Functional cardialgia. Diagnosis of functional disorders of the cardiovascular system. Treatment of cardiovascular diseases
Functional disorders of the cardiovascular system, or so-called cardiac neuroses, or cardiovascular neuroses, occupy a large place among cardiovascular diseases and are often the cause of decreased ability to work.
Modern diagnosis of cardiovascular neurosis and its proper treatment are of great importance for the prevention of organic damage to the cardiovascular system, since the disease, starting with functional disorders, ultimately leads to organic changes. Therefore, we can talk about a purely functional disorder of the cardiovascular system of neurogenic origin only at a certain stage in the development of the pathological process.
Further various influences(trophic, vasomotor, etc.) of the nervous system can and do lead to structural changes; over time they join and age-related changes. In general, from the standpoint of Pavlovian teaching, it is impossible to draw a sharp line between organic and functional disorders of the cardiovascular system, because these processes are closely related, and a functional disorder successively turns into an organic one. However, from the point of view of treatment practice, it is very important to distinguish between functional pathology and organic one. Therefore, modern diagnosis and treatment of functional cardiac disorders are necessary and important.
Functions of the cardiovascular system are under the influence and control of the nervous system, and their disorders may depend both on damage to the heart itself and on nervous influences. Changes in the nervous system innervating the cardiovascular system at any level, from interoceptors in the walls of the coronary vessels and myocardium to the cerebral cortex, can have a pathological effect on the heart. These changes can be organic or functional in nature. Disorders of cardiovascular functions as a result of pathological influences from the nervous system are defined as functional, neurogenically caused.
Until now, there is a lot of confusion and much that is unclear in the assessment of patients with cardiovascular neurosis. There was a time when the so-called cardiac neurosis was isolated as an independent nosological form, but this term met with sharp objections in connection with its introduction into clinical practice the term neurosis in Pavlov's understanding. If by neurosis we mean a disorder of higher nervous activity due to overstrain of nervous processes, psychotraumas (disturbances), then without appropriate reservations the term “organ neurosis” becomes unacceptable. Therefore, other terms began to be used: neurocirculatory asthenia, soldier’s heart, irritable heart, autonomic neurosis, vegetative dystonia, etc.
Numerous experimental and clinical studies in the subsequent period have shown that all parts of the extra- and intracardial nervous system can cause changes in the functions of the cardiovascular system.
Meanwhile, the clinic still does not make such a differentiation of neurogenic functional disorders, and they are considered either as something single called cardiovascular neuroses, or as neurocirculatory dystonia or asthenia. Therefore, almost as a rule, the underlying nervous disease remains unrecognized; hence the incorrectness of the treatment.
Currently, some authors emphasize that disorders designated as organoneuroses represent a collective group that includes toxic “li infectious lesions nerve trunks and centers of the autonomic nervous system. G.F. Lang also pointed out this, believing that the so-called cardiovascular neuroses include little-known and poorly diagnosed lesions of the vegetative trunks and nodes.
Currently, clinicians already have a sufficiently studied picture of some diseases of the autonomic nervous system - sympathetic ganglionitis and diseases of the diencephalic region, which can be transferred to cardiological practice and talk about different forms functional neurogenic disorders of the heart and blood vessels, distinguishing them from the general group of cardiac neuroses.
So, we can assume that functional disorders of the cardiovascular system can be caused by various pathological conditions at any level of the nervous system that regulates the activity of the heart and blood vessels. They cannot be reduced to one form. Functional disorders of neurogenic origin should be distinguished, with an obligatory indication of which one. Thus, functional disorders of the cardiovascular system are not a disease, but syndromes, and a neurological diagnosis is needed with subsequent determination of the nature of the cardiovascular disorders.
Very often the patient is bothered by heart complaints, and he, bypassing the neurologist, turns to the therapist. The latter avoids neurological examination, as a result of which the underlying neurological disease remains unrecognized. The doctor, having determined the presence of a functional disorder of the cardiovascular system and excluding its organic damage, should try to find out the cause of these disorders, and not be satisfied with the diagnosis: cardiac neurosis without differentiating lesions of the nervous system.
As the cause of functional disorders of the cardiovascular system, neurosis in the Pavlovian understanding with its neurasthenic, hysterical and psychasthenic forms comes first.
Neurosis is based on a violation of the functional state of the cerebral cortex as a result of overexertion of strength, mobility and balance of nervous processes. The cause of neurosis may be frequent repeated mental trauma or acute mental trauma, overwork of the nervous system by prolonged and intense mental work.
Mental trauma and emotions such as fear, anxiety, melancholy, concern, cause extensive autonomic reactions that affect the functions of all internal organs, especially the cardiovascular system. The work of physiologists from the school of I.P. Pavlov showed the connection between the function of the cerebral cortex and the function of internal organs.
The regulatory role of the cerebral cortex in relation to internal organs is carried out through vegetative department nervous system with the participation of endocrine-humoral factors. The pathogenesis of functional disorders of internal organs in neuroses is currently looked at from the perspective of the leading role of disorders of autonomic innervation. However, with neuroses, vegetative disorders are not associated with primary lesion vegetative centers, but with a weakened inhibitory influence of the cortex.
Autonomic disorders arise secondary to changes in the relationship between the cortex and the autonomic centers of the subcortical areas. Let us only note that in the clinical picture of cardiovascular neurosis there are pronounced autonomic disorders (so-called vegetative neuroses).
Autonomic disorders are manifested by vascular lability, vasomotor disorders, acrocyanosis, altered dermographism, a feeling of heat, sweating, etc. There are often vegetative-vascular crises of the diencephalic type, manifested by an increase (hypertension) or a decrease in blood pressure, tachycardia, chill-like tremors, paleness or redness of the skin etc. Most neurologists regard these disorders as secondary diencephalic disorders.
In patients with neuroses and functional cardiovascular disorders, “sore points” easily appear, that is, foci of stagnant excitation and parabiotic inhibition in the sections of the cortex and subcortex that innervate the cardiovascular system.
Diseases of the diencephalic region with their characteristic vegetative crises are of significant importance. This group largely includes patients who were previously diagnosed with vegetative neurosis. Cardiovascular disorders are most pronounced in the vegetative-vascular form of diencephalic pathology (according to the classification of N. I. Grashchenkov). The main clinical manifestation of these forms of pathology are vegetative-vascular crises of a sympathetic-adrenal, vagotonic or mixed nature, combined with functional disorders of the cardiovascular system, sleep disorders, causeless anxiety and fear, often metabolic disorders. However, the predominant symptoms are vegetative-vascular crises, cardiac pain syndrome and dysfunction of the cardiovascular system.
Sympathetic-adrenal crises are characterized by the appearance of pallor, tachycardia, heart pain, and increased blood pressure. Vagotonic crises are manifested by bradycardia, hypotension, salivation, the urge to defecate, a feeling of heat, hot flashes, weakness, and stiffness of movement.
Between crises, the clinical picture of the disease is dominated by the astheno-neurotic symptom complex: fatigue, irritability, sleep disturbances and autonomic disorders in the form of sweating, pronounced vasomotor reactions, etc.
The clinical picture of sympathetic truncinitis with functional disorders of the cardiovascular system is dominated by symptoms of irritation of the sympathetic nodes.
At present, one can only assume the presence of lesions of the cardiac plexuses, but not diagnose them.
A special, very significant group consists of patients whose functional disorders of the cardiovascular system are reflexive as a result of damage to other organs - the gallbladder, stomach, small and large intestine, etc.
The given forms do not exhaust all diseases of the nervous system in which cardiovascular disorders are observed. They also occur in other diseases of the nervous system, but we will focus only on those forms in the clinical picture of which disorders of the cardiovascular system function come to the fore, and patients are forced to seek help from general practitioners.
We distinguish 4 symptom complexes of functional cardiovascular disorders.
1. Sensory-pain symptom complex, which includes angina pectoris (the so-called angioneurotic, diencephalic and sympathetic-ganglionic form), sympathalgia with sympathico-ganglionitis, central pain with diencephalic lesions, cardialgia with neuroses and all kinds of unpleasant sensations in the heart area, pathological perception of it, sensation of heartbeat with normal contractions and normal heart rhythm.
2. Arrhythmic symptom complex, manifested by tachycardia, bradycardia, rhythm lability, paroxysmal tachycardia (Bouveret type), extrasystole, and conduction disturbances.
3. Dissystolic symptom complex, manifested by disorder contractile function hearts; This side of the issue has still been very little studied. The teaching of I.P. Pavlov about the strengthening and weakening nerve makes us think about the clinical picture of motor neurogenic disorders. This question needs elaboration.
As a rule, pronounced phenomena of decompensation are not observed in patients with functional cardiovascular disorders. However, symptoms of heart failure such as shortness of breath with relatively minor physical exertion and rapid physical fatigue are present in all patients. Many patients experience changes in periods of tension and ejection, diastolic tension, asynchronism of ventricular contractions (“disorder” in the contractile activity of the heart, as indicated by ballistocardiography indicators and phase analysis of left ventricular systole.
4. Vasomotor symptom complex, manifested by sensations of heat and hot flashes, redness or pallor of the face, the appearance of red spots, vasospastic reactions in the periphery, Raynaud's syndrome, acroparesthesia, acrocyanosis, asymmetry of blood pressure, hypotonic and hypertonic reactions, etc.
Identification of syndromes of functional cardiovascular disorders caused by various diseases of the nervous system has not only theoretical, but also practical significance in the development of pathogenetic treatment methods.
Treatment should be aimed at the underlying nerve disorder, causing one or another syndrome of functional disorders of the cardiovascular system. However, there are some general issues in the principles of treatment of various syndromes of functional disorders of the cardiovascular system.
To exclude rheumatism, organic damage to the heart and blood vessels and to determine the patient's syndrome of functional disorders of the cardiovascular system, a neurological diagnosis of the disease that caused this syndrome is necessary. This, as a rule, requires a consultation with a neurologist or a joint examination and observation of the patient by a neurologist and a therapist. Often, along with treatment of diseases of the nervous system, therapy for cardiovascular disorders is also required.
At the same time, the question arises about where to treat patients with functional cardiovascular disorders: in sanatoriums and what profile?
We believe that such patients can be treated in sanatoriums of both neurological and cardiological profiles with the obligatory participation of neurologists and therapists. They can also be sent to cardiological resorts, where consultation with a neurologist is provided. Doctors in cardiological sanatoriums should now already be familiar with the origin, clinical manifestations and treatment of functional disorders of the cardiovascular system of a neurogenic nature.
An enormously high position among vascular and cardiac ailments is occupied by such an ailment as FNS, or cardiac neurosis. These illnesses bring discomfort and also do not provide the opportunity to lead a lifestyle that healthy people lead.
It is important to be able to recognize the disease in time - then there will be no negative consequences. The thing is that FTS can lead to many other diseases that are extremely undesirable.
Causes of functional disorders of the cardiovascular system
Nowadays, there are many reasons that can lead to the acquisition of the Federal Tax Service. The cause of this disease can be either obvious damage to the heart muscle or the harmful effects of various factors on the human nervous system. Our body is one whole, and the fact that negative influences on the nervous system lead to changes in the functioning of the entire organism has long been no secret.
The reason for the FTS may be factors such as:
- Impact of chronic diseases
- Depression
- Severe stress
- Traumatic brain injury
- Heredity
- Severe hormonal changes
Symptoms of functional disorders of the cardiovascular system
Symptoms of FNS include increased sweating, pallor or slight redness of the skin on the face, constant fainting, headache, paroxysmal or constantly increased beating of the heart muscle (tachycardia), tachypnea, heaviness and pressure in the chest, impaired blood pressure, shortness of breath. The patient may also experience rapid fatigue, decreased attention and memory, be overly hot-tempered, irritable, suffer from insomnia and experience a constant state of anxiety. There may be various jumps in body temperature (from 35 to 37-38 degrees), nausea, vomiting, belching, diarrhea, frequent urination, anorgasmia with normal sexual desire, constipation. All this signals the Federal Tax Service.
Diagnosis of functional disorders of the cardiovascular system
Diagnosis of the Federal Tax Service, due to huge amount Factors influencing the diagnosis are made by: neurologist, cardiologist and endocrinologist. Initially, it is necessary to determine the cause of the disorder, after which treatment is prescribed. Then the initial tone of the cardiovascular system is measured, and an ECG and EEG of the brain are prescribed.
Treatment of functional disorders of the cardiovascular system
Healing from this disease implies complex and individual therapy, which is carried out only under the close supervision of an endocrinologist, cardiologist, neurologist or psychiatrist. Treatment of a functional disorder of the cardiovascular system depends on the manifestation of symptoms in the patient. Physical activity and stressful situations are limited, proper rest and good nutrition are recommended. Massage, water treatments and reflexology are also prescribed. Appointment possible medications: mellis, St. John's wort, valerian, motherwort, glycine, antidepressants, glutamic acid.
Prevention of functional disorders of the cardiovascular system
Prevention measures should include a healthy lifestyle, giving up bad habits, normal rest and avoidance of stressful situations. It is also necessary to be outdoors as often as possible and play your favorite sport.
Specialists in the treatment of diseases Functional disorders of the cardiovascular system
- Ultrasound diagnostics doctor (ultrasound) ()
As you know, the leading position among all internal diseases is occupied by disturbances in the activity of the cardiovascular system, which determines the special attitude of patients and doctors to diseases of the heart and blood vessels. In turn, among diseases of the cardiovascular system, maximum attention is traditionally paid to coronary heart disease (CHD), which is based on the narrowing of the lumen of the coronary artery by an atherosclerotic process (the disease is based on organic causes, in this case atherosclerosis). It is atherosclerosis of the coronary arteries that is most often to blame for the development of such widespread known diseases, such as angina pectoris and myocardial infarction. At the same time, it is known that basically various diseases There are not always organic causes. Many so-called functional disorders of various organs and systems of the body have been described, and cardiovascular diseases are no exception.
Among functional disorders of internal organs, the leading place is currently occupied by disorders of the cardiovascular system. In addition, it has been noted (by both domestic and foreign scientists) that the number of patients with functional disorders of the cardiovascular system is steadily increasing and today accounts for at least 15% of all patients in cardiology hospitals.
Causes of development of cardioneuroses.
Unbiased statistics claim that in at least half of patients experiencing various unpleasant sensations in the left half of the chest, the resulting fear for their heart is either exaggerated or completely unfounded. A thorough objective study reveals that this group includes people with a purely neurotic origin of functional disorders, as well as people with very minor organic changes, in which psychogenic layers play the main role in the clinical picture of the disease. It is practically important that in most patients with periodically occurring painful sensations in the heart area, it develops and often becomes permanent. varying degrees severity of fear of death, either from cardiac arrest, or from heart rupture, or from myocardial infarction.
The formation of fear of death is especially often observed in connection with attacks of psychogenic arrhythmia - bradycardia (decreased heart rate), tachycardia (increased heart rate) and extrasystole (feeling of additional heart beats). It is the painful fear of death that turns out to be the leading clinical manifestation of the so-called cardioneuroses.
As a rule, the formation of cardiovascular dysfunction and cardiophobia occurs as a result of a neurotic breakdown due to a difficult life situation and adaptation difficulties. The reason for such a neurotic breakdown is most often a conflict situation in the family or at work, the loss of a loved one, various sexual problems, industrial, social or legal circumstances that are difficult to resolve or practically impossible to resolve, but actively influence the patient’s psyche. In the occurrence of acute attacks of cardialgia of psychogenic origin, i.e. cardialgia without signs of organic heart damage and pathological ECG changes, great importance belongs to active physical activity, all kinds of intoxications, previous operations, somatic or infectious diseases and - especially - long-term psychotraumatic experiences associated with illness.
The influence of the patient’s personality on the formation of cardioneurosis.
Along with depressive traumatic experiences and prolonged stressful situations, the most important reasons for the appearance of painful sensations in the heart area (in the absence of any objective indicators of cardiac disorders) are often well-known factors usually associated with intense work of the heart: prolonged intense physical and psycho-emotional stress, abuse alcohol, excessive consumption of strong coffee, insomnia and some other factors.
