Vegetosovascular dystonia (VSD, or neurocirculatory dystonia) is clinically a combination of emotional disorders with autonomic disorders (fluctuations in the arterial pressure, palpitation, heart rhythm disturbance, pain in the heart, violation of motility of the gastrointestinal tract, violation of thermoregulation, etc.). This is a syndrome that occurs as a result of a violation of the central part of the autonomic nervous system. Since the autonomic nervous system regulates many processes in the body and the functioning of all organs, there are many signs of damage, and they differ in great variety. This is a very common pathology, which is encountered by doctors of almost all specialties, so many are this disease.
Since the symptoms of this ailment are many, and the development of this disease is fraught with complications, the timely Diagnosis and properly prescribed treatment of vegetative dystonia in adults is very important. Let's talk about this in this article.
- 1The autonomic nervous system: what is it?
- 2The causes of vegetovascular dystonia
- 4.1Vegetative tonus
- 4.2Vegetative reactivity
- 4.3Research of vegetative maintenance of activity
The autonomic nervous system: what is it?
The function of the autonomic nervous system is to ensure the mental and physical activity of the body, in the adaptation to constantly changing environmental conditions while maintaining the consistency of the internal environment. The central part of the autonomic nervous system is represented by the hypothalamus, limbic system and reticular formation, and also by some nuclei (accumulations of gray matter) of the brain; this department is peripheral: it is a part of nerves and plexuses. In addition, the structures of the autonomic nervous system are divided into two sections: sympathetic and parasympathetic, which carry out opposite effects on internal organs.
The sympathetic part provides increased blood pressure, increased heart rate, rapidity of breathing, acceleration of metabolism, dilatation of the pupils, relaxation of smooth muscles, etc. The parasympathetic department is engaged in lowering blood pressure, slowing down the heartbeat, breathing, increasing the tone of smooth muscles, narrowing pupils, etc. If there is a mismatch between the joint activities of these structures, the imbalance between them and vegetative vascular dystonia occurs.
The causes of vegetovascular dystonia
Among the factors contributing to the emergence of VSD, there are:
- constitutional features: congenital predisposition of the autonomic nervous system. This means that some people from birth have a very "vulnerable", sensitive vegetative system that instantly reacts even to insignificant stressful effects. Moreover, this reaction immediately goes beyond the normal range and manifests itself as a violation of the functions of internal organs. The probability of occurrence of signs of VSD in such people is very high, starting from the earliest age;
- chronic stress: in the conditions of prolonged stay in a state of increased stress, the compensatory possibilities of the organism fail, and symptoms of the VSD may appear;
- periods of hormonal fluctuations in the body (adolescence, pregnancy, menopause): in these time intervals in the body a person is restructuring already established earlier interactions between different parts of the autonomic nervous system. A gap is created between the needs of the organism and the capabilities of the nervous system, resulting in the symptoms of the VSD;
- presence of chronic somatic diseases and infections (for example, stomach ulcer, bronchial asthma, ischemic heart disease, cholelithiasis, chronic tonsillitis, etc.): long entering the brain "information" about the presence of a pathological process in the body, chronic pain syndrome leads to disruption of the coordinated activity of the autonomic nervous system;
- some aspects of the way of life: physical inactivity (a small amount of physical activity, "sedentary" work), physical overload, smoking, alcohol abuse, coffee, lack of sleep, "night" lifestyle and the like;
- individual personality characteristics: emotional lability (instability), anxiety, suspiciousness.
It is believed that the female sex suffers more often VSD, precisely because of the peculiarities of the female psyche.
It is commonly believed that the VSD is not a primary independent disease, but always an effect. Sometimes the disease is masked for neurocirculatory dystonia, and in the foreground only the symptoms of VSD are visible, and with a more thorough examination, the organic pathology of an organ is revealed. That is why patients with VSD are subject to scrupulous medical examination.
Vegeto-vascular dystonia is characterized by a variety of complaints and symptoms at the same time in one patient. Therefore, often the patient has time to visit a variety of specialists before the true reason.
