Bradyarrhythmia microbial. What is sinus bradycardia of the heart, what are its causes, symptoms and does it need to be treated? Other heart rhythm disorders

Almost every person encounters such a phenomenon as sinus bradycardia.

At the same time, you should be aware of in what cases this may be a variant of the norm, and in what cases it may be a dangerous heart pathology.

If signs of arrhythmia are regular, this is a reason to consult a doctor.

This type of pathology means an underestimated, compared to the normal value, the number of contractions of the heart muscle per unit of time (less than 60 beats per minute). The cardiac nerve formation, the sinus node, is responsible for the occurrence and maintenance of contractile rhythm. Normally, it generates from 60 to 90 conductive impulses per minute, each of which causes one heartbeat. This sets the correct healthy pace of myocardial work.

What happens to the rhythm during sinus heart bradycardia? With this, impulses are generated at a lower frequency, and the heart contracts less frequently. This is how blood circulation disorders occur, leading to hypoxia (oxygen starvation).

There are two types of sinus arrhythmia:

physiological;
pathological

In the first case, arrhythmia is observed under a certain external influence and is considered a normal condition. Influencing factors include:

constant physical activity (sports, hard work);
night sleep;
prolonged exposure to the cold;
keeping the body in a lying position for more than a day.

Heart rate (HR) with physiological sinus bradycardia is at least 50 beats per minute without disturbances in rhythm time intervals and other clinical symptoms.

Pathological arrhythmia itself is not an autonomous disease, but only a consequence of other existing pathologies. In this case, a confused, irregular pulse is recorded, accompanied by a deterioration in the general condition of the body.

ICD 10 code

According to the normative document ICD-10 (International Classification of Diseases, Tenth Revision), sinus bradycardia has the code: R00.1 Bradycardia, unspecified. Contained in section R00 (Abnormal heart rhythm).

Normal rhythm and sinus bradycardia on ECG

Signs on ECG

Bradycardia can be detected using electrocardiogram (ECG) data - a graphic image of the biopotentials of the myocardium. The distinctive features of arrhythmia in this case will be the following indicators:

Heart rate ranges from 40 to 60 beats per minute;
increase in the R-R interval due to changes in the T-P segment;
P-Q interval value from 0.12 to 0.22 seconds;
prolongation of the Q-T interval in accordance with heart rate;
no noticeable changes in the direction and amplitude of the teeth.

Sinus bradycardia, displayed on the ECG, is confirmed by other methods used in the diagnosis of cardiovascular diseases.

Vertical position of the EOS

Along with ECG analysis, such an important parameter as the position of the electrical axis of the heart (EOS) is also taken into account. This indicator determines the electrical activity of the myocardium and its orientation in the plane of the chest. The normal position of the EOS can be:

vertical;
horizontal;
semi-vertical;
semi-horizontal.

In case of cardiac rhythm disturbances, as well as the presence of myocardial diseases, the EOS deviates to the left or to the right.

Thus, a shift to the right indicates hypertrophy of the right ventricle due to heart diseases such as myocarditis and others. These pathologies are characterized by arrhythmic behavior of the myocardium, including slow heartbeat.

Deviation of the EOS to the left indicates left ventricular hypertrophy due to similar reasons associated with heart pathologies.

The vertical position of the EOS in the presence of characteristic changes in the electrical activity of the heart indicates existing sinus bradycardia.

Symptoms

A slow heart rate leads to a lack of oxygen in the organs and tissues of the body. In this case, the brain is especially affected. Depending on the clinical manifestations, the slowing of the heart rate is divided into three stages.

Causes and features of manifestation

The physiological type of arrhythmia does not require special therapy, since it is caused by external influences that do not cause harm to the body. The causes of pathological bradycardia are deeper and are associated with internal disorders of organs and tissues.

Diseases of the cardiovascular system: sick sinus syndrome, heart attack, myocarditis, cardiomyopathy, etc. In this case, they speak of an organic form of arrhythmia.
Pathologies associated with high intracranial pressure and neuroses are the causes of the extracardiac nature of abnormal heartbeat.
The presence in the body of sources of severe infections: sepsis, pneumonia, abscesses.
Intoxication associated with severe food or chemical poisoning.
Abuse of drugs that reduce heart rate.
Endocrine system disorders.
Acute and chronic diseases of the kidneys and liver.

In an adult

When it comes to sinus bradycardia in adults, adults often wonder what it is. If a person is healthy, then such disorders are natural and do not require special treatment. Violation of sinus contractile tempo caused by physiological reasons does not cause significant harm to the body. An erratic pulse can be observed in healthy women during pregnancy. In most cases, therapy is not required. The exception is constant attacks and deterioration in the general condition of the pregnant woman.

A slower heart rate is common in older people because aging affects all life support systems. Without pathological prerequisites, this is also a variant of the norm.

If an adult suffers from any chronic pathology or leads an unhealthy lifestyle (alcohol abuse, smoking), then deviations in the functioning of the myocardium are inevitable. In this case, the answer to the question of what sinus bradycardia of the heart is in an adult and why it is dangerous is of fundamental importance, since future life will depend on it.

In teenagers

For newborns and young children, a heart rate of more than 80 beats per minute is typical. In adolescents (12 years and older), the normal heart rate is 70 to 75 beats per minute. If these indicators are reduced by 20 or more units, they speak of sinus arrhythmia. The causes of physiological arrhythmia in this case may be:

excessive physical activity, regular sports;
hypothermia.

The pathological nature of a sinus rhythm disorder is indicated if there are:

genetic predisposition to the disease;
congenital heart defects or other myocardial pathologies;
untreated or severely suffered infectious diseases;
disruption of the endocrine system;
allergies to medications, intoxication.

Accelerated growth of the body and rapid puberty provoke the appearance of sinus bradycardia in a teenager. This also negatively affects the child’s psycho-emotional background, leading to constant irritability, aggressiveness, and frequent mood swings.

In athletes

Sinus bradycardia is not a rare phenomenon in athletes. This is due to the fact that with regular physical activity, the heart adapts to work in an enhanced mode, changing the parameters of blood circulation and energy exchange. Moreover, these changes persist even in the absence of sports training. This can be verified by reading the ECG. In adolescents and adults who are professionally involved in sports, mild or moderate sinus bradycardia is recorded. Such sinus bradycardia is characterized by a vertical or semi-vertical EOS, which is typical for thin people with an athletic build.

