Neurocirculatory dystonia (DNC.) is a dysregulation of the heart and / or peripheral vascular, psychogenic or subkortikalnog foundation, poslijedičnog no organic damage to the cardiovascular apparatus.
Special notes:
• it is a syndrome, a homogeneous group of psychosomatic disorders,
• Their nature has not been well studied,
• there is no unique positions in relation to DNC,
• it is a border area of cardiology and neuropsychiatry,
• DNC in the concept of a partially coincides with the "functional disorders of the heart"
• syndrome is very common,
Symptoms and diagnosis of the DNC's. often misused in practice serves as the "labeling" unclear situation, or is misdiagnosed initial stage of organic heart damage (starting Pectoral angina, unfixed arterial hypertension, etc..).
Types of neurocirculatory dystonia
Based on the predominant aetiological factor (or dominant symptom) can be distinguished as special forms:
• neurocirculatory asthenia,
• iatrogenic DNC.,
• anxious DNC.,
• menopausal DNC.,
• supporting neurocirculatory dystonia.
In most cases, however, the main etiological factors are, presumably, conflict or other mental disorders, who "somatizuju" in the form of polymorphic clinical picture.
Symptoms and diagnosis
Symptoms are usually very numerous and varied: less often, the patient said a few symptoms (oligosymptomatic form). There may be following symptoms: dyspnea, precordial pain, palpitations, feeling of increased heart rate and feeling of heart failure, inability to lying on the left; fatigue; '. Door knocking Damar', typing in Lazic (unpleasant abdominal aortic pulsations); red spots the face, neck, chest, excessive sweating, sticky, cold hands; trvoglavica ("fainting"); headache insomnia; alteration affects; tremor; reputed sensitivity to weather, sub-febrile states.
Although each of the above symptoms for themselves nonspecific, if combined, they provide a lot of the typical clinical picture. It is characteristic and diagnostic of, almost pathognomonic importance, the manner in which the patient describes his illness: colorful expression, using optimal metaphors that it allows the level of education and the inventory of words and terms, the patient describes his symptoms such as experience, if it even allows the physician detail, zauzlmajući quasi-objective attitude towards the disease and during his speech.
The physical signs
There may be signs of the following: eretični tones, tachycardia, exceptionally, bradycardia, extrasystoles, hyperkinetic noise, variable blood pressure, often with high systolic pressure, positive dermografizam, paroxysmal tachycardia, paroxysmal arrhythmias absolute.
There are no signs of organic (anatomical) damage to the heart, with the exception of "supporting neurocirculatory dystonia."
Clinical features of special forms
Neurocirculatory asthenia (described as "military heart" in I and World War II)
It occurs in acute mental load or immediately after acute psychological trauma, although there may be all the listed symptoms, asthenia prevails, ie. effort intolerance due to abnormal heart adaptation to physical effort.The main sign of the tachycardia after a very light load.
Anxious DNC
Subscribe to anxiety neurosis, may be their main events. In the foreground are hypochondriac ideas, and behind them a rich symptomatology.
Iatrogenic DNC
Indicated a reckless statement or the use of so-called doctors. powerful to say, such as "heart murmur", "Enlargement of the aorta," "angina pectoris", "arrhythmia" to the patient, if susceptible to this kind of suggestions, and accepting yourself and upgrade processes.
Menopausal DNC
It occurs during and after menopause women (rarely men) in the foreground are vazoregulacioni disorders (heat waves), and affective instability.
Cover DNC
It occurs together with organic heart disease, coincidentally or poslijedično. Regardless of the somatic effects of organic heart disease, the mere knowledge of the patient's disease of his heart, that mystical body, can act as a mental trauma. In these cases there is a discrepancy between the organic findings (eg, compensatory vicijuma, infracted scar, etc..) And clinical symptoms of the DNC's. The DNC is a special form, sometimes insurmountable difficulties in the diagnosis and evaluation of functional and operational capabilities.
Radiological signs of
Quite often, the heart is a bit lively and pulsating.
ECG signs of
ECG is usually normal. Not infrequently, however, flattened T waves, which are normalized after the effort. On the other hand, the T waves may be high and pointed. There can be significant sinus arrhythmia, often
beats, as a rule, no postekstrasistolnog phenomenon. There may be genuine ST segment depression; down of the more common point of T. Sometimes there paroiksizmalna supraventricular tachycardia, rarely paroxysmal atrial fiibrilacija. Partly be seen and AV block, which can be corrected with atropine (diagnostic test).
Functional signs
There may be intolerance to effort, sometimes a very considerable degree, so the patient does not tolerate even small ergometric load. More often, however, the functional capability is preserved, although the effort, as a rule, there is a significant tachycardia.
Laboratory: no findings
The minimal diagnostic program
ECG with the load (double Master test or cirkloergometar). Rtg-incur the heart.
Pathophysiology
The matter is controversial not only in terms of definition and etiology, but (especially) in terms of pathophysiology. Simplistic interpretation of this is a change of "tone" of vegetative nervous system - hence the (outdated) the name of the syndrome - it is unsustainable. It is certain, however, by definition, and clearly, that these are disorders of the regulatory function of the heart and circulatory system, whose interpretation can be approached only by using modern knowledge of cybernetics.
Forecast
In most cases the prognosis quo ad function is good; quo ad sanationem is uncertain, and often depends on, whether the patient will be able to establish mental balance and satisfying relationships with their srijeđinom.Not infrequently, after many years, the symptoms gradually subside, and seeing the phenomenon of "psychosomatic refilling", ie. usually after a long period of neurocirculatory dystonia manifested in some other psychosomatic disease (eg colitis, hyperthyroidism, ulcers), then NCD symptoms are suppressed.
It should be noted that the DNC. may represent the first phase of development of a permanent dysregulation as hypertension or organic diseases, especially coronary heart disease.
Useful
information about health and healthy diet you can find on:
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.