sympathetic and parasympathetic conductors, influence the function of the salivary glands mainly of the same side. The parasympathetic part also contains afferent fibers that run in the vagus nerve system and are directed to the sensory nuclei of the brain stem.

Features of the activity of the autonomic nervous system.

The autonomic nervous system regulates processes occurring in organs and tissues. When the autonomic nervous system is dysfunctional, a variety of disorders occur. Periodicity and paroxysmal disturbances of the regulatory functions of the autonomic nervous system are characteristic. Majority pathological processes in it is not due to loss of functions, but to irritation, i.e. increased excitability of central and peripheral structures. A feature of the autonomic nervous system is repercussion: a disturbance in some parts of this system can lead to changes in others.

Clinical manifestations of lesions of the autonomic nervous system.

Processes localized in the cerebral cortex can lead to the development of autonomic, in particular trophic disorders in the innervation zone, and when the limbic-reticular complex is damaged, to various emotional changes. They more often occur with infectious diseases, injuries of the nervous system, and intoxication. Patients become irritable, hot-tempered, quickly exhausted, they experience hyperhidrosis, instability of vascular reactions, and trophic disorders. Irritation of the limbic system leads to the development of paroxysms with pronounced vegetative-visceral components (cardiac, epigastric auras, etc.). When the cortical part of the autonomic nervous system is damaged, severe autonomic disorders do not occur. More significant changes develop with damage to the hypothalamic region.

Currently, an idea has been formed of the hypothalamus as an integral part of the limbic and reticular systems of the brain, which interacts between regulatory mechanisms and integrates somatic and autonomic activity. Therefore, when the hypothalamic region is damaged (tumor, inflammatory processes, circulatory disorders, intoxication, trauma), various clinical manifestations may occur, including diabetes insipidus, obesity, impotence, sleep and wakefulness disorders, apathy, thermoregulation disorder (hyper- and hypothermia), widespread ulcerations in the gastric mucosa, lower part of the esophagus, acute perforations of the esophagus, duodenum and stomach.

Damage to vegetative formations at the level of the spinal cord is manifested by pilomotor, vasomotor disorders, disorders of sweating and pelvic functions. In segmental disorders, these changes are localized in the zone of innervation of the affected segments. In these same areas, trophic changes are noted: increased dry skin, local hypertrichosis or local hair loss, and sometimes trophic ulcers and osteoarthropathy. When segments CVIII - ThI are damaged, Bernard-Horner syndrome occurs: ptosis, miosis, enophthalmos, often - decrease intraocular pressure and dilation of facial vessels.

When the nodes of the sympathetic trunk are affected, similar clinical manifestations occur, especially pronounced if the cervical nodes are involved in the process. There is impaired sweating and dysfunction of the pilomotors, dilation of blood vessels and increased temperature on the face and neck; due to decreased tone of the laryngeal muscles, hoarseness and even complete aphonia, Bernard-Horner syndrome, may occur.

In case of irritation of the upper cervical ganglion, dilatation of the palpebral fissure and pupil (mydriasis), exophthalmos, and the reverse syndrome of Bernard-Horner syndrome occur. Irritation of the upper cervical sympathetic ganglion can also manifest itself as sharp pain in the face and teeth.

Damage to the peripheral parts of the autonomic nervous system is accompanied by a number of characteristic symptoms. Most often, a peculiar syndrome occurs, called sympathalgia. In this case, the pain is burning, pressing, bursting in nature, and is characterized by a tendency to gradually spread around the area of ​​​​primary localization. Pain is provoked and intensified by changes in barometric pressure and ambient temperature. Changes in skin color may be observed due to spasm or dilation of peripheral vessels: paleness, redness or cyanosis, changes in sweating and skin temperature.

Autonomic disorders can occur with damage to the cranial nerves (especially the trigeminal), as well as the median, sciatic, etc. It is believed that paroxysms with trigeminal neuralgia are mainly associated with damage to the autonomic parts of the nervous system.

Damage to the autonomic ganglia of the face and oral cavity is characterized by the appearance of burning pain in the area of ​​innervation related to this ganglion, paroxysmalness, the occurrence of hyperemia, increased sweating, and in the case of damage to the submandibular and sublingual nodes - increased salivation.

Research methodology.

There are numerous clinical and laboratory methods for studying the autonomic nervous system. Usually their choice is determined by the task and conditions of the study. However, in all cases it is necessary to take into account the initial state of autonomic tone and the level of fluctuations relative to the background value.

It has been established that the higher the initial level, the smaller the response will be during functional tests. In some cases, even a paradoxical reaction is possible. It is better to conduct the study in the morning on an empty stomach or 2 hours after meals, at the same time, at least 3 times. In this case, the minimum value of the obtained data is taken as the initial value.

To study the initial autonomic tone, special tables are used, which contain data clarifying the subjective state, as well as objective indicators vegetative functions(nutrition, skin color, condition of the skin glands, body temperature, pulse, blood pressure, ECG, vestibular manifestations, respiratory functions, gastrointestinal tract, pelvic organs, performance, sleep, allergic reactions, characterological, personal, emotional characteristics, etc.). We present the main indicators that can be used as criteria underlying the study.

After determining the state of autonomic tone, autonomic reactivity is examined when exposed to pharmacological agents or physical factors. The administration of solutions of adrenaline, insulin, mezatone, pilocarpine, atropine, histamine, etc. is used as pharmacological agents.

To assess the state of the autonomic nervous system, the following functional tests are used.

Cold test . With the patient lying down, the heart rate is counted and blood pressure is measured. After this, the hand of the other hand is immersed for 1 minute in cold water at a temperature of 4 °C, then the hand is removed from the water and blood pressure and pulse rate are recorded every minute until it returns to the original level. Normally this happens within 2-3 minutes. When blood pressure increases by more than 20 mm Hg. the reaction is assessed as pronounced sympathetic, less than 10 mm Hg. Art. - as moderate sympathetic, and with a decrease in pressure - as parasympathetic.

Oculocardiac reflex (Danyini-Aschner). When pressing on the eyeballs in healthy individuals, heart contractions slow down by 6-12 per minute. If the number of contractions slows down by 12-16, this is regarded as a sharp increase in the tone of the parasympathetic part. The absence of a slowdown or acceleration of heart contractions by 2-4 per minute indicates an increase in the excitability of the sympathetic part.

Solar reflex . The patient lies on his back, and the examiner applies pressure with his hand on the upper abdomen until a pulsation of the abdominal aorta is felt. After 20-30 seconds, the number of heartbeats slows down in healthy individuals by 4-12 per minute. Changes in cardiac activity are assessed as in the oculocardiac reflex.

Orthoclinostatic reflex . The study is carried out in two steps. With the patient lying on his back, the number of heartbeats is counted, and then he is asked to quickly stand up (orthostatic test). When moving from horizontal position in a vertical position, the heart rate increases by 12 per minute with an increase in blood pressure by 20 mm Hg. When the patient moves to a horizontal position, pulse and pressure indicators return to their original values ​​within 3 minutes (clinostatic test). The degree of pulse acceleration during an orthostatic test is an indicator of the excitability of the sympathetic part of the autonomic nervous system. A significant slowdown of the pulse during a clinostatic test indicates an increase in the excitability of the parasympathetic part.