Consequences

Mild or moderate sinus bradycardia, caused by physiological causes, does not pose a threat to life and does not require treatment.

Pathological arrhythmia, especially the organic form, can lead to very serious consequences, such as the appearance of extrasystoles. In this case, the causative agent of the heart rhythm is not only the sinus node, but also other sources of the myocardial conduction system that stimulate extraordinary cardiac contractions.

In professional athletes, the heart undergoes significant changes associated with hypertrophy of its parts. If physical activity is unbalanced or irregular, then against the background of a slow heart rate, blood circulation disorders occur, which can lead to cardiosclerosis.

The consequences of sinus bradycardia for children are very dangerous, especially for newborns and preschool children. If the heart rate is recorded significantly below normal, urgent medical attention is required, since hypoxia in this case can be fatal.

Disruption of sinus contractile rhythm in pregnant women, in the case of existing pathologies, can lead to serious disturbances in the functioning of the fetus associated with a lack of oxygen. Therefore, every expectant mother should know what sinus bradycardia means and what danger it can pose.

Why is it dangerous?

The question of why sinus bradycardia is dangerous becomes inevitable for those who are faced with this problem. Arrhythmia, detected for the first time, requires a full diagnosis to identify the causes of the disease. If hidden pathologies are discovered, immediate treatment and constant monitoring by a cardiologist will be required. Ignoring recurring symptoms of arrhythmia can lead to their aggravation and progression of untreated diseases.

Severe sinus bradycardia is dangerous because of the suddenness and transience of its symptoms, which can lead to cardiac arrest.

Arrhythmia provokes attacks of Morgagni-Adams-Stokes Syndrome, which are life-threatening if there is no cardiac pacing. If resuscitation therapy is not carried out in a timely manner, it will lead to disability or death of the patient. Therefore, people suffering from this pathology should first of all know why sinus bradycardia is dangerous.

Treatment

Before making a diagnosis of sinus bradycardia, the doctor carries out a set of diagnostic measures to identify the type of arrhythmia, its causes and characteristics of genesis. Diagnostics include:

description of complaints and medical history;
Ultrasound of the heart;
laboratory blood test;
Holter monitoring.

Based on the information collected, taking into account the severity of the symptoms of sinus bradycardia, treatment is prescribed.

How to treat?

How to treat sinus bradycardia of the heart if such a diagnosis is established? It is important to remember that treatment will primarily be aimed at eliminating the disease that led to the arrhythmia.

If sudden signs of arrhythmia appear in the absence of serious illnesses, a person should provide first aid aimed at restoring normal heart rate: drink a cup of strong coffee, tea or take drops that accelerate the heart rate, do some physical exercises, etc.

Treatment of sinus bradycardia of the heart of a pathological nature involves drug as well as non-drug therapy and surgery.

Drugs

Drug treatment of sinus bradycardia involves taking drugs that activate the contractile function of the myocardium and reduce the dependence of cardiac conductivity on autonomic neurogeneration. These include:

anticholinergics (atropine). Used as an intravenous emergency;
adrenomimetics (izadrin). Prescribed in the form of tablets or inhalations if the patient has a temporary respiratory arrest;
bronchodilators (aminophylline);
cardioprotectors, antioxidants (riboxin, mexidol);
activators of metabolism in cardiomyocytes (actovegin, mildronate);
nootropics (piracetam);
multivitamins.

Medicines are taken only as prescribed by a doctor, in the dosage and frequency specified by him. Self-medication, in this case, is life-threatening!

If the drug therapy is ineffective and the patient’s condition is serious, an operation is performed to install an electrical pacemaker - a device that sets the correct heart rate.

The use of folk remedies

Treatment with folk remedies for sinus bradycardia is acceptable in the treatment of mild or moderate forms due to physiological causes. Alternative treatment for sinus bradycardia includes taking tinctures or decoctions based on ginseng, eleutherococcus, yarrow, lemongrass, and immortelle. These herbs have a tonic effect, leading to increased heart rate.

Are they allowed into the army with this diagnosis?

The answer to the question of whether one is recruited into the army if sinus bradycardia is registered depends on the possible causes and the severity of the symptoms. A healthy young man who has no serious illnesses, but with a fixed arrhythmia, is fit for military service, since there is no threat to his life (fitness category 1). In the presence of pathologies, along with arrhythmia, the intensity of manifestation of signs of arrhythmia is taken into account:

The appearance of moderate symptoms (weakness, shortness of breath, dizziness) when performing physical exercises (category 2 – limited use).
Severe symptoms of arrhythmia during mild physical exertion (category 3 – not suitable).
Severe symptoms even with complete inactivity (category 4 – exempt from military service).

Useful video

For more information about sinus bradycardia, watch this video:

Conclusions

Summarizing all of the above about what it is - sinus bradycardia of the heart and how to treat it, it can be argued that this disorder cannot be ignored.
A slow heart rate in many cases is a normal condition in the absence of pathological preconditions. It does not cause significant discomfort and does not require special treatment.
If a slow heartbeat is accompanied by any progressive disease, you should definitely consult a doctor to identify the causes and prescribe the necessary treatment. Delay, in this case, is life-threatening.

Sinus bradycardia(SB) is caused by a violation of the ability of the sinoatrial node to generate electrical impulses with a frequency of more than 60 per minute. In 25% of healthy young men, the heart rate is between 60 and 50 per minute; During sleep, heart rate decreases by 30%.

Code according to the international classification of diseases ICD-10:

R00.1

Classification. Extracardiac SB (neurogenic). Causes: carotid sinus massage, pressure on the eyeballs (Aschner reflex), increased ICP (for example, meningitis, brain contusion, subarachnoid hemorrhage, cerebral edema), Meniere's disease, intubation, gastric and duodenal ulcers, myxedema. Organic SB: atherosclerosis of the coronary arteries, MI, myocarditis, degenerative and fibrotic changes in the sinus node (see Sickness of the sinoatrial node syndrome). Drug SB: quinidine, beta-blockers, sympatholytic drugs (for example, reserpine), calcium channel blockers (for example, verapamil), cardiac glycosides, morphine. Toxic SB: sepsis, jaundice, uremia, typhoid fever, poisoning with organophosphorus compounds. SB of athletes: heart rate at rest is 40-35 per minute, even during the daytime. The reason is the peculiarities of the neurovegetative regulation of cardiac output in people engaged in heavy physical work or professional sports.