The very course of IRD can be of several types: permanent (when the symptoms of the VSD are more or less constant), paroxysmal (paroxysmal, with clearly expressed periods of exacerbations and remissions), latent (latent, the symptoms are detected only when examined).
Since the autonomic nervous system regulates almost everything in the body (breathing, digestion, cardiac activity, urination, temperature, perspiration, even sexual behavior), then manifestations will be from different organs and systems:
- from the side of the heart (occur most often): persistent or recurrent pains (cardialgias) of the aching, pricking, grinding nature, in the form of lumbago in the heart, the inability to take a deep breath because of the pain on the inspiration, compression and pain in the chest. Disturb disturbances of the heart rhythm in the form of "fading" or stopping the heart, rapid heartbeat (heart "Pounding") more than 90 beats per minute or slowing the rhythm of less than 60 strokes, lability of the pulse. Similar complaints are presented by patients both with and without exercise;
- from the side of the vascular system: changes in blood pressure (both increase and decrease); change in skin color - redness or blanching (depending on prevalence sympathetic or parasympathetic department of the autonomic nervous system); Raynaud's syndrome, acrocyanosis (cyanosis of the skin), cold extremities; chilliness or fever;
- from the side of breathing: sensation of a coma in the throat, quickening of the breath, shortness of breath until the attacks of suffocation, feeling of lack of air, dissatisfaction inhaling (patients claim that they periodically need deep forced breaths to feel fully breathing). Respiratory phenomena intensify under conditions that require stress of the nervous system: passing the exam, climbing to the altitude, public speaking, etc .;
- gastrointestinal disorders: abdominal pain, including spasms, increased peristalsis and, accordingly, the number of feces per day, constipation, belching, swelling, a feeling of nausea, occasionally even vomiting;
- from the side of the central nervous system: headaches (most diverse), dizziness, unstable walking, tinnitus and head, flies before the eyes, violation visual acuity, a look in the "tunnel", a feeling of "helmet" on the head, sleep disturbances, meteosensitivity (dependence of health on weather changes), fainting;
- from the side of thermoregulation - an increase in body temperature (usually to subfebrile values, 37-37.5 ° C) or a decrease to 35.5-36 ° C for no apparent reason;
- violation of sweating: increased sweating (up to profuse sweating) or, conversely, dry skin;
- motor and muscle reactions: trembling in the hands and feet to a fever, a feeling of inner tremor, muscle cramps (more often gastrocnemius, facial muscles), involuntary jerking;
- sensitive manifestations: numbness, tingling, crawling sensation (especially with emotional stress);
- from the genitourinary system: painful and frequent urination, impotence in men, lack of sexual desire, anorgasmia, menstrual irregularities in women;
- psycho-emotional manifestations: weakness, lethargy, increased fatigue, decreased efficiency, decrease attention, tearfulness, irritability, anxiety, fears (phobias) of transport, closed space, etc.
Sometimes the manifestations of the VSD suddenly increase, a crisis develops. According to the predominance of this or that part of the autonomic nervous system, crises occur:
- sympathoadrenal: with excessive release of norepinephrine by the adrenal glands due to a sudden increase in the activity of the sympathetic department of the nervous system. Characterized by an unexpected increase in blood pressure to 150 / 90-180 / 110 mm Hg. (tachycardia) to 140 beats per minute, an increase in temperature to 38-38.5 ° С, a chill, a tremor, a cooling limbs, pale skin, dilated pupils, a sense of anxiety and fear of death, excitement and motor anxiety. At the end of the attack, a lot of urine is released;
- vagoinsular: with a sharp increase in the activity of the parasympathetic nervous system. Clinically manifested by slowing the heart rate to 45 beats per minute, reducing blood pressure to 80/50 mm Hg. dizziness, nausea and vomiting, salivation, a feeling of lack of air, increased depth and frequency of breathing, redness of the skin, a sensation of heat in the head, abundant sweating, lowering of body temperature, headache, narrowing of the pupils, rumbling in the abdomen, pronounced flatulence, frequent defecation, liquid stool is possible. After an attack the patient feels sluggish and broken;
- mixed: combine the signs of both sympathetic and parasympathetic crises. They occur much more often than the previous two options.