Pharmacological tests are also carried out.

Adrenaline test. In a healthy person, subcutaneous administration of 1 ml of a 0.1% solution of adrenaline causes paleness of the skin, increased blood pressure, increased heart rate, and an increase in blood glucose levels within 10 minutes. If these changes occur faster and are more pronounced, this indicates an increase in the tone of the sympathetic innervation.

Skin test with adrenaline . A drop of 0.1% adrenaline solution is applied to the skin puncture site with a needle. In a healthy person, such an area appears pale and has a pink halo around it.

Atropine test . Subcutaneous injection of 1 ml of 0.1% atropine solution causes dry mouth and skin, increased heart rate and dilated pupils in a healthy person. Atropine is known to block the body's M-cholinoreactive systems and is, therefore, an antagonist of pilocarpine. With an increase in the tone of the parasympathetic part, all reactions that occur under the influence of atropine are weakened, so the test can be one of the indicators of the state of the parasympathetic part.

Segmental vegetative formations are also studied.

Pilomotor reflex . The “goose bumps” reflex is caused by pinching or applying a cold object (a test tube with cold water) or coolant (cotton wool soaked in ether) on the skin of the shoulder girdle or the back of the head. On the same half chest“goose bumps” occur as a result of contraction of smooth hair muscles. The reflex arc closes in the lateral horns of the spinal cord, passes through the anterior roots and the sympathetic trunk.

Test with acetylsalicylic acid . The patient is given 1 g of acetylsalicylic acid with a glass of hot tea. Diffuse sweating appears. If the hypothalamic region is damaged, its asymmetry may be observed. When the lateral horns or anterior roots of the spinal cord are damaged, sweating is disrupted in the area of ​​innervation of the affected segments. When the diameter of the spinal cord is damaged, taking acetylsalicylic acid causes sweating only above the site of the lesion.

Test with pilocarpine . The patient is injected subcutaneously with 1 ml of a 1% solution of pilocarpine hydrochloride. As a result of irritation of postganglionic fibers going to the sweat glands, sweating increases. It should be borne in mind that pilocarpine excites peripheral M-cholinergic receptors, causing increased secretion of the digestive and bronchial glands, constriction of the pupils, increased tone of the smooth muscles of the bronchi, intestines, gall and bladder, and uterus. However, pilocarpine has the most powerful effect on sweating. If the lateral horns of the spinal cord or its anterior roots are damaged in the corresponding area of ​​the skin, sweating does not occur after taking acetylsalicylic acid, and the administration of pilocarpine causes sweating, since the postganglionic fibers that react to this drug remain intact.

Light bath. Warming the patient causes sweating. The reflex is spinal, similar to the pilomotor one. Damage to the sympathetic trunk completely eliminates sweating due to pilocarpine, acetylsalicylic acid and body warming.

Skin thermometry (skin temperature ). It is studied using electric thermometers. Skin temperature reflects the state of the blood supply to the skin, which is important indicator autonomic innervation. Areas of hyper-, normo- and hypothermia are determined. A difference in skin temperature of 0.5 °C in symmetrical areas is a sign of disorders of autonomic innervation.

Dermographism . Vascular reaction of the skin to mechanical irritation (handle of a hammer, blunt end of a pin). Typically, a red stripe appears at the site of irritation, the width of which depends on the state of the autonomic nervous system. In some individuals, the stripe may rise above the skin (elevated dermographism). When increasing sympathetic tone the strip has White color (white dermographism). Very wide bands of red dermographism indicate increased tone of the parasympathetic nervous system. The reaction occurs as an axon reflex and is local.

For topical diagnostics Reflex dermographism is used, which is caused by irritation with a sharp object (drawn across the skin with the tip of a needle). A strip with uneven scalloped edges appears. Reflex dermographism is a spinal reflex. It disappears when the dorsal roots, spinal cord, anterior roots and spinal nerves are affected at the level of the lesion.

Above and below the affected area, the reflex is usually preserved.

Pupillary reflexes . The direct and friendly reactions of the pupils to light, their reaction to convergence, accommodation and pain (dilation of the pupils when pricking, pinching and other irritations of any part of the body) are determined.

Electroencephalography is used to study the autonomic nervous system. The method allows us to judge the functional state of the synchronizing and desynchronizing systems of the brain during the transition from wakefulness to sleep.

When the autonomic nervous system is damaged, neuroendocrine disorders often occur, so hormonal and neurohumoral studies are carried out. The function of the thyroid gland is studied (basic metabolism using the complex radioisotope absorption method I311), corticosteroids and their metabolites in the blood and urine, carbohydrate, protein and water-electrolyte metabolism, the content of catecholamines in the blood, urine, cerebrospinal fluid, acetylcholine and its enzymes, histamine and its enzymes, serotonin, etc.

Damage to the autonomic nervous system can manifest itself as a psychovegetative symptom complex. Therefore, they conduct a study of the emotional and personal characteristics of the patient, study the anamnesis, the possibility of mental trauma, and carry out a psychological examination.

Under the influence of the autonomic nervous system occurs difficult process regulation of all internal processes of the body. The autonomic (autonomic) nervous system ensures the constancy of the internal environment of the body. Vegetative-neural influences extend to all organs and tissues. The term “autonomic nervous system” reflects the control of involuntary functions of the body. The autonomic nervous system is dependent on the higher centers of the nervous system. There are sympathetic and parasympathetic parts of the autonomic nervous system. Their main difference lies in the functional innervation and is determined by the relationship to the means affecting the autonomic nervous system. The sympathetic part is excited by adrenaline, and the parasympathetic part by acetylcholine. Ergotamine has an inhibitory effect on the sympathetic part, and atropine has an inhibitory effect on the parasympathetic part.

Sympathetic division of the autonomic nervous system

The main formations of the sympathetic part are located mainly in the cerebral cortex, as well as in the spinal cord (in the lateral horns). In the spinal cord, the peripheral formations of the sympathetic division of the autonomic nervous system begin from the lateral horns. The sympathetic trunk is located along the lateral surface of the spinal column. The sympathetic trunk has 24 pairs of sympathetic nodes.

Parasympathetic part of the autonomic nervous system

The formations of the parasympathetic part begin from the cerebral cortex. The craniobulbar region is distinguished in the brain and the sacral region in the spinal cord. In the craniobulbar department there are:

1) the system of visceral nuclei (III nerve), namely paired small-celled nuclei, which are related to the innervation of the pupil (smooth muscle), and an unpaired small-celled accommodative nucleus, which provides innervation to smooth muscle - in the bottom of the Sylvian aqueduct, under the anterior tubercles of the quadrigeminal tubercles;

2) secretory lacrimal cells in the system of nuclei of the facial nerve (VII nerve), located in the pons;

3) secretory salivary nucleus in the glossopharyngeal nerve system (IX nerve) - for the parotid gland and XIII nerve - for the submandibular and sublingual salivary glands - in the medulla oblongata;

4) the visceral nuclei of the vagus nerve in the medulla oblongata, which innervate the heart, bronchi, gastrointestinal tract, digestive glands, and other internal organs.