Symptoms (signs)

Clinical manifestations depend on the severity of SB, the magnitude of stroke volume, the state of the autonomic nervous system and/or the nature of the underlying disease.

Diagnostics

ECG - identification- Heart rate is less than 60 per minute, each P wave corresponds to a QRS complex. A frequent combination of SB with respiratory arrhythmia is typical.

Treatment

Treatment. When moderate SB is combined with arterial hypotension, belladonna preparations, for example Zelenin drops, bellataminal, bellaspon (contraindicated in glaucoma). Treatment of severe SB - see Sick sinus syndrome.

ICD-10. R00.1 Bradycardia, unspecified

When fluid accumulates in a certain area of the head, the patient is diagnosed with high intracranial pressure (ICP), in which the circulation of cerebrospinal fluid is impaired. The fluid is found in the ventricles of the spinal cord and brain, as well as between the cranial bones. Due to the cerebrospinal fluid, the gray matter is protected from overstrain and injury. A liquid is characterized by a constant pressure indicator. At the same time, its frequent renewal is observed, as a result of which it moves to different parts of the skull. But if fluid has accumulated in one intracranial area, then the intracranial pressure increases. A person is diagnosed with increased or decreased intracranial pressure. The change manifests itself for various reasons (usually after injury) and in any case the patient needs the help of a doctor.

Normal intracranial pressure

Intracranial pressure indicators depend on how much cerebrospinal fluid is produced, how it circulates and how much it is absorbed by the cerebral venous sinuses.

In order to provide the brain with additional protection, there is a layer of special liquid around it - cerebrospinal fluid. Healthy people produce about a liter of fluid per day. The normal rate is different for each age group. In children under two years of age, the normal ICP is considered to be up to 6 mmHg. Art., and in young patients from two years of age, intracranial pressure is normal if the indicator is 3-7 mm Hg. Art. In adults, the normal ICP is 5-7 mm Hg. Art. If this indicator is higher in an adult or child, this indicates impaired functioning of the body. According to ICD-10, the disease has code G93.2.

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Reasons for changes in ICP

impaired metabolic processes;
vascular spasms;
the presence of excess fluid in the body;
manifestation of cerebral hypoxia;
strokes;
excess weight (often causes increased ICP);
poisoning of the body (to one degree or another always affects ICP);
benign or malignant neoplasms (and the pressure can be either low or high).

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Symptoms in adult patients

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Symptoms of intracranial pressure in a young patient

Increased cranial pressure in childhood is associated with hydrocephalus, in which too much cerebrospinal fluid collects in the ventricles of the brain. At the same time, the child lags behind in development, unlike his peers, he is constantly worried about something, and the baby’s gaze is directed not straight, but downward. In young patients, the following main symptoms of intracranial pressure appear:

pulsation of fontanelles;
the baby’s cranial bones diverge and the sutures increase;
behavior changes: the little patient often cries, sleeps poorly, becomes irritable and moody;
frequent vomiting, after which it does not get better;
visual impairment appears;
strabismus appears, the eyeballs move little;
coma may occur due to impaired consciousness;
convulsions appear;
head size changes;
limbs move worse, and in some children they completely cease to function;
When eating food, the patient regurgitates.

The clinical picture of the disease can manifest itself in two forms. In some cases, the first signs of high pressure in the skull develop suddenly, and the little patient’s consciousness is impaired, leading to the development of coma. In such cases, the chance of death increases. In other cases, signs of intracranial pressure in a child develop gradually.

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Rules for measuring ICP

When measuring intracranial pressure, special sensors are used.

In order to measure internal cranial pressure, the clinic uses special sensors. The hydraulic ventricular system is used to check the ICP in the cerebral ventricles. A catheter is inserted internally into them and connected to the system. In this case, treatment is possible. To measure parameters in the parenchyma, sensors are inserted into the frontal or temporal area. Intracranial pressure can also be determined indirectly by measuring it in the spinal subarachnoid zone, located in the waist region.

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Diagnosis of the disease

Method	Description
Ultrasound examination	Using ultrasound, it examines the structural features of the brain, determines ICP indicators and the causes of abnormalities. Contraindicated for children with enlarged fontanel.
Fundus examination	The fundus is examined because the optic nerve is swollen due to increased ICP. In this case, the vessels stop pulsating and hematomas appear.
MRI	Magnetic resonance imaging should be done to study the structure of the brain. Using the method, it is possible to find out in time about the presence of a malignant or benign neoplasm by assessing its size and location.
Carrying out electroencephalography	Using the method, indirect information is detected, but if the patient has obvious signs of increased pressure in the head, then these data play an important role.
Blood test	Blood tests make it possible to assess the condition of the blood, determine the leukocyte count and identify the onset of inflammatory processes.

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Therapeutic measures for illness

Drug therapy

If the doctor makes a diagnosis on time, it is easier to help the patient because there are no complications.

To reduce elevated ICP or, conversely, increase it and restore the patient’s condition, the doctor prescribes a conservative treatment complex. For treatment, sedatives and medications to normalize the condition of blood vessels are prescribed. Diuretics are also prescribed, under the influence of which fluid outflows and intracranial pressure indicators decrease slightly. But with their help, severe ICP cannot be eliminated forever. If the patient wants to take a medicine that has been independently selected, there will be a risk of complications.

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Treatment with traditional methods

Traditional methods of treatment are safer than using medications because they do not contain chemical compounds. To do this, use herbal infusions or decoctions that remove signs of the disease. An infusion for treatment is made from the leaves of valerian, hawthorn, mint, eucalyptus and motherwort. A tablespoon of the herbal mixture is poured with half a liter of vodka and left for a week, then filtered. You need to take the infusion 20 drops three times a day. A decrease in ICP will occur if the patient is treated with lavender decoction. To do this, take a tablespoon of herb and pour half a liter of hot water, then leave for an hour and squeeze. You need to drink the decoction once a day.

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Surgical intervention

Depending on the cause of ICP, surgery may be prescribed.

The disease can be cured with surgery in cases where it appears due to tumors, injuries or hydrocephalus. The disease is treated by shunting, the purpose of which is to remove excess cerebrospinal fluid. Using a puncture, internal catheters are inserted, which can normalize intracranial pressure. Positive results are observed after endoscopic surgery, because this method does not cause negative consequences in patients.

