Somatoform vegetative dysfunction is a complex disease in terms of diagnosis. It has many symptoms of both somatic and mental nature. Moreover, patients suffering from them feel the signs of the disease acutely enough, which violates their professional implementation. Therefore, everything related to the disease should be understood in detail.
SVD Disease Overview
Somatoform autonomic dysfunction (SVD) is more often detected in men of military age or in individuals who undergo urgent labor or participate in direct hostilities. This disease, which manifests itself in a mass of nonspecific symptoms and requires detailed diagnosis. Its purpose is to exclude structural abnormalities of the heart and arrhythmias, as well as lesions of the central nervous system.
It is believed that somatoform autonomic dysfunction is a persistent imbalance between the sympathetic and parasympathetic nervous system. SVD itself is divided into three types: SVD according to the cardiac, hypotonic and hypertonic types. They should be differentiated from heart diseases, arterial hypo- and hypertension, which is decided in the course of implementation of measures for conscription. 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 nonspecific 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, since it includes a really large number of symptoms. They are manifested by the following syndromes: cardiac, hypotonic, hypertonic. General symptoms may also be observed, signs of dyspepsia, respiratory failure, physical disadaptation. These symptoms will be examined in detail.
Diagnostics Basics
The main criteria for diagnosis related to SVD are: the period of symptoms (more than 2 years) and the absence of hemodynamically significant or life-threatening disturbances in the structure of the heart or arrhythmias. Strictly speaking, all small cardiac abnormalities that do not lead to changes in heart cavities or rhythm disturbances can be combined.
The diagnosis of "Somatoform autonomic 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 violations. Obviously, most of the diagnoses of SVD made to draftees and adolescents have no right to exist. Often the diagnosis is made by the 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 associated pathologies and syndromes are of clinical importance.
Common symptoms of SVD
In a disease such as somatoform vegetative dysfunction, symptoms of a general nature are numerous. These are mood disorders, dysphoria, dysthymia, unwillingness to do any physical work, appetite disorders, muscle weakness, periodic headaches, mainly localized in the parietal and occipital region. Sometimes the patient is disturbed by dizziness and a burning sensation in the pit of the stomach, not connected in any way with hunger or satiety.
Such complaints characterize asthenic syndrome of somatoform vegetative dysfunction. Patients, as a rule, are inactive, sometimes uninitiated and easily upset. Each of them has a characteristic reluctance to take on new things. More often than not they end. Paradoxically, however, an introversion that develops as a result of slight success in sports 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. Avoiding stress and unwillingness to engage in activities that require emotional excitement is a characteristic feature of a patient with somatopharmic autonomic dysfunction.
SVD exercise
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 given to such patients easily, while strength exercises cause a lot of difficulties. You may notice that after a run he has more pronounced shortness of breath than other children of the same complexion. Moreover, 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 may appear, described below.
Cardiac (heart) complaints of patients
Somatoform dysfunction of the autonomic nervous system is manifested by numerous symptoms that are caused by an imbalance between the sympathy and parasympathetic of the innervated organ. Heart complaints, since the organ has a vegetative innervation, are one of the most important. The most typical symptoms of SVD from the heart and blood vessels are: cardiac pain, tachycardia, increased or decreased blood pressure.
The nature of heart pain is not specific to a particular disease. The pains are usually stitching and sometimes pressing. 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 stress. It is important that it develops disproportionately to the severity of the tolerated load. For example, tachycardia appears immediately before the exercise, or at the very beginning, and not as it grows.
It is important that pains in the heart, if they have the character of burning and (or) constricting and occur 20-30 minutes, should be regarded as ischemic, which requires recording electrocardiography for the shortest possible period of time. This is due to the presence of such nosological forms as variant angina and cardiac syndrome X. With such pathologies, the probability of sudden coronary death is 50-100 times higher.
Hypotension and hypertension
Hypotension rarely develops. This is the most rare type of SVD, because the cardiac or hypertonic types are most often manifested. Nevertheless, the hypotonic type of SVD is manifested by periodic drops in blood pressure on both hands. It is important that the diagnosis of this type of disease requires the implementation of echocardiography and electrocardiography, which can eliminate the presence of heart defects or arrhythmias. Fainting is also a sign of SVD, although non-specific.
Hypertension is a more common complaint. Patients try to increase the pressure before performing physical activity, and not during this. Pressure, as a rule, rises in isolation: systolic blood pressure rises to 160, while the dystolic blood pressure remains the same. Due to the elasticity of blood vessels in adolescents and young women, in whom somatoform vegetative dysfunction of the heart is more often diagnosed, diastolic blood pressure may even slightly decrease.