Features of autonomic innervation

All organs of our body are under the influence of the autonomic nervous system (both of its parts). The sympathetic part changes the functional abilities of organs. Both parts of the autonomic nervous system are interconnected. But there are conditions when one part of the system prevails over the other. Vagotonia (predominance of the parasympathetic part) is characterized by narrow pupils, moist, bluish skin, bradycardia, low blood pressure, constricted (asthmatic) breathing, profuse salivation, increased acidity gastric juice, a tendency to spasms of the esophagus, stomach, spastic constipation followed by diarrhea, low metabolism, a tendency to obesity. The state of vagotonia is typical, for example, for a sleeping person. Sympathicotonia (predominance of the sympathetic part) is characterized by shiny, convex eyes with wide pupils; pale, dry skin with a tendency to piloarrection; tachycardia, high blood pressure, free breathing; dry mouth, achylia, dilation of the stomach, atonic constipation; brisk metabolism, tendency to lose weight. The state of sympathicotonia is characteristic, for example, of affective states (fear, anger, etc.).

How does the autonomic nervous system affect the body? Conditions are possible in which the activity of individual organs or systems of the body is disrupted as a result of the predominance of the tone of one of the parts of the autonomic nervous system. Vagotonic crises are, for example, bronchial asthma, urticaria, Quincke's edema, vasomotor rhinitis, motion sickness, sympathicotonic - vascular spasms in the form of symmetrical acroasphyxia, migraine, intermittent claudication, Raynaud's disease, transient form of hypertension, cardiovascular crises with hypothalamic syndrome, ganglion lesions.

Methods for studying the autonomic nervous system

The study of autonomic innervation is based, first of all, on assessing the state and function of the corresponding organs and systems. There are many clinical and laboratory methods studies of the autonomic nervous system. The choice of methodology is determined in accordance with the task and conditions of the study. However, in all cases it is necessary to take into account the initial state of autonomic tone. The study is best carried out in the morning on an empty stomach or 2 hours after meals, at the same time, at least 3 times. In this case, the minimum value of the obtained data is taken as the initial value.

Clinical, clinical-physiological and biochemical research methods are of great practical value and application.

The largest group consists cutaneous autonomic reflexes And samples.

Local dermographism– a reaction of the skin capillaries in the form of redness of the skin, which is caused by applying pressure with the handle of a hammer. Most often, a red stripe appears at the site of irritation; its width depends on the state of the autonomic nervous system. Of particular importance is too long (persistent) dermographism; this can be assessed as a predominance of excitability of skin vasodilators.

An even more convincing sign of such excitability (parasympathetic) is elevated dermographism, when after a stroke a swollen ridge of skin is formed. A manifestation of increased vasoconstrictor excitability (sympathetic) is white dermographism (spasm). The nature of local dermographism depends on the degree of pressure during streak stimulation and on the area of ​​the skin surface. For example, weak irritations usually cause only white dermographism. It is especially pronounced on the skin of the lower extremities. The reaction of local dermographism can only be used to determine the tone of the sympathetic or parasympathetic part of the autonomic nervous system.

How does the autonomic nervous system affect the body? Reflex dermographism caused by irritation with a sharp object (drawn across the skin with the tip of a pin or needle). The reflex arc of such dermographism is closed in the segmental apparatus of the spinal cord. Some time after the impact, a strip appears with scalloped, uneven edges of varying widths, which lasts for several seconds. Reflex dermographism disappears with lesions of the dorsal roots of the spinal cord, as well as the anterior roots and spinal nerves at the level of the lesion. Above and below the innervation zone, the reflex is usually preserved. The so-called mustard test may also be recommended: thinly cut strips of mustard plasters are applied in a long narrow strip from top to bottom within the expected level of the lesion: the changes correspond to the indications of reflex dermographism (but this is not always accurate).

Pilomotor (piloarrector) reflexes skin are caused by pinching or cold (ice, ether) skin irritations, most often in the back of the head. “Goose bumps” (spinal reflex) should be considered a sympathetic reflex. Piloarrection, especially in a cold room, occurs normally. Pilomotor reflexes may have topodiagnostic value. With transverse lesions of the spinal cord, pilomotor reflexes, when stimulated at the top, do not extend below the zone of preservation of the segments (thus the upper limit of the lesion can be determined); with irritation below (in the area below the lesion), piloarrection extends upward only to the affected segments (i.e., the lower border of the lesion can be determined). In the area of ​​the affected segments of the spinal cord themselves, the pilomotor reflex is absent.

Both dermographism and piloarrection do not always accurately determine the boundaries of the lesion.

Sweat reflexes skin are of great diagnostic value. Sweat glands have only sympathetic innervation. The mechanism of sweating is different. Disturbances in the sweating reflex can occur in various localizations of the disease process.

Aspirin test(1.0 g of acetylsalicylic acid is given with a glass of hot tea) causes diffuse sweating. With cortical lesions, a monoplegic type of absence or decrease in sweating occurs, with damage to the diencephalic, hypothalamic region - hemiplegic.

Warming the test subject causes spinal sweat reflexes (through cells of the lateral horns of the spinal cord). If the segmental centers of the spinal cord are affected, warming the patient, as well as an aspirin test, establishes the absence or decrease in sweating in the corresponding areas.

Test with pilocarpine(1 ml of a 1% solution of pilocarpine hydrochloride is administered subcutaneously to the patient). The absence or decrease in sweating indicates damage to the peripheral nervous system.

The best way to identify sweating and areas of sweating is to Minor's method. The patient's skin is covered with a solution of iodine mixed with alcohol and castor oil. Some time after drying, the skin is evenly sprinkled with starch powder. Then sweating is induced in various ways; as a result of the combination of iodine with starch, an intense blue-violet, sometimes even black color is formed in the areas of sweating. In those areas where sweating has not occurred, staining does not form. The results are photographed or sketched.

Another method for determining skin sweating (moisture) is electrometric. With this method, the fairly common apparatus of N. I. Mishchuk is used. With this method, it is more difficult to determine areas of impaired sweating.

Interesting, but difficult and difficult to evaluate the results obtained is electrodermal resistance method. The electrical conductivity of the skin is determined by a number of factors: humidity, i.e. sweating of the skin, condition of blood vessels, degree of hydrophilicity of the skin, etc. An increase in electrocutaneous resistance should be considered as a manifestation of the predominance of sympathetic innervation tone in the skin area under study.

Among skin tests, the study is widespread skin temperature. This test is of particular importance in the general assessment of visceral innervation, tone and its stability. The constancy of temperature is ensured by the regulating influence of cerebral visceral centers. In addition to specially adapted for fast and precise measurement skin temperature of any areas of the skin using mercury thermometers, recently the electrometric method (thermocouple) is increasingly used, which is provided by N. N. Mishchuk’s device (combined apparatus PK-5).