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Negative consequences

It doesn’t matter what the cause of the increased pressure inside the skull is, the patient must treat the disease in any case. If the patient does not cure the signs of ICP in time, the disease will become chronic. This is dangerous because this condition leads to stroke. Also, the danger is that the patient may experience paralysis or hemorrhage in the brain.

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Prevention and prognosis

To prevent ICP from being constantly elevated, the patient must remember about prevention. To do this, it is recommended to monitor your daily routine, exercise, get rid of signs of illness in time, and monitor your diet. The patient should stop drinking alcoholic beverages and smoking, which have a detrimental effect on the condition of blood vessels. As practice shows, if a patient consults a doctor on time in the presence of unpleasant signs, then the prognosis is positive. But without treatment, the risk of death increases.

Neurocirculatory dystonia: causes, signs, types, treatment

Obviously, the essence of the numerous names of neurocirculatory dystonia syndrome (NCD) is the same - impaired autonomic regulation of primary organs reduces the quality of life, starting from childhood or adolescence, therefore NCD is considered a “youth” disease.

Most often, neurocirculatory dystonia (vegetative-vascular dystonia, vegetative-vascular dysfunction, vegetative dystonia syndrome) begins in the puberty period, when secondary sexual characteristics are just about to be determined, and hormones begin to be active in connection with the upcoming restructuring.

The disease, as a rule, is associated with certain causes, which gave impetus to a persistent disorder that remains for life and makes a person “neither sick nor healthy.”

Why does this happen?

The autonomic nervous system permeates the entire human body and is responsible for the innervation of internal organs and systems of lymph and blood circulation, digestion, respiration, excretion, hormonal regulation, as well as tissues of the brain and spinal cord. In addition, the autonomic nervous system maintains the constancy of the internal environment and ensures the body’s adaptation to external conditions.

The operation of all systems is ensured by the equilibrium behavior of its two departments: sympathetic and parasympathetic. When the function of one department predominates over another, changes occur in the functioning of individual systems and organs. With this phenomenon, the adaptive abilities of the body naturally decrease.

Interestingly, damage to certain organs and disruption of the endocrine system can themselves lead to an imbalance in the autonomic nervous system. Neurocirculatory dystonia is the result of an imbalance in the autonomic nervous system, therefore the form of NCD depends on the predominance of a particular part of the ANS (sympathetic or parasympathetic).

The impetus to the disease

The question of why someone gets sick and someone doesn’t is inherent in NCD just like other diseases. In the etiology of neurocirculatory dystonia, the main factors can be identified:

The combination of several or all factors together leads to the body's reaction to stimuli. This reaction causes the formation of pathological conditions that are manifested by disorders:

Metabolic processes;
Innervation of internal organs;
Works of the gastrointestinal tract;
In the blood coagulation system;
Activities of the endocrine system.

The course of the mother's pregnancy, hypoxia and birth trauma also have a negative impact on the state of the autonomic system and can cause neurocirculatory dystonia in children.

Inconsistency between the systems ultimately leads to a vascular response—their spasm. Thus, the manifestation of neurocirculatory dystonia begins.

Video: neurocirculatory dystonia - Dr. Komarovsky

Types of NDC

Neurocirculatory dystonia occurs differently in everyone. The essence of these phenomena lies in the predominance of a certain part of the autonomic nervous system and in the formation of the type of NCD. One person’s heart hurts or “pops out”, another feels dizzy as soon as the ambient temperature changes a degree or two. And, if God forbid, there is excitement, stress or a sudden change in weather - the reaction is generally uncontrollable. The symptoms of neurocirculatory dystonia are vivid and varied, but the sensations are always unpleasant.

You can feel anything. Dizziness, lightheadedness, accompanied by nausea or an unpleasant “lump” in the stomach. The feeling is such that sometimes you want to lose consciousness in order to get relief later. Often, fainting is a salvation for some people, because after it comes a pleasant languor and relaxation...

Treatment of neurocirculatory dystonia is long-term, due to the undulating course of the process, and is aimed at preventing relapse. In addition, the complex of medications directly depends on the type of NCD and changes in the cardiovascular system.

Types of neurocirculatory dystonia are divided depending on blood pressure indicators:

Neurocirculatory dystonia of the hypertensive type - blood pressure tends to increase, regardless of age and circumstances;
Neurocirculatory dystonia of the hypotonic type - lethargy, weakness, decreased blood pressure and pulse;
Neurocirculatory dystonia of a mixed type, it’s difficult to keep track of how and when everything will turn out. The worst thing is that the patient does not know in advance and waits with trembling for either an increase or decrease in pressure.

Hypertensive type of NCD

Neurocirculatory dystonia of the hypertensive type is characterized by an imbalance of the autonomic nervous system, expressed by the predominance of the tone of the sympathetic system over the parasympathetic department (sympathicotonia) and is expressed by:

Increased blood pressure;
Headaches that depend on physical activity and intensify with it;
Dizziness;
Dependence on weather conditions (headaches, rise in blood pressure);
Rapid heartbeat, sometimes intermittently;
Mitral valve prolapse on ultrasound examination of the heart;
Violation of thermoregulation - high body temperature in children with infectious diseases;
Changes in the gastrointestinal tract in the form of weak peristalsis, and hence a tendency to constipation;
Insufficiency of the function of the lacrimal glands (“dry tears”);
Changes in mood (sadness and melancholy);
Fatigue quickly.

Hypotonic type of NCD

When the parasympathetic part of the autonomic nervous system predominates (vagotonia), neurocirculatory dystonia of the hypotonic type develops, the main symptoms of which are:

Reduced blood pressure;
Rare pulse (bradycardia), which can quickly increase in speed (tachycardia);
Pain in the heart (cardialgia);
Dizziness;
Frequent fainting conditions, especially characteristic in the presence of neurocirculatory dystonia in children (mainly girls) during puberty;
Headaches associated with weather conditions, physical and mental stress;
Increased fatigue and low performance;
Biliary dyskinesia, which is associated with uneven and chaotic contraction of the gallbladder;
Digestive disorders (tendency to diarrhea and flatulence);
Violation of thermoregulation: decreased body temperature and prolonged low-grade fever due to infections in children;
Complaints of “shortness of breath” and “sighs”;
Tendency to allergic reactions;
Pale skin (marbling), cyanosis of the extremities;
Cold sweat.

