Neurocirculatory dystonia (NDC) is a functional disruption 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. The pathology is manifested not only by heart 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.
Nature of the problem
The basis of violations is a violation of neurohumoral regulation for various reasons. Even the sharpest clinical manifestations of NDC have a benign course and a good prognosis. The course of the pathology is undulating, with relapses.
The diagnosis of NDC is made only when studies confirm the absence of organic changes. Very often, NDC is determined as part of another disease or becomes an external reaction.
Among calls to a cardiologist or neurologist - 70% of patients have NDC. Most often, dystonia is characteristic of adolescents, middle-aged - in the range from 12-13 to 45 years.
In women, it occurs 4 times more often. Why? Because they have hormonal fluctuations every month in the body - the menstrual cycle is one of them, not to mention pregnancy.
Neurocirculatory dystonia in children is characteristic of the puberty, during the restructuring of the body. At the same time, a person is very sensitive to external influences.
Disease or syndrome?
NDC - what is this disease? There is still no consensus. Vegetative-vascular dystonia (another name for NDC) is considered a more correct name, since it expresses the pathogenesis of the disease. Other synonyms: neurocirculatory asthenia, vegetoneurosis, cardiac neurosis. One thing is certain - NDC is considered by many doctors to be a way of experiencing internal and external problems, disturbing mental balance, and not bodily.
ICD-10 code
ICD-10 code for neurocirculatory dystonia: F45.3. F48.0, F48.8.
ICD-10 - only means that the WHO, which conducted the 10th review in Geneva in 1989, included the term neurocirculatory dystonia in the list of known diseases and health problems.
Independent nosology, this diagnosis is not recognized. So this is neurocirculatory dystonia. It is ranked only as a number of somatoform dysfunctions and neuropsychiatric disorders (neuroses). Therefore, it is often determined as part of another pathology, which has its own code in the classification. The age category of patients is any.
The class of diseases selected is V - 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 means psychogenic etiology. Therefore, the final diagnosis is made by psychiatrists.
According to the same classification of ICD, neurocirculatory dystonia is recognized not as a nosology, but as a syndrome of disorders of the autonomic nervous system (ANS). This means a violation of the balance of its departments - sympathetic and parasympathetic.
Many today do not know that neurocirculatory dystonia according to the ICD-10 is a whole symptom complex that occurs when unbalanced vegetation. Also often VSD belong to the group "Other symptoms and signs related to the emotional state." Then the ICD code for neurocirculatory dystonia will pass as R 45.8, and a psychiatrist 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 term altered and combined the VSD, pathological conditions of functional disorders of the circulatory system, referred to as Da Costa syndrome, cardioneurosis, neurocirculatory asthenia, and others into this group.
Among them, the clinic was dominated by disturbances in the activity of CVS, they were primary, functional in nature and showed 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 assigned to the group of mental disorders.
As a result, neurocirculatory dystonia is today recognized as the most common vegetative form of neurosis (vegetoneurosis), it is diagnosed in 50-75% of adolescents and young people. There are no exact statistics, since each doctor interprets the pathology heterogeneous.
Regarding NDC as a borderline state in children, the systematic manifestations of autonomic disorders and their generalization are characteristic. All internal organ systems - nervous, respiratory, endocrine, digestive, immune, and, of course, primarily cardiovascular, are involved in the process. In such cases, the diagnosis of neurocirculatory dystonia as an autonomic dysfunction syndrome is eligible.
Etiology
All factors are divided into 2 groups: predisposing and starting, the boundary between them is conditional. The first include:
- hereditary constitutional factors;
- a characteristic type of nervous system;
- society;
- hormonal vibrations of the body.
Launchers or callers:
- stresses - acute and chronic;
- external influences - insolation, overfatigue, radiation, vibration, overheating, work in hazardous industries;
- the use of caffeine in large quantities;
- stuffiness;
- alcohol;
- infections - ENT organs and SARS;
- endocrinopathies (diabetes, hyperthyroidism, adrenal disease);
- head injuries.
Pathogenesis
Neurocirculatory dystonia - what is it? The 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: 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 would not be able to survive - the body will simply destroy itself in a matter of seconds. In the event of an imbalance, disruption and defeat in the hypothalamus, its structures playing the role of coordinator, become the leading one. Violations of regulation are manifested in a malfunction of the cholinergic (secretes acetylcholine) and sympathoadrenal system.
What is neurocirculatory dystonia? Its essence is in violation of the control of the work of some organs and systems, starting with CCC. Because it is the myocardium that turns out to be the most sensitive to these changes and reacts with irregular functions and tone: inadequacy of tachycardia, fluctuation of vascular tone, regional vasospasm. Thus, the symptom complex of NDC of a certain type develops as a stable response to the impact of the external environment.
Classification
Savitsky's classification of types is based on the leading symptom of pathology. There are 4 types:
- Cardiac-type neurocirculatory dystonia. Here, in the foreground, dysfunctions of the heart are noted.
- Neurocirculatory dystonia by hypotonic type. In this case, the tone of parasympathetic NS (vagotonia) prevails with a decrease in pressure.