Skin temperature reflects the state of blood supply to the skin, which is an important indicator of autonomic innervation. Asymmetries of skin temperature (such as hemisyndrome) exceeding 1°C are observed with unilateral lesions of the hypothalamic region. There are territorial changes in temperature with focal lesions of the cerebral cortex - cerebral hemiplegia.

Skin tests also include the determination skin sensitivity to ultraviolet rays by determining the biodose, i.e. establishing the minimum degree of exposure to rays at which redness occurs.

To ensure the standard, constant irradiation conditions are applied. As a control, the results of irradiation under the same conditions of a symmetrical, “healthy” area are usually taken into account. Redness occurs through a reflex mechanism: histamine or histamine-like substances are formed in the skin during irradiation. Early onset and intensity of redness is regarded as a parasympathetic effect, delayed onset, weak intensity of erythema (redness) is regarded as sympathetic. This method is widely used for topical diagnostics: very clear data are obtained for damage to peripheral nerves; asymmetries occur with cerebral hemiplegia, diencephalic and spinal lesions.

For research hydrophilicity skin, 0.2 ml is injected intradermally saline solution and take into account the time of resorption of the resulting papule. The speed of resorption varies in different areas of the skin. On average it is 50–90 minutes. This test is highly sensitive (as is electrodermal resistance); using the results of this test to assess the general condition and damage to the nervous system requires caution, since the hydrophilicity of tissues changes significantly, for example, during feverish conditions, edema, cardiovascular disorders, etc.

Skin tests include the study of local reactions to sympathicotropic And vagotropic substances. Sympathicotropic drugs include adrenaline (administered in a solution of 1: 1000 in an amount of 0.1 ml intradermally). At the injection site, a spot of blanching and piloarrection (“goose bumps”) appears within 5-10 minutes, which is surrounded by a red border of varying size and intensity. If the reaction is severe and lasts for a long time, a conclusion is drawn about a sympathetic effect.

Acetylcholine is used as a vagotropic (parasympathicotropic) substance (0.1 ml of a 1: 10,000 solution is injected intradermally). A pale papule with a reddish border appears at the injection site; after some time, the area of ​​redness increases to a maximum and after 15–25 minutes completely disappears. Greater intensity of the reaction is regarded as a parasympathetic effect.

The study has become quite widespread in clinical practice. cardiovascular reflexes.

Oculocardial reflex– the subject lies on his back in a free position, after some time his pulse is counted. After this, pressure is applied, preferably on both eyeballs simultaneously with the thumb and forefinger. It is recommended to apply pressure not on the anterior chamber, but on the lateral parts of the eyeball, and it should be quite intense, but not painful. After 20–30 s, without stopping the pressure, count the pulse for 20–30 s. The pulse rate before and after pressure is compared. Normally, the pulse slows down slightly (up to 10 beats). Large deceleration is regarded as a vagotonic effect, absence of deceleration or paradoxical acceleration - as sympathicotonic.

Neck reflex is caused by pressing with the thumb on the area anterior to the sternocleidomastial muscle, at the level of its upper third, below the angle of the lower jaw - until a pulsation of the carotid artery is felt. Normally, the heart rate slows down by 6-12 beats per minute. A high degree of deceleration, as well as changes in breathing, intestinal peristalsis and other signs, are regarded as a manifestation of increased tone of the vagus nerve system.

Epigastric (solar node) reflex called when the subject is positioned on his back with the abdominal muscles as relaxed as possible; measure blood pressure and pulse. Using your fingers, apply pressure to the area between the xiphoid process and the navel, gradually increasing the pressure until you feel a clear pulsation abdominal aorta. As a result, the heart rate slows and blood pressure decreases; a sharp degree of these reflex phenomena is regarded as an indicator of increased excitability of the parasympathetic department. Sometimes reflexes of the sympathetic order also occur simultaneously - dilation of the pupils, etc. This is explained by the presence of both sympathetic and parasympathetic innervation in the solar plexus.

How does the autonomic nervous system affect the body?

When studying the autonomic nervous system, various hormonal studies are carried out due to the possibility of developing neuroendocrine disorders. A number of studies are also being conducted to determine the emotional and personal characteristics of a person to determine his mental state.

A detailed study of changes in autonomic innervation in diseases of internal organs can help make an accurate diagnosis and determine the area for the use of reflex therapy.

Dysfunctions of the autonomic nervous system are usually present in the clinic of every disease of the nervous system. But there are diseases in which autonomic disorders are leading. They are caused by damage to the autonomic formations of the nervous system. The forms of diseases are distinguished depending on the level of damage to the autonomic nervous system.

Vegetative-vascular dystonia is a symptom complex that includes many different symptoms of the of various etiologies. The most common synonyms for this disease are vegetative neurosis, neurocirculatory dystonia and autonomic dysfunction syndrome. In the clinical picture of vegetative-vascular dystonia, there are more than a hundred different symptoms, the main cause of which is dysfunction of the autonomic nervous system.

Vegetative-vascular dystonia syndrome is a very common pathology. It is diagnosed in 60–70 percent of cases in adults and in 10–15 percent in children and adolescents. In 98 percent, patients complain of pain in the heart and palpitations, in 96 percent of weakness and malaise, and in 90 percent of headaches. In addition to physical symptoms, neurotic disorders such as restlessness and anxiety are also observed ( 85 – 90 percent), decreased mood ( 90 – 95 percent). There are also sleep disorders in 80 percent and respiratory disorders in 85 percent. Every second person complains of cold extremities and chilliness in them, every third person complains of abdominal pain and every fourth person complains of hot flashes. 30 percent of men experience a decrease in libido that is not associated with any organic damage.

Interesting facts about vegetative-vascular dystonia

The diagnosis of vegetative neurosis is universal - many symptoms and syndromes fit it. Thus, to date, 150 symptoms and 40 syndromes of this disease have been described. This explains the fact that vegetative-vascular dystonia has the features of many diseases. That is why this diagnosis is made in excess. Sometimes the patient literally “everything” hurts, which makes vegetative neurosis syndrome especially “convenient” in such cases. Also, very often this pathology is diagnosed when no other reasons for the patient’s complaints have been found.

At the same time, despite the abundance of symptoms, there are no uniform criteria for this diagnosis, nor a consensus on the mechanism of its causes. Academician Wayne believed that the cause of dystonia is acute or chronic stress. This is confirmed by high efficiency psychotherapeutic approach in the treatment of this disease.

In Western countries, this syndrome is more often part of a somatoform ( bodily) cardiac dysfunction or psychovegetative syndrome. This syndrome is observed in panic disorders, neuroses, phobias and post-traumatic disorders.

What is the autonomic nervous system?

There are practically no pathologies in the development of which the autonomic nervous system does not take part. In turn, it contains the sympathetic and parasympathetic divisions.