Mixed type of NDC - when there is no agreement between departments

Uncoordinated work of the sympathetic and parasympathetic departments leads to dysfunction of systems and organs. If the pressure “jumps”, if the complexion suddenly turns red or pale in a matter of minutes, if the body reacts unpredictably even to minor events, then a mixed type of neurocirculatory dysfunction can be suspected.

Signs of mixed-type neurocirculatory dystonia include symptoms characteristic of both hypotonic and hypertonic types. Which part of the autonomic nervous system will prevail at what moment, such signs will be inherent in the patient’s condition.

Video: how does NCD manifest itself?

Crises of neurocirculatory dystonia

Neurocirculatory dystonia, which arose in childhood, can become “enriched” with symptoms over time and in young people give more pronounced vegetative manifestations in the form of crises. Attacks with neurocirculatory dystonia also depend on its type, although they often do not have a clear picture of the identity, but are of a mixed nature. High activity of the parasympathetic division of the ANS can cause a vagoinsular crisis, which is characterized by the following symptoms:

Sweating and nausea;
Sudden weakness and darkening of the eyes;
Reduced blood pressure and body temperature;
Slowing heart rate.

After a vagoinsular crisis, the patient still feels tired and weak for several days, and is periodically dizzy.

When the sympathetic department takes “primacy,” another type of neurocirculatory dysfunction develops. Neurocirculatory dystonia with sympathoadrenal crises makes itself felt by the sudden appearance of causeless fear, to which is quickly added:

Intense headache;
Pain in the heart;
Increased blood pressure and body temperature;
The appearance of chills;
Skin redness or pallor.

Video: how to deal with exacerbations of NCD?

Autonomic dysfunction and pregnancy

Although pregnancy is a physiological condition, it is then that neurocirculatory dystonia can manifest itself, occurring latently (hidden), because during pregnancy the body is rebuilt and prepares for the birth of a new life. Hormonal levels, the regulator of all pregnancy processes, undergo significant changes. The internal organs are “packed” differently, making room for the ever-expanding uterus. And all this is under the control of the autonomic nervous system, which could not always cope without such a load, but here...

Women suffering from NCD may find out they are pregnant even before the test, because the first sign may be fainting. Neurocirculatory dysfunction during pregnancy has a more pronounced clinical picture, so pregnancy is more difficult.

Reaction to everything that is “wrong”, tears for every reason, heart pain and hysterics, decreased blood pressure, and it’s better not to get into transport... Pregnant women are often visited by a feeling of lack of air and stuffiness, and those with neurocirculatory dysfunction even know the “smell of fresh blows."

But everything may not be so bad and you shouldn’t be upset. There have been many cases of disappearance of manifestations of NCD after childbirth. What is the reason for this - either “restoring order” in a woman’s body, or a responsible occupation associated with caring for a baby - is unknown. But patients themselves often note that if they are distracted by important matters, the vegetative-vascular complex recedes.

Disease or syndrome?

When discussing vegetative-vascular disorders and what to call them, scientists still haven’t decided. Vegetative-vascular dystonia is considered a more correct name, since it expresses the pathogenesis of the disease. The most recent trend in defining this condition was the syndrome of vegetative dystonia, which did not become an independent unit in the International Classification of Diseases (ICD).

The ICD 10 code for neurocirculatory dystonia is F45.3, where the letter F indicates a psychogenic origin, which, in general, is the case. According to the same classification, NCD is recognized not as a disease, but as a symptom complex that arises as a result of inadequate behavior of the autonomic nervous system (uncoordinated and unbalanced interaction of two parts of the ANS: sympathetic and parasympathetic). It is unlikely that people who are well acquainted with this complex of symptoms will “get better” from this, but today this is the case.

Vegetative-vascular dysfunction raises many questions when the time comes to repay one’s debt to the Motherland. How are neurocirculatory dystonia and military service compatible? As varied are the manifestations, so should be the approach.

Preparing for military duty: NDC and the army

Of course, some are so eager to join the ranks of defenders of the Fatherland that they forget about the disease. Or are they hiding? Others, on the contrary, having had an entry on their card since childhood - NDC, are trying to save themselves from military duties. In this regard, the commission’s approach should be objective and versatile. On the one hand, seeing a conscript for the first time, who does not show any complaints and is “eager to fight”, who is only identified by low or high (below 100/60 or above 160/100) blood pressure and obvious vegetative disorders on the “face”, in breathing and heart rhythms, you can satisfy his desire. However, a qualified commission must find out this for the first time, periodically or permanently. The situation is the same with those who present a lot of complaints, and only meager entries in the child’s card indicate illness. Of course, there is an average: the clinic also has complaints indicating the presence of autonomic disorders. In all cases, the commission’s task is to find out:

Are the complaints persistent?
Is blood pressure persistently high or low?
Do you have cardialgia and heart rhythm disturbances?
To what extent do NCD symptoms affect a conscript’s performance?

To study the health status of a young person, related specialists (neurologist, cardiologist, ophthalmologist, endocrinologist, otolaryngologist) are required to be involved.

In addition, when deciding on suitability for military service in the case of neurocirculatory dystonia, differential diagnosis is carried out with other diseases to clarify the diagnosis and exclude diseases of the gastrointestinal tract, heart and lungs, which may be similar to NCD in symptoms.

Who does “Farewell of the Slav” sound like?

For an objective approach to resolving the issue, the conscript is sent to a hospital for examination, after which he may be declared temporarily unfit under Article 48. In this case, the young man is subject to treatment for neurocirculatory dystonia, but if it turns out to be ineffective, and the symptoms indicate persistent disorders of autonomic innervation, then the conscript is not subject to military service and receives a military ID with a mark of unfitness under Art. 47 "a".

The commission acts similarly with those young men who clearly have persistent vegetative-vascular disorders with an increase or decrease in pressure, there are clear signs of heart rhythm disturbances, and pain in the heart is constant.

Well, the one who had the only record of a disease of the autonomic nervous system, but did not confirm it, must go with honor to serve the Motherland and Fatherland. Ancient, but still unchanged and unique, the march of Vasily Ivanovich Agapkin with its solemnity will make his own mother and his beloved girl cry... Nothing terrible - a little time will pass and yesterday’s healthy, mature and self-confident conscript will return home, completely forgetting about the illness.

And yet: what to do with it?