The personality type most susceptible to neurosis
It has been established that representatives of different personality types are predisposed to various diseases. People belonging to the so-called coronary personality type show the greatest tendency to myocardial infarction. They are characterized by such qualities as persistence in achieving their goals, determination, ability and desire to compete. These people are not satisfied with little; their level of aspirations is quite high. Their activities are varied, and there is always a lack of time to implement numerous plans. Such a person is constantly on his toes, he must work proactively, he does not allow himself to relax, overcoming fatigue by willpower. It's not just a workaholic; This is a person who is in a state of constant tension, even after the end of the working day. Even at home, he is full of plans and often continues to work. However, if a difficult situation arises that gets out of control, such a person may develop a disease. The disease develops in such cases according to the following scenario: at first, desperate attempts are made to restore lost ground.
These energetic actions are necessary primarily for the self-affirmation of the individual. If the circumstances are unfortunate (the result of the actions taken is negative, the situation continues to remain uncontrollable), the person gives up and falls ill.
Typical psychosomatic disorders of the cardiovascular system include the so-called “neuroses of the heart” - functional disorders of the heart rhythm. Functional heart rhythm disorders manifest themselves the following symptoms: an increase in the number of heart contractions (tachycardia) with the patient simultaneously feeling a rapid heartbeat, spasms in the heart and short-term heart rhythm disorders (arrhythmias). Patients often complain of a feeling of numbness, itching, tingling, burning, coldness, crawling, etc. in various parts of the body (paresthesia), a feeling of pressure in the heart area combined with shortness of breath. Typical complaints are fear of suffocation and fear of myocardial infarction.
Cardialgia.
The word "cardialgia" translated into Russian means pain in the region of the heart. Cardialgia is a symptom of a very large number of different diseases. It is fundamentally important to note that pain in the heart area is not necessarily associated with heart pathology.
Moreover, with the exception of angina and myocardial infarction, pain in the heart area, as a rule, does not pose a threat to health and life.
Thus, cardialgia is a symptom (sign), not a disease.
Classification of cardialgia
Extracardiac cardialgia
All cardialgia can be divided into two large groups: cardialgia of cardiac and extracardiac (non-cardiac) origin. Extracardiac cardialgia can develop under the following conditions:
For diseases of the peripheral nervous system and muscles shoulder girdle(including in connection with the very common osteochondrosis and other diseases of the spine; with intercostal neuralgia; in those who have had herpes zoster, even after many months);
With pathology of the ribs;
For diseases of the abdominal organs, including diseases of the digestive tract (for example, in patients with a hiatal hernia, esophagitis - inflammation of the esophagus, ulcer of the esophagus, chronic (including calculous) cholecystitis;
For diseases of the lungs and (or) pleura;
In patients with chronic tonsillitis;
For alcoholism.
Cardiac cardialgia
Cardialgia of cardiac origin can be caused by organic changes (coronary heart disease as a manifestation of atherosclerosis of the coronary arteries), such as angina pectoris.
At the same time, it has long been noted that feelings such as melancholy, fear, sadness and some others can cause a variety of unpleasant sensations either in the left half of the chest or directly in the heart area.
These sensations often arise against the background of depression or anticipation of anxiety. In duration, these sensations can be almost instantaneous, for example associated with a short-term disturbance in heart rhythm; in other cases, they can be paroxysmal in nature, lasting from 15-30 minutes to 2-3 hours or more. Less often, attacks are very long-lasting, almost constant - for many days or even months. The frequency of such attacks varies widely: from 1-5 per day to 1-2 per year.
Clinical picture
It is characteristic that the localization and nature of unpleasant sensations in the heart area are extremely diverse. This can be almost constant, sometimes throbbing pain with increased skin sensitivity in the area of the apex of the heart or the left nipple. In other cases it is a dull pressure, heaviness, tightness, tingling, constriction in the region of the heart or below it; Acute squeezing, squeezing, tension, “stuffiness,” a burning sensation in the heart area or in the left hypochondrium and even throughout the entire upper abdomen, as well as a feeling of fullness or, conversely, a feeling of emptiness in the chest, are also possible. Such various sensations can spread from the heart area not only across the entire anterior surface of the chest, but also capture its right half, irradiate (give) to the neck, shoulder blades, spine at any level up to the lumbar region and even to the lower limbs and genitals. organs. On the other hand, some patients very accurately determine the area of cardialgia by pointing to the main pain point with their fingertip.
Pain in the heart area is usually characterized as dull, dull, pressing, aching, pulling, aching, cutting or tingling. Cardialgia is often accompanied by unpleasant sensations and paresthesias (tingling sensation, crawling sensations) in the arms (usually the left) and legs (often like “socks” and “gloves”). In addition, cardialgia is usually accompanied by a feeling of lack of air or even suffocation at the height of a depressive or anxious state. In the clinical picture of neurogenic cardialgia, these characteristic symptoms in the form of a feeling of compression, difficulty breathing, the presence of a sensation of obstruction in the chest, they force patients to periodically inhale deeply, sometimes with a groan, which is one of the most important distinguishing signs of the psychosomatic nature of the disease.
It is very important that these variable and numerous painful and frightening sensations (feeling short of breath, presence of a lump in the throat, lack of effect from sublingual administration of nitroglycerin or nitrosorbitol) serve for many patients as convincing evidence of serious cardiac dysfunction. Sometimes a doctor, when interviewing such a patient, may regard complaints as manifestations of atypical or mild angina and prescribe excessive treatment, which may help to consolidate in the patient’s mind incorrect ideas about his condition.
Diagnostics
Significant diagnostic difficulties for both the doctor and the patient arise in cases where classic complaints of attacks of pain in the chest or in the heart area with irradiation to the left shoulder and (or) left shoulder blade (at the height of negative emotions or, much less often, during physical tension) actually imitate the complaints of patients with chronic coronary insufficiency. Serious diagnostic difficulties arise if the patient's age is more than 40 years. The term “cardiac mimicry” is used in cases where a person feels pain of a psychogenic nature in the region of the heart, similar to that which one of his relatives or friends experienced or information about which he received while reading fiction or popular literature.
Differential diagnosis
However, with a thorough examination of the patient, it is usually possible to distinguish cardialgia of psychosomatic origin from classical angina, which represents a serious medical problem and a threat to the patient’s health. Psychosomatic cardialgia is characterized by a very pronounced variability of manifestations, an extremely short-lived, volatile, changing nature of the severity, intensity, localization and prevalence of pain. The complaints expressed by the patient change repeatedly not only during one day, but also during the conversation with the doctor. Also characteristic is the patient's neurotic fixation only on a certain type of cardialgia, when he complains, for example, only of a burning sensation or distension.
But more often there is lability of manifestations, when the heart either squeezes, then tingles, then shoots, or “burns with fire.” The nature and localization of pain are also labile: the pain is sometimes dull, sometimes sharp or piercing, it appears first on one side, then on the other.
Migration of pain is characteristic: from the area of the heart it moves either under the left shoulder blade, then along the spine, then to the left or right hypochondrium, then completely fills the left or right half of the chest or even the entire chest, then again it is fixed in the region of the heart.
Typical symptoms of psychogenic cardialgia
Experts consider the cornerstone of the clinical diagnosis of psychosomatic cardialgia to be a special phenomenon - the so-called “sense of the heart.” It is extremely typical when this “feeling of the heart” appears in people who previously had no idea where it should be, but now they often even “exactly feel” its boundaries. This “feeling of the heart” is most often not even identified by patients with pain; this painful sensation, in fact, represents one of the most common complaints, accompanied by the fear of death, in the absence of complaints of pain in the heart or left half of the chest.
In addition, the concept of “feeling of the heart” may include a pathological feeling of its fixation (the patient feels the heart is not in its place); a vague, indefinite and therefore very disturbing feeling of some kind of mental discomfort, a feeling of unease in the area of the heart. In other cases, the patient feels how the heart decreases in size, shrinks or, on the contrary, enlarges, swells, and becomes so huge that it does not fit in the chest. There may also be a feeling of insecurity, bareness of the heart, combined with complaints of a feeling of its overload with the most insignificant, minimal physical exertion. Patients often complain of tachycardia (increased heart rate) when visiting a doctor or while talking with their boss at work, while reading fiction or while watching a movie.
Patients suffering from psychosomatic cardialgia syndrome are characterized by daily fluctuations not so much in their condition as in their well-being. Patients usually feel worse either with insomnia, or in the morning, amid an influx of anxious thoughts immediately after waking up. Patients very often define the nature of discomfort in the chest as pinching, gnawing, exhausting, debilitating pain. It is typical that these sensations are not so much painful as painful and painful. Quite typical may be complaints of a feeling of anxiety and heaviness in the heart area or in the left half of the chest, combined with causeless nausea, weakness and depressed mood, especially in the morning or as night approaches.
Patients often complain of sensations of high or low temperature (thermal sensations). The heart either “burns like fire” or freezes and “is covered with ice, like in a refrigerator.”
As a rule, these thermal sensations do not occur in isolation; they are accompanied either by pronounced palpitations, or, on the contrary, by a feeling of freezing, or by heart spasms, or numbness of the left half of the chest.
Psychological features of psychogenic cardialgia
The nature of cardialgia of psychosomatic origin is also distinguished by the special nature and degree of severity of manifestations: anxiety, usual in any disease, clearly outgrows the degree of its adequacy to the objective state. Excitement transforms into anxiety, then fear and at times even panic horror appear with a feeling of imminent catastrophe. Patients may moan and wail loudly, gesticulate incessantly, and constantly change body position. In some cases, patients sometimes rush around the room or even roll on the floor. A characteristic manifestation of the psychosomatic nature of the disease is also the fact that patients take any medications that come to hand, often in huge doses. In addition, patients often apply either a warm heating pad or mustard plaster or an ice pack to the heart. In some cases, all of the above actions end with calling an ambulance or visiting a clinic with a requirement for immediate hospitalization.
This behavior, as a rule, is uncharacteristic for a patient with angina pectoris, in which even minor activity, both physical and emotional, only increases the intensity of pain. A patient with psychosomatic cardialgia is characterized by excessive haste in conversation, fussiness, excessive demonstration of specific points of localization and direction of movement of pain, as well as an inability to concentrate for a long time. Due to increased lability, such a patient during a conversation with a doctor does not so much answer questions as strive to express what he himself considers important.
Diagnostic value of cardiac tests and nitroglycerin administration
In addition to clinical manifestations, the psychogenic origin of painful sensations is supported by data from special cardiological tests: the absence of objective signs of coronary heart disease (CHD) according to ECG and ultrasound of the heart, special blood tests (biochemical tests) even at the height of a painful attack.
The negative effect of sublingual use of nitroglycerin is also fundamentally important. Taking this drug does not provide a noticeable improvement in the condition of many patients or even causes a deterioration in their health.
In patients with classic angina caused by atherosclerotic lesions of the coronary arteries, therapeutic effect from sublingual administration of nitroglycerin occurs within 2-3 minutes, while with the psychosomatic genesis of the disease the attack passes either almost instantly or 30-40 minutes after taking the drug, which is not associated with the use of nitroglycerin. As evidenced by the experience of qualified cardiologists, most patients with neurogenically caused cardialgia prefer to use valocordin and sedatives such as Relanium or valerian, since taking validol usually causes nausea, and nitroglycerin causes a strong heartbeat.
Cardialgia with hysteria
Pain in the heart area can be the most important manifestation of hysteria. Hysteria is a series of unreasonable human actions aimed at attracting attention. These actions are generated by the inability to find a way out of the situation in which the individual finds himself; At the same time, the desire to maintain dignity in the eyes of others plays an important role. Hysteria is always intended for an audience, it is always for show. Hysteria often begins in childhood. A typical picture is when a child lies on the floor and kicks his legs screaming, carefully watching his parents. Not knowing how to achieve what he wanted, he chose exactly this method of action, since before he had been pitied, for example, if he fell, and given something tasty.
Signs of hysterical cardialgia
Main hallmark Cardialgia in a patient with hysteria is the extraordinary persistence of heart pain in the complete absence of changes on the ECG or data from other methods of objective research.
However, cardialgic syndrome is rarely the only manifestation of hysteria. Heart rhythm disturbances of hysterical origin are sometimes practically indistinguishable from arrhythmias with concomitant somatic diseases. Their peculiarity is that they are still arbitrary: there are known cases of the development of so-called atrial fibrillation and extrasystole under the influence of self-hypnosis in people suffering from hysteria.
Cardiophobia.
Cardiophobia (from the Greek kardia - heart and phobos - fear) is one of the most common syndromes, but only in some cases it causes severe suffering, chaining the patient to a hospital bed for months and years.
Reasons for the development of cardiophobia
The most important factor in the life of any person is normal cardiac activity, which allows each individual to feel comfortable and confident. However, vague, initially diffuse anxiety and gradually increasing tension, anxiety, suspiciousness and finally fear can be the basis for the development of a cardiophobic state. In some cases, anxiety can be a manifestation of general neurosis, when the slightest random pain in the heart area or short-term transient extrasystoles (additional heart contractions), severe heart disease in someone close becomes the cause of the development of cardiophobia.
In other cases, the development of persistent cardiophobia is indeed based on heart disease, but the fear for its condition experienced by the patient is not only inadequate to the condition of his heart, but goes beyond common sense. It must be emphasized that in this case, the excruciating fear experienced by the patient in connection with disorders of cardiovascular activity is incommensurable, incommensurable, neither in intensity nor in nature, with ordinary human feelings and experiences. The only existing reality for such a patient is not even a feeling of threat, but an immediate feeling of the proximity of impending death. Moreover, the fact that similar attacks he had previously suffered did not lead to the development of serious heart disease has no significance for the patient.
However, even for experienced specialists it is not always easy to distinguish primary fear, which arises in the complete absence of any organic changes, from secondary fear, which is, albeit an inadequate (exaggerated, hyperbolic), but still a natural reaction in the presence of minimal ones, revealed only by the most subtle methods changes (for example, disturbances in biochemical parameters).
The mechanism of development of cardiophobia
A feeling of discomfort and unusual (and previously not noted) sensations in the left half of the chest, arising initially in a psychotraumatic situation or even in its absence, after prolonged asthenia gives rise to gradually increasing anxiety and increased vigilance in patients, which over time transforms into a persistent feeling of having them of serious heart disease (most often a “pre-infarction condition”) and induce fear of death.
The consolidation of this belief can be facilitated, for example, by detectable minimal changes detected during the mandatory instrumental examinations of the patient in such cases: ECG, biochemical blood test, ultrasound of the heart and others. And if for some reason the patient is diagnosed with coronary heart disease (CHD), then a vicious circle may form, based on panic. The complexity of the situation is aggravated by the fact that later studies by other doctors may not confirm the diagnosis, but its refutation even by leading specialists may be unconvincing for the patient. As a result, conflict may develop and, as a consequence, cardiophobia will become stronger.
The most common forms of cardiophobia
There is no single clinical picture of cardiophobia: many differences in the manifestations of the disease are due to the mental characteristics of the patient, his age, and the presence of concomitant pathology of internal organs.
The difficulty of diagnosing cardiophobia is due to the fact that, to one degree or another, it resembles severe and common heart diseases.
Pseudoreumatic form
The pseudorheumatic form, as the name suggests, clinically resembles the condition of rheumatic heart disease, always manifests itself as cardialgia and is one of the common forms of cardiophobia. As a rule, the pseudorheumatic form of the disease develops against the background of chronic tonsillitis. Patients' complaints are most often numerous: patients note pain in the heart (cardialgia), palpitations, shortness of breath, and irregularities in the heart area. Manifestations of the disease are most often associated with physical activity; Periodic aching pain in the joints is also characteristic. However, this is usually not enough for the development of cardiophobia: its occurrence is most often provoked by severe rheumatic carditis in one of the close relatives. Medical tactics also matter; In such cases, extreme caution and high professionalism are required from the doctor.