Sympathetic nervous system

The processes of neurons that are located in the spinal cord go to the sympathetic nerve trunk, which is located on both sides of the spine. He, being important structure This section consists of 23 nodes, including 3 cervical nodes, 12 thoracic nodes, 4 abdominal nodes and 4 pelvic nodes. Interrupting at the nodes of the trunk, the fibers of the neurons leave it and go to those organs and tissues that subsequently innervate. Thus, the fibers that are interrupted in the cervical nodes innervate the tissues of the neck and face, and those in the thoracic nodes go to the heart, lungs and other organs of the chest cavity. From the abdominal nodes, fibers approach the kidneys and intestines, and from the pelvic nodes - to the pelvic organs ( bladder, rectum). In addition to organs, fibers of the sympathetic nervous system innervate blood vessels, sweat and sebaceous glands, skin

Thus, the autonomic nervous system directly or indirectly regulates all internal organs.

Effects of the sympathetic nervous system on the organs it innervates

Parasympathetic nervous system

The neurons of the parasympathetic nervous system are located in the spinal cord at the level of the sacrum ( peripheral part of the system) and in the brain ( central department). At the level of the brain, neurons are grouped into so-called autonomic nuclei. These nuclei are either part of other cranial nuclei or exist separately. Fibers from the nuclei of the parasympathetic nervous system go as part of the cranial nerves to various organs. Thus, fibers from the Edinger-Westphal nucleus go as part of the oculomotor nerve to the muscles of the eyeball and the pupil, as part of the facial nerve - to salivary glands, as part of the vagus nerve - to the internal organs.

Effects of the parasympathetic nervous system on the organs it innervates

In its natural state, parts of the autonomic nervous system are in constant tension, called “tone.” The predominance of parasympathetic tone is called vagotonia, while the dominance of sympathetic effects is called sympathicotonia. Based on this, all people can be divided into vagotonics and sympathotonics.

Despite the opposing effects of these parts of the nervous system, they are normally in a “balanced” state. If necessary, the body activates one or another mechanism. Thus, excitement and fear are accompanied by activation of the sympathetic nervous system with a further increase in blood pressure, the release of stress hormones, and the production of cold, viscous sweat. With vegetative-vascular dystonia, the synchronicity of the work of these parts of the nervous system is disrupted. The work of the autonomic nervous system ( whether sympathetic or parasympathetic) gets out of control and begins to work regardless of the needs of the body. So, increased sweating can occur almost constantly, regardless of the presence of stress or elevated air temperature.

In the clinical picture of vegetative-vascular dystonia, a predominance of the parasympathetic or sympathetic system can be observed. But, at the same time, combined syndromes can be observed.

Causes of vegetative-vascular dystonia

The causes of the development of vegetative-vascular dystonia are:

• hereditary predisposition;
• spicy or chronic stress;
• climate change;
• neurological and somatic ( bodily) pathology;
• hormonal changes in the body;
• mental illness.

Hereditary predisposition

However, in addition to certain character traits that an individual inherits, the family atmosphere, upbringing and environment play a big role. A child, being in constant tension, even without a hereditary predisposition, can already show symptoms of vegetative neurosis from a young age.

Some experts even identify vegetative-vascular dystonia of a hereditary-constitutional nature. This type of dystonia manifests itself in adolescence and is characterized by unstable autonomic parameters.

Acute or chronic stress

Climate change

Neurological and somatic ( bodily) pathology

The condition for the development of psychovegetative syndrome is the presence of pain due to any pathology. Thus, pain in the heart that occurs once is recorded by a person and interpreted by the body as a threat. In response to this, stress mechanisms are activated in the body, for which the sympathetic system is responsible. Further fixation of the patient’s feelings about his illness and its outcome leads to overstrain of the autonomic nervous system. An imbalance between both parts of the autonomic nervous system leads to the development of dystonia. Combined variants may also be observed, in which vagotonia may be replaced by severe sympathicotonia.

Hormonal changes in the body

Vegetative changes during menopause are also caused by changes in hormonal levels. A decrease in estrogen levels is accompanied by hot flashes and fluctuations in blood pressure.

Mental illness

Under the influence of stress factors, vegetative-vascular dystonia can occur even in harmonious and emotionally stable individuals. However, it most often occurs in accentuated individuals. As a rule, these are anxious and excitable personality types.

Symptoms of vegetative-vascular dystonia

Syndromes and symptoms of vegetative-vascular dystonia are:

• cardiac dysfunction syndrome;
• respiratory syndrome;
• asthenic syndrome (or exhaustion);
• thermoregulation disorders;
• fainting conditions;
• neurotic disorders.

Cardiac dysfunction syndrome

In addition to pain, patients with vegetative-vascular dystonia may experience fluctuations in blood pressure. In this case, a person’s blood pressure may rise sharply and also drop sharply. This phenomenon is called a vegetative crisis. Its origin is associated with a sharp and short-term activation of the sympathetic nervous system. It stimulates the receptors of blood vessels, causing them to sharply spasm.

Very often this phenomenon is accompanied by the release of cold, sticky sweat ( vegetative hyperhidrosis). Since the sweat glands are innervated by the sympathetic nervous system, its activation leads to an increase in their secretion.

Respiratory syndrome

Asthenic syndrome

Children and adolescents experience a decline in intellectual function. At the same time, the decline in academic performance is not due to any brain damage, but due to the inability to concentrate and absent-mindedness. Children are quick-tempered, irritable, and do not tolerate stress well.

Thermoregulation disorders

Very often, patients with vegetative-vascular dystonia experience low-grade fever ( 37 degrees Celsius). At the same time, fluctuations in body temperature are also observed from 36.7 to 37.1 degrees Celsius. It is important to note that this fever does not respond to anti-inflammatories, antibiotics, or other medications.

Fainting conditions

Neurotic disorders

In one fourth of cases, vegetative-vascular dystonia is complicated by the development of depression. This may be anxiety or hypochondriacal depression. In patients, depressed mood and its fluctuations throughout the day come to the fore. With hypochondriacal disorder, the patient is constantly busy with his health. He is overcome by fears about the outcome of the disease. As a rule, people suffering from vegetative-vascular dystonia constantly visit doctors, each time overwhelming them with new complaints. They constantly measure temperature, pressure, pulse, and also look for new methods of treatment.

Drug treatment of vegetative-vascular dystonia

• sedatives;
• medications that affect the cardiovascular system;
• anti-anxiety drugs and antidepressants.

Drugs used in the treatment of vegetative-vascular dystonia

Sanatorium-resort treatment of vegetative-vascular dystonia

• climatic;
• balneological;
• mud therapy

Climatic resorts

Spa treatment in coastal areas
The healing effect of visiting medical institutions located in coastal areas lies in the healing effects of sea water and air on the body.

Sea air does not contain dust and is saturated with a large number of useful elements. Under the influence of air, metabolism accelerates and the functioning of the circulatory system is activated. Bromine, which is present in large quantities in sea air, strengthens the body’s nervous system and helps normalize the emotional background. Sea water is a source of elements that have a healing effect on patients with vegetative-vascular dystonia.

Substances that are part of sea water and help cure this disease are:

• calcium – normalizes sleep and helps fight depression;
• magnesium – helps fight irritability and nervousness;
• bromine – has a beneficial effect on the nervous system;
• manganese – strengthens the immune system;
• selenium – improves the functioning of the heart and blood vessels;
• iodine – normalizes the functioning of the brain and immune system.

