Internal illnesses. Neurocirculatory asthenia (main types, diagnosis, complications, treatment) (most important)

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Internal illnesses. Neurocirculatory asthenia (main types, diagnosis, complications, treatment) (most important)

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3. NEUROCIRCULATORY ASTHENIA (MAIN TYPES, DIAGNOSIS, COMPLICATIONS, TREATMENT)

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.

The dynamics of changes in blood pressure depends on the type of NCA.

For NCA by cardiac type are 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).

NCA of the hypertensive type is characterized by: lability of blood pressure with a tendency to systolic hypertension, an increase in stroke and minute blood volumes, good tolerability of an orthostatic test with an increase in average hemodynamic pressure.

NCA of the hypotensive type is characterized by fainting or collapsed states, lability of blood pressure with a tendency to hypotension, muffled heart sounds, increased cardiac output, poor tolerance of an orthostatic test with a drop in average hemodynamic pressure, tachycardia, an increase in minute blood volume during physical activity (immediately after its end, a sharp decrease in blood pressure is possible).

Arterial hypotension is considered pressure numbers: at the age of 25 years - 100/60 mm Hg. Art. and less, over the age of 30 - below 105/65 mm Hg. Art.

Diagnostic research. Of diagnostic importance are studies of the level of catecholamines in the blood and urine, 17-hydroxycorticosteroids (increase in quantity), estrogen levels (decrease in quantity), and the study of thyroid function.

Indicators of central hemodynamics: with the cardiac type, there is an increase in cardiac output and a decrease in specific peripheral resistance, the average hemodynamic pressure remains unchanged.

Blood pressure indicators are examined with the determination of residual and basal pressure.

The average hemodynamic pressure is investigated - it is measured by the tachiooscillographic method.

Functional stress tests are used: Master's test, step test, bicycle ergometry in cardiac NCA, dosed physical activity test, hyperventilation test, breath holding test.

If there are negative T waves on the ECG, stress pharmacological tests are performed: a test with inderal, potassium chloride, atropine, and adrenaline. The ECG may reveal: sinus tachycardia, bradycardia and arrhythmia, impaired atrioventricular conduction, displacement of the RS-T segment below the isoelectric line, flattening and appearance of a negative T wave, ventricular extrasystoles.

Complications. Arrhythmia, acute vascular insufficiency (fainting, collapse), autonomic crises, angioedema.

Treatment. Elimination of etiological factors, rehabilitation of hidden foci of chronic infection. Sedatives according to indications, hypnotics are used only for severe sleep disorders. Tranquilizers are used in small doses, short courses. β-blockers are used for the hypertensive type of NCA with tachycardia.

Forecast. The prognosis is favorable, performance is restored.

Author: Myshkina A.K.

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