- Hypertensive neurocirculatory dystonia. Here the leading is the increase in pressure, which indicates sympathicotonia.
- Mixed type. It is characterized by pressure instability.
In practical medicine, a classification is used not only of types of neurocirculatory dystonia, but also of severity. There are only 3 of them - light, medium and heavy.
With a mild degree, the symptoms are mild, only in response to external exposure. No treatment required. With moderate severity, 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 necessary, often in a hospital.
Clinic
Allocate about 40 most frequent symptoms at NCD. On average, one patient may have from 9 to 26 symptoms.
Although the clinic is variable, 6 clinical syndromes can be distinguished:
- cardialgic (cardiovascular);
- respiratory (respiratory failure);
- arrhythmic;
- asthenic;
- paroxysmal autonomic vascular crises;
- neurotic disorders.
Clinic of Syndromes:
- Cardial syndrome, or cardiac-type neurocirculatory dystonia, is characterized by pain in the heart and arrhythmias. Pain stitching, aching, burning, can last from several minutes to hours. It is important to note that with neurocirculatory dystonia according to the cardiac type of pain, they appear after exercise - this is a differentiation from coronary artery disease. Unpleasant sensations disappear after taking Corvalol or Validol. But nitroglycerin does not help - unlike IHD.
- Respiratory syndrome (respiratory disorders) is one of the most striking and obligatory. During stress or exertion, breathing suddenly increases, 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. Heart rate jumps from 80-90 to 130-140 beats per minute. The syndrome can occur even during meals, during unrest, physical activity. Heart rate jumps respond little to medication. Perhaps the development of paroxysmal supraventricular tachycardia. It is characteristic of neurocirculatory dystonia of the hypertonic type that arrhythmias are accompanied by fear for their lives.
- Asthenic syndrome - a feeling of chronic fatigue, decreased attention.
Often, against the background of complete or incomplete remissions, vegetative crises provoked by external causes occur, or they can be spontaneous. They can proceed quite hard, up to 2-3 hours, and end with involuntary urination or defecation. Most often, they occur at night and are always accompanied by fear, they are difficult to tolerate by patients.
Crises are divided into:
- Vagoinsular or parasympathetic. There is a sharp weakness, a feeling of freezing of the 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, fever in the face, dizzy and sore head, body trembling and tense, shivering. Such crises often end with excessive urination.
- Crisis states of mixed orientation combine the features of both types.
If crises are manifested by a sharp sense of fear, affective disturbances - they are called "panic attacks." They last in different ways - from a few minutes (more often) to several hours (rarely).
Of the other symptoms, thermoregulation disorders are often characteristic: intolerance to heat and cold. Every third of such a patient has an unreasonable subfebrile condition. An interesting fact is that in each armpit there is a different temperature. The limbs are often cold, the pressure is labile and unstable, the veins on the legs are dilated and the legs swell by the evening - especially in women. Patients are also characterized by fainting on fright, stress and pain. These are peripheral manifestations of NDC.
By type briefly
So, neurocirculatory dystonia of the hypertonic type is sympathicotonia:
- high blood pressure;
- interruptions and tachycardia;
- physical activity causes cephalgia and dizziness;
- low-grade fever;
- tendency to constipation;
- there are no tears when crying;
- clear weather dependence.
Hypotonic neurocirculatory dystonia - vagotonia:
- low pressure;
- cardialgia;
- rare soft pulse;
- cephalgia as a response to any stimulus;
- dizziness;
- weather response;
- body temperature is reduced and the feeling of chilliness is constant;
- diarrhea;
- dyspnea;
- hyperhidrosis that occurs very easily;
- blueness of the feet and hands, pale skin, with a marble pattern; permanent fatigue;
- decreased performance.
Mixed neurocirculatory dystonia:
- the alternation of the dominance of the departments of the ANS;
- pressure variability;
- cardialgia and sinking hearts;
- fluctuations in body temperature;
- stool instability;
- tendency to fainting;
- headache.
Neurocirculatory dystonia - what is this disease in the clinic? Symptoms depend on the type, but, as you can see, there are many common manifestations. NDC resembles a neurosis in its manifestations:
- tremor, internal tension of the body;
- sweating and anxiety;
- choking and lump in throat;
- mixed dermographism;
- irritability and fatigue;
- the tone of emotions is reduced;
- there are cognitive impairment and insomnia.
All this can be attributed to the manifestations of asthenic syndrome.
By the way, 100% of patients have cardialgia. In their occurrence with NDC, the role of coronary spasm and electrolyte disturbances (hypokalemia) plays a role. It has been noted that NDC often develops in people who are anxious, unsure of themselves, dissatisfied with their state of health, and tend to blame doctors for this. They love to be treated.
Diagnostics
At the reception, when asked by the patient, the above symptoms can be identified. Let not all, but most. Patients very willingly and colorfully describe their condition. A pulsation of the carotid arteries is visible on the neck. The chest on palpation is painful in the 3-4 intercostal space, more on the left - the so-called "left-sided hyperalgesia."