If the vegetative-vascular crisis is accompanied by severe severe anxiety, a fit of fear with loss self-control (sometimes to insanity), then it is believed that the patient developed a panic attack.
The modern approach to the diagnosis of vegetovascular dystonia is the complex examination of the patient. This means that if a patient has a large list of the most diverse complaints, after careful collection of anamnesis and a primary examination, he is referred for consultation to related specialists. This is done, first of all, in order to exclude the organic pathology of internal organs and systems that require specific treatment. For example, complaints of pain in the heart can be a sign of coronary heart disease, and pain in the abdomen - peptic ulcer. Depending on the nature of complaints, the patient should be examined by a cardiologist, gastroenterologist, oculist, endocrinologist, ENT doctor, urologist, psychiatrist, gynecologist, etc.
In addition, neurologists use special techniques and tests to determine the state of the central parts of the autonomic nervous systemvegetative tonus, reactivity and maintenance of activity.Let's talk about them in more detail.
Vegetative tonus is the level of the function of a particular organ (heart, lungs) at rest. To determine it, use several methods. Here are some of them.
The Kerdo index makes it possible to evaluate the influence of the autonomic nervous system on cardiac activity. It is determined by the formula: Kerdo Index = (1- diastolic blood pressure / heart rate) × 100. It is believed that with positive values of the index, sympathetic effects on the heart predominate, with negative values - parasympathetic, if the result is zero - the condition is described as a normotonus of the autonomic nervous system.
Another way: the patient is offered to answer the questions of the special table. The questions are extremely simple (for example, do you have excessive sweats?), Require a "yes" or "no" answer. For each answer, a score is assigned. The scores are then summed up and the total score is interpreted. If you exceed a certain amount of points, you can talk about the presence of IRR.
By vegetative reactivity is the ability of the autonomic nervous system to react to the action of stimuli. To evaluate it, use the cold and heat samples (lying to the patient to measure blood pressure and heart rate, then lower the hand in a cold or warm water for a certain period of time, then again register blood pressure and heart rate, compare the changes and draw conclusions); cardiovascular vegetative reflexes (glandular, sinocarotid, epigastric); a sample with deep breathing, a sample with isometric tension, a Valsalva test.
The heart-shaped reflex is checked as follows: in the supine position on the back after 15 minutes of rest the frequency is counted then the patient is pressed on the closed eyes with the pads of the fingers to light pain for 15 seconds. Then the heart rate is counted and compared with the original. In the norm there is a slowdown. For certain numerical values of deceleration or lack thereof, conclusions are drawn regarding a possible IRR.
The rest of the samples have similar execution procedures, only they are performed in different positions of the body with fixation of other physiological indices.
Research of vegetative maintenance of activity
These methods of research are carried out with the help of dosed physical exercise (velergometry, squats, lifting of legs lying, etc.), mental load (account in the mind), negative and positive emotions. During the tests, vegetative indices are recorded: blood pressure, heart rate, frequency respiration, hormones (cortisol, insulin, etc.) and neuromediators (adrenaline, serotonin, etc.) in the blood.
Additional diagnostic methods are widely used in patients with a likely IRR. These are ECG (including daily recording), ultrasound of the heart, and EEG, and rheovasography, and MRI, and many others. What exactly needs to be investigated is specified individually for each patient. Usually, such a comprehensive approach to the survey allows you to set the right diagnosis.
It should be noted that in vegetovascular dystonia, the results of most additional examination methods do not reveal pathological changes. This is because the organs themselves are, in fact, "not sick", and only their regulation is disturbed. It is the fact of "normal" results and testifies in favor of the diagnosis of "vegetovascular dystonia".
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