The work of the internal organs and systems of the body is guided not only by the central nervous system - the central nervous system, but also by the ANS (vegetative nervous system). The functioning of the heart also interacts in close connection with the ANS. With sympathetic and parasympathetic divisions.
Manifestations of the functionality of the cardiovascular system
Important indicators of the functioning of the cardiovascular system - pulse or heart rate and its changes in different circumstances, cardiac output and blood pressure.
The sympathetic division of the ANS is represented by the fibers of the thoracic and cervical nodes. It tones the entire body: it increases blood pressure (BP), speeds up and intensifies the heartbeat, regulates the cardiac output of blood into the aorta, dilates the pupil, speeds up breathing, causes a rush of blood to the skin, etc.
The parasympathetic division of the ANS acts exactly the opposite - the pulse slows down, the pressure decreases, and the cardiac output decreases. The influence of this department is due to the vagus nerve - the vagus. In case of imbalancethese departments of the ANS develop VVD (vegetative-vascular dystonia). Among its many manifestations are cardiac arrhythmias. With a neurogenic origin, they are sinus and supraventricular. To assess the imbalance of these systems, various functional tests are used.
What is this?
Functional test is an integral part of medical control in the complex. It can indicate the presence of pathologies even before the appearance of clinical symptoms. These tests include the Ashner test - the eye-heart reflex.
The essence of the test is the increasing pressure on the closed eyeballs for a certain time, which causes reflex excitation of the parasympathetic division of the ANS, in particular, the vagus. It affects the vessels and the heart, which is why the test is called the reflex. The application may be diagnostic. But even in the treatment, Ashner's test is indispensable, for example, heart palpitations. When using this test, attacks of paroxysmal tachycardia stop. The patient himself can apply this test, being a trained doctor. He applies pressure to his eye sockets with his thumbs.
Ashner test - symptoms and treatment
In the office for 15 minutes, the patient first rests on the couch lying down. Then his ECG is recorded for 1 minute - at rest, with the determination of the average heart rate (heart rate). After the initial ECG, the patient's pulse is also determined. Without stopping the recording of the ECG,with fingertips for 15-25 seconds, pressure is applied to the apples of the eyes until a feeling of slight discomfort appears.
I. I. Rusetsky recommends pressing the thumb and forefinger on the lateral surface of the eyeball, not on the front. The eyes are closed. Instead of fingers, pressure can be produced with weights weighing 30-40 g. After 20 seconds after the end of pressure, the average pulse rate is determined for another 15 seconds. After that, the patient can be free.
Ashner's test is a functional test. It is based on the fact that the tone of the vagus increases reflexively, and the pressure on the eyeballs becomes the reason for this. Therefore, such a test requires caution, since reflex excitation of the vagus can lead to rhythm disturbances - become atrioventricular, extrasystole may occur, and in some cases - cardiac arrest for 30 or more seconds.
The Dagnini-Ashner test (oculocardial reflex) is important for clinicians because it can indicate the activity of the phase of the rheumatic process in rheumatic heart disease, even if clinical symptoms are not observed. The test is not used in children.
Interpretation of results
The results practically evaluate the type of nerve influences on the heart, and the list is as follows:
- Normotonic type - the rhythm slows down only by 4-10 beats / min. Such an Ashner test is called positive.
- Vagotonic type - slowing down the rhythm by more than 10 beats / min.
- Sympathicotonic type - rhythmspeeding up, but not slowing down. The next point is to clarify the type of tachycardia. This is done based on the ECG. In cases of sinus tachycardia, the slowing of the rhythm is insignificant.
- With ventricular tachycardia, the rhythm does not change at all.
- With supraventricular - the rhythm either returns to normal, or does not change. Inverted or perversion reaction - the pulse quickens more than 4-6 beats. This is an increase in the sympathetic department. This Ashner test is called negative.
With a therapeutic purpose, the test will be called effective if the heart rhythm has become correct on the ECG or subjectively. The test was proposed simultaneously by Danini and Ashner in 1908, therefore it is called the Danini-Ashner eye-heart test.
Mechanism
The reflex arc in this case starts from the fibers of the ophthalmic branch of the trigeminal nerve, which are excited by pressure. The impulses are transmitted to the brain, where they switch to the vagus centers. And already he sends impulses to the heart muscle, leading to a decrease in heart rate, blood pressure and a decrease in cardiac output.
Heart counts return to normal in a few seconds after the end of pressure. This is normal. Otherwise, the patient needs further examination. An interesting fact is that the Ashner reflex occurs in children only on the 7th-9th day of life and it has a normal or sympathicotonic effect.
Indications for conduction
Ashner's test is often used not only by cardiologists and therapists, but also by neurologists. It is used for:
- Detecting the predominance of the tone of any department of the ANS, as mentioned above, these can be the influence of 2 departments.
- Differential diagnosis of the type of tachycardia.
- Reception can also be used for therapeutic purposes to relieve tachycardia. Then it can be performed by the patient himself after clarifying the diagnosis of supraventricular tachycardia.
Contraindications for Ashner's test
Ashner test cannot be performed at:
- decompensated heart defects;
- decompensated heart failure;
- strokes and heart attacks;
- sharp arrhythmias;
- PE (pulmonary embolism);
- aortic aneurysm;
- hypertension crisis;
- general serious condition;
- acute infections with fever and bleeding;
- acute pathologies of internal body systems;
- thrombophlebitis;
- atherosclerosis.
Also, Ashner's reception is not performed if tachycardia is accompanied by additional dizziness, fainting, chest pain, suffocation, and a drop in blood pressure. Then you only need to call an ambulance.
Ashner's test is undesirable due to the danger of applying to elderly patients, since they often have a violation of cerebral or cardiac circulation. Also, the test is contraindicated in myopia and ocular pathologies.
