Internal illnesses. Neurocirculatory asthenia (etiology, pathogenesis, classification, clinical picture) (most important)

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Internal illnesses. Neurocirculatory asthenia (etiology, pathogenesis, classification, clinical picture) (most important)

Lecture notes, cheat sheets

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2. NEUROCIRCULATORY ASTHENIA (ETIOLOGY, PATHOGENESIS, CLASSIFICATION, CLINIC)

Neurocirculatory asthenia 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 development 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.

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. 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 according to Z. N. Savitsky (1956) and V. P. Nikitin (1957) with the following types: cardiac, hypertensive, hypotensive, mixed.

Clinic. Main syndromes: neurotic, cardiac (algic or arrhythmic variants), hypertonic, hypotonic, respiratory disorders syndrome, hyperkinetic, asthenic, vascular. It is characterized by the presence of a large number of various subjective signs of the disease. There are complaints of pain in the region of the heart, which 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. Pain is often associated with excitement and emotional stress, can be short-term or long-term. They can radiate to the left arm and shoulder blade of the left shoulder, they are not removed by nitroglycerin, which is poorly tolerated by anyone.

Complaints that characterize respiratory distress include periodic deep breaths, frequent shallow breathing, leading to a state of hyperventilation (dizziness, blackouts).

There may be sensations of heat, hot flashes to the head, a short-term fainting state. Acrocyanosis, sweating, pronounced red or white dermographism, "games" 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, a functional systolic murmur can be heard at the apex, 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 body position, decreases or disappears with physical activity.

Author: Myshkina A.K.

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