• chemical – useful elements contribute to achieving healing effect;
• mechanical - the pressure of a large mass of water when swimming is a hydromassage, which helps improve blood circulation;
• physiological - the temperature difference between sea water and the human body helps to increase heat transfer, due to which metabolic processes in the body intensify;
• psychotherapeutic – waves and gentle rocking of water have a calming effect on a person.

Climate treatment in mountain sanatoriums
The mountain climate is characterized by clean air with low oxygen content. Once in the body, such air improves the functionality of the circulatory system. The positive effect of mountain air masses is also due to the large number of negative ions in their composition. The climate in the mountains helps to improve blood composition and activate metabolism, which gives positive results in the treatment of this pathology. Staying outdoors calms the nervous system and has a beneficial effect on the body's immunity.

Procedures carried out at climatic resorts
The basis of treatment carried out at climatic resorts is the dosed effect on the body of climatic factors and special procedures.

The main methods of climatotherapy are:

• heliotherapy - sunbathing;
• hypoxic therapy - treatment mountain air;
• aerotherapy - exposure to fresh air on the naked ( completely or partially) body;
• speleotherapy – visiting karst caves, grottoes, salt mines and mines;
• thalassotherapy - therapeutic procedures using algae, water and other marine products.

Balneological resorts

Balneotherapy methods for vegetative-vascular dystonia are:

• souls ( fan, circular, underwater, Charcot shower) – help stabilize vascular tone;
• shared and private baths ( nitrogen, coniferous, pearl, oxygen) – have a calming effect;
• contrast mineral baths – improve blood circulation.

• for hypertensive and cardiac types of disease, radon, hydrogen sulfide, iodine-bromine waters are indicated;
• for hypotensive vegetative-vascular dystonia, procedures using iodine-bromine waters are recommended;
• in case of vasomotor syndrome, the patient is shown hydrogen sulfide and carbon dioxide baths;
• radon and nitrogen baths help with nervous excitement;
• in case of exhaustion, carbon dioxide baths are prescribed;
• for sympathicotonia, treatment based on sulfamide waters is useful.

Mud resorts

• mud baths;
• local mud applications;
• mud wraps;
• the combined effects of dirt and electric current ( electrophoresis of mud).

Rehabilitation treatment

Spa treatment methods include:

• massage ( general and point);
• reflexology;
• physical therapy;
• psychotherapy;
• physiotherapy;

Reflexology
Reflexology is the use of needles, a magnetic field, a laser or an electrical impulse on active points of the body located on the surface of the skin. Stimulation of reflex zones has a beneficial effect on the nervous system and, in combination with other methods, gives positive results in the treatment of vegetative-vascular dystonia.

Physiotherapy
Physiotherapeutic treatment methods help strengthen vascular tone, normalize blood circulation and activate the body's metabolic processes.

The most common physical procedures include:

• electrophoresis ( administering drugs through the skin using an electric current);
• electrosleep ( effects of weak electrical impulses on the brain);
• magnetotherapy ( treatment using a magnetic field);
• laser therapy ( procedures using special physiotherapeutic lasers).

Physiotherapy
Therapeutic exercise includes sets of exercises and physical activity, the purpose of which is to strengthen and increase the body's resistance. Exercising helps normalize blood pressure, promotes emotional release and improves the functioning of the circulatory system.

• aerobics in water;
• swimming;
• outdoor sports walking;
• skiing, skating.

Types of sports activities that are not recommended for this disease are:

• strength gymnastics;
• body-building;
• high jumps;
• somersault;
• somersaults;
• oriental martial arts.

Diet
A balanced diet in sanatoriums allows patients to achieve positive results in the treatment of vegetative neurosis. The menu of such institutions includes dishes that contain a sufficient amount of vitamins and other useful elements that help the body fight this disease.

The products that are emphasized in spa treatment are:

• fresh vegetables and fruits;
• porridge ( mostly buckwheat and oatmeal);
• dairy and dairy products;
• Fish and seafood.

Duration of spa treatment

When starting a sanatorium-resort treatment, many patients are faced with such a factor as acclimatization ( adaptation). This phenomenon manifests itself as a short-term decrease in the intensity of work of all body systems and is explained by a change in the usual lifestyle. During the adaptation period, strong medical procedures should be avoided. It is also necessary to adhere to a regime that helps reconfigure the body. If these rules are not followed, the patient’s health condition may deteriorate to such an extent that sanatorium treatment becomes impossible.

Physiotherapy in the treatment of vegetative-vascular dystonia

Physiotherapeutic treatment methods for this autonomic disorder include:

• electrosleep;
• electrophoresis;
• darsonvalization;
• galvanization;
• laser therapy;
• magnetic therapy;
• inductothermy;
• aeroionotherapy.

The effects that physiotherapy produces on a patient with vegetoneurosis are:

• calming – electrosleep, electrophoresis of sedative drugs, aeroionotherapy;
• tonic – magnetic and laser therapy, inductothermy;
• vasodilator - galvanization, local darsonvalization;
• vasoconstrictor - electrophoresis of adrenaline and other adrenomimetic agents ( medications that stimulate adrenergic receptors);
• antiarrhythmic - electrophoresis of potassium chloride, lidocaine.

With the hypotensive nature of the disease, the pulse frequency ranges from 10 to 40 Hertz. Begin the course of treatment with minimum values, subsequently increasing them. For any type of vegetative neurosis, the duration of the first procedure will be 30–40 minutes, and after 2–3 sessions the time is increased by 5 minutes.

Electrophoresis
Drug electrophoresis is a method of administering drugs through the skin or mucous membranes of the body using an electric current. During the procedure, a special pad moistened with a medication solution is placed on the patient’s body. A protective hydrophilic layer is fixed on top, on which the electrode is installed. Electrophoresis is prescribed in accordance with the type of vegetative-vascular dystonia.

Electrophoresis for hypertensive type of vegetoneurosis
In case of hypertensive syndrome, the procedure is carried out using the method of general exposure or on the collar area. The current strength is from 10 to 15 milliamps, the duration of exposure is 15 to 20 minutes.

Medicines that are used to perform electrophoresis for this type of disorder are:

• sodium solution ( 5 – 10 percent);
• potassium bromide ( 5 – 10 percent);
• magnesium sulfate ( 5 percent);
• aminophylline solution ( 1 percent);
• papaverine ( 2 percent);
• dibazole ( 1 percent);
• anaprilin ( 40 milligrams).

Electrophoresis for hypotensive vegetative-vascular dystonia
For this type of autonomic disorder, it is recommended to perform electrophoresis using caffeine. The duration of the procedure ranges from 10 to 20 minutes with a current strength of 5 to 7 milliamps. The systematic nature of the treatment is 15 sessions, which are carried out every other day. Also, for this type of disease, electrophoresis based on mesatone can be prescribed. If the patient suffers from insomnia and severe neurotic disorders, bromine electrophoresis on the collar area is recommended. If severe asthenia manifests itself, the patient undergoes electrophoresis using a galvanic anode collar according to Shcherbak.