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 autonomic nervous system dysfunction, the symptoms are also respiratory. 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 may appear after the exercise is completed during the rest period. This distinguishes respiratory complaints from SVD from symptoms of bronchial asthma of physical stress.
Examples of complaints with SVD: severe mixed dyspnea during exertion or during rest after it is performed, a feeling of tightness in the chest and difficulty in breathing. For comparison, with asthma, exhalation is impaired. Along with respiratory complaints in a disease such as somatoform dysfunction of the autonomic system, cardiac ones also appear. Their joint appearance is an informative, but non-specific sign, which makes it possible to make such a diagnosis.
Dyspepsia in SVD
With a disease such as 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, intestines. He 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 pains in the epigastric region, which are of a pressing or stitching nature, should be distinguished. Their appearance does not depend on meals: it is chaotic and is associated mainly with stress. Also, pain can be localized in any other part of the abdomen. They also appear suddenly or during physical exertion. These pains are not carried to other parts of the abdomen and are not accompanied by fever, diarrhea or vomiting.
It is important that the above symptoms occur with irritable bowel syndrome. It is believed that these diseases are different. However, in IBS, the cause is also the unbalanced motility of the large intestine. 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 autonomic nervous system dysfunction, treatment is selected individually depending on the prevailing symptoms. The diagnosis of SVD cannot be made without patient complaints manifesting for 2 or more years that meet the above criteria. It is also important to exclude all organic diseases: congenital (or acquired) heart defects, arrhythmias, thyroid diseases, stomach ulcers (or duodenal ulcers), 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 do some research: do a general and biochemical blood test, a general urinalysis, blood glucose and thyroid hormones, record an ECG, perform an echocardiography, FEGDS, ultrasonography of the brachiocephalic arteries and thyroid gland. Based on the results of the studies, a conclusion is made whether the diagnosed symptom complex is a manifestation of SVD or whether it refers to another disease.
Somatoform vegetative dysfunction: treatment
SVD is treated with several methods that combine pharmacotherapy, vitamin therapy, replenishing the body's mineral balance, ergotherapy, and physiotherapy. In pharmacotherapy, it is important to balance nootropic drugs (or antidepressants) with cardiotropic drugs. An example is a combination of Phenibut or Noofen at a dose of 250 mg 3 times a day for 2 months with Thiotriazolin 100 mg 2 times a day for 2 months. On the appointment of antidepressants, you should consult with a psychiatrist who will assess the age and potential danger of drugs for the patient.
In 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 failure of other valves is associated with interstitial imbalance of magnesium. Replenishment of its levels can reduce the manifestations of cardiac complaints and the severity of hypotension or hypertension.
Vitamin therapy, in particular 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, 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 themselves, fresh vegetables and herbs should also be eaten without heat treatment.
Since low interest in one's own health and neglect of the body's needs play a role in the development of SVD, replenishing vitamins and minerals can reduce the severity of symptoms. Occupational therapy during the spa treatment (paid, because in the clinic vouchers are not issued to patients with SVD) will have a much more stable effect. But it is better for the patient to explain that even rest is a cure for him, if only because during the rest he has no complaints.
Somatoform dysfunction of the autonomic nervous system (ICD 10)
In the international classification, this disease has been present since 1993. This pathology is found throughout the world and does not depend on the characteristics of a particular race or nation. In ICD 10, somatoform vegetative dysfunction is reviewed in V and VI headings. The first includes Mental and Behavioral Disorders (encoded by code F0-99), and the second includes Neurotic, Stress-Related and Somatoform Disorders (encoded by F45-F48).
Section F45 includes the following pathologies: somatized disorders, undifferentiated somatoform disorder, directly somatoform autonomic dysfunction, hypochondriac disorder, persistent somatoform pain disorder, and other unspecified disorders of nervous regulation. The somatoform autonomic dysfunction itself is encoded by code 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. Moreover, in a number of situations, the combined manifestation of SVD and structural anomalies in the heart is proved. The widespread practice of echocardiography revealed that the presence of an additional chord of the left ventricle and prolapse of the mitral valve of low degrees with minimal regurgitation. Recent 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 diagnosis from the doctor aimed at identifying concomitant pathologies. Although in its pure form, SVD is a neurogenic disease that is associated with an imbalance between the sympathetic and parasympathetic peripheral nervous systems. Also, in view of the social significance of the pathology, it is important to establish clear diagnostic criteria for SVD. This will allow us to differentiate between psychogenic and somatic diseases when carrying out measures for conscription on military service.