We can talk about neurocirculatory dystonia for a long time and a lot, fortunately there are numerous names for this pathology, and this allows for diversity. But those who have such “happiness” are looking for ways to escape from this symptom complex, which pretty much poisons life and manifests itself in the most unforeseen situations. In general, a significant part of humanity is occupied with the question of how to treat neurocirculatory dystonia, which has a dozen other names. After all, changing the name will not affect the patient’s well-being in any way.

Oddly enough, vegetative-vascular dysfunction does not like physical inactivity. And despite the fact that the manifestations of the disease are especially noticeable after physical activity, physical exercise not only does not harm the patient, but is also indicated. True, we should be talking about targeted, therapeutic physical education, dosed and deliberate.

Mandatory adherence to the work and rest regime is also an integral part of the treatment process. Of course, working night shifts, lack of sleep, and spending a long time near the monitor are unlikely to help you feel light in your head and body. But fresh air, quiet evening walks, a warm bath with soothing herbs, on the contrary, will ensure good healthy sleep and improve your mood.

Patients should pay special attention to their psycho-emotional state. Avoid stressful situations, engage in auto-training, take soothing tea and do everything possible to create a calm, friendly environment at home and in the team for yourself and those around you.

No matter how trivial it may sound, diet also plays a significant role here. Neurocirculatory dystonia does not like spices, spicy foods, or alcohol. Anything that excites the nervous system can aggravate the process, so it is better to avoid excesses and not overexert yourself. But foods rich in potassium (eggplants, potatoes, bananas, prunes and apricots) will “like” the “capricious” nervous system.

Treatment prescribed by a doctor

It is highly advisable to carry out drug treatment for neurocirculatory disorders with general health measures and physiotherapy. Therapeutic massage, electrophoresis with sedatives on the collar area, electrosleep and a circular shower will help strengthen the nervous system and give the positive emotions that patients with neurocirculatory dystonia so need.

What a wonderful procedure - acupuncture. Using it, you can stop taking medications for a long time and feel great only thanks to the annual repetition of acupuncture. Thin gold or platinum needles placed in the neuromuscular bundles will lead to long-term and stable remission, and the disease will recede...

Vitamin therapy and an antioxidant complex (Doctor Theiss, Gerovital, etc.) will be an excellent addition to general strengthening measures.

Medicines for the treatment of neurocirculatory dystonia are taken on the recommendation of a doctor and prescribed by him. No advice from friends or the Internet is inappropriate here, since drug treatment is prescribed taking into account blood pressure, the presence of cardialgia and the state of the heart rhythm. It is clear that what helps a patient with high blood pressure can have a detrimental effect on the condition of a person with low blood pressure, so it is unlikely that egilok (a beta-blocker) will be indicated for the hypotonic type. Drugs that regulate heart rate are serious and require special care, so “amateur” in such cases is useless.

Patients with autonomic disorders are often prescribed drugs from the group of tranquilizers - adaptol, afobazole, grandaxin. The herbal preparation Gelarium, which has antidepressant properties, has a remarkable effect. To relieve spasms, bellataminal is often prescribed, which also gives a sedative effect.

Hawthorn, valerian, motherwort - alcoholic infusions of these plants are very familiar to patients with neurocirculatory dystonia; they are constantly stored in the home medicine cabinet and serve as an “ambulance”.

Video: expert opinion about NDC

How can traditional medicine help?

The variety of recipes for treating neurocirculatory dystonia with folk remedies is even more striking than the variety of clinical manifestations. The contrasting souls, breathing exercises of Tibetan monks and the Austrian healer Rudolf Breuss are undoubtedly wonderful, but for some reason people prefer the Russian “creation”. A popular drink made from the church “Cahors” and a mixture of garlic, lemon, beet, carrot and radish juices, flavored with natural honey, is passed down “from mouth to mouth and from generation to generation.”

However, to treat NCD with folk remedies, one should not forget about pressure, so traditional healers also recommend different treatments. For example, for high blood pressure, people use infusions of mint and white birch leaves, calendula flowers and dill seeds. Alcohol infusions of magnolia and mistletoe are good for reducing blood pressure.

Strong tea and coffee are not recommended for the hypertensive type of NCD, but in the morning you can drink amazing tea prepared at home:

Dry blueberries, chokeberries, currants and barberries are taken in equal parts, ground, mixed and consumed, poured with boiling water.

With normal blood pressure levels and a downward trend, prepare infusions of elecampane and immortelle, drink freshly squeezed juices of carrots and rose hips. They say it helps a lot.

Of course, valerian root (you can take it internally, you can do baths), hawthorn, hot milk with honey at night - everyone knows. Such folk remedies are, perhaps, in every home, even where neurocirculatory disorders are not found.

How is the diagnosis made?

Autonomic dystonia syndrome is not based only on patient complaints. Before the doctor makes a diagnosis, the patient must undergo tests and undergo instrumental examinations, therefore the main stages “on the path” to NDC will be:

General blood and urine tests, which do not deviate from the norm for this disease;
Blood pressure profile for 10-14 days to establish the type of NCD;
Ultrasound of the kidneys and heart to exclude independent diseases of these organs;
Rheoencephalography;
ECG, FCG, echoCG;
Consultations with an endocrinologist, otolaryngologist, neurologist, ophthalmologist.

In addition, to determine the cause, there is often a need for a detailed study of the function of the kidneys, adrenal glands, hypothalamus and thyroid gland.

Excluded: bradycardia NOS (R00.1) complicating conditions. abortion, ectopic or molar pregnancy (O00-O07, O08.8). obstetric surgeries and procedures (O75.4) cardiac arrhythmia in the newborn (P29.1)

I49.0 Ventricular fibrillation and flutter

I49.1 Premature atrial depolarization

Premature atrial contractions

I49.2 Premature depolarization originating from the junction

I49.3 Premature ventricular depolarization

I49.4 Other and unspecified premature depolarization

Ectopic systoles Extrasystoles Extrasystolic arrhythmia Premature. abbreviations NOS. compression

Tachycardia-bradycardia syndrome

I49.8 Other specified cardiac arrhythmias

Rhythm disturbance. coronary sinus. ectopic. nodal

I49.9 Heart rhythm disorder, unspecified

Diltiazem: instructions, use and formula

Russian name

Diltiazem

The Latin name of the substance is Diltiazem

Diltiazemum ( genus. Diltiazemi)

Chemical name

(2S-cis)-3-(Acetoxy)-5--2,3-dihydro-2-(4-methoxyphenyl)-1,5-benzothiazepin-4(5H)-one (as hydrochloride)

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Diltiazem

A benzothiazepine derivative. White or off-white crystalline powder with a bitter taste. Insensitive to light. Soluble in water, methanol, chloroform.