Electrophoresis for cardiac dystonia
In case of autonomic disorder of the cardialgic type, electrophoresis using a solution of novocaine is prescribed ( 5 – 10 percent) and nicotinic acid. Procedures are carried out according to the principle of general exposure or the cardiac method. The second method involves placing electrodes in the heart area and between the shoulder blades.
If the patient has an arrhythmic syndrome, he is prescribed electrophoresis using panangin ( 2 percent) or anaprilin using the cardiac method.

Local darsonvalization
Darsonvalization is a medical procedure in which certain areas of the patient’s body are exposed to pulsed alternating current, the characteristics of which are low frequency, high voltage and weak strength. This procedure has a vasodilating and stimulating effect on the body.
In the cardiac form of the disease, darsonvalization in the heart area is prescribed. If you are predisposed to cerebral vascular spasms, electric shock is applied to the area cervical region. The course of treatment ranges from 6 to 10 sessions, which are carried out every day.

Galvanization
During galvanization, the body is exposed to direct current, which has low voltage and low power. Metal plates are applied to the patient's body, to which current is supplied from the device using a wire. To avoid damage, a protective pad made of material that absorbs water is fixed between the electrode and the skin. When the equipment is turned on, the current strength begins to increase, and towards the end of the session it decreases. The duration of the procedure depends on the specifics of the disease and can range from 10 to 30 minutes.

The effects of galvanization in the treatment of vegetative neurosis are:

• increased blood circulation;
• increased vascular permeability;
• stimulation of the nervous system;
• improvement of metabolism.

Magnetic therapy
Magnetic therapy in the treatment of vegetative-vascular dystonia is a method physical impact on the human body by a magnetic field of a constant or variable nature. The magnetic field is perceived by all systems of the body, but the nervous system is most sensitive to it. The effect of these procedures is manifested in stabilizing the emotional background of patients, improving sleep, and reducing the level of nervous tension. The magnetic field also has a beneficial effect on the cardiovascular system, which is reflected in a decrease in blood pressure and normalization of the pulse.

The effects of magnetic therapy in the treatment of this autonomic disorder are:

• activation of metabolism;
• increased peripheral vascular tone;
• improving blood circulation.

Aeroionotherapy
Aeroion therapy is a treatment method in which the patient inhales air saturated with negative ions. To carry out the procedures, special air ionizer devices for individual or collective use are used. The patient is located at a distance of a meter from the equipment and inhales air for 20–30 minutes. When undergoing a course of treatment, the duration of which is 12–14 sessions, patients experience a decrease in blood pressure, a decrease in the number of heartbeats, and normalization of sleep. In addition, after this method of physiotherapy, the intensity of headaches decreases, weakness disappears and the body’s immune processes are activated.

Contraindications for physiotherapy

Absolute contraindications for all types of physiotherapeutic procedures are:

• diseases of the cardiovascular system in the acute stage;
• malignant neoplasms;
• mental illness;
• severe blood diseases;
• tuberculosis in the active stage;
• cerebral atherosclerosis;
• hypertension ( Stage 3);
• body temperature from 38 degrees and above.

Traditional methods of treating vegetative-vascular dystonia

• agents for the treatment of hypertensive type dystonia;
• medications intended for hypotensive diseases;
• drugs for the treatment of autonomic cardiac disorders;
• folk recipes for all types of this vegetative disease;

Treatment of hypertensive dystonia with folk recipes

• hawthorn;
• magnolia;
• mint;
• valerian;
• chokeberry;
• barberry;
• viburnum.

Remedy made from hawthorn berries and flowers
The components needed to make the decoction are:

• dried hawthorn flowers - half a tablespoon;
• dry hawthorn berries - half a tablespoon;
• water – 250 milliliters ( 1 glass).

Magnolia tincture
Magnolia leaves are used for the tincture, which must be purchased in specialized herbal stores. The crushed fresh plant should be filled with alcohol ( 96 degrees) at a rate of one to one and leave for two weeks, protecting the vessel from sunlight. The strained tincture should be taken 20 drops daily, mixed with 50 milliliters of water. The product helps to equalize blood pressure and also has a positive effect on functionality immune systems body.

Honey infusion with valerian and dill seeds
This traditional medicine helps to alleviate the patient’s condition with vegetative pathology of a hypertensive nature.

The products that you need to purchase for the infusion are:

• valerian root – 2 tablespoons;
• dill seeds – 1 cup;
• natural honey– half a glass ( 150 grams);
• water – 2 cups ( half a liter).

Viburnum juice for vegetative neurosis of the hypertensive type
Juice from viburnum berries not only normalizes blood pressure, but also activates protective functions body, helping the patient more effectively fight the disease. To squeeze juice from viburnum, pour boiling water over the berries and lightly mash them with your hands. Place the mashed berries in gauze, folded several times and put under pressure or squeeze firmly with your palms so that the juice flows out. The freshly prepared product should be mixed with May honey in a ratio of one tablespoon per hundred milliliters of juice.

Collection of herbs for the treatment of hypertensive dystonia
Buy components for this folk remedy needed at the pharmacy. When prepared, the herbal decoction has a short shelf life, which does not exceed 1 - 2 days. Therefore, it is worth steaming the plants daily, and storing the drink in the refrigerator during the day.

The herbal ingredients of the collection are:

• valerian root – 20 grams;
• lily of the valley flowers – 10 grams;
• hawthorn flowers – 20 grams;
• peppermint – 15 grams;
• fennel – 15 grams.

Combined herbal tea
With this autonomic disorder, it is necessary to reduce the amount of tea and coffee consumed. You can replace these drinks with herbal tea, the components of which help reduce blood pressure and have a mild sedative effect.

The ingredients needed to brew tea are:

• chokeberry;
• barberry;
• black currant;
• blueberry.

Folk remedies for the treatment of vegetative neurosis of the hypotensive type

Plants used to treat dystonia hypotonic type, are:

• ginseng;
• Eleutherococcus;
• St. John's wort;
• Rhodiola rosea;
• immortelle;
• juniper;
• dandelion;
• stinging nettle;
• Chinese lemongrass.

Rhodiola rosea tincture
To prepare the tincture, you need to purchase Rhodiola rosea root at the pharmacy. It should be borne in mind that the leaves of this plant lower blood pressure, so the underground part of the flower is needed for the tincture. It is necessary to grind the dry rhizome in an amount of 100 grams and pour it with vodka or alcohol diluted to 40 degrees. Place the container with the composition in a place where it does not penetrate sunlight, and shake periodically throughout the week. Before use, the tincture must be made less concentrated by adding water in a ratio of 1 to 5.

Herbal tea from St. John's wort
This folk remedy has a pleasant taste, is well invigorating and has no restrictions on use. To prepare the tea mixture, place 10 parts of St. John's wort and 1 part of angelica in a hermetically sealed fireproof container. Herbs must be used fresh. Place the vessel with the raw materials in the oven and keep on low heat for 3 hours. Grind the steamed raw material and use it instead of tea leaves. To extend the shelf life of plant materials, they can be divided into portions and frozen.