Events usually develop as follows: in a persistent patient with multiple and varied complaints about the activity of the heart, some functional disorders are discovered during examination (this may be a slight increase in temperature or minimal, within normal limits, changes in the ECG, etc.). Then there is an acquaintance with seriously ill patients suffering from heart defects. The patient is persistent, uses all possible levers of influence, and seeks a course of antirheumatic treatment, which, of course, turns out to be unsuccessful. As a result, the patient is convinced of the seriousness of his “heart” suffering, and the doctor is in a state of confusion.
This is usually followed by consultations with various specialists who express different opinions; As a result, the patient develops a pseudorheumatic variant of cardiophobia. To prevent this from happening, the patient and the attending physician should show mutual tolerance and attention. It is necessary not only to carefully examine the patient using the most modern techniques, but also to give an objective assessment of the identified symptoms.
Pseudo-infarction form of cardiophobia
Another variant of cardiophobia is pseudo-infarction; it develops, as a rule, in those who are more or less informed in the field of medicine. This type Cardiophobia is a synthesis of the unpleasant sensations experienced by the patient with the supposed terrible diagnosis and the corresponding prognosis. Doctors have long noticed that various phobias (fears) develop only in relation to dangerous diseases. As a rule, when a pseudo-infarction variant of the disease develops, an attack of pain in the heart area is immediately followed by fear of developing a myocardial infarction. This feeling of fear begins to dominate, determining the patient’s actions and aspirations.
The natural initial reaction in this case is examination. However, the matter is often not limited to just examination; quite active drug therapy can be prescribed at the same time. The examination is carried out dynamically, takes a certain time, sometimes 2-3 weeks, many tests are performed repeatedly (ECG several times in a row, repeated blood tests, etc.), which in itself can become the basis for the formation of a phobia. In addition, the patient’s well-being does not improve: despite the regimen and active drug therapy, attacks of pain are repeated, nitroglycerin does not help, no changes are noted on the ECG, just as no changes in biochemical parameters are observed.
Thus, there is a discrepancy between subjective sensations, which really go beyond banal cardialgia and to a certain extent resemble myocardial infarction, and objective examination data (ECG, ultrasound, tests, follow-up), which make it possible to responsibly exclude the assumption of recurrent coronary pathology. Here the role of the doctor is extremely important, who will be able to understand the situation and clearly and convincingly explain to the patient the essence of what is happening. Pain in the heart area can be caused by many factors, such as cervical osteochondrosis, menopausal disorders, etc.; You should explain to the patient what caused his pain, that this pain (for example, caused by alcohol intake or cervical osteochondrosis) is relatively safe and, under the influence of appropriate treatment, will be eliminated within 3-4 weeks, although pain may remain at the initial stage of treatment.
Clinical picture
If the pseudo-infarction form of cardiophobia is caused by a previous injury or inflammation, the disease may be paroxysmal in nature. The first heart attack usually occurs acutely, then the disease becomes recurrent. During an attack, the appearance of excruciating fear is typical, there is a feeling of very rare heartbeats and its impending stop. As a rule, patients show pronounced anxiety, rush about, moan, call an ambulance, persistently and noisily demand immediate medical intervention. The attack is accompanied by pronounced autonomic reactions: diffuse redness of the face, spots of hyperemia (redness) on the neck, chest, increased breathing, severe tachycardia (increased heart rate) up to 120 beats per minute (despite the patient feeling rare beats), increased blood pressure, sudden sweating .
Peculiarities of behavior of patients with cardiophobia
The consciousness of the patients is preserved, although a certain uncriticality of the patients can be stated: excessive concentration of attention on their sensations with a reduced reaction to external stimuli, for example, doctor’s recommendations, is very typical. For example, a request to calm down and stop moaning is usually fulfilled, but after a few minutes the patient may forget all the advice, begin to rush around in bed again, throw off the blanket, etc. The duration of the attack can vary widely: from several tens of minutes to several days.
Feeling fear for their hearts even in the interictal period, patients constantly count their pulse, carefully record and analyze any changes in well-being, and react in panic to the slightest unpleasant sensations in the left half of the chest or even the entire upper body. These patients know how to subordinate not only their entire lives, but also the lives of those around them to caring for their heart, shifting all household chores to loved ones and even children. They completely give up sexual activity and divorce their spouses that they already hate. In addition, they are afraid to sleep on their left side and are afraid of nightfall, because they are convinced that most people die at night. Insomnia in such patients may be due to the fear of falling asleep and not waking up.
They also refuse everything that can excite them and thus have an impact on the heart: watching movies, going to the theater, smoking and drinking alcohol, coffee, strong tea, talking about death, attending funerals, reading serious literature and any mental stress . Such patients strictly follow a strict daily routine and a certain diet: in order to prevent an increase in the level of cholesterol in the blood, they do not take fats into their mouths at all; do not eat black bread and cabbage, so as not to increase the load on the heart due to flatulence - bloating; They make up healing mixtures, go on various diets, prescribe and carefully study popular medical literature. Such patients do not risk going outside again; they experience fear of loneliness, literally not letting their family go; They are also characterized by fear of crowds and closed premises(including train cars, subways, from which you cannot exit immediately).
In addition, they require special treatment, constant medical supervision, frequent instrumental examination (ECG), stock up big amount medications, as well as heating pads and thermometers and do not leave home without nitroglycerin and validol. They try a variety of treatments, especially new ones, but almost never complete the course.
Thus, two main variants of cardiophobia are distinguished: the first, caused by cardialgia, i.e., having a cardiac basis, and the second, associated exclusively with the neuropsychic status of the patient.
Course of the neurotic variant of cardiophobia
If the cardiac-caused form of the disease usually more or less resembles fairly well-known, including severe, heart lesions, then cardiophobia as a variant of neurosis is clinically characterized precisely by the absence of complaints typical of heart disease. As a rule, it is the uncertainty and atypicality of the patient’s story about his feelings that makes one suspect the exclusively neurotic nature of the disease. The set of complaints of a patient suffering from cardiophobia is not specific, they are of a general nature. Typical complaints are compression and (or) congestion of the chest, a feeling of lack of air (the most characteristic feature is dissatisfaction with inhalation) and cardiac arrest or, on the contrary, a feeling of loud heartbeats. Some such patients can lie in bed for years, instilling fear for their hearts in those around them and relatives.
Cardiophobic syndrome of a neurotic nature may not be accompanied by attacks at all for quite a long time. However, sometimes just the memory of past pain can become the reason for a complete withdrawal into illness, a deep fear of moving, a fear of being alone in an apartment, a fear of walking unaccompanied down the street, etc. Many patients with cardiophobia (although not all) gradually narrow the circle their interests, leaving only what is relevant to their illness. They are only interested in diet, bowel regularity, taking medications, limiting physical stress, i.e. life becomes limited by the framework of their own illness. In addition, a rule is developed not to worry, since any excitement, in their opinion, poses a danger.
Diagnostics
The diagnosis of cardiophobic syndrome, not associated with heart pathology, does not represent a complex medical problem, since with an adequate modern examination, the doctor cannot detect any signs of heart disease, except for subjective complaints. According to modern authors dealing with the problems of psychosomatic diseases, the development of cardiophobic syndrome, especially purely neurotic, is primarily due to an altered psyche. Many scientists believe that the disease is often hereditary in nature, since in family members of patients they noted a number of specific character traits that contribute to the development of the disease (excessive anxiety of parents for their children, extreme despotism of parents, especially fathers, in relation to children, pronounced fear of loneliness, fear of the sight of blood, persistent vomiting, etc.).
However, in cases where the dominant symptom is pain behind the sternum or in the heart region, even with obvious neurotic symptoms, all efforts must be directed to a complete and thorough examination of the patient to exclude damage to the heart muscle. The need for this tactic is determined by the fact that in the acute period of severe myocardial infarction, general psychomotor agitation may occur.
The prognosis of cardiophobia with correct and timely diagnosis and adequate treatment is favorable.
Psychogenic heart rhythm disorders (arrhythmias).
Before introducing this section, it is necessary to emphasize that various heart rhythm disturbances are constantly recorded in practically healthy people. Data from various scientists differ only in assessing the prevalence of this phenomenon. For example, various arrhythmias in healthy people during a single examination are detected in a small percentage of cases (no more than 2%). However, with long-term monitoring (a special device is fixed on the body of the subject for a day), all kinds of heart rhythm disorders are found in almost every third of the healthy people examined (30 ± 2-3%).
Development of psychogenic arrhythmias
It has long been noted that there is a direct relationship between mood and heart rate. This connection is most clearly manifested in extreme situations: a state of painful, painful fear of death is inevitably accompanied by various heart rhythm disorders, regardless of whether the person has organic lesions of the heart muscle or whether the arrhythmia is purely psychogenic in nature. The inextricable connection between heart rhythm and mood, their harmony is normally the most important condition for a person’s sense of well-being - both mental and somatic.
A person is designed in such a way that any violation of the usual, optimal heart rhythm for a given individual usually does not go unnoticed by him. However, the way to respond to the occurrence of arrhythmia is different. For a certain number of people, both short-term (several seconds) and long-term heart rhythm disturbances, which occur suddenly, without any warning, or recur with a certain periodicity, inevitably cause fear of death. Moreover, often even the normalization of a sharply increased heart rate with a pronounced fear of death from rupture or cardiac arrest becomes the cause of an even more panicky state of patients if the previous heart rhythm disorder (tachycardia) lasted for a relatively long time (several hours or days).
Clinical picture
Complaints of patients with psychogenic arrhythmia are often characterized by colorful descriptions. Patients report that the pulse seems to disappear, sometimes for 30-40 minutes; in other cases, an unusual decrease in heart rate is felt, and this decrease, even in the absence of pain in the heart area, causes the patient significant anxiety and even fear.
A colorful manifestation of the psychogenic basis of arrhythmia is the following observation by doctors: an attack of paroxysmal tachycardia that developed in a patient at home or at work is not removed even by the maximum dose of a potent antiarrhythmic drug, but stops as soon as the patient feels safe, finding himself in an ambulance or in hospital. In the future, a situation is often noted when such a patient does not experience arrhythmia attacks during the entire period of his stay in the hospital, and one can rightfully state the psychogenic impact of the very fact of hospitalization. Moreover, attacks of arrhythmia may resume on the eve of discharge from the hospital or at home on the first day after discharge. Such patients may experience heart rhythm disorders even in the hospital in the absence of the attending physician - in the evening, on weekends and holidays.
Typical symptoms of psychogenic arrhythmia
Complaints of palpitations not only with minor physical effort and (or) the slightest emotional excitement, but also at rest with an influx of thoughts of alarming content represent almost persistent symptom psychogenically caused arrhythmia. Particularly characteristic are attacks of palpitations in the morning (at the moment of awakening), when falling asleep, and often at night (due to insomnia or superficial, intermittent or restless sleep).
Also typical are sharp attacks of tachycardia with a feeling of sharp heartbeat with any surprise or fear. In some patients, even the mention of heart disease (angina) causes extremely painful tachycardia with fear of death and increased heart rate to 140-160 beats per minute. Attacks of paroxysmal tachycardia (heart rate 140 beats per minute or more) are observed in people of predominantly asthenic build, provoked by emotional stress, physical activity and even digestive disorders.
It is characteristic that in almost half of the patients with clinical manifestations of neurasthenia, the noted sensations are not accompanied by objective monitoring data during instrumental recording of the pulse (ECG). A paradoxical situation is often recorded: the patient complains of increased heart rate, feels a pronounced palpitation, but when instrumentally recorded on the ECG, a decrease in heart rate is noted. This phenomenon is associated with perception disorders. Typical manifestation neurogenic arrhythmia is that the feeling of a sharp heartbeat against the background of a pronounced emotional reaction is usually accompanied by tremor of the fingers and the need for continuous movements.
For patients with psychogenically caused arrhythmia, even a purely subjective perception of a rapid and increased heartbeat, which is not objectively confirmed, turns out to be extremely painful. If such a patient develops an attack of paroxysmal tachycardia (heart rate exceeds 140 beats per minute), the manifestations of the disease are accompanied by a pronounced fear of death from rupture or cardiac arrest, which is ready to “jump out” of the chest and beats “like a fish on the shore.” Patients hear the beat of their heart through a pillow or mattress, feel abnormal pulsation not only in the heart, but also in the temples, throat, under the left shoulder blade, in the epigastric region and even throughout the whole body.
The combination of cardialgia and an attack of sharp tachycardia is accompanied in some cases by sensations of chills, internal trembling, a rush of blood to the head and neck, a feeling of heat throughout the body or coldness and numbness of the arms and legs, as well as the inability to take a full breath and a feeling of lack of air. It is possible to develop a fear of death from suffocation.
Often, the development of extrasystoles (additional, extraordinary heart contractions) can be provoked by fear of the examination itself, and the office and equipment serve as physical visual factors. In most cases, extrasystole occurs either only in the morning upon awakening, or on the way to work against the background of a subdepressive state, but stops with emotional upsurge and a change of situation, in particular on weekends and (or) during vacation. Extrasystole in such a patient also stops while taking small doses of antidepressants (for example, amitriptyline). Patients with extrasystole are characterized by a certain periodicity and episodic manifestations of the disease, which often serves as the main condition for the formation and fixation of painful sensations. A sudden change in heart rhythm, a feeling of interruptions and fading, unexpected shocks in the heart, a feeling of short-term cardiac arrest, often combined with slight dizziness and a rush of blood to the head, causes extreme anxiety in these patients.
Diagnostics
The diagnosis of psychosomatic heart rhythm disturbances is extremely difficult for a general practitioner and even a specialist, since the section of arrhythmias in cardiology is the most problematic. However, a number of characteristic signs, such as the absence of structural changes in the heart area, the absence of signs of decompensation of cardiac activity, the transient nature of arrhythmias without progressive organic changes, the appearance of attacks in certain life situations, a good therapeutic effect from taking tranquilizers and antidepressants and the lack of effect from the use of special antiarrhythmic drugs can serve as a valid basis for making a diagnosis.
Coronary heart disease (CHD) with unchanged coronary vessels.
IHD is based on narrowing of the coronary arteries due to damage by the atherosclerotic process. At the same time, it has been established that in some cases with symptoms quite characteristic of IHD, modern research methods do not reveal any pronounced changes in the blood vessels.
Differences between classical and psychogenic angina
Classic angina pectoris with atherosclerosis of the coronary arteries is characterized by the severity, uniformity and short duration of the attack with its sudden onset during physical activity and fairly rapid elimination after a short rest and (or) taking nitroglycerin. Painful sensations in the heart area can often largely imitate the clinical picture of angina pectoris, and only a thorough examination can reveal subtle differences in the functional disease. Painful sensations with normal coronary vessels in the heart area usually occur against the background of obvious fatigue, in asthenic people, as a rule, no older than 40 years, more often in women. These pains are associated primarily with emotional rather than physical stress and, unlike classical angina, are characterized by either a significantly longer duration of the attack or a slower, sometimes gradual increase in pain. These attacks are not as demonstrative as with classic angina, and can recur for an indefinite period of time without worsening the patient's condition.
The attacks themselves throughout this time (often from 1 to 3 years) do not become more severe, as with angina pectoris. An important symptom is that the sublingual use of nitroglycerin does not improve the condition of such patients or creates only the impression of an incomplete or short-lived effect that occurs not in the first 1-3 minutes after taking the drug (as with angina), but after 10-15 minutes or more. Unlike classic angina, pain in normal coronary arteries often develops after the end of physical activity and often does not go away during rest.
Features of psychogenic angina
The disease is characterized by a benign course of the disease and a favorable life prognosis. In particular, 50% of such patients experience independent (spontaneous) improvement in clinical manifestations and long-term remission (a period without exacerbation of the disease). Experts believe that it is acute emotional stress or chronic stressful situations that underlie attacks in people with normal coronary arteries.