Pharmacology

Pharmacological action - antianginal, hypotensive, antiarrhythmic.

Blocks voltage-dependent L-type calcium channels and inhibits the entry of calcium ions into the depolarization phase of cardiomyocytes and vascular smooth muscle cells. As a result of inhibition of the slow depolarizing flow of calcium into the cells of excitable tissues, the formation of the action potential is inhibited and the “excitation-contraction” process is uncoupled. Reduces myocardial contractility, reduces heart rate and slows AV conduction. Relaxes vascular smooth muscle, lowers peripheral vascular resistance. It has a dose-dependent antihypertensive effect in mild to moderate hypertension. The degree of reduction in blood pressure correlates with the level of hypertension (in people with normal blood pressure there is only a minimal decrease in blood pressure). The hypotensive effect is manifested in both horizontal and vertical positions. Rarely causes postural hypotension and reflex tachycardia. Does not change or slightly reduce maximum heart rate during exercise.

Long-term therapy is not accompanied by hypercatecholaminemia or increased activity of the renin-angiotensin-aldosterone system. Reduces the renal and peripheral effects of angiotensin II. The antianginal effect is due to a decrease in myocardial oxygen demand due to a decrease in heart rate and systemic blood pressure. vasodilation of epicardial vessels, the ability to eliminate coronary spasm. Relaxes the smooth muscles of the coronary vessels in a concentration that does not cause a negative inotropic effect. Efficacy in supraventricular tachycardias is associated with an increase (by 20%) in the effective and functional refractory period of the AV node and an extension of conduction time in the AV node (with normal heart rate, the effect on the AV node is minimal). Slows the ventricular rate in patients with high ventricular rates due to atrial fibrillation and flutter. Restores normal sinus rhythm in case of paroxysmal supraventricular tachycardia, interrupts the circulation of excitation of the re-entry type in case of junctional tachycardias and tachycardias with reciprocal conduction, incl. WPW syndrome e. Long-term use is accompanied by a slight increase in the sinoatrial PR interval on the ECG. In case of sick sinus syndrome, it significantly increases the duration of the sinus cycle. With atrial fibrillation and flutter under bolus administration, it effectively reduces heart rate (by at least 20% in 95% of patients). The effect usually occurs within 3 minutes and reaches a maximum within 2-7 minutes. The slowdown in rhythm persists for 1-3 hours. With long-term infusion administration, a decrease in heart rate by 20% is observed in 83% of patients and persists after administration for a period of 0.5 hours to 10 hours. Efficiency in restoring sinus rhythm in paroxysmal supraventricular tachycardias is 88 % for 3 min. In patients with severe changes in the left ventricular myocardium (heart failure, myocardial infarction, hypertrophic cardiomyopathy), contractility, final dBP in the left ventricle and pulmonary capillary wedge pressure do not change. Has minimal effect on the smooth muscles of the gastrointestinal tract. Long-term (8 months) therapy is not accompanied by the development of tolerance and changes in the plasma lipid profile. Can cause regression of left ventricular hypertrophy in patients with arterial hypertension. At usual therapeutic doses it does not affect mortality, but in patients with signs of pulmonary congestion it increased the incidence of cardiovascular complications by 40%. In patients with acute myocardial infarction, thrombolytic therapy with plasminogen activator increased the incidence of hemorrhagic complications by 5 times.

Well (more than 90% of the dose) absorbed from the gastrointestinal tract. Bioavailability is 40% (the “first pass” effect through the liver is pronounced). Cmax is achieved in 2-4 hours (table), 3.9-4.3 hours (180 mg capsules), 5-7 hours (retard table), 6-14 hours (extended capsules). Volume of distribution 5.3 l/kg. T1/2 is 1-3 hours (with intravenous administration), 3-4.5 hours (table), 5-7 hours (table retard), 7.3-14.7 hours (caps. 180 mg). Binds to plasma proteins by 70-80% (40% with acidic alpha glycoprotein, 30% with albumin). The action develops within 3 minutes with rapid intravenous administration, after 2-3 hours (long-term capsules) or 30-60 minutes (table) when administered orally. The duration of action when taken orally is 4-8 hours (table) and 12-24 hours (extended capsules). Metabolized in the liver by deacetylation, demethylation with the participation of cytochrome P450 (in addition to conjugation). The two main metabolites found in plasma after oral administration are deacetyldiltiazem and desmethyldiltiazem. The deacetylated metabolite has the properties of a coronary vasodilator (plasma concentration is 10-20%, activity is 25-50% of that of diltiazem), and is capable of accumulation. With a single intravenous administration, these metabolites are not detected in plasma. It is concentrated in bile and undergoes enterohepatic circulation. Excretion (including metabolites) is carried out mainly through the gastrointestinal tract (65%) and to a lesser extent by the kidneys (35%). 5 metabolites and 2-4% of unchanged drug are determined in the urine. Passes into breast milk. With prolonged oral administration, bioavailability increases and clearance decreases, which leads to increased therapeutic effects and side effects.

Based on results obtained in 21-24 month experiments on rats and mice and in bacterial tests in vitro, does not have carcinogenic or mutagenic activity. In experiments on rats, mice, rabbits, when using doses 5-10 times higher than the recommended daily doses for humans, it caused the death of embryos and fetuses, decreased survival of newborn rats and the development of skeletal abnormalities. At doses 20 or more times higher than recommended for humans, it increased the incidence of stillbirths in experimental animals.

Possible use in transplantology: after kidney transplantation (prevention of graft failure), during immunosuppressive therapy (to reduce the nephrotoxicity of cyclosporine A).

Use of the substance Diltiazem

Angina pectoris (stable, vasospastic); prevention of coronary spasm during coronary angiography or coronary artery bypass surgery; arterial hypertension (monotherapy or in combination with other antihypertensive drugs), incl. after myocardial infarction (mainly retard forms, when beta-blockers are contraindicated), in patients with concomitant angina (if there are contraindications to the use of beta-blockers), in patients with diabetic nephropathy (when ACE inhibitors are contraindicated); paroxysmal supraventricular tachycardia.

