Internal illnesses. Neurocirculatory asthenia (lecture notes)

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Internal illnesses. Neurocirculatory asthenia (lecture notes)

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LECTURE No. 2. Neurocirculatory asthenia

Neurocirculatory asthenia (NCA) is most common in young people during the period of hormonal changes in the body. NCA is a functional disease, which is based on a failure of adaptation or a violation of the neuroendocrine regulation of the cardiovascular system.

Etiology. The reasons for the development of NCA can be external and internal factors.

External factors: psycho-emotional, physical overstrain, violation of the regime of work and rest. Internal factors: congenital or acquired inferiority of the nervous and humoral systems of regulation of vascular tone, features of the protective and adaptive mechanisms of the body (such as higher nervous activity, the state of the endocrine system).

Pathogenesis. The formation of the disease occurs against the background of a genetic or acquired inferiority of the neurohormonal system.

There is a formation of neurosis and visceral disorders, while the internal organs are involved in emotional arousal selectively.

The type of NCA is formed depending on the nature and severity of dysfunctions of the sympathoadrenal and cholinergic systems, as well as on the relationship between adreno- and cholinergic processes.

With an increase in the activity of the sympathoadrenal system and a relative decrease in the activity of the cholinergic system, the formation of hypertensive and cardiac types of NCA occurs (central or peripheral or combined dysfunction of the cardiovascular system). With an increase in the activity of the cholinergic system and a relative insufficiency of the sympathoadrenal system, the formation of the hypotensive type of NCA occurs.

Classification. In the clinic, the most common classification of NCA is according to N. N. Savitsky (1956) and V. P. Nikitin (1957), distinguishing the following types:

1) cardiac;

2) hypertensive;

3) hypotensive;

4) mixed.

Clinic. Main syndromes: neurotic, cardiac (algic or arrhythmic variants), hypertensive, hypotonic, respiratory distress syndrome, hyperkinetic, asthenic, vascular.

It is characterized by the presence of a large number of various subjective signs of the disease with the insignificance of objective data. There are complaints of pain in the region of the heart, which differs from coronarogenic ones - they are localized in the region of the apex of the heart, have a dull, aching, stabbing character. There may be a feeling of heaviness and pressure. Physical stress often does not increase pain, but relieves it (it is noted in half of the patients). Pain is often associated with excitement and emotional stress, can be short-term or long-term. They can radiate to the left arm and scapula, be accompanied by hyperalgesia in the region of the apex of the heart, the left shoulder, and are not removed by nitroglycerin, which is also poorly tolerated.

Perhaps the appearance of complaints that characterize the disorder of breathing - a periodic deep breath (dreary breath), frequent shallow breathing, leading to a state of hyperventilation (dizziness, darkening in the eyes).

There may be sensations of heat, hot flashes to the head, a short-term fainting state. Perhaps the presence of acrocyanosis, sweating, pronounced red or white dermographism, "play" of vasomotors of the skin.

There may be signs of peripheral circulatory disorders (such as Raynaud's syndrome), temperature asymmetries, lability of the pulse, blood pressure, a tendency to tachycardia, respiratory arrhythmia due to dysfunction of the respiratory center, extrasystole, group extrasystoles, attacks of paroxysmal tachycardia.

There are general weakness, fatigue, irritability, headache, unstable sleep, a tendency to rapid mood swings. Distracted attention, memory loss, dizziness, a feeling of fear are noted.

The boundaries of the heart do not change, the tones are clear, at the apex, a functional systolic murmur can sometimes be heard, associated with an acceleration of blood flow and a change in the tone of the capillary muscles. The nature of the noise changes with a change in the position of the body. Noise is not conducted into the left armpit, decreases or disappears during exercise.

The dynamics of changes in blood pressure depends on the type of NCA. Arterial hypotension is considered pressure figures: at the age of 25 years - 100/60 mm Hg. Art. and less, over the age of 30 - below 105/65 mm Hg. Art.

For NCA by cardiac type characteristic: persistent sinus (sometimes paroxysmal) tachycardia, extrasystole, an increase in minute blood volume. Severe tachycardia and a decrease in pulse pressure are noted during functional tests (orthostatic and with physical activity).

For NCA for hypertensive type characteristic: lability of blood pressure with a tendency to systolic hypertension, an increase in stroke and minute blood volumes, good tolerance of the orthostatic test with an increase in mean hemodynamic pressure.

For NCA by hypotensive type fainting or collaptoid states, lability of blood pressure with a tendency to hypotension, muffled heart tones, a tendency to increase cardiac output, poor tolerance of an orthostatic test with a drop in mean hemodynamic pressure, tachycardia, an increase in minute blood volume during exercise (immediately after its completion is possible sudden drop in blood pressure).

Additional diagnostic study. Of diagnostic importance are studies of the level of catecholamines in the blood and urine, 17-hydroxycorticosteroids (increased amounts), estrogen levels (decreased amounts), and studies of thyroid function (radioimmunological determination of T3, T4 and TSH).

The indicators of central hemodynamics are studied: in the cardiac type, there is an increase in minute volume and a decrease in specific peripheral resistance, the average hemodynamic pressure remains unchanged.

A study of blood pressure indicators is carried out with the determination of residual pressure (pressure measured 10-15 minutes after a random, single dose) and basal pressure (pressure measured in the morning under basal metabolic conditions).

The average hemodynamic pressure is investigated (the integral value of the pressure variables during one cardiac cycle) is measured by the tachiooscillographic method according to Savitsky, normally 80-90 mm Hg. Art., with NCA of the hypertensive type - does not exceed 90 mm Hg. Art.

Functional stress tests are widely used: Master's test, step test, bicycle ergometry in NCA by cardiac type, test with dosed physical activity (20 squats in 30 seconds), hyperventilation test, breath holding test. In NCA for hypertensive and hypotensive types, active and passive orthostatic tests are performed.

If there are negative T waves on the ECG, stress pharmacological tests are performed: a test with inderal, potassium chloride, atropine, adrenaline. When performing an electrocardiographic study, the following can be detected: sinus tachycardia, bradycardia and arrhythmia, impaired atrioventricular conduction, displacement of the RS-T segment below the isoelectric line, flattening and the appearance of a negative T wave, ventricular extrasystoles are more often detected.

Echocardiographic examination allows to confirm the functional nature of the changes. Be sure to consult specialists: ophthalmologist, endocrinologist, nephrologist, neuropathologist, psychiatrist.

Complications. The development of arrhythmias, acute vascular insufficiency (fainting, collapse), autonomic crises, and angioedema is possible.

Treatment. Includes elimination of etiological factors. Sanitation of hidden foci of chronic infection should be carried out. The normal mode of physical activity must be restored, the duration of sleep increased to 10 hours per day. Non-drug methods are widely used in treatment: acupuncture, hypnosis. Physical therapy is prescribed. Spa treatment is used.

Preference is given to local sanatoriums and rest houses. In the summer, staying in a hot climate is not shown.

Sedatives are used according to indications, hypnotics are used only for severe sleep disorders. Tranquilizers are used in small doses, short courses. β-blockers are used in the hypertensive type of NCA with tachycardia. With an increase in the activity of the cholinergic system, anticholinergic agents are used. Of the agents that increase the activity of the central nervous system, tinctures of ginseng, eleutherococcus, Chinese magnolia vine, etc. are used.

Forecast. The prognosis is favorable, performance is restored.

Author: Myshkina A.A.

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