Decoction with immortelle
Sandy immortelle fights fatigue, apathy and increases blood pressure. A tablespoon of fresh herb should be poured with a glass of water, the temperature of which is 70 - 80 degrees. If dry raw materials are used, then they need to be steamed with boiling water. You need to use the decoction throughout the day, dividing the amount into 3 doses.

Schisandra chinensis decoction
To prepare a decoction of Chinese lemongrass, the fruits of the plant in the amount of 2 tablespoons should be poured with a glass of water. Place the container on the fire, wait for it to boil and let stand for 5 minutes. You need to consume the resulting amount of infusion throughout the day, dividing it into 3 doses.

Juniper fruits in the treatment of vegetoneurosis of the hypotonic type
The active ingredients that are part of juniper fruits help normalize blood pressure and fight well against general weakness of the body. Berries can be added as seasonings when preparing pork, beef, and chicken dishes. Separate consumption of juniper berries also has a beneficial effect. You should start with 1 piece, increasing their quantity by 1 more berry every day. After 3 - 4 weeks of treatment it is necessary to stop.

Combined preparation to combat hypotensive dystonia
The constituent elements of this folk remedy are:

• Rhodiola rosea root – 20 grams;
• Echinacea flowers – 20 grams;
• hop cones – 10 grams;
• May honey – 2 teaspoons;
• water – 250 milliliters.

Herbal mixture for the treatment of dystonia with low blood pressure
The components of this drug are:

• dandelion ( leaves) – 10 grams;
• gray blackberry ( leaves) – 20 grams;
• stinging nettle ( leaves) – 20 grams;
• water – 250 milliliters ( 1 glass).

It is necessary to use plant raw materials for making herbal infusion after preliminary grinding. This will reduce the time required to infuse the decoction. The drink must be prepared daily, as it will spoil the next day. To do this, bring the water to a boil and steam the dry plants with boiling water. Wrap the vessel with the composition and leave for one hour. After this, the infusion needs to be filtered and drunk 30 milliliters ( 2 tablespoons) 3 times a day.

Traditional recipes for the treatment of cardiac dystonia

The components on which the treatment of dystonia with cardialgia syndrome can be based are:

• raisin;
• mint;
• rose hip;
• rosemary;
• valerian.

Healing collection to strengthen the heart muscle
This folk remedy helps fight heart pain, which is characteristic of this type of pathology.

The components of the herbal mixture for the treatment of cardiac dystonia are:

• mint;
• hop;
• rosemary;
• valerian;
• hawthorn;
• St. John's wort.

Herbal tea for the treatment of vegetoneurosis of the cardialgic type
This folk remedy contains plants that promote normal heart function. This tea also contains a large number of vitamins and useful elements that help strengthen the body's protective functions.

The components of tea are:

• valerian;
• hawthorn;
• rose hip;
• raspberries ( greenery);
• coltsfoot.

A drug for the treatment of vegetative neurosis with cardiac syndrome
A decoction prepared from the seeds of dill, wormwood, mint, and linden has a mild calming effect and helps reduce pain in patients with this pathology. Dried and crushed plants should be combined in equal proportions. To prepare the drink, add 2 tablespoons of herbs to water and bring to a boil on the stove. After cooling the broth, it must be filtered and taken one third of a glass 3 times a day.

A mixture of tinctures to normalize cardiac activity in dystonia
This remedy helps improve the patient’s condition with a cardiac-type autonomic disorder, because it strengthens blood vessels and improves the functionality of the heart. This folk medicine is made from tinctures, which must be purchased ready-made at the pharmacy.

The components of the combined tincture for the treatment of this pathology are:

• peony tincture – 100 milliliters;
• hawthorn tincture – 100 milliliters;
• valerian tincture – 100 milliliters;
• motherwort tincture – 100 milliliters;
• eucalyptus tincture – 50 milliliters;
• mint tincture – 25 milliliters;
• cinnamon grains – 10 pieces.

Folk remedies with a general spectrum of action for dystonia

• means for normalizing sleep and stabilizing the emotional background;
• medications to help relieve fatigue

Herbs that have a sedative effect include:

• lavender;
• Melissa;
• peppermint;
• violet;
• chamomile.

• lavender ( flowers) – 50 grams;
• peppermint ( leaves) – 50 grams;
• chamomile ( flowers) – 75 grams;
• valerian ( root) – 75 grams.

Combination evening tea
The medicinal plants from which tea is prepared to treat this autonomic disorder are:

• Veronica officinalis ( grass);
• violet ( grass);
• lavender ( flowers);
• barberry ( berries);
• Melissa ( leaves).

Herbal tea with calming effect
This folk remedy not only calms the nervous system, but also activates the body's protective functions.

The components of the collection are:

• St. John's wort;
• peppermint;
• Melissa;
• valerian;
• common hop cones.

Soothing baths for the treatment of dystonia
Baths using herbal extracts help to relax, relieve muscle tension and normalize sleep.

The rules for baths for good sleep are:

• dim lights in the bathroom;
• The water should not be hot, but warm ( 35 – 37 degrees);
• staying in the bath should not exceed 15 minutes;
• After the bath you need to take a warm shower.

Plants that can be used for water procedures for vegetative neurosis are:

• lemon balm;
• valerian;
• lavender;
• oregano

Soothing baths with essential oils
Baths with essential oils added to water have an effective effect. To avoid skin irritation, essential oil can be mixed with honey or milk before adding to water. The dosage of essential oil is 3 – 4 drops per whole bath.

Plants, essential oils which contribute to good sleep are:

• jasmine;
• lavender;
• neroli;
• sweet marjoram.

General strengthening agent with pomegranate
The biologically active components included in this remedy for the treatment of autonomic dysfunction help restore the patient’s physical and mental fitness. This recipe also normalizes the functionality of the circulatory system, thanks to pomegranate juice.

The ingredients of the drink are:

• birch leaves ( fresh) - 100g;
• Kalanchoe leaves – 150 grams;
• pomegranate juice – 125 milliliters;
• water – 250 milliliters.

Tincture of enticement
Zamanika high is a plant that has an effective positive effect on mental and physical exhaustion. The tincture purchased at the pharmacy should be consumed in the amount of 30 - 40 drops twice a day, thirty minutes before meals. People who suffer from sleep disorders should avoid this remedy.

Rose hip drink
Rosehip contains a large number of active elements that help fight fatigue. To prepare the infusion you need 20 grams of fruits ( dry or fresh) steam with two glasses of boiling water in a thermos. The next day, add sugar or honey to the infused rose hips and take half a glass 3 times a day.

Remedy with red wine for low energy
To prepare this folk remedy you need red dessert wine ( for example, Cahors). Wine in the amount of 350 milliliters must be mixed with 150 milliliters of fresh aloe juice and 250 grams of May honey. To maximize the benefits of aloe, the plant should not be watered for several days before cutting off the lower leaves. Aloe needs to be washed, crushed, add wine and honey and leave for 7 - 10 days. The temperature in the place where the container is stored should not exceed 8 degrees. After the infusion is ready, it should be filtered and taken a tablespoon three times a day.

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