Contraindications

Hypersensitivity, severe arterial hypotension (SBP less than 90 mm Hg), cardiogenic shock, left ventricular systolic dysfunction (clinical and radiological signs of pulmonary congestion, left ventricular ejection fraction less than 35-40%), incl. in acute myocardial infarction, sinus bradycardia (less than 55 beats/min), sick sinus syndrome (if a pacemaker is not implanted), sinoatrial and AV block of the II-III degree (without a pacemaker), WPW syndrome and Lown-Ganong-Levine syndrome with paroxysms of atrial fibrillation or flutter (except for patients with a pacemaker), pregnancy, breastfeeding.

Restrictions on use

Sinoatrial and AV block of the first degree, severe aortic stenosis, intraventricular disturbance of excitation conduction (blockade of the left or right bundle branch), chronic heart failure, renal and/or liver failure, old age, childhood (efficacy and safety of use have not been determined) age.

Use during pregnancy and breastfeeding

Contraindicated during pregnancy.

Breastfeeding should be stopped during treatment.

Side effects of the substance Diltiazem

From the cardiovascular system and blood (hematopoiesis, hemostasis): transient hypotension; bradycardia, conduction disorder I degree, decrease in cardiac output, palpitations, fainting, eosinophilia.

From the nervous system and sensory organs: headache, dizziness, weakness, feeling tired.

From the genitourinary system: peripheral edema, impaired potency (individual cases).

From the gastrointestinal tract: dyspeptic symptoms (constipation or diarrhea, nausea, heartburn, etc. more often in elderly patients), hyperplasia of the gum mucosa (rarely).

From the skin: sweating, redness of the skin.

Allergic reactions: skin rash and itching, rarely - exudative erythema multiforme.

Others: increased activity of transaminases (ALT. AST), LDH and alkaline phosphatase. hyperglycemia (selected cases).

Interaction

Increases plasma levels of carbamazepine, theophylline, cyclosporine A, digoxin. May enhance the inhibitory effect of anesthetics on contractility, conductivity and automaticity of the heart. Weakens the nephrotoxic effects of cyclosporine A. Cimetidine increases the level of diltiazem in plasma, digoxin potentiates the effectiveness in the tachysystolic form of atrial fibrillation. Antiarrhythmic drugs and beta-blockers contribute to the development of bradycardia, AV conduction disorders, and symptoms of heart failure. Antihypertensive drugs enhance the hypotensive effect. Diltiazem solution is incompatible with furosemide solution.

Overdose

Symptoms: bradycardia, hypotension, intracardiac block and heart failure.

Treatment: gastric lavage, administration of activated carbon, plasmapheresis and hemoperfusion using activated carbon. Calcium preparations (calcium gluconate) with intravenous administration have antidote properties; symptomatic therapy is the administration of atropine, isoproterenol, dopamine or dobutamine, diuretics, and fluid infusion. At high degrees of AV blockade, electrical cardiac stimulation is possible.

Directions for use and doses

Inside, without chewing, 30 mg 3-4 times a day; if necessary - up to 240 mg/day. Against the background of impaired renal or liver function, in old age the initial dose is 60 mg/day in 2 divided doses. Long-acting dosage forms: 90 mg 2-3 times a day or 120-180 mg 2 times a day with an interval of 12 hours, or 200-300 mg 1 time a day. The maximum daily dose is 360 mg.

Precautions for the substance Diltiazem

While taking long-acting dosage forms, intravenous administration of beta-blockers is not recommended. It should be used with caution to normalize the heart rhythm in patients with impaired hemodynamics or in conjunction with drugs that reduce peripheral vascular resistance. myocardial contractility and conductivity. Parenteral administration is possible if facilities and equipment (including a defibrillator) are available to provide emergency assistance. With prolonged intravenous administration, constant monitoring of ECG and blood pressure is necessary.

Year of last adjustment

Clinical picture

Aneurysms of the ascending aorta and aortic arch

An aortic aneurysm is understood as a local expansion of the aortic lumen by a factor of 2 or more compared to that in the unchanged immediate section.

The classification of aneurysms of the ascending aorta and arch is based on their location, shape, causes of formation, and the structure of the aortic wall.

Blood lipid disorders occupy a leading place in the list of risk factors for major diseases.

The disease, as a rule, is associated with certain causes, which gave impetus to a persistent disorder that remains for life and makes a person “neither sick nor healthy.”

Why does this happen?

The impetus to the disease

The question of why someone gets sick and someone doesn’t is inherent in NCD just like other diseases. In the etiology of neurocirculatory dystonia, the main factors can be identified:

The combination of several or all factors together leads to the body's reaction to stimuli. This reaction causes the formation of pathological conditions that are manifested by disorders:

Metabolic processes;
Innervation of internal organs;
Works of the gastrointestinal tract;
In the blood coagulation system;
Activities of the endocrine system.

The course of the mother's pregnancy, hypoxia and birth trauma also have a negative impact on the state of the autonomic system and can cause neurocirculatory dystonia in children.

Inconsistency between the systems ultimately leads to a vascular response—their spasm. Thus, the manifestation of neurocirculatory dystonia begins.

Video: neurocirculatory dystonia - Dr. Komarovsky

Types of NDC

Types of neurocirculatory dystonia are divided depending on blood pressure indicators:

Neurocirculatory dystonia of the hypertensive type - blood pressure tends to increase, regardless of age and circumstances;
Neurocirculatory dystonia of the hypotonic type - lethargy, weakness, decreased blood pressure and pulse;
Neurocirculatory dystonia of a mixed type, it’s difficult to keep track of how and when everything will turn out. The worst thing is that the patient does not know in advance and waits with trembling for either an increase or decrease in pressure.

Hypertensive type of NCD

Increased blood pressure;
Headaches that depend on physical activity and intensify with it;
Dizziness;
Dependence on weather conditions (headaches, rise in blood pressure);
Rapid heartbeat, sometimes intermittently;
Mitral valve prolapse on ultrasound examination of the heart;
Violation of thermoregulation - high body temperature in children with infectious diseases;
Changes in the gastrointestinal tract in the form of weak peristalsis, and hence a tendency to constipation;
Insufficiency of the function of the lacrimal glands (“dry tears”);
Changes in mood (sadness and melancholy);
Fatigue quickly.

Hypotonic type of NCD

When the parasympathetic part of the autonomic nervous system predominates (vagotonia), neurocirculatory dystonia of the