Somatoform autonomic dysfunction is a difficult disease in terms of diagnosis. It has many symptoms, both somatic and mental. Moreover, patients suffering from it feel the signs of the disease quite acutely, which violates their professional implementation. Therefore, everything related to the disease should be de alt with in detail.
SVD disease overview
Somatoform autonomic dysfunction (SVD) is more often detected in men of military age or in persons who are in urgent service or participate in direct combat operations. This is a disease that is manifested by a mass of non-specific symptoms and requires a detailed diagnosis. Its goal is to exclude structural anomalies of the heart and arrhythmias, as well as lesions of the central nervous system.
Somatoform autonomic dysfunction is thought to beis a persistent imbalance between the sympathetic and parasympathetic nervous systems. SVD itself is divided into three types: SVD according to the cardiac, hypotonic and hypertonic type. They should be differentiated from heart disease, arterial hypo- and hypertension, which is solved in the course of the implementation of conscription measures. For this reason, SVD is less common in women than in men and adolescents. Although in 80% of cases the diagnosis is not confirmed by the central medical consultation commission.
Symptoms of SVD
Somatoform dysfunction of the autonomic nervous system is manifested by a mass of non-specific symptoms. Often they appear chaotically against the background of stress and pass in calm situations. It is important that SVD can also be called a syndrome, as it includes a really large number of symptoms. They are manifested by the following variants of syndromes: cardiac, hypotonic, hypertonic. There may also be general symptoms, signs of dyspepsia, respiratory disorders, physical disadaptation. These symptoms will be discussed in detail.
Basics of diagnosis
The main diagnostic criteria relevant to SVD are: duration of symptoms (more than 2 years) and absence of hemodynamically significant or life-threatening cardiac structural abnormalities or arrhythmias. Strictly speaking, all minor cardiac anomalies that do not lead to changes in the cavities of the heart or rhythm disturbances can be combined.
Diagnosis "Somatoformautonomic dysfunction" can then be combined with, for example, tricuspid (mitral, pulmonary or aortic) insufficiency, rare extrasystole, transient WPW or CLC syndrome. However, such patients should be observed 2 times a year to identify further disorders. Obviously, most of the diagnoses SVD, issued to conscripts and adolescents, has no right to exist. Often the diagnosis itself is made by a doctor without complaints, only on the basis of the presence of small structural disorders in the heart. Therefore, about 80% of diagnoses are disputed, and only complaints and comorbidities and syndromes are of clinical importance.
Common SVD symptoms
In a disease such as somatoform autonomic dysfunction, general symptoms are numerous. These are mood disorders, dysphoria, dysthymia, unwillingness to do any physical work, appetite disorders, muscle weakness, recurrent headaches, mainly localized in the parietal and occipital regions. Sometimes the patient experiences dizziness and a burning sensation in the pit of the stomach, which is not related to hunger or satiety.
Such complaints characterize the asthenic syndrome of somatoform autonomic dysfunction. Patients tend to be inactive, sometimes uninitiated and easily upset. Each of them is characterized by a reluctance to take on new cases. Most of the time they don't finish. Paradoxically, however, introversion, which develops as a result of minor successes insports or low physical activity leads to the fact that children tend to compensate for this by studying. They remember well, but in stressful situations they think irrationally. Avoidance of stress and unwillingness to participate in activities that require emotional excitement is a characteristic feature of the patient with somatoform autonomic dysfunction.
Exercise for SVD
Low exercise tolerance is a typical symptom of SVD. Patients are reluctant to undertake exercise in physical education classes, especially if it requires strength. As a rule, outdoor games are easy for such patients, while strength exercises cause a lot of difficulties. It can be seen that after a run he has more pronounced shortness of breath than other children of the same build. In addition, such patients get tired faster, their endurance is lower than that of others. Also, against the background of the load, respiratory or cardiac symptoms of SVD, described below, may appear.
Cardiac (cardiac) patient complaints
Somatoform dysfunction of the autonomic nervous system is manifested by numerous symptoms, which are caused by an imbalance between the sympathetic and parasympathetic innervated organ. Cardiac complaints, since the organ has autonomic innervation, are among the most important. The most typical symptoms of SVD from the side of the heart and blood vessels are: cardiac pain, tachycardia, increased or decreased blood pressure.
The nature of pain in the heart is not specific to a particular disease. The pains are usually stabbing and sometimespressing. Their localization is the base of the heart (3-6 cm to the left of the sternum) and the apex (5 cm to the left of the sternum along the 5th intercostal space). Tachycardia can be caused by emotional stress or physical exertion. It is important that it develops disproportionately to the severity of the load being carried. For example, tachycardia appears immediately before the exercise or at the very beginning, and not as it increases.
It is important that pains in the heart, if they have a burning and (or) squeezing character and appear for 20-30 minutes, should be regarded as ischemic, which requires an electrocardiogram recording for the shortest possible period of time. This is due to the presence of such nosological forms as variant angina pectoris and cardiac syndrome X. With such pathologies, the probability of sudden coronary death is 50-100 times higher.
Hypotonia and hypertension
Hypotension rarely develops. This is the rarest type of SVD, because cardiac or hypertensive types are most often manifested. Nevertheless, the hypotonic type of SVD is manifested by periodic drops in blood pressure in both arms. It is important that the diagnosis of this type of disease requires the performance of echocardiography and electrocardiography, which allow to exclude the presence of heart defects or arrhythmias. Fainting is also a sign of SVD, although non-specific.
Hypertension is the more common complaint. Patients suffer from an increase in pressure before exercise, and not during it. Pressure, as a rule, rises in isolation: systolic rises to 160BP, while distolic remains the same. Due to the elasticity of the vessels in adolescents and young women, in whom somatoform autonomic dysfunction of the heart is diagnosed more often, diastolic blood pressure may even decrease slightly.
The same is due to an imbalance of the sympathetic and parasympathetic nervous system, when norepinephrine expands the muscle arteries, reducing the peripheral resistance of the vascular bed. It is important that the pressure does not increase constantly, because the diagnosis of arterial hypertension cannot be made.
Respiratory complaints
With a disease such as somatoform dysfunction of the autonomic nervous system, the symptoms are also respiratory in nature. The patterns of their occurrence are similar to those in the case of cardialgia, hypotension or hypertension. That is, respiratory complaints appear during exercise. Also, which is specific to SVD, they can appear after the completion of the exercise during the rest period. This distinguishes the respiratory complaints of SVD from the symptoms of exercise-induced asthma.
Examples of complaints in SVD: pronounced mixed shortness of breath during exercise or during the rest period after exercise, a feeling of tightness in the chest and difficulty in breathing. By comparison, expiration is impaired in asthma. Along with respiratory complaints in a disease such as somatoform dysfunction of the autonomic system, cardiac complaints also appear. Their joint appearance is an informative but non-specific sign that allows such a diagnosis to be made.
Dyspepsia in SVD
With such a disease,as a somatoform dysfunction of the autonomic nervous system, the causes are multiple. They hide in the imbalance between the parasympathetic and sympathetic nervous systems. Moreover, the entire gastrointestinal tract is also involved in this process, because it is completely innervated by the parasympathetic system. The vagus nerve regulates secretion in the stomach, pancreas, and intestines. It is responsible for motility and all digestion. Therefore, with SVD, dyspepsia and abdominal pain often appear.
Of the most frequent dyspeptic phenomena, nausea without vomiting, periodic pain in the epigastric region, which are in the nature of pressing or stabbing, should be distinguished. Their appearance does not depend on meals: it is chaotic and associated for the most part with stress. Also, pain can be localized in any other part of the abdomen. They also appear suddenly or on exertion. These pains do not radiate to other parts of the abdomen and are not accompanied by fever, diarrhea, or vomiting.
It is important that the above symptoms occur in irritable bowel syndrome. It is believed that these diseases are different. However, in IBS, the cause is also unbalanced colonic motility. Therefore, probably, IBS should be considered a symptom complex of SVD. In addition, it is more common in individuals suffering from SVD. Symptoms of intestinal syndrome are: stool retention, bloating and rumbling in the abdomen.
Competent diagnosis of SVD
With a disease such as somatoform dysfunction of the autonomic nervous system, treatment is selected individually depending onprevailing symptoms. The diagnosis of SVD cannot be made without the patient's complaints manifesting for 2 years or more, meeting the above criteria. It is also important to exclude all organic diseases: congenital (or acquired) heart defects, arrhythmias, thyroid disease, stomach (or duodenal ulcer), gastritis, Crohn's disease, intestinal diverticulosis.
It is also required to exclude possible mental illnesses that manifest as somatoform disorders. This means that the patient needs to perform some studies: do a general and biochemical blood test, a general urine test, blood glucose and thyroid hormones, record an ECG, perform echocardiography, FEGDS, ultrasonography of the brachiocephalic arteries and the thyroid gland. Based on the results of the studies, a conclusion is made about whether the diagnosed symptom complex is a manifestation of SVD or refers to another disease.
Somatoform autonomic dysfunction: treatment
SVD is treated by several methods that combine pharmacotherapy, vitamin therapy, replenishment of the body's mineral balance, occupational therapy and physiotherapy. In pharmacotherapy, it is important to balance nootropics (or antidepressants) with cardiotropics. An example is the combination of the drug "Fenibut" or "Noofen" at a dose of 250 mg 3 times a day for 2 months with "Thiotriazoline" 100 mg 2 times a day for 2 months. On the appointment of antidepressants, a psychiatrist should be consulted, who will assess the age and potential danger.medications for the patient.
With a disease such as somatoform dysfunction of the autonomic nervous system, treatment also includes mineral therapy. It has been proven that, for example, mitral valve prolapse or insufficiency of other valves are associated with interstitial magnesium imbalance. Replenishing its levels can reduce the manifestations of cardiac complaints and the severity of hypotension or hypertension.
Vitamin therapy, in particular the replenishment of vitamins C, E and D, as well as B1, B2, B5 and B6, is a rational requirement. However, these vitamin substances are poorly absorbed when taken together. Therefore, a course treatment is required: 1 month vitamins of groups C, E and D, and then 1 month vitamins B1 and B2, then 1 month B6 and B5. Of course, since these vitamins are synthesized in the human large intestine, you should also eat fresh vegetables and herbs without heat treatment.
Since low interest in one's own he alth and neglect of the body's needs play a role in the development of SVD, replenishment of vitamins and minerals can reduce the severity of symptoms. Occupational therapy in the course of spa treatment (paid, since vouchers are not issued to patients with SVD in the clinic) will have a much more stable effect. But it is better to explain to the patient that even rest is a treatment for him, if only because during resthe has no complaints.
Somatoform dysfunction of the autonomic nervous system (ICD 10)
This disease has been present in the international classification since 1993. This pathology is found all over the world and does not depend on the characteristics of a particular race or nation. In ICD 10, somatoform autonomic dysfunction is reviewed under sections V and VI. The first includes "Mental and behavioral disorders" (coded as F0-99), and the second includes "Neurotic, stress-related and somatoform disorders" (coded as F45-F48).
Category F45 includes the following pathologies: somatization disorders, undifferentiated somatoform disorder, directly somatoform autonomic dysfunction, hypochondriacal disorder, persistent somatoform pain disorder and other unspecified disorders of nervous regulation. The somatoform autonomic dysfunction itself is coded F45.3 and requires the exclusion of damage to organs innervated by the peripheral autonomic nervous system.
Conclusion
Many scientists today are convinced that somatoform autonomic dysfunction should be considered in more detail. This disease affects the social adaptation of the patient. At the same time, in a number of situations, a combined manifestation of SVD and structural anomalies in the heart has been proven. The widespread practice of echocardiography made it possible to find out that the presence of an additional chord of the left ventricle and mitral valve prolapselow degrees with minimal regurgitation. The latter pathologies are complicated by arrhythmias and lead to congestive heart failure with age.
This means that somatoform vegetative dysfunction should be regarded as a symptom complex (syndrome), requiring further diagnostics from the doctor, aimed at identifying comorbidities. Although in its purest form, SVD is a neurogenic disease that is associated with an imbalance between the sympathetic and parasympathetic peripheral nervous system. Also, in view of the social significance of pathology, it is important to establish clear diagnostic criteria for SVD. This will make it possible to differentiate psychogenic and somatic diseases when performing conscription activities.