Clinical picture
These patients are characterized by diffuse anxiety with a vague sense of danger, a feeling of unreasonable fatigue and shortness of breath, a combination of pain in the heart or left half of the chest with more or less pronounced anxiety, a clear connection between a painful attack and emotional stress or constant internal tension, the absence of any or structural changes in the myocardium and coronary vessels during an objective examination, as well as a benign course of the disease with possible spontaneous improvement in half of such patients and a favorable prognosis for life with long-term observation.
Typical for this type of pathology is the occurrence of painful attacks mainly at home or, on the contrary, exclusively at work, which is usually associated with various conflict situations and constant internal emotional tension or frequent negative emotions. For some patients, all sorts of painful sensations periodically arise during the working day and completely disappear as soon as the person leaves the territory of the enterprise. In parallel with this, there is a complete normalization of mood and well-being. Doctors often encounter patients who have suffered from chest pain for a number of years on the way to work, but painlessly take long, aimless walks of several kilometers.
Distinctive features of cardialgia in psychogenic angina
In the final part of the section devoted to the clinical manifestations and causes of psychosomatic disorders of the cardiovascular system, it is fundamentally important to describe the distinctive features of the manifestations of heart pain of psycho-emotional origin and pain caused by atherosclerotic changes in the blood vessels (angina pain). With cardialgia of neurotic origin, a painful attack occurs at rest and in a clear connection with emotional overload, a conflict situation, or can develop for no apparent reason against the background of an anxious-depressive state. With classic angina pectoris, an attack usually occurs after physical or emotional stress.
In terms of nature and intensity, pain in neurotic cardialgia is often dull, aching, stabbing, dull, aggravated by breathing. Angina pectoris is characterized by acute, sharp, squeezing, pressing, burning pain behind the sternum, which does not increase with breathing.
With neurotic cardialgia, the pain is monotonous or increases slowly and stops gradually; The duration of periods of increased and decreased pain is not the same. With angina pectoris, the duration of the increase in pain exceeds the duration of its easing; the attack often ends suddenly. Differences in the localization of pain are characteristic: with neurotic cardialgia, the pain in the left half of the chest is vague, diffuse in nature or, on the contrary, very specific, when the patient can indicate the main painful point - usually in the area of the apex of the heart or the left nipple.
With neurotic cardialgia, pain irradiation is most often absent, while with angina pectoris, the pain usually radiates to the left shoulder and left scapula, is relatively constant and practically does not change with each attack. The duration of pain in cardialgia of neurotic origin is usually long and can last from several hours to several days; with angina pectoris, its duration is on average several minutes. Differences in the cyclicity of the onset of pain are characteristic: with cardialgia, deterioration is usually observed in the morning or against the background of depression, anxious thoughts and insomnia. With angina pectoris, such a pattern is usually absent; an attack can develop at any time of the day.
Differences in the behavior of patients are typical: with cardialgia of a psychogenic nature, there is a rather sharp and pronounced psychomotor agitation, usually not corresponding to the painful state; angina pectoris is characterized by lethargy, immobility, and the desire to limit movements as much as possible. If with neurotic cardialgia physical activity can interrupt a painful attack, then with angina pectoris physical effort provokes an attack.
As a rule, ECG changes in cardialgia are either absent or limited to a short-term rhythm disturbance; in patients with angina pectoris moderate changes are revealed. Special studies of blood vessels in cardialgia do not reveal their changes, while in patients with angina pectoris there is a clear narrowing of the lumen of the vessels.
In patients with neurogenic cardialgia, myocardial infarction does not develop; With angina pectoris, the development of myocardial infarction of any size and location is possible. Cardialgia is characterized by a benign course of the disease with long-term remissions and complete cessation of pain, and in patients with angina there is a progression of cardiac pathology with the possibility of developing heart failure with increasing atherosclerotic damage to the blood vessels of the heart. In addition, an attack of psychosomatic cardialgia is usually not stopped by nitroglycerin, while taking this drug an attack of angina is interrupted within a few minutes.
Pseudoreumatic disorders.
Types of pseudorheumatism
Rheumatism is usually understood as a group of diseases that are related to the so-called cold and are accompanied by pain of a more or less peculiar nature (rheumatic pain) in the muscles or joints. This definition is based on the vague concept of "cold" and such a variable and subjective symptom as pain. Therefore, not only ordinary people define aching “in the bones and in all members” as rheumatism, but also doctors sometimes mistake for rheumatism the initial stages of tabes dorsalis, diabetes mellitus, scurvy, softening of the bones (osteomalacia), etc.
With syphilis, pseudorheumatic joint damage occurs with a chronic course in both the secondary and tertiary periods, when only specific antisyphilitic treatment helps. Gripper rheumatism is etiologically different from true articular rheumatism, but has the same symptoms and the same pathological changes in the joints. The disease occurs in 2% of all cases of gonorrhoea, more often in men, and usually affects knee-joint. Typically, gonorrhea rheumatism is limited to one joint, without jumping to others. Pain and fever are moderate, the course is subacute and tends to drag on for many weeks. The usual outcome is recovery.
Psychogenic pseudorheumatism is combined with autonomic disorders (with arterial hypotension, rarely with hypertension). Symptoms: dull, pulling, aching pain in the joints and muscles of the limbs. Occurs spontaneously. It subsides after slight physical exertion (after taking caffeine). All kinds of pain are noted along the spine (in the interscapular and lumbosacral region).
An objective examination does not reveal adequate medical pathology. Pain is most pronounced with afferent tension during insomnia.
Sometimes the pain is accompanied by swelling of the joints and limited mobility. Psychotherapy has a preventive effect. Psychogenic pseudorheumatism occurs at the beginning of the depression phase; at the height of depression, pain disappears.
Repeated manifestations are noted upon recovery from depression. If the diagnosis is incorrect, the pain remains and the person becomes disabled.
Treatment of psychosomatic disorders in diseases of the cardiovascular system.
Phytotherapy
In case of cardiac dysfunction with concomitant insomnia, a medicinal collection of the following composition is recommended: chamomile flowers - 10.0 g; May lily of the valley flowers - 10.0 g; fennel fruits - 20.0 g; peppermint leaves - 30.0 g; valerian root - 40.0 g. The collection is taken in the form of an infusion during the day in several doses. The course of treatment is 12-14 days.
The following herbal collection helps eliminate internal emotional stress and improve sleep: valerian root - 15.0 g; hop cones - 15.0 g; peppermint leaves - 30.0 g; motherwort herb - 30.0 g. The infusion is taken 2 glasses in the morning and evening or in sips throughout the day. The course of treatment is 12-14 days. For psychosomatic disorders of the cardiovascular system, other collections of medicinal plants are also recommended:
I. Peppermint leaves - 20.0 g; valerian root - 10.0 g; three-leaf leaves - 20.0 g; hop cones - 10.0 g. A glass of infusion is taken in sips in several doses throughout the day. The course of treatment is 2-3 weeks.
II. Peppermint leaves - 30.0 g; valerian root - 40.0 g; lily of the valley flowers - 10.0 g; fennel fruits - 20.0 g. Infusion is taken 1/2 cup 1-2 times a day. The course of treatment is 2-4 weeks.
III. Peppermint (leaves) - 30.0 g; motherwort five-lobed (grass) - 30.0 g; valerian officinalis (root) - 20.0 g; common hops (cones) - 20.0 g. Take 1/2 cup of infusion 3 times a day for nervous excitement, irritability, insomnia.
IV. Valerian officinalis (root) - 25.0 g; motherwort five-lobed (grass) - 25.0 g; caraway seeds (fruit) - 25.0 g; fennel (fruit) - 25.0 g. Take 1/2 cup of infusion 3 times a day for nervous excitement and rapid heartbeat.
V. Valerian officinalis (root) - 30.0 g; peppermint (leaves) - 30.0 g; watch three-leaf (leaves) - 40.0 g. Take 1/2 glass per day for nervous excitement and irritability.
VI. Horsetail (herb) - 20.0 g; knotweed (grass) - 30.0 g; blood-red hawthorn (flowers) - 50.0 g. Take 1/3-1/4 cup of infusion 3-4 times a day for rapid heartbeat, irritability and insomnia.
VII. Valerian officinalis (root) - 30.0 g; motherwort five-lobed (leaves) - 30.0 g; common yarrow (herb) - 20.0 g; Common anise (fruit) - 20.0 g. Take 1/3-1/4 cup as an infusion 2-3 times a day for heart pain.
Psychotherapy
"Whatever structure we consider, it is clear that it is controlled and controlled from one center. All processes occurring in the human body are controlled and controlled by the brain, which is the highest center, and all commands spread from the center to the periphery. When not disturbed internal order, then the body is able to independently cope with any external damaging influence" (J. T. Kent).
"The control system of the human body consists of three levels: the brain - the spinal cord - the nerves. Looking more deeply, we can highlight the will (freedom of action) and the mind, which constitute the vital force, which is the internal, immaterial essence of a person, and the physical body - the material substance of man" (J. T. Kent).
Diseases of the cardiovascular system are numerous. Some of them primarily affect the heart, others - arteries or veins, and still others - the cardiovascular system as a whole. These diseases can be caused by a congenital defect, trauma, inflammation, infection, metabolic disorders or regulatory processes of the cardiovascular system, etc. Diagnosis of pathology of the cardiovascular system in some cases does not present significant difficulties and can be carried out by a doctor based on complaints the patient, the history of the disease, life characteristics and objective examination data (medical examination). In other cases, to establish the correct diagnosis, various types of instrumental studies are required (electrocardiogram, phonocardiogram - recording of heart sounds and murmurs, polycardiogram - recording the phase structure of the heart, ultrasound - a special method that allows you to examine the cavities and walls of the heart, valves and vessels) . There are many more different methods for studying the cardiovascular system, however, each of the listed methods has specific goals and is the most informative for a particular disease. And only after conducting the necessary set of studies and carefully assessing them can a diagnosis of the disease be made, and therefore, the correct treatment can be prescribed.
FUNCTIONAL DISORDERS OF THE CARDIOVASCULAR SYSTEM
Functional disorders of the cardiovascular system occupy a leading place among all disorders of the internal organs.
gans caused by disorders of their regulation. According to some data, up to 15% of patients in hospital cardiology departments suffer predominantly from functional disorders. Such
the high frequency of functional disorders is largely associated with the vital importance of the cardiovascular system for human activity and existence. It is not for nothing that in the Middle Ages the heart was considered as the seat of the human soul. And even now, for many, the heart is an organ directly related to a person’s psychological state. Lelar, in one of his songs, Mikhail Shufutinsky sings: The soul is burning, but the heart is crying!
In this section we will consider the main variant of functional disorders of the cardiovascular system - autonomic dysfunction syndrome. Let the reader not be intimidated by this medical term. During the course of the presentation, we will try to decipher it in more detail.
Autonomic dysfunction syndrome
In the medical and popular literature you can find different names for the same disorder: neurocirculatory dystopia, peirocirculatory asthenia, vegetative dystonia, vegetative-vascular dystonia, vegetative-vascular dystopia. The last two formulations are the most popular V pass in the country. The World Health Organization (abbreviated as WHO) recommends using the name autonomic dysfunction syndrome. There are three words in this title. Syndrome cumulative! b manifestations of the disease, th ecu. symptoms. Dysfunctions are disturbances in the functioning of organs and systems of the body. And finally, the third term is vegetative. HMeei makes sense to dwell on this in more detail.
Man lives in a CONSTANTLY changing world. The changes that occur require continuous adaptation of the body to them. Such processes are called adaptation. In addition to THIS, processes in the body must be regulated aimed at restoring its internal environment, i.e. it is necessary to maintain a CONSTANT composition of the blood, to renew individual components of tissues and organs. This maintenance of a constant internal environment is called homeostasis. To regulate adaptation processes and homeostasis, the body has an autonomic nervous system. The highest centers of THIS system are located in the brain, in the so-called subcortical formations. These include the department of the cerebral nervous system, located deep in the brain, and its cortex.
How does it work? A HEALTHY person has everything he needs! and - attack* or avoidance (re-
logical or psychological) there is an increase in the activity of those parts of the autonomic nervous system that are responsible for active adaptation. Immediately after the response is completed, the sections that ensure the restoration of pelvic homeos are activated, and balance is restored. With the development of autonomic dysfunction syndrome, such coordination is disrupted and one of the regulatory departments (or both of them) is excessively activated. As a result, autonomic dysfunction syndrome occurs.
Functional diseases (vegetative-vascular, or neurocirculatory dystonia) are a motley group of syndromes, diverse both in etiopathogenesis and in their clinical manifestations; the functional pathology of the cardiovascular system is based on neurotic disorders, endocrine and humoral regulation. There are hypertensive, hypotonic, cardiac, arrhythmic and mixed variants of neurocirculatory dystonias.
Homeopathic remedies play a prominent role in the treatment of patients with functional disorders. Of particular importance is the use of constitutional remedies that contain cardiovascular disorders in their pathogenesis.
Ignatia 6, 12, 30. Neurotic cardialgia and shortness of breath, palpitations, extrasystole in emotionally labile women with hysterical accentuation of character in the presence of a traumatic situation and compliance with the constitutional type.
Platina 6,12,30; Pain in the heart area, against the background of pronounced egocentrism, changeable mood, and other signs of hysterical neurosis.
Spigelia 3, 3, 6. Aching or stabbing pain in the apex of the heart, psychogenic tachycardia.
Nux moschata 3, 6. Neurotic cardialgia and tachycardia, combined with aerophagia (gastrocardial syndrome).
Moschus 3, 6. Tachycardia, agitation, neurotic shortness of breath, tendency to faint in persons with hysterical neurosis.
Cactus x3, 3. Compressive pain in the heart area, tachycardia, anxiety, especially when lying on the left side.
Actea racemosa x3, 3, 6. Functional disorders of the cardiovascular system during periods of hormonal changes in women.
Pulsatilla x3, 3, 6. Dystonia of a hypotonic nature, against the background of menstrual irregularities and venous insufficiency in women of the corresponding constitutional type.
Camphora x3. Dystonia with a tendency to hypotensive crises.
Magnesium phosphoricum x3, 3 (trit), 6, 12. Has a beneficial effect on headaches in hypertensive patients, cramping abdominal pain.
Aurum iodatum 3,6,12. It is used for severe atherosclerosis of cerebral vessels.
Strontiana carbonica 3, 6, 12. For cervical osteochondrosis, accompanying hypertension, with severe occipital pain (“cervical hypertension”).
Plumbum 3, 6, 12. With high persistent hypertension, mainly of renal origin.
Lachesis 6. Arterial hypertension of the menopause.
Actea racemosa 3, 6, 12, 30. Unstable blood pressure during menopause.
Phosphorus 3, 6, 12; Kalium phosphoricum 3, 6, 12. For advanced hypertension, with general weakness, loss of ability to work, weakened memory, sleep disturbance.
Arnica x3, 3, 6. To improve the function of a hypertrophied heart. For hemorrhages in the retina of the eye. For fresh hemorrhages - also Crotalus 6, 12.
Peripheral vascular diseases
Pulsatilla 3, 6. Early signs of venous insufficiency in women of the corresponding constitutional type.
Calcarea fluorica 3, 6. When varicose veins and insufficiency of the valve apparatus of the veins of the lower extremities.
Carbo vegetabilis x3, 3, 6. Torpid varicose ulcers with burning pain in the background venous stagnation in the elderly, with severe general condition and loss of strength, with a variety of visceral pathologies. “Carbo vegetabilis was given to us so that we never fall into despair, no matter how difficult the patient’s situation.”
Secale cornutum 3, 6, 12. Obliterating endarteritis with a burning sensation and chilliness of the affected limb. Raynaud's disease (30 dilution).
Cuprum 3, 6; Cuprum arsenicosum 3, 6. Burning spasmodic pain, decreasing at night; from the heat. Raynaud's disease.
Plumbum metallicum 6, 12, 30. For atherosclerotic lesions of peripheral arteries in combination with arterial hypertension, polyneuritis. Hemorrhagic whines.
Circulatory failure
Acute and chronic forms of heart failure, as a rule, are effectively treated with modern saluretics, peripheral vasodilators and cardiac glycosides. In some cases, homeopathic remedies are also used. In case of an overdose of cardiac glycosides and the appearance of arrhythmias as a result, homeopathic Digitalis (x3, 3), which operates according to the basic law of homeopathy, can be prescribed. The following medications are also recommended:
Apocynum cannabinum x2, x3, 3. For right ventricular heart failure with ascites.
Antimonium arsenicosum 3, 6. For congestion in the lungs, moist wheezing, shortness of breath, cough with sputum production.
Camphora x2, x3, 3. For hypotension and tendency to collapse.
Veratrum viride x3. For acute vascular insufficiency.
Acidum hydrocyanatum 3, 6. Cardiac asthma with a drop in blood pressure.
Phosphorus 6. For circulatory failure, congestive liver, with dystrophic changes in organs and tissues.
Solidago virga x3; Lycopodium 6, 12. “Drainage” agents used to increase diuresis.
There is probably not one person among us who would not ask the question: what is our heart? Soul container or regular pump? If it’s a pump, then what about the statements that the heart can love and hate? If it is the seat of the soul, then why can it be easily replaced (transplanted) and the person remains the same? Be that as it may, one thing is certain - our heart is a great tireless worker. Second by second, which adds up to hours and days, it pumps blood in our body. Without a heart, without this ordinary muscular organ, a person cannot live longer than 3-5 minutes; without it, the life of the body is impossible in principle. This is why heart disease is so scary for us and even the smallest functional disorders cause fear in every normal person.
But let's figure out how functional disorders differ from truly dangerous heart diseases, and why they are subject to mandatory treatment.
Our heart works in a certain rhythm and any violation of it causes a number of not very pleasant sensations. These sensations are so diverse that they do not lend themselves to any precise ranking. Among them there may be a rapid heartbeat, a sinking heart, a feeling of free fall, pain, etc. In each person, these symptoms - sensations may manifest themselves differently, but the cause of all sensations is a violation of the heart rhythm due to a violation of the innervation of the heart muscle - cardiac neurosis.
A person is subject to emotions: fear, joy, delight, surprise and horror - any of them can cause heart rhythm disturbances. Remember how we say: out of fear the heart froze, out of love or tenderness the heart began to beat faster. And indeed this is exactly what happens. But if stress and depression have become your companion - this is your usual state, then trouble is not far away. Why? It's simple! Irregular heart rhythm over and over again can provoke the development of organic lesions of the heart muscle, which can ultimately lead to serious heart diseases such as ischemia and heart attack.
Sometimes the cause of disruption of the innervation of the heart muscle is another companion of modern man - osteochondrosis of the cervical and thoracic spine. Displacement or curvature of the spinal column leads to pinching of the spinal processes of the nerve trunk. In turn, this leads to malfunction of all chest organs. A person aggravates the degree of damage by a sedentary lifestyle and low loads on the muscles of the limbs. The heart, which works in a disturbed rhythm, literally strains itself in its desire to provide blood to the entire body, and the skeletal muscles that should help it push blood do not work. The load on the heart muscle increases several times, which undoubtedly leads to functional disorders and the occurrence of organic lesions.
Please note that stress, osteochondrosis, and a sedentary lifestyle do their dirty work and lead to serious heart diseases, which significantly reduce the quality of life.
It is necessary to treat functional disorders of the heart, but they are treated not by a cardiologist, but by a neurologist and therapist. Therapy is aimed at eliminating the factors that lead to heart rhythm disturbances and adjusting the patient’s lifestyle. Therefore, if you have any concerns and symptoms of functional origin appear, consult a doctor; under no circumstances should you self-medicate! Remember, not all chest pain is heart pain, and not all heart pain is a death sentence. An experienced doctor will diagnose and determine the true causes of a functional disorder in the heart, and therefore will be able to prescribe adequate treatment.
Definition and nosological essence. Neurocirculatory dystonia (NCD) is a polyetiological disease, the main symptoms of which are instability of pulse and blood pressure, cardialgia, respiratory discomfort, autonomic and psycho-emotional disorders, disturbances of vascular and muscle tone, low tolerance to physical activity and stressful situations with a benign course and a good prognosis. for life (S. A. Abbakumov, V. I. K4akolkin, 1997).
NCD is a disease that has long been considered primarily a suffering of the soul, not the body, since its morphological substrate remained (and remains) unknown. The important role of functional changes in the cardiovascular system and the importance of exogenous factors for their occurrence was pointed out by S. P. Botkin (1967), who wrote: One must think that changes in the function of the heart often do not go in proportion to the anatomical changes in the heart itself. heart, and are often dependent on the central nervous apparatus, the condition of which in turn depends largely on environmental conditions.
There is still no uniform terminology for functional heart pathology. Its earliest descriptions were made in the second half of the 19th century. military doctors for male military personnel. Linking the occurrence of functional heart disease with physical overexertion during military service, British doctor W. McLean (1867) coined the term irritable heart.
In 1871 J. Da Costa, whose research was based on observations of veterans of the American Civil War, gave a detailed description of the symptoms of such an irritated, or excited, heart, emphasizing its connection in a significant proportion of cases with previous infectious diseases, occurring with or without diarrhea, and the benign nature of its course. Subsequently, such functional changes in the heart began to be called Da Costa syndrome after the author. The terms soldier's heart, effort syndrome, and painful chest, which appeared during the First World War, became less widespread. A reflection of the ideas about the important role of disorders in the psycho-emotional sphere, primarily anxiety and depression, and the secondary nature of cardiac symptoms, was that functional disorders of the heart were classified by a number of authors as nosological units such as neurasthenia and anxiety neurosis (S. Freud, 1894 ). The American doctor V. Oppenheimer (1918) suggested using the term neurocirculatory asthenia instead of all these terms, which has long been rooted in the English-language medical literature. The first studies that showed the prevalence of neurocirculatory asthenia among the civilian population and a higher frequency of this disease in women than men date back to the same period.
Further progress in the study of the functional pathology of the cardiovascular system is associated with the name of G. F. Lang (1935), who, among the diseases of the neurohumoral apparatus that regulates blood circulation, identified cardiovascular disorders of a neurogenic nature.
The term neurocirculatory dystonia was proposed by N.N., Savitsky (1963, 1964). In this concept N.N. Savitsky put the idea of the primacy of the violation of the tone of the central nervous apparatus regulating the activity of individual parts of the cardiovascular system. He also proposed dividing NCD according to the leading clinical manifestations into hypertensive, hypotonic and cardiac types.
In foreign literature, a number of researchers still use the term cardiac neurosis, which was widespread
nen in our country in the 60s. Close to it in meaning is the term functional disorders of the cardiovascular system, used in German literature. This term, as well as the terms anxiety neurosis, neurasthenia, neurocirculatory asthenia, are used by psychiatrists. Obviously, in connection with this, the last term is included in the Statistical Classification of Diseases, Injuries and Causes of Death of the Xth Revision in the section of mental diseases.
The study of connections between functional disorders of the autonomic nervous and cardiovascular systems led to the emergence of such terms as autonomic dystonia, autonomic dysfunction, autonomic neurosis, autonomic dysregulation. The most widely used term is vegetative-vascular dystonia (VSD), which is widely used in neurology. At the same time, functional changes in the heart and blood vessels are considered as a syndrome observed in many diseases and caused by dysfunction of suprasegmental vegetative formations (A. M. Vein, 1989).
The question of the essence of the conditions designated as vegetative-vascular and neurocirculatory dystopia is the subject of discussion between cardiologists and neurologists. Neurologists (A.M. Vein, O.A. Kolosova, 1974, etc.) and some cardiologists (E.E. Gogin, M.M. Krugly, 1981), without seeing significant differences between them, consider VSD more a broad concept that includes NCD, which they do not consider an independent disease. Most cardiologists (V, I. Makolkin, S. A. Abbakumov, 1985; T. M. Pokalev, 1994, etc.), however, believe that NCD cannot be identified with VSD, which they consider as a manifestation of neurosis and various organic diseases caused by changes in sympathetic and parasympathetic innervation. The famous neurologist E.V. Schmidt (1985) also speaks in favor of the nosological independence of NCD. According to these scientists, NCD is based on changes in vascular tone and their reactivity caused by emotional stress, infection, intoxication and other exogenous factors against the background of an innate constitutional predisposition, cardiac metabolic disorders, insufficient
the importance of neuroendocrine support for vital functional systems.
NCD cannot be considered as a variant of neurasthenia. This point of view developed in those years when most symptoms of NCD could be explained only by nervous factors. However, a careful study of the anamnesis and clarification of the causes of the disease indicate that somatic changes often occur earlier than neurotic ones. In youth and adolescence, the disease generally occurs without neurotic symptoms.
Recently, instead of the terms neurocirculatory dystonia and vegetative-vascular dystonia, the term panic attack syndrome has been used abroad, which was included in the classification of mental illnesses of the US Psychiatric Association in 1980. This concept emphasizes the paroxysmal nature of the occurrence of cardiac symptoms, accompanied by certain manifestations of a vegetative storm and often - more or less pronounced phobias, depression and depersonalization. As will be shown below, this description, however, does not fully correspond to the clinical picture of NCD, which is not limited to such paroxysms of heartbeat, trembling and other symptoms and in a significant part of cases is devoid of obvious manifestations of psychotic reactions.
Although the idea of NCD as a syndrome still has its supporters, the point of view of the majority of scientists in Ukraine and other CIS countries should be considered more reasonable (B. N. Bezborodko, L. N. Timoshenko, 1987; V. V. Vasilchenko, 1987 ; N.V. Bashmakova, 1992, etc.) that it is an independent disease. The identification of NCD as a separate nosological unit was dictated primarily by the needs of examination of work ability and differential diagnosis with organic diseases of the cardiovascular system, in which, unlike NCD, there can be a severe course, loss of ability to work and a poor prognosis.
Thus, in our country, two terms are most often used to denote functional changes in the cardiovascular system: neurocirculatory
tortuous dystonia and vegetative-vascular dystonia. The latter should be used to indicate various manifestations autonomic dysfunction syndrome, which may accompany organic pathology of the circulatory system and other organs and systems. NCD is recognized by most researchers as an independent disease with fairly fully formulated ideas about etiology and pathogenesis, clear clinical symptoms and a well-studied course and prognosis. Confirmation of the nosological independence of NCD can be the presence of not only characteristic changes in functional systems, indicating functional disorders, but also structural-dystrophic changes in the myocardium and trophic disorders of peripheral vegetative formations and tissues (S. A. Abbakumov, V. I. Makolkin, 1996). It was the disease, referred to as NCD, that was included in the Great Medical Encyclopedia, manuals and textbooks for students, orders for expert commissions and military doctors. In the International Classification of Diseases, X Revision, it corresponds to the term neurocirculatory asthenia in the section Somatic diseases of presumably psychogenic etiology, which, however, does not fully correspond to modern ideas about the essence of this disease.
Epidemiology. NCD is one of the common diseases. General practitioners, cardiologists, and neurologists especially often encounter it. Due to different views on the essence of the disease, there is also conflicting information about its frequency, which averages 2-4% (M. Cohen, P. White, 1981; L. Robins et al., 1984). Among patients with therapeutic and cardiological profiles, according to summary data from different authors (Table 36), this pathology is detected in 30-50% of cases.
The disease occurs at any age, but most often in young people, mainly in women, who get sick 2-3 times more often than men (L. Robins et al., 1984, etc.). NCD rarely occurs before the age of 15 years and after 40 years. In persons aged 25-44 years, NCD is observed 2 times more often than in 45-64 year-olds (D. Sheehan et al., 1981). Alarming facts were obtained when studying the prevalence of NCD here-
di high school students and students. Thus, according to M. Ya. Studenikin (1979), the frequency of NCD among schoolchildren is 10%, among students - 25-30% (G. M. Pokalev, 1984).
Etiology. No single cause of NCD has been identified. Regarding the occurrence of functional changes with There are different points of view on the aspects of the cardiovascular and nervous systems. Researchers often believe that various factors affecting the central nervous system are important in the occurrence of the disease: overwork, negative emotions, stress, sleep disturbances leading to mental asthenia. Chronic intoxication, harmful occupational exposures, endocrine dysfunction, foci of acute and chronic infection, and pregnancy are important. The occurrence of the disease is facilitated by prolonged hypokinesia, irrational work and nutrition regimens against the background of a hereditary predisposition. Considering the disease to be polyetiological, causative and predisposing factors are distinguished (Table 37).
A number of researchers, including neurologists (E.F. Davidenkova, I.S. Liberman, 1978; E.I. Panchenko, 1987), believe that the main cause of the disease is a hereditarily determined inferiority of the apparatus that regulates vascular tone . Reasons such as stressful situations, injuries, infections, intoxication, create only conditions for pro-
phenomena of this causal factor. The authors believe that in cases where the listed factors cause dysfunction of a genetically complete apparatus that regulates vascular tone, we should speak of symptomatic vegetative dystonia. This concept is supported by evidence that NCD is more often observed at a young age and is accompanied by inadequate changes in vascular tone in response to various influences. NCD disease is often observed in the same family. The probability of its occurrence in blood relatives of the patient is 15-25% (R. Crowe et al., 1987). There are indications of an autosomal dominant type of inheritance of panic attacks (D. Pauls et al., 1980) and its connection with the Q 2 2 locus on chromosome 16 (R. Crowe et al., 1987). Most researchers recognize, however, the polyetiological nature of the disease.
Pathogenesis. Despite its polyetiology, NCD is characterized by a single pathogenesis - dysregulation of the circulatory system. There are regulatory disorders that are fixed at the level of the cerebral cortex and its deep structures ( reticular formation, limbic or hypothalamic-pituitary system), as well as vegetative-vascular disorders, manifested by dysfunction of the sympathoadrenal and cholinergic systems and changes in the sensitivity of peripheral receptors. Great importance in the pathogenesis of NCD is attached to functional disorders in
hypothalamic-pituitary-adrenal system with the formation of either sympathetic dominance or hyperreactivity of the cholinergic system (S. B. Khanina, G. I. Shirinskaya, 1971) - diagram 3. In the regulation of cardiac activity, reflexogenic zones of the venous system are of great importance. The venous system has rich innervation. Irritation of the receptor apparatus of the veins has a significant effect on hemodynamics. These changes have been especially well studied during irritation of the mouths of the vena cava and the venous system of the brain. Viscerocardiac reflex mechanisms also have a great influence on cardiac function. Changes in the functioning of the heart are observed when vascular receptors in many internal organs are irritated. The presence of viscero-cardiac connections was established by S. P. Botkin (1875).
Regulatory disorders are expressed in a violation of homeostasis, which is manifested by multiple changes in hormonal and mediator systems, water-electrolyte, carbohydrate metabolism and CBS. Biologically active substances (histamine, serotonin, kinins, etc.) are activated in the myocardium, which lead to metabolic disorders and the development of dystrophy.
Such disorders of neurohumoral regulation can occur in persons who have suffered infectious diseases, surgical interventions, childbirth, as well as after any prolonged hypokinesia, which is especially pronounced during the period of convalescence with the expansion of the motor regime. In some cases, this pathological reaction on the part of the circulatory system is consolidated, despite the cessation of the trigger mechanism. The pathogenetic mechanisms formed in this way acquire autonomy, the disease becomes independent. The close interconnection of all parts of the nervous system determines the diversity clinical symptoms and makes it difficult to determine the level of primary failure.
Clinic. The discrepancy between the severity of complaints and the paucity of changes during an objective study is considered typical for NCD and serves as one of the basis for diagnosis. It is believed that patients with NCD experience up to 26 different symptoms during an exacerbation. Number of symptoms
in some patients reaches 150. For experienced doctor correct assessment of the genesis of this clinical symptoms usually not difficult. Many young doctors, however, are at a loss when faced with a large number of cardiac complaints and overestimate their significance.
As a rule, the most characteristic and common clinical syndromes are identified, which include:
Cardialgic;
Hyperkietic;
Heart rhythm and automaticity disorders;
Changes and pronounced lability of blood pressure;
Respiratory (respiratory distress syndrome);
Autonomic disorders;
Vegetovascular crises;
Asthenoneurotic.
The most common complaint (up to 98% of cases) is a complaint of pain or discomfort in the heart area. Cardialgia with NCD has characteristics, which makes it easy to distinguish it from angina pectoris and pain syndrome in a number of other organic pathologies. Pain syndrome is as typical for NCD as classic angina for ischemic heart disease, and therefore is used as one of the main diagnostic criteria. Patients with NCD describe their pain sensations in very detailed and colorful terms. The pain, as a rule, is localized in the precordial region, most often in the apex of the heart, is aching or stabbing in nature, and does not radiate. Sometimes it is more of an unpleasant sensation or a feeling of discomfort. The duration of pain varies - from a few seconds to several hours. The pain occurs predominantly at rest. It often appears with excitement or physical stress, weakening or completely disappearing with movement. The pain syndrome usually goes away on its own or stops after taking valocordin, tincture or tablets of valerian, validol, novo-passit. Occasionally, however, the pain may resemble exertional or resting angina.
The essence of cardialgia in NCD and the mechanism of its occurrence remain poorly understood. There is no consensus even on the question of what origin it has
pain - cardiac or extracardiac. Possible mechanisms of cardialgia include disorders of the tone of the coronary arteries of the heart, hyperventilation, hypercatecholaminemia, irritation of the cardiac sympathetic plexuses. Some authors (Yu. T. Gaevsky, 1976) associate cardialgia with a deficiency of norepinephrine in the myocardium, which leads to paretic dilatation of heart vessels. However, evidence against such a mechanism of pain is the fact that there is no parallelism between the severity of cardialgia and the signs of dystrophic changes in the myocardium recorded on the ECG. A number of researchers consider cardialgia as left-sided sympathalgia (V.S. Volkov et al., 1983; V.S. Volkov, V.P. Bratolyubov, 1986). P. Wood (1968) believes that pain in the heart area is of extracardiac origin and is associated with a disturbance in the frequency and rhythm of breathing and overstrain of the respiratory muscles. However, overstrain of the respiratory muscles cannot explain the left-sided localization of pain (T. S. Istamanova, 1958). According to G.F. Laig and T.S. Istamanova (1957), cardialgia with NCD has an extracardiac origin, but is pathogenetically associated with a decrease in the threshold of pain sensitivity of the perceptive apparatus of the brain, which leads to the fact that the usual physiological impulses from the heart is perceived as pain.
Hyperkinetic syndrome. It has been established that patients with NCD are characterized by a significant increase in MOS, mainly due to SOS. At the same time, OPSS decreases significantly. Such changes in systemic hemodynamics correspond to the hyperkinetic type of circulation and lead to an increase in the work and contraction power of the left ventricle.
One of the main clinical manifestations of hyperkinetic syndrome is complaints of palpitations, which are not always accompanied by an increase in heart rate upon objective examination. Patients often also note tremors in the heart area, pulsation of the vessels of the neck or head, freezing, failure, cardiac arrest. All these symptoms are painful to bear, but just like shortness of breath, they go away with physical exertion. Heart rate ranges from 80 to 130 per minute. Pulse quickens with excitement, change
body position, hyperventilation, standing. Feelings of fading and cardiac arrest are often associated with ventricular extrasystole. The peculiarity of these extrasystoles is that they appear at rest, more often towards the end of the working day, after physical activity (and not at the height of the load, as with angina!), and during emotional stress. Physical activity leads to a decrease in the frequency of extrasystoles or to their complete disappearance. Upon examination, the borders of the heart are usually not changed, and the tones are sonorous. Sometimes you hear an innocent systolic murmur above the apex or at the base of the heart. Atrial fibrillation is not observed with NCD. Signs of congestive heart failure are not detected.
Syndrome of changes and lability of blood pressure. Important signs of NCD include increased blood pressure and its extreme lability. An increase in blood pressure can be spontaneous or more often in the form of an inadequate reaction to emotional stress, physical activity, hyperventilation and transition from horizontal position to vertical. In most cases, blood pressure rises to a level corresponding to borderline arterial hypertension, but in some patients short-term increases in blood pressure reach higher values. During a breath-hold test, blood pressure increases by 20-25 mmHg. Art. and more. If these symptoms are present, a diagnosis of NCD of the hypertensive type is made.
A number of patients have a tendency to low blood pressure, which is usually referred to as hypotonic type NCD. A feature of this blood pressure reaction is normal blood pressure numbers at rest and their decrease during exercise. In the development of these disorders in NCD, a major role is played by a decrease in the tone of the peripheral veins, which leads to the deposition of blood in them and a decrease in the return of venous blood to the heart. This can explain the fainting conditions in such patients during physical stress, changes in body position, painful stimulation, and excitement.
Respiratory distress syndrome is observed frequently - in more than 85% of cases. Although patients, as a rule, assess their sensations as shortness of breath, upon detailed questioning it turns out that this is rather a feeling of dissatisfaction.
difficulty breathing, which occurs both during physical activity and at rest. Often they note a feeling of oxygen deficiency, lack of air, suffocation, inability to take a deep breath, a painful sensation in the trachea or upper sternum. Upon examination, frequent shallow breathing is detected, which at rest, while talking about his illness, is interrupted by deep sighs. V. S. Nesterov (1965) describes such breathing as suction. Percussion of the lungs reveals a clear percussion sound, a decrease in the depth of breathing, and no wheezing. When examining the function of external respiration, signs of hyperventilation (increased minute ventilation of the lungs) and a decrease in expiratory reserve volume are recorded.
It is generally accepted that the basis of this breathing disorder is hyperadrenalineemia. In this case, increased breathing can quickly lead to disruption of control over it by the brain, as a result of which breathing becomes poorly controlled, and an increase in the content of residual air in the lungs leads to ineffective pulmonary ventilation (S. A. Abbakumov, 1997).
Autonomic disorders characteristic of patients with NCD are manifested by complaints of excessive sweating and a feeling of chills. In a number of cases, long periods of low-grade fever are detected, and a monotonous temperature curve is characteristic, without significant fluctuations in body temperature in the morning and evening hours. At the same time, no changes are observed in the clinical blood test, and biochemical studies do not reveal signs of inflammation. Upon objective examination, the condition of patients is assessed as satisfactory, although sometimes there is an increase in body temperature to febrile.
The majority of patients with NCD have a pronounced weather dependence. It most often manifests itself as a headache, constant or migraine-type, which is provoked by changes in atmospheric pressure. Arthralgia and myalgia may occur, coinciding with exacerbation of other autonomic disorders. Often, patients experience swelling of the face and hands in the morning and legs in the evening, the cause of which is microcirculation disorders and cell swelling. Development
The occurrence of edema may coincide with psycho-emotional stress, vegetative crises, and the premenstrual period. At clinical examination acrocyanosis, coldness of the extremities, marbling of the skin, sweating of the palms, feet and armpits are detected.
V. F. Zelenin (1950) divided the symptoms of autonomic dysfunction depending on the predominance of the tone of the sympathetic or parasympathetic part of the autonomic nervous system. Thus, autonomic dysfunction of the vagotonic type is characterized by cold, damp, pale skin, hyperhidrosis, hypersalivation, bright red dermographism, bradycardia, a tendency to arterial hypotension, respiratory arrhythmia, a tendency to fainting and weight gain. Patients with sympathicotonia experience pale and dry skin, cold extremities, a tendency to tachycardia and increased blood pressure, tachypnea, and constipation. Reduced tolerance to heat, noise, bright light, muscle tremors, paresthesia, and chilliness are observed.
One of the most severe manifestations of NCD is vegetative-vascular syndrome. These include sympathetic-adrenal and vagoinsular crises.
Sympathetic-adrenal crisis, which in modern English-language literature is referred to as a panic attack, in NCD occurs in a hyper- and hypotonic type. The crisis develops more often in the afternoon or at night. The attack is preceded by psycho-emotional stress, fatigue, and changes in weather conditions. In women, it often develops during the premenstrual period. Subjective sensations are very vivid; there is a feeling of fear, melancholy, and approaching death. Characterized by a sharp headache, sensations of constriction in the chest, lack of air, uncontrollable trembling, accompanied by sharp chills and a feeling of coldness in the extremities. Blood pressure rises to 200/100 mm Hg. Art. Tachycardia and extrasystole are noted. A clinical blood test reveals leukocytosis in some patients up to 9-9.5 10°/l; the ECG shows a sharpening of the wave R, sometimes segment decline ST(but no more than 2 mm). The duration of the attack is usually 1.5-2 hours. It ends with copious urination.
Vagoinsular crisis occurs in NCD of the hypertensive type. This is characterized by lethargy, severe dizziness, general weakness, sweating, physical inactivity, increased peristalsis, diarrhea. Objectively, pronounced bradycardia and a decrease in systolic pressure to 90-80 mm Hg are noted. Art. ECG shows bradycardia, prolongation of the interval R- Q up to 0.22 s, interval shortening Q-T, increase in tooth amplitude T in lead Vj - V 2, segment depression ST obliquely ascending in nature, but not more than 1 mm.
The duration of the attack is 3-4 hours, fatigue and weakness persist for about 3 days. Crises aggravate the general condition of patients and reduce their ability to work.
Asthenic syndrome is manifested by weakness and increased fatigue. Characterized by fixation of attention on own feelings, anxiety, restlessness, irritability, sleep disturbance, cardiophobia. A number of patients experience a decrease in physical performance.
Diagnostics. Deserves special attention ECG changes and their evaluation. The most common are disorders of automatism and rhythm - sinus tachycardia, bradycardia, extrasystole, mainly ventricular, migration of the pacemaker through the atria. Conduction disturbances are observed in the form of sinoauricular and pre-ventricular blockades of the first degree, and occasionally Mobitz type I. In most cases, these arrhythmias disappear after administration of atropine sulfate. Repolarization disturbances are noted in the form of a shift below the isoelectric line of the segment ST and tooth changes T, until its inversion. Negative prong T and segment depression ST are recorded predominantly in the right chest leads and leads II, III, aVF and only occasionally in the left. In some patients, teeth are detected U and early ventricular repolarization syndrome. In hyperkinetic syndrome, there is a shortening of the interval R- Q, decrease in the width of the complex QRS and an increase in the amplitude of the tooth T. Characteristic lability of the tooth T and segment ST during hyperventilation and orthostatic tests, which is expressed in temporary inversion of the wave T and in the decline of the segment ST. A negative G wave usually becomes positive during potassium and inderal tests, i.e.
40 minutes - 1.5 hours after ingestion of 6 g of potassium chloride or 60-80 mg of propranolol (anaprilin, obzidan) - fig. 47. The sensitivity of these tests in patients with NCD reaches 95%, and the specificity - 85% (M. S. Kushakovsky and K. N. Medvedev, 1972; V. I. Makolkin, 1973; V. N. Orlov, 1987).
In the pathogenesis of repolarization disorders, importance is attached to neurogenic myocardial dystrophy. The beginning of the doctrine of trophic innervation was laid by I. P. Pavlov (1883), who discovered the influence of the centrifugal nerves of the heart on metabolic processes in the myocardium. Later, in the 60-80s of the XX century. the essential role of catecholamines was established. Particularly interesting is the experiment of Z. I. Vedeneeva (1967), which showed that myocardial dystrophy can be caused not only by α-adrenergic agonists, but also by the β-adrenergic stimulant isadrin, which dilates the coronary vessels of the heart. This allows us to conclude that dystrophic changes in the myocardium caused by catecholamines are not associated with their vasoconstrictor effect.
The development of neurogenic myocardial dystrophy with excessive adrenergic impulses is caused by the uncoupling of oxidation and phosphorylation in mitochondria with a decrease in the reserves of macroergs (ATP and creatine phosphate) and the accumulation of inorganic phosphorus (I. S. Zavodskaya et al., 1977, 1981). The activating effect of catecholamines on the enzyme adenyl cyclase, which catalyzes the formation of cyclic AMP from ATP, has also been shown (E. Sautherland et al., 1966).
By doing stress tests A significant proportion of patients with NCD exhibit a decrease in tolerance to physical activity on a bicycle ergometer. At the same time, imperfect regulation of the body's energy supply systems is manifested by a hyperkinetic type of hemodynamics at rest and under low power load (up to 50 W). There is a higher heart rate and respiratory rate at each level of load compared to healthy people. Characterized by impaired adaptation to physical activity, which is also evidenced by an increase in pulmonary ventilation and a decrease in oxygen pulse.
The physical performance of patients with NCD depends on the initial autonomic tone. The lowest load tolerance is observed with sympathicotonia, when already
When performing a low-power load on a bicycle ergometer, a significant increase in heart rate and rapid fatigue are observed. The main role in reducing the physical performance of patients is played by disturbances in the neuroendocrine regulation of cardiac activity and myocardial metabolism. With an increase in the tone of the parasympathetic part of the autonomic nervous system, there is a decrease in myocardial oxygen consumption and an increase in the energy efficiency of the heart.
When recording an ECG during dosed physical activity in patients with NCD, no ischemic depression of the segment is observed ST. If there is a negative tooth T its positivity is often noted.
In the majority of patients with NCD, including those with severe disease and ECG changes assessed using EchoCG indicators of left ventricular systolic function at rest do not differ from those in the norm. In some patients, however, at the height of physical activity, a decrease in EF and other indicators of myocardial contractility may be observed. Doppler echocardiography can sometimes detect initial signs of left ventricular diastolic dysfunction.
Based on the identification of the most common signs in NCD, V.I. Makolkin and S.A. Abbakumov (1996) formulated diagnostic criteria for NCD, which are divided into basic and additional. Each of these headings includes 5 groups of characteristics. A reliable diagnosis of NCD is established in the presence of two or more main and at least two additional criteria.
The main diagnostic criteria for NCD include:
1) peculiar cardialgia, characteristic only of NCD or neurotic conditions;
2) characteristic respiratory disorders in the form of a feeling of oxygen starvation or insufficient inhalation;
3) pronounced lability of pulse and blood pressure;
4) changes in the final part of the ventricular ECG complex in the form of negative G waves, mainly in the right chest leads II, III, aVF, and signs of early ventricular repolarization syndrome;
5) tooth lability T and segment ST during hyperventilation and orthostatic tests.
Additional diagnostic criteria for NCD include:
1) cardiac complaints and symptoms - sensations of palpitations, strong tremors and pain in the heart area as manifestations of a hyperkinetic state of blood circulation;
2) vegetative-vascular symptoms - vegetative-vascular crises, dizziness, headache, low-grade fever, myalgia, hyperalgesia, feeling of internal trembling;
3) psycho-emotional disorders in the form of anxiety, restlessness, irritability, cardiophobia, sleep disturbances;
4) manifestations of asthenic syndrome - weakness, decrease in maximum oxygen consumption and exercise tolerance during bicycle ergometry and other stress tests;
5) benign course of the disease without signs of the formation of gross pathology of the cardiovascular system, neurological and mental disorders.
The proposed criteria for diagnosing NCD can be used even in outpatient practice, since they do not require labor-intensive laboratory and instrumental examination.
Differential diagnosis. The error rate in diagnosing NCD ranges from 50 to 80% (V.I. Makolkin, S.A. Abbakumov, 1980; A.A. Bova, 1998; G. Goldwitch, 1952). The diversity of clinical manifestations of NCD often leads to overdiagnosis of various organic cardiovascular pathologies. Thus, at the prehospital stage, the correct interpretation of the functional genesis of disorders of the cardiovascular system occurs only in 30-40 % cases. Most of these patients are misdiagnosed as ischemic heart disease, myocarditis, hypertension, rheumatic carditis, thyrotoxicosis, bronchial asthma, chronic bronchitis, osteochondrosis, intercostal neuralgia.
The greatest number of errors are made when carrying out differential diagnosis between NCD and IHD. If in the 40-60s their frequency was 10-30%, then by the 90s it increased to 50-57 % (P. A. Sarapultsev, 1993).