With such an abundance of heart complaints during percussion and auscultation, its dimensions are not changed. 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 3-4 intercostal space. This indicates that it is inorganic in nature.
An additional tone may also be heard. Pulse and pressure are labile, asymmetric. It is characteristic that the pulse changes abruptly when changing the position of the body from horizontal to vertical - by 100-300%. This eliminates doubts about the absence of coronary heart disease.
The blood picture does not show any signs of inflammation or changes in immune status. A chest x-ray shows the normal size of the heart and aorta.
In half or a third of patients on the ECG, a decrease in the height of the T wave can be noted, more often in the right (V1-V2) leads, less often in all chest. Such changes can be with organic pathologies. Therefore, for example, a test such as bicycle ergometry is required. It well reveals latent heart failure. With it, a decrease in exercise tolerance is detected - this clearly indicates NDC. With coronary heart disease, etc., this does not happen.
Differentiation can be supplemented with a medical test with beta-blockers and potassium chloride. After taking them, the ECG is repeated after 40 and 90 minutes. With organic heart lesions, the T wave will not change, and with NDC it becomes positive. This is a functional lesion.
As a result, it turns out that there is no data for the disease. That is why many doctors do not recognize NDC as a disease. Yes, NDC does not pose a threat to life with its most striking and sharp manifestations, it has a good prognosis, but it significantly worsens the patient's quality of life during exacerbations. Therefore, you can’t dismiss it and not treat it.
The 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 satisfied without fail. After waking up, you should not jump out of bed, it is better to lie down a bit and only then rise, without making sudden movements. With hypotension, the head end of the bed should be raised.
Rule number 2 - rest. It is about observing the correctness of the regime of work and rest.
Rule number 3 - nutrition. It must be balanced, fortified and varied. There are no special restrictions, but spicy dishes should not abound. Try to eat more fiber.
Rule number 4 is sports. Any exercises in water are especially good. If possible, do not deny yourself visits to the pool. If this is not possible, a contrast shower should become permanent. For vessels, this is best. All this perfectly tones them. The evening walks, self-massage, relaxation, yoga, dousing according to Ivanov, etc. will bring considerable benefit to the body.
Rule number 5 - motivation. For the successful treatment of NDC, the patient’s positive attitude remains important. Eliminate (eliminate) any workloads, home stresses, normalize the situation at work. Do not be a workaholic and do not show despair. The mood is important because the treatment of dystonia is a long process.
Rule number 6 - use the right medications, take them only as directed by your doctor. Among the drugs:
- Plant sedatives - motherwort, chamomile, valerian, lemon balm, St. John's wort, mint, hops, oregano, etc.
- Tranquilizers - "Grandaxinum", "Phenazepam", "Sibazon", etc.
- Antidepressants - Amitriptyline.
- Nootropics - "Piracetam".
- Cerebroangiocorrector - Cavinton, Vinpocetine, Cinnarizine, etc.
- With hypertensive neurocirculatory dystonia, doctors often prescribe beta-blockers - Anaprilin, Atenolol, Metoprolol, etc.).
- Effective calcium channel blockers - Verapamil.
With neurotic syndromes, it is necessary to work with a psychotherapist, auto-training, sometimes antidepressants in small doses according to the scheme are indicated.
Rule number 7 - preventive treatment. Of the drugs that improve brain function, Pantogam, Piracetam, etc. are usually used. Multivitamin drugs in injections or tablets can also be effective. You can also take adaptogens: eleutherococcus, ginseng, lemongrass, Rhodiola rosea, lure, aralia. In this case, it is necessary to monitor the pulse and pressure.
Rule number 8 - physiotherapy. She is very helpful. The following procedures apply:
- electric sleep;
- electrophoresis;
- showers - contrast, fan, circular, dousing, bubble baths;
- air ions;
- general strengthening and collar massage, including acupressure;
- general strengthening gymnastics.
With cardialgia, laser-magnetic therapy and darsonval on the precardial region give an excellent effect.
Sanatorium treatment in areas with a mild climate is desirable. This is Crimea, Sochi. Climatotherapy and balneotherapy will be held here. In addition, do not neglect the hardening and training of blood vessels.
NDC in draftees
What kind of neurocirculatory dystonia is of interest to many recruits. They are very different in their aspirations. Not everyone wants to rush into embrasures and serve at all costs.
Many, having very scanty entries in the outpatient card, seek to convince doctors of the incurability of their condition and danger to life. To prevent this from happening 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 “unsuitable” under Art. 47a.
Disability examination
A sick leave for 1-2 days is issued only in case of crisis and with rhythm disturbances. If the treatment is primary, the sick leave will be for a week, but subject to a thorough examination to exclude organics.
Reviews of real people
Many patients diagnosed with NDC, after numerous attempts at treatment and going to the doctors, conclude that the pills give only improvements at the time of administration. It is better to do psychotherapy, sports and have more rest. Only the improvement of the body is the key to well-being. It all depends 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 exclude stressful situations as much as possible, try to treat everything positively. People recommend normalizing weight, then life becomes more fun, and all the negative symptoms go away on their own.