Neurocirculatory dystonia (NCD) is a functional disorder of the cardiovascular system (CVS), which is not accompanied by organic changes in the tissues of the heart. In other words, with NCD, cardiac hypertrophy, heart failure and arrhythmias do not develop. Pathology is manifested not only by cardiac symptoms, but also by respiratory, asthenic, neurotic, brain disorders, intolerance to stress and any stress. Manifestations arise or intensify precisely after physical exertion and stress.
The essence of the problem
The basis of disorders is the violation of neurohumoral regulation due to various reasons. Even the most severe clinical manifestations of NCD have a benign course and a good prognosis. The course of the pathology is undulating, with relapses.
NCD is only diagnosed when research confirmsno organic changes. Very often, NCD is determined as part of another disease or becomes an external reaction.
Among the visits to a cardiologist or a neurologist, 70% of patients have NCD. Most often, dystonia is typical for adolescents, middle age - in the range from 12-13 to 45 years.
In women, it occurs 4 times more often. Why? Because they have monthly hormonal fluctuations in the body - the menstrual cycle is one of them, not to mention pregnancy.
Neurocirculatory dystonia in children is typical for puberty, during the restructuring of the body. At the same time, a person is very sensitive to external influences.
Disease or Syndrome?
NCD – what is this disease? There is still no consensus. Vegetative-vascular dystonia (another name for NCD) is considered a more correct name, since it expresses the pathogenesis of the disease. Other synonyms: neurocirculatory asthenia, vegetative neurosis, heart neurosis. One thing is certain - NDC is considered by many doctors as a way of experiencing internal and external problems, a violation of mental balance, and not bodily.
ICD-10 code
Code for neurocirculatory dystonia according to ICD-10: F45.3. F48.0, F48.8.
ICD-10 - only means that the WHO, which conducted the 10th revision in Geneva in 1989, added the term neurocirculatory dystonia to the list of known diseases and he alth problems.
This diagnosis is not recognized as an independent nosology. So this is neurocirculatory dystonia. It is ranked only among a number of somatoform dysfunctions and neuro-mental disorders (neurosis). Therefore, it is often defined as part of another pathology, which has its own code in the classification. Age category of patients - any.
Disease class V is selected - mental and behavioral disorders. It belongs to the group of neurotic diseases associated with stress and somatoform disorders.
The ICD code for neurocirculatory dystonia is F45.3, where the letter F stands for psychogenic etiology. Therefore, the final diagnosis is made by psychiatrists.
According to the same ICD classification, neurocirculatory dystonia is recognized not as a nosology, but as a syndrome of disorders of the autonomic nervous system (ANS). This means an imbalance in her departments - sympathetic and parasympathetic.
Many today do not know that neurocirculatory dystonia according to ICD-10 is a whole symptom complex that occurs when the vegetative system is out of balance. Also, VVD is often referred to as "Other symptoms and signs related to the emotional state." Then the code for neurocirculatory dystonia according to the ICD will pass as R 45.8, and a psychiatric consultation is not needed.
A bit of history
The term was first proposed in 1953 by G. Lang. He considered this syndrome a prerequisite for the development of hypertension. In 1954, the Soviet cardiologist N. Savitsky modified the term and combined into this group VVD, pathological conditions of functional disorders of the circulatory system, referred to as Da Costa syndrome, cardioneurosis, neurocirculatory asthenia, excitable heart, etc.
Among them all in the clinicviolations of the CVS activity prevailed, they were of a primary, functional nature and demonstrated the absence of their connection with any clear pathology, including neurosis.
Another group of specialists proposes to include VVD in the group of neuroses, since according to ICD-10 this dystonia is classified as a group of mental disorders.
As a result, neurocirculatory dystonia is today recognized as the most common vegetative form of neurosis (vegetative neurosis), it is diagnosed in 50-75% of adolescents and young people. Accurate statistics are not available, since each doctor interprets the pathology differently.
With regard to NCD as a borderline condition in children, the systemic manifestations of vegetative disorders and their generalization are characteristic. All internal organ systems are involved in the process - nervous, respiratory, endocrine, digestive, immune, and, of course, first of all, cardiovascular. In such cases, the diagnosis of neurocirculatory dystonia as a syndrome of autonomic dysfunction is competent.
Etiology
All factors are divided into 2 groups: predisposing and triggering, the boundary between them is conditional. The first ones include:
- hereditary-constitutional factors;
- feature of the type of the nervous system;
- society;
- hormonal fluctuations in the body.
Launchers or callers:
- stress - acute and chronic;
- external influences - insolation, overwork, radiation, vibrations, overheating, work in hazardous industries;
- caffeine consumption in largequantities;
- stuffiness;
- alcohol;
- infections - ENT organs and SARS;
- endocrinopathy (diabetes, hyperthyroidism, adrenal disease);
- head injury.
Pathogenesis
Neurocirculatory dystonia - what is it? Complex as a result of violations of neuroendocrine regulation. It becomes an addition to the deterioration of well-being against the background of already existing stress.
What is normal: the endocrine glands secrete hormones into the blood, they are controlled by the central nervous system and exert their neurohumoral effect on homeostasis, human reactions. A person constantly adapts to circumstances, thanks to the interaction of these systems. They interact in both directions. If they were not there, in a moment of stress or danger, a person could not survive - the body would simply destroy itself in a matter of seconds. In the event of an imbalance, the disruption and damage in the hypothalamus, its structures that play the role of a coordinator, becomes the leading one. Dysregulation manifests itself in the failure of the cholinergic (secretes acetylcholine) and sympathetic-adrenal systems.
What is neurocirculatory dystonia? Its essence is in violation of the control of the work of some organs and systems, starting with the CCC. Because it is the myocardium that is the most sensitive to these changes and reacts with jumps in function and tone: inadequacy of tachycardia, fluctuations in vascular tone, and regional vasospasms. Thus, a symptom complex of NCD of a certain type is formed as a stable response to the influence of the external environment.
Classification
ClassificationSavitsky by type is based on the leading symptom of the pathology. There are 4 types:
- Neurocirculatory dystonia of cardiac type. Here, in the foreground, violations of the functions of the heart are noted.
- Neurocirculatory dystonia of hypotonic type. At the same time, the tone of the parasympathetic NS (vagotonia) prevails with a decrease in pressure.
- Neurocirculatory dystonia of hypertonic type. Here, an increase in pressure becomes the leading one, which indicates sympathicotonia.
- Mixed type. It is characterized by pressure instability.
In practical medicine, not only the types of neurocirculatory dystonia are classified, but also the degrees of severity. There are only 3 of them - light, medium and heavy.
With a mild degree, the symptoms are moderate, only in response to external influences. Treatment is not required. With moderate severity, the symptoms are more pronounced, performance is reduced, treatment is needed. In severe cases, the symptoms are persistent, the quality of life is reduced, treatment is mandatory, often in a hospital.
Clinic
There are about 40 most common symptoms in NCD. On average, one patient may experience from 9 to 26 symptoms.
Although the presentation is variable, 6 clinical syndromes can be identified:
- cardialgic (cardiac pain);
- respiratory (impaired respiratory function);
- arrhythmic;
- asthenic;
- paroxysmal vegetative-vascular crises;
- neurotic disorders.
Syndrome Clinic:
- Cardiac syndrome, or neurocirculatory dystonia of the cardiac type, is characterized by pain in the heart and arrhythmias. The pains are stabbing, aching, burning, and can last from several minutes to hours. It is important to note that with neurocirculatory dystonia according to the cardiac type, pain appears after exercise - this is differentiation with coronary artery disease. Unpleasant sensations disappear after taking "Corvalol" or "Validol". But nitroglycerin does not help - unlike coronary artery disease.
- Respiratory syndrome (respiratory disorders) is one of the most striking and mandatory. During stress or exertion, breathing suddenly quickens, it is superficial. The syndrome can also be manifested by a feeling of "lump" or pressure in the throat on inspiration, intolerance to stuffiness.
- Arrhythmic syndrome - most often it is tachycardia. The pulse rate jumps from 80-90 to 130-140 beats per minute. The syndrome can occur even during meals, during unrest, physical exertion. Jumps in the pulse respond little to drugs. Perhaps the development of paroxysmal supraventricular tachycardia. It is characteristic of neurocirculatory dystonia of the hypertensive type that arrhythmias are accompanied by fear for one's life.
- Asthenic syndrome - a feeling of chronic fatigue, decreased attention.
Vegetative crises often occur against the background of complete or incomplete remissions, provoked by external causes, or they can be spontaneous. They can proceed quite hard, up to 2-3 hours, and end with involuntary urination or defecation. Most oftenthey occur at night and are always accompanied by fear, they are subjectively difficult to endure by patients.
Crises are divided into:
- Vagoinsular or parasympathetic. There is a sharp weakness, a feeling of sinking heart, lightheadedness and sweating, discomfort in the stomach and intestines, often there is nausea, hypersalivation.
- Sympathoadrenal or sympathetic. With them, there is a strong heartbeat, heat in the face, dizziness and headache, the body trembles and is tense, shivering. Such crises often end with copious urination.
- Mixed crisis states combine features of both types.
If crises are manifested by a sharp sense of fear, affective disorders - they are called "panic attacks". They last in different ways - from several minutes (more often) to several hours (rarely).
Other symptoms are often characterized by violations of thermoregulation: intolerance to heat and cold. Every third such patient has causeless subfebrile condition. An interesting fact is that each armpit has a different temperature. The extremities are often cold, the pressure is labile and unstable, the veins in the legs are dilated and in the evening the legs swell - especially in women. Patients are also characterized by fainting due to fear, stress and pain. These are peripheral manifestations of NCD.
Briefly by type
So, hypertensive neurocirculatory dystonia is sympathicotonia:
- high blood pressure;
- interruptions and tachycardia;
- exercise causes cephalalgia and dizziness;
- subfebrile temperature;
- prone to constipation;
- there are no tears when crying;
- clear weather dependence.
Neurocirculatory dystonia of hypotonic type – vagotonia:
- low blood pressure;
- cardialgia;
- rare soft pulse;
- cephalgia as a response to any stimulus;
- dizziness;
- weather response;
- body temperature is low and feeling chilly all the time;
- diarrhea;
- shortness of breath;
- hyperhidrosis that occurs very easily;
- cyanosis of the feet and hands, pale skin, with a marbled pattern; permanent fatigue;
- decrease in performance.
Mixed neurocirculatory dystonia:
- alternating predominance of ANS departments;
- pressure variability;
- cardialgia and heart failure;
- fluctuations in body temperature;
- stool instability;
- prone to fainting;
- headaches.
Neurocirculatory dystonia - what is this disease in the clinic? The symptoms depend on the type, but as you can see, there are many common manifestations. NDC resembles neurosis in its manifestations:
- tremor, internal body tension;
- sweating and anxiety;
- choking and lump in throat;
- mixed dermographism;
- irritability and fatigue;
- the tone of emotions is reduced;
- has cognitive impairment and insomnia.
All thiscan be attributed to manifestations of asthenic syndrome.
By the way, 100% of patients have cardialgia. Coronary spasm and electrolyte disturbances (hypokalemia) play a role in their occurrence in NCD. It has been noted that NCD develops more often in people who are anxious, insecure, dissatisfied with their state of he alth and tend to blame doctors for this. They love to be treated.
Diagnosis
At the reception, when questioning the patient, you can identify the above symptoms. Maybe not all, but most. Patients very willingly and colorfully describe their condition. The pulsation of the carotid arteries is visible on the neck. On palpation, the chest turns out to be painful in the 3rd-4th intercostal space, more on the left - the so-called "left-sided hyperalgesia".
With such an abundance of complaints about the heart during percussion and auscultation, its dimensions are not changed. A systolic murmur is heard in 70% of cases, but it is non-conductive, it is also heard at the left edge of the sternum in the 3rd-4th intercostal space. This indicates that it is inorganic.
An additional tone may also be heard. Pulse and pressure are labile, asymmetric. It is characteristic that the pulse changes dramatically when the body position changes from horizontal to vertical - by 100-300%. This sweeps aside doubts about the absence of coronary artery disease.
The blood picture does not show any signs of inflammation or changes in the immune status. Chest x-ray showing normal size heart and aorta.
Half ora third of patients on the ECG may show a decrease in the height of the T wave, more often in the right (V1-V2) leads, less often in all chest leads. Such changes can also be with organic pathologies. Therefore, for example, such a test as bicycle ergometry is required. It well reveals latent heart failure. With it, a decrease in exercise tolerance is revealed - this clearly indicates NCD. With coronary artery disease, etc., this does not happen.
You can supplement the differentiation with a drug test with beta-blockers and potassium chloride. After taking them, the ECG is repeated after 40 and 90 minutes. With organic lesions of the heart, the T wave will not change, and with NCD it becomes positive. This is a functional lesion.
As a result, it turns out that there is no data for the disease. This is why many doctors do not recognize NCD as a disease. Yes, NCD does not pose a threat to life with its most striking and severe manifestations, it has a good prognosis, but it significantly worsens the patient's quality of life during exacerbations. Therefore, it is impossible to dismiss it and not treat it.
Basic Principles of Therapy
How to treat neurocirculatory dystonia, the doctor should tell. There are several rules for this.
Rule number 1 - a full sleep for 8-9 hours. This condition must be fulfilled without fail. After waking up, you should not jump out of bed, it is better to lie down a bit and only then get up, without making any sudden movements. In case of hypotension, the head end of the bed should be raised.
Rule 2 – Rest. This is aboutobserving the correct regime of work and rest.
Rule 3 – Nutrition. It should be balanced, fortified and varied. There are no special restrictions, but spicy dishes should not abound. Try to eat more fiber.
Rule 4 is sport. Any exercise in the water is especially good. If possible, do not deny yourself a visit to the pool. If this is not possible, a contrast shower should become permanent. For blood vessels, this is the best. All this perfectly tones them. Evening walks, self-massage, relaxation, yoga, dousing according to Ivanov, etc. will bring considerable benefits to the body.
Rule 5 – motivation. For the successful treatment of NCD, a positive attitude of the patient remains important. Eliminate (eliminate) any load, domestic stress, normalize the situation at work. Don't be a workaholic and don't be desperate. The attitude is important because the treatment of dystonia is a long process.
Rule 6 - use the right medications, take them only as directed by your doctor. Among the drugs:
- Vegetable sedatives - motherwort, chamomile, valerian, lemon balm, St. John's wort, mint, hops, oregano, etc.
- Tranquilizers - Grandaxin, Phenazepam, Sibazon, etc..
- Antidepressants - "Amitriptyline".
- Nootropics - Piracetam.
- Cerebroangiocorrectors - Cavinton, Vinpocetine, Cinnarizine, etc.
- With neurocirculatorydystonia of the hypertensive type, doctors often prescribe beta-blockers - Anaprilin, Atenolol, Metoprolol, etc.).
- Effective calcium channel blockers - "Verapamil".
In case of neurotic syndromes, it is necessary to work with a psychotherapist, auto-training, sometimes antidepressants are shown in small doses according to the scheme.
Rule number 7 - preventive treatment. Of the drugs that improve brain function, Pantogam, Piracetam, and others are usually used. Multivitamin drugs in injections or tablets can also be effective. You can also take adaptogens: eleutherococcus, ginseng, lemongrass, rosea rhodiola, zamaniha, aralia. In this case, it is necessary to monitor the pulse and pressure.
Rule 8 - Physiotherapy. She is very helpful. The following procedures apply:
- electrosleep;
- electrophoresis;
- souls - contrast, fan, circular, douches, pearl baths;
- aeroions;
- general strengthening and collar massage, including acupressure;
- general strengthening gymnastics.
With cardialgia, laser magnetic therapy and darsonval on the precordial region give an excellent effect.
Preferably sanatorium treatment in areas with a mild climate. This is Crimea, Sochi. Climatotherapy and balneotherapy will be carried out here. In addition, do not neglect the hardening and training of blood vessels.
NCD for recruits
What kind of neurocirculatory dystonia is this, many recruits are interested. They are very different in their aspirations. Not everyone wants to throw themselves into embrasures and serve at all costs.
Many, having very meager records in the outpatient card, seek to convince doctors of the incurability of their condition and the danger to life. To avoid this on the commission, the conscript is sent to the hospital for a month.
Here the examination will be complete and objective. The result may be an entry in the column "temporary unsuitability" (Article 48). Then the patient is treated further. If the treatment was ineffective, the conscript is recognized as "unfit" under Art. 47a.
Examination of working capacity
Sick leave for 1-2 days is issued only in case of a crisis and in case of rhythm disturbances. If the appeal is primary, the sick leave will be for a week, but with the condition of a thorough examination to exclude organic matter.
Reviews from real people
Many patients diagnosed with NCD, after numerous attempts at treatment and visits to doctors, come to the conclusion that the pills only give improvements for the time they are taken. It is better to do psychotherapy, sports and get plenty of rest. Only the improvement of the body is the key to good he alth. Everything depends only on oneself.
Another conclusion in the reviews: NDC is not a diagnosis, but a symptom complex, which may include several pathologies. All diseases are only from nerves, so you need to reconsider your lifestyle - to eliminate stressful situations as much as possible, try to treat everything positively. People recommend normalizing weight, then life becomes more fun, andall negative symptoms go away on their own.