An analysis of the reasons for the erroneous diagnosis of coronary artery disease in NCD shows that in the majority (80%) of cases it is associated with non-
correct assessment of the nature of the pain syndrome due to insufficient clarification of its characteristics. A frequent source of diagnostic errors is also insufficient knowledge by doctors of the clinical picture of NCD. A common cause of overdiagnosis of coronary artery disease is the incorrect interpretation of the genesis of changes in the repolarization phase on the ECG. Angina pectoris can be distinguished from NCD by the pressing, squeezing nature of the pain characteristic of the first disease, which occurs during physical activity or with excitement, is usually localized behind the sternum, radiating to the left shoulder, left or both arms, and jaw. When the provoking factors are eliminated or after taking nitroglycerin, the pain is relieved within 1-3 minutes. Changes in the G wave in NCD are more often localized and usually more pronounced in the right precordial leads, while left ventricular hypertrophy associated with arterial hypertension, which is very common in coronary artery disease, is more often accompanied by wave changes T in the left chest leads. In patients with NCD, segment changes ST at rest are much less common than tooth changes T(6%), while with ischemic heart disease they are detected in 25-32% of cases (I. B. Gordon, A. I. Gordon, 1994).
Exercise testing plays an important role in the differential diagnosis of pain in the heart and changes in the phase of ventricular repolarization on the ECG. The information content of a positive result of a bicycle ergometer study in patients with coronary artery disease reaches 85%. However, one should keep in mind the possibility of the appearance of oblique depression of the segment ST in approximately 8% of patients with NCD. Moreover, as a rule, it occurs during the recovery period, and not at the height of the load, as with ischemic heart disease. In patients with NCD, significantly more often than in patients with ischemic heart disease, an increase in the amplitude of the G wave occurs at the height of the load. Contrary to the prevailing idea among doctors about the hypoxic nature of negative and high pointed positive waves T on the ECG, in fact, they are much more likely to serve as a nonspecific manifestation of myocardial metabolic disorders and occur in patients with NCD at rest and during exercise more often than in patients with coronary artery disease.
In the differential diagnosis of NCD and ischemic heart disease as the cause of changes in repolarization on the ECG, S. A. Abbakumov and co-authors (1982) suggest using several tests simultaneously: bicycle ergometer, potassium, inderal, orthostatic and hyperventilation, which, according to their data, can improve its accuracy up to 100%. Highly informative methods for diagnosing myocardial ischemia are Holter ECG monitoring and myocardial scintigraphy, especially when performing a dipyridamole test. In diagnostically difficult cases, coronary angiography is necessary.
For myocarditis, Unlike NCD, there are signs of myocardial damage - an increase in heart size, impaired systolic and diastolic functions of the left ventricle, which are often accompanied by clinical signs of heart failure. ECG changes in myocarditis are more varied. These include a decrease in voltage, various rhythm and conduction disturbances, and persistent changes in the repolarization phase. A negative result of pharmacological, orthostatic and hyperventilation tests is typical.
In case of NCD of the hypertensive type, when the leading symptom in the clinic is an increase in blood pressure, there is a need for differential diagnosis with stage I hypertension. At the same time, a family history of hypertension and a more persistent nature of the increase in blood pressure, which can be judged by the results of its systematic measurement every 2-3 hours for 3-4 days, testify in favor of hypertension. Segmental narrowing of fundus arterioles may be detected. The response of blood pressure to physical activity is important. In hypertension, a hypertensive type reaction is observed, i.e., systolic and diastolic pressure increases simultaneously (normally, diastolic pressure decreases). 5 minutes after the load, blood pressure does not normalize and does not return to the initial level (Fig. 48). In NCD of the hypertensive type, along with an increase in systolic blood pressure, there is a more pronounced decrease in diastolic pressure than in healthy individuals (Fig. 49).
Sometimes difficulties arise in the differential diagnosis of NCD with thyrotoxicosis. Common signs are: palpitations, low-grade fever, pain in the heart area, increased blood pressure. In patients with thyrotoxicosis, constant tachycardia is observed, even during sleep, in contrast to NCD, in which it is unstable. Thyrotoxicosis is also characterized by weight loss against the background of preserved and increased appetite and an increase in pulse pressure due to an increase in systolic pressure and a decrease in diastolic pressure. In NCD, these symptoms are not pronounced. Patients with thyrotoxicosis may periodically experience attacks of atrial fibrillation, which does not happen with NCD. In the advanced stage of the disease, eye symptoms are often detected: exophthalmos, Graefe's symptoms, Mobius's. Determination of the content of thyroxine, 3-iodine-thyronine and thyroid-stimulating hormones in the blood and radionuclide examination of the thyroid gland are of decisive importance (with thyrotoxicosis, the increase in the accumulation of radioactive iodine in it exceeds 25% in 2 hours, and 50% in 24 hours).
Low-grade fever, tachycardia, rhythm disturbances, pain in the heart area and systolic murmur, characteristic of patients with NCD, often cause the diagnosis misdiagnosis primary or recurrent rheumatic carditis. The latter, however, is distinguished by the onset of the disease 2 weeks after a streptococcal infection, joint damage in the form of polyarthralgia or polyarthritis, and signs of endomyocarditis in clinical, radiological and echocardiographic studies. Laboratory research data are important, in which leukocytosis with a shift of the leukocyte formula to the left, increased ESR, C-reactive protein, seromucoid, fibrinogen, and dysproteinemia are determined.
The criteria for the differential diagnosis of NCD with the most common diseases with a similar clinical picture - ischemic heart disease, myocarditis, menopausal cardiomyopathy and intercostal neuralgia - are presented in Table. 38,
Classification and flow options. There is no generally accepted international classification of NDCs. Classification, pre-
laid down by N.N. Savitsky (1953, 1957), provides for the identification of 4 types of disease depending mainly on the level of blood pressure: cardiac, hypotonic, hypertensive, mixed). At present, however, it is criticized due to the possibility of transition from one type of disease to another during observation, underestimation of the diversity of symptoms of NCD and the lack of indication of the degree of disorders of the main functional systems affecting the ability of patients to work.
Recently, a more detailed classification of NCD, proposed and further improved by V. I. Makolkin, S. A. Abbakumov, I. G. Alliluyev (1980, 1986), which takes into account etiological factors, features of clinical manifestations, degree severity and phase of the disease (Table 39).
The severity of NCD is determined by the severity of the main clinical syndromes and tolerance to physical activity, which characterizes the degree of functional disorders.
With I degree of functional disorders (or mild flow) the number of complaints is small (3-6), the symptoms are mild.
There are no crisis conditions or neurotic symptoms. Portability physical activity satisfactory or good. Patients are able to work and do not require drug therapy.
In case of II degree of functional disorders (or course of
diseases of moderate severity) patients develop many complaints and symptoms (8-16). There is a comprehensive clinical picture of NCD with characteristic respiratory disorders, severe tachycardia during emotional or physical stress, lability of blood pressure, and the presence of vegetative-vascular crises. Neurotization and poor tolerance of intellectual stress are noted. Physical exercise tolerance is significantly reduced (according to bicycle ergometry data, by more than 50%). Patients usually require drug therapy.
Stage III functional disorders (or severe disease) are characterized by an abundance of clinical symptoms (more than 17), their significant severity and persistence. Almost all patients experience changes in the phase of ventricular repolarization on the ECG, rhythm disturbances and automaticity. Physical exercise tolerance is sharply reduced according to bicycle ergometry data. Working capacity is sharply reduced or lost. Patients require constant drug therapy.
Constructing a diagnosis of NCD taking into account the etiology (if possible), leading clinical syndromes and degree of function
national disorders, i.e., the severity of the disease, allows you to individualize treatment and assess work capacity.
Close to the classification of V.I. Makolkin and co-authors (1980, 1986) is the NCD classification adopted by the IV Congress of Cardiologists of Ukraine (1993):
I. According to the leading clinical syndrome (cardiac, hyperkinetic, neurotic, arrhythmic, respiratory and asthenic);
II. By degree of severity: mild (I), moderate (II), severe (III);
III. According to the nature of the course: labile, latent, stable;
IV. By phase: exacerbation, remission.
Treatment. Etiotropic treatment of NCD consists of eliminating the influence of various unfavorable factors on the body external environment. Negative emotions should be avoided, if possible, normalize working and living conditions, improve sleep and increase physical activity. Psychotherapy is of great importance. The patient is explained the essence of the disease and convinced of its favorable outcome. It is recommended to eliminate harmful occupational exposures, quit smoking and alcohol, sanitize chronic foci of infection, and limit the consumption of tonic products (tea, coffee). Overeating should be avoided.
The diverse range of autonomic and hemodynamic disorders in patients with NCD necessitates the need for adequate therapy in accordance with the main links of pathogenesis by influencing disorders of the psychoemotional sphere, autonomic and visceral relationships, and metabolic and trophic disorders of internal organs. Therefore, therapy for patients with NCD includes tranquilizers, antipsychotic drugs, antidepressants and milder sedatives - valerian extract, Corvalol. Of the tranquilizers, benzodiazepine derivatives are most often used - sibazone 10-30 mg per day, nozepam 10 mg 2 times a day, alprazolam, etc. Of the antipsychotics that have the ability to block dopaminergic receptors, sonapax 0.025-0.1 g per day is recommended day, giving a good effect in neurogenic
cardialgia, extrasystole, paroxysmal tachycardia. Of the mild antipsychotics, teralene is successfully used, which is used at a dose of 5-15 mg per day. The therapeutic effect of these drugs occurs on the 3rd - 5th day. Of the antidepressants, the most widely used is amitriptyline (25-75 mg per day), which can be combined with sibazon. Experience is accumulating in the use of selective serotonin reuptake inhibitors (sertraline, citalopram, etc.). Antidepressants are effective not only in the presence of symptoms of depression, but also in their absence. Among psychostimulants, tincture of ginseng root, 15-25 drops orally, is recommended.
Increased activity of the sympathetic-adrenal system is reduced by using beta-blockers. They are especially effective for vegetative-vascular crises of the sympathetic-tonic type, for pain syndrome and manifestations of a hyperkinetic state of blood circulation. These drugs help normalize high blood pressure, eliminate tachycardia and discomfort in the heart, and increase tolerance to physical activity. P-blockers are not indicated for bradycardia, a tendency to arterial hypotension and other signs of predominance of the tone of the parasympathetic part of the autonomic nervous system.
The dose of β-blockers is selected individually. During periods of improvement, the drug can be discontinued or the dose reduced. Instead of β-blockers, verapamil or diltiazem can be prescribed. In some cases, the use of the α-adrenergic blocker pyrroxan 0.015-0.03 g orally or 1-2 ml of a 1% solution intramuscularly has a good effect.
Similar treatment is carried out for sympathetic-adrenal crises.
For vagoinsular crises, atropine sulfate and diphenhydramine are prescribed intramuscularly in standard doses. If the crisis is accompanied by hyperventilation, sibazon is used intramuscularly and calcium chloride intravenously.
To correct hemodynamic disorders, drugs are used that increase tolerance to physical activity - β-blockers (according to indications), metabolic agents
personal therapy - mildronate, B vitamins, ascorbic acid, tocopherol acetate in courses of 1-2 months 2-3 times a year.
In some cases, the use of various physical factors for the treatment of NCD has a good effect. Electrosleep is widely used, the effectiveness of which is associated with its corrective effect on disturbances in the functional state of various parts of the cardiovascular system and autonomic dysfunction. Under the influence of a predominantly low-frequency alternating magnetic field, the conditioned reflex activity of the brain changes, mainly towards the activation of inhibitory processes. Balneotherapy - carbon dioxide and pine baths - are successfully used. Among non-drug methods of treating NCD, physical therapy is important. Physical training helps to increase tolerance to physical activity and has a beneficial effect on the patient’s psyche.
Controlled studies of the effectiveness of various drug and non-drug therapies for NCD, however, have not been conducted.
The prognosis for life is favorable. NDC does not lead to organic damage heart and, as long-term observations show, is not associated with an increase in mortality from cardiovascular pathology (E. Wheeler et al., 1950; G. Winokur, D. Black, 1987). However, in approximately 50% of patients it causes a significant deterioration in the quality of life and in a significant part of them leads to greater or lesser disability (L. I. Olbinskaya, 1986; E. V. Proshina, 1989). Despite treatment, in more than 50% of patients, painful symptoms, including crises, rhythm and conduction disturbances, persist for a long time - more than 10 and even 20 years (S. Greer et al., 1969; P. Skeritt, 1983). As a rule, they are triggered by stress (infection, surgery, physical and mental trauma). About 30 % patients with hypertensive type NCD develop over time
hypertension develops. Although it has been established that people with a family history of hypertension are most susceptible to this, it is not yet possible to predict such an outcome of NCD in each case.
Prevention. A healthy lifestyle is the basis for preventing NCD. Sufficient physical activity, giving up bad habits, proper upbringing in the family, fighting focal infections, and in women, timely correction of hormonal disorders are important.
The following factors lead to disturbances in the activity of the heart:
- coronary heart disease, characterized by impaired blood circulation in the myocardium, provokes oxygen starvation. Accompanied by painful sensations of a pressing or aching nature, which intensify with emotional shocks. The work of the sweat glands increases, shortness of breath develops, nausea and vomiting are possible. The patient becomes more irritable and suffers from panic attacks:
- arterial pressure increase above acceptable limits, characterized by weakness, difficulty speaking, flashing of midges before the eyes, tinnitus. The frequency of migraines increases, develops against the background of viral diseases, and may have a hereditary factor;
- rheumatic carditis, characterized by disruption of the valves of the heart system. Initially, painful sensations in the joint tissues develop, swelling appears, body temperature rises, and nausea develops. The causative agent of the disease is streptococci;
- cardiomyopathy, characterized by disruption of the functioning of the heart muscle; in the initial stages of the development of the disease there are no symptoms. Mortality from the disease is 50 %. It is necessary to consult a doctor if the skin is pale, fatigue, swelling, dizziness, or heart rhythm disturbances. Develops due to intoxication of the body, chronic alcoholism, arterial hypertension;
- arrhythmia, characterized by a change in heart rate. Associated symptoms are cardiac arrest or overly active work, fainting, attacks of dizziness, angina pectoris. Develops in infectious and inflammatory diseases;
- atherosclerotic vascular disease, characterized by the accumulation of cholesterol in plaques, causing artery blockage, impairing blood circulation, the risk of occurrence increases with frequent consumption of fast food;
- cardiosclerosis, characterized by the proliferation of connective fibers, the functioning of the heart valves is disrupted. Develops against the background of infectious diseases;
- Myocardial infarction is a life-threatening condition characterized by blockage of the coronary arterial canal. Blood circulation in the brain and cardiac system is disrupted. Hospitalization of the patient is required. The prognosis is favorable with timely assistance. Develops against the background of drinking alcohol, smoking, and also with a high concentration of cholesterol in the blood vessels;
- stroke, characterized by impaired blood circulation in the brain. The death of cells of the nervous system is provoked. More often leads to death. With timely assistance, there is a high probability of remaining disabled. One of the first signs is numbness of the face, upper and lower limbs;
- blood diseases, for example, pulmonary embolism. It is characterized by a decrease or disappearance of the lumen of the arterial canal. More often leads to sudden death of the patient;
- physical damage to blood vessels;
- excess body weight;
- insufficient physical activity;
- the risk of progression of cardiac pathologies increases during pregnancy;
- aging process;
- improperly composed diet, high concentration fats, sugar, chemical additives;
- polluted environment;
- frequent stressful situations;
- previous heart attacks.
Diseases of the cardiovascular system rank first in terms of morbidity and mortality worldwide. This is due to many reasons, including poor lifestyle, bad habits, poor nutrition, stress, heredity and much more. Every year, the age of heart pathologies is getting younger, and the number of patients who become disabled after suffering heart attacks, strokes and other complications is growing. That is why doctors strongly recommend that you pay close attention to your body and immediately go to the hospital if alarming symptoms appear.
What are cardiovascular diseases
Heart and vascular diseases are a group of pathologies affecting the functioning of the heart muscle and blood vessels, including veins and arteries. The most common pathologies are coronary heart disease, diseases of the cerebral vessels and peripheral arteries, rheumatic carditis, arterial hypertension, strokes, heart attacks, heart defects and much more. Defects are divided into congenital and acquired. Congenital ones develop in the womb, acquired ones often become the result of emotional experiences, wrong image life, various infectious and toxic lesions.
Important! Each disease requires timely diagnosis and competent medical treatment, since if neglected there is a risk of developing severe complications and death of the patient.
The list of common diseases of the cardiovascular system includes coronary heart disease. This pathology is associated with impaired blood circulation in the myocardium, which leads to its oxygen starvation. As a result, the activity of the heart muscle is disrupted, which is accompanied by characteristic symptoms.
Symptoms of IHD
When the disease occurs, patients experience the following symptoms:
- pain syndrome. The pain can be stabbing, cutting, pressing in nature, and intensifies with emotional experiences and physical activity. IHD is characterized by the spread of pain not only to the sternum, it can radiate to the neck, arm, shoulder blade;
- dyspnea. Lack of air appears in patients first during intense physical exertion, during hard work. Later, shortness of breath occurs more and more often, when walking, while climbing stairs, sometimes even at rest;
- increased sweating;
- dizziness, nausea;
- a feeling of sinking heart, rhythm disturbance, less often fainting.
On the psychological side, irritability, attacks of panic or fear, and frequent nervous breakdowns are noted.
Due to circulatory disorders, ischemia occurs in certain areas of the heart
Causes
Factors that provoke IHD include anatomical aging of the body, gender characteristics (men get sick more often), race (residents of Europe suffer from the pathology more often than black races). The causes of coronary artery disease include excess body weight, bad habits, emotional overload, diabetes mellitus, increased blood clotting, hypertension, lack of physical activity, etc.
Treatment
Treatment methods for IHD include the following areas:
- drug therapy;
- surgery;
- eliminating the causes of pathology.
Among the medications used are antiplatelet agents - drugs that prevent the formation of blood clots, and statins - drugs to lower bad cholesterol in the blood. For symptomatic treatment, potassium channel activators, beta-blockers, sinus node inhibitors and other drugs are prescribed.
Hypertonic disease
Arterial hypertension is one of the most common diseases affecting the heart and blood vessels. The pathology consists of a persistent increase in blood pressure above acceptable standards.
Signs of hypertension
Signs of cardiovascular pathology are often hidden, so the patient may not be aware of his disease. A person leads a normal life, sometimes he is bothered by dizziness and weakness, but most patients attribute this to normal fatigue.
Obvious signs of hypertension develop with damage to target organs and can be of the following nature:
- headaches, migraines;
- noise in ears;
- flashing midges in the eyes;
- muscle weakness, numbness of the arms and legs;
- difficulty speaking.
The main danger of this disease is myocardial infarction. This serious condition, often ending in death, requires immediate delivery of the person to a hospital and the necessary medical measures.
Causes
The reasons that cause a persistent increase in blood pressure include:
- strong emotional overload;
- excess body weight;
- hereditary predisposition;
- diseases of viral and bacterial origin;
- bad habits;
- excessive amount of salt in the daily diet;
- insufficient motor activity.
Hypertension often occurs in people who spend long periods of time in front of a computer monitor, as well as in patients whose blood often experiences surges of adrenaline.
A common cause of hypertension is bad habits.
Treatment
Treatment of cardiovascular disease accompanied by increased blood pressure involves eliminating the causes pathological condition and maintaining blood pressure within normal limits. For this purpose, diuretics, inhibitors, beta-blockers, calcium antagonist and other drugs are used.
Important! A sharp increase in pressure is called. This dangerous complication requires urgent medical attention using complex therapy.
Rheumatic carditis
The list of cardiovascular diseases includes a pathology accompanied by disruption of the functioning of the heart muscle and valve system - rheumatic carditis. The disease develops due to damage to the organ by group A streptococci.
Symptoms
Symptoms of cardiovascular disease develop in patients 2 to 3 weeks after suffering a streptococcal infection. The first signs are pain and swelling of the joints, increased body temperature, nausea, and vomiting. Getting worse general health the patient becomes weak and depressed.
The pathology is classified into pericarditis and endocarditis. In the first case, the patient suffers from chest pain and lack of air. When listening to the heart, muffled tones are heard. Endocarditis is accompanied by rapid heartbeat and pain that occurs regardless of physical activity.
Causes
As already mentioned, heart damage is caused by diseases caused by group A streptococci. These include sore throat, scarlet fever, pneumonia, erysipelas dermis and so on.
Treatment
Patients with severe rheumatic carditis are treated in a hospital setting. A special diet is selected for them, which consists of limiting salt, saturating the body with potassium, fiber, protein and vitamins.
Among the medications used are non-steroidal anti-inflammatory drugs, glucocorticosteroids, painkillers, quinoline drugs, immunosuppressants, cardiac glycosides, etc.
Cardiomyopathy
Cardiomyopathy is a disorder of the functioning of the heart muscle of unknown or controversial etiology. The insidiousness of the disease is that it often occurs without visible symptoms and causes death in 15% of patients with this pathology. The mortality rate among patients with symptoms characteristic of the disease is about 50%.
Cardiomyopathy is often the cause of sudden death
Signs
Patients with cardiomyopathy experience the following symptoms:
- fast fatiguability;
- loss of ability to work;
- dizziness, sometimes fainting;
- pallor of the dermis;
- tendency to edema;
- dry cough;
- dyspnea;
- increased heart rate.
It is cardiomyopathy that often causes sudden death in people leading an active lifestyle.
Causes
The causes of cardiovascular disease, such as cardiomyopathy, are as follows:
- poisoning;
- alcoholism;
- diseases of the endocrine system;
- arterial hypertension;
- myocardial damage of an infectious nature;
- neuromuscular disorders.
Often it is not possible to determine the cause of the disease.
Treatment
Treatment of cardiovascular disease requires lifelong adherence to preventive measures aimed at preventing serious complications and death. The patient needs to give up physical activity, bad habits, follow a diet and a proper lifestyle. The patient's menu should exclude spicy, smoked, sour, and salty foods. Strong tea, coffee, carbonated sweet waters are prohibited.
Drug therapy includes drugs such as β-blockers and anticoagulants. Severe pathology requires surgical intervention.
Important! Lack of treatment for cardiomyopathy leads to the development of heart failure, valvular organ dysfunction, embolism, arrhythmias, and sudden cardiac arrest.
It is customary to talk about cardiovascular diseases when a person experiences any disturbance in heart rate or failure of the electrical conductivity of the heart. This condition is called arrhythmia. The disease may have a latent course or manifest itself in the form of palpitations, a feeling of a sinking heart, or shortness of breath.
Arrhythmia is accompanied by disturbances in heart rhythm
Symptoms
Signs of arrhythmia depend on the severity of the disease and are as follows:
- rapid heartbeat is replaced by a sinking heart, and vice versa;
- dizziness;
- lack of air;
- fainting;
- suffocation;
- attacks of angina.
Patients' general health deteriorates and the risk of ventricular fibrillation or flutter develops, which often leads to death.
Causes
The development of pathology is based on factors that provoke morphological, ischemic, inflammatory, infectious and other damage to the tissue of the heart muscle. As a result, the conductivity of the organ is disrupted, blood flow decreases, and a malfunction of the heart develops.
Treatment
To prescribe treatment, the patient must consult a specialist and undergo a full examination. It is necessary to find out whether arrhythmia has developed as an independent pathology or is a secondary complication of any illness.
Treatment methods:
- physical therapy – helps restore metabolic processes, normalize blood flow, improve the condition of the heart muscle;
- diet – necessary to saturate the body useful vitamins and minerals;
- drug treatment - beta blockers, potassium, calcium and sodium channel blockers are prescribed here.
People suffering from various heart pathologies are required to take medications to prevent complications. These are vitamin complexes and sedatives that reduce stress and nourish the heart muscle.
Atherosclerosis is a disease characterized by the accumulation of cholesterol in the arteries. This causes blockage of blood vessels and poor circulation. In countries where people eat fast food, this problem occupies one of the leading positions among all heart diseases.
Atherosclerosis causes blockage of blood vessels
Signs
For a long time, atherosclerosis does not manifest itself in any way; the first symptoms are noticeable with significant deformation of blood vessels, due to bulging of veins and arteries, the appearance of blood clots and cracks in them. The blood vessels narrow, which causes circulatory problems.
Against the background of atherosclerosis, the following pathologies develop:
- ischemic stroke;
- atherosclerosis of the arteries of the legs, which causes lameness, gangrene of the limbs;
- atherosclerosis of the arteries of the kidneys and others.
Important! After suffering an ischemic stroke, a patient's risk of developing a heart attack increases threefold.
Causes
Atherosclerosis is caused by many causes. Men are more susceptible to pathology than women. It is assumed that this is due to lipid metabolism processes. Another risk factor is the patient's age. Atherosclerosis affects people mainly after 45–55 years of age. The genetic factor plays an important role in the development of the disease. People with a hereditary predisposition need to prevent cardiovascular diseases - watch their diet, move more, give up bad habits. The risk group includes women during pregnancy, since at this time the metabolism in the body is disrupted, women move little. It is believed that atherosclerosis is a disease of unhealthy lifestyle. Its appearance is influenced by excess body weight, bad habits, poor nutrition, bad ecology.
Treatment
To prevent complications of the disease and normalize the functioning of blood vessels, patients are prescribed treatment with medications. Statins, LC sequestrants, nicotinic acid medications, fibrates, and anticoagulants are used here. In addition, exercise therapy and a special diet are prescribed, which involves avoiding foods that increase cholesterol levels in the blood.
The growth and scarring of connective fibers in the myocardial area, resulting in disruption of the functioning of the heart valves, is cardiosclerosis. The disease has focal and diffuse forms. In the first case, we are talking about local damage to the myocardium, that is, only a separate area is affected. In the diffuse form, tissue scarring extends to the entire myocardium. This most often occurs with coronary heart disease.
Cardiosclerosis causes connective tissue hypertrophy
Symptoms
The focal form of cardiosclerosis sometimes has a hidden course. When lesions are located close to the atrio-sinus node and areas of the conduction system, serious disturbances in the functioning of the heart muscle occur, manifested in arrhythmia, chronic fatigue, shortness of breath and other symptoms.
Diffuse cardiosclerosis causes signs of heart failure, such as increased heart rate, fatigue, chest pain, and swelling.
Causes
The following diseases can cause the development of pathology:
- myocarditis;
- myocardial dystrophy;
- infectious lesions of the myocardium;
- autoimmune pathologies;
- stress.
In addition, atherosclerosis and hypertension are provoking factors.
Treatment
Therapy aimed at eliminating the symptoms of pathology and preventing cardiovascular disease, which is carried out to prevent complications, helps to cope with cardiosclerosis and prevent such negative consequences as rupture of the wall of the heart aneurysm, atrioventricular blockade, paroxysmal tachycardia, etc.
Treatment necessarily includes limiting physical activity, avoiding stress, and taking medications. Among the medications used are diuretics, vasodilators, antiarrhythmic drugs. In especially severe cases, surgical intervention and installation of a pacemaker are performed.
Myocardial infarction
A heart attack is a dangerous condition caused by blockage of a coronary artery by a blood clot. This causes disruption of blood circulation in the tissues of the brain and heart. The condition develops against the background of various cardiovascular pathologies and requires immediate hospitalization of the patient. If medication assistance provided within the first 2 hours, the prognosis for the patient is often favorable.
A heart attack causes severe pain in the sternum, sharp deterioration general well-being
Signs of a heart attack
A heart attack is characterized by pain in the sternum. Sometimes the pain is so severe that the person screams. In addition, the pain often spreads to the shoulder, neck, and radiates to the stomach. The patient experiences a feeling of tightness, a burning sensation in the chest, and numbness in the hands.
Important! A distinctive feature of myocardial infarction from other diseases is persistent pain at rest and after taking Nitroglycerin tablets.
Causes
Factors leading to the development of a heart attack:
- age;
- previous small-focal heart attacks;
- smoking and alcohol;
- diabetes;
- hypertension;
- high cholesterol;
- excess body weight.
The risk of developing a serious condition increases with a combination of the conditions described above.
Treatment
The main goal of therapy is the rapid restoration of blood flow in the area of the heart muscle and brain. For this purpose, drugs are used that help resolve blood clots, such as thrombolytics, heparin-based drugs, and acetylsalicylic acid.
When the patient is admitted to the hospital, coronary artery angioplasty is used.
Stroke
A stroke is a sudden disruption of blood circulation in the brain, leading to the death of nerve cells. The danger of the condition is that the death of brain tissue occurs very quickly, which in many cases ends in death for the patient. Even with timely assistance, a stroke often ends in disability.
Symptoms
The following signs indicate the development of a stroke:
- severe weakness;
- sharp deterioration in general condition;
- numbness of the muscles of the face or limbs (often on one side);
- acute headache, nausea;
- impaired coordination of movements.
You can recognize a stroke in a person yourself. To do this, ask the patient to smile. If one part of the face remains motionless, we are more often talking about this condition.
Causes
Doctors identify the following reasons:
- atherosclerosis;
- excess body weight;
- alcohol, drugs, smoking;
- pregnancy;
- sedentary lifestyle;
- high cholesterol and more.
Treatment
Diagnosis of cardiovascular disease and its treatment are carried out in a hospital setting in the intensive care unit. During this period, antiplatelet agents, anticoagulants, and tissue plasminogen activators are used.
How to warn this pathology? The individual risk of developing cardiovascular pathologies can be determined using the score (SCORE). A special table allows you to do this.
This technique allows you to determine the level of risk for developing cardiovascular pathologies and serious conditions that develop against their background. To do this, you need to select gender, age, status - smoking or non-smoking. In addition, in the table you should select the level of blood pressure and the amount of cholesterol in the blood.
The risk is determined according to the color of the cell and the number:
- 1 – 5% – low risk;
- 5 – 10% – high;
- over 10% – very high.
At high levels, a person should take everything necessary measures to prevent the development of stroke and other dangerous conditions.
Pulmonary embolism
Blockage of the pulmonary artery or its branches by blood clots is called pulmonary embolism. The lumen of the artery may be completely or partially closed. The condition in most cases causes sudden death of the patient; only 30% of people are diagnosed with the pathology during their lifetime.
Signs of thromboembolism
Manifestations of the disease depend on the degree of lung damage:
- when more than 50% of the pulmonary vessels are affected, a person develops shock, shortness of breath, blood pressure drops sharply, and the person loses consciousness. This condition often provokes the death of the patient;
- thrombosis of 30 - 50% of the vessels causes anxiety, shortness of breath, drop in blood pressure, cyanosis of the nasolabial triangle, ears, nose, rapid heartbeat, chest pain;
- with less than 30% damage, symptoms may be absent for some time, then coughing up blood, chest pain, and fever appear.
With minor thromboembolism, the prognosis for the patient is favorable; treatment is carried out with medication.
Causes
Thromboembolism develops against the background of high blood clotting, local slowing of blood flow, which can provoke prolonged recumbency and severe heart pathologies. Factors that cause pathology include thrombophlebitis, phlebitis, and vascular injuries.
Blood clots in the lung
Treatment
The goals of treatment for pulmonary embolism include preserving the patient’s life and preventing the re-development of vascular blockage. Normal patency of veins and arteries is ensured by surgery or medication. To do this, they use drugs that dissolve blood clots and medications that thin the blood.
Rehabilitation for diseases of the cardiovascular system in the form of pulmonary embolism is carried out through correction of nutrition and lifestyle, regular examinations, and taking medications that prevent the formation of blood clots.
Conclusion
The article lists only the most common cardiovascular pathologies. Having knowledge about the symptoms, causes and mechanism of development of a particular disease can prevent many severe conditions, provide timely assistance to the patient. A correct lifestyle, a healthy diet and timely examination will help to avoid pathologies if even minor alarming symptoms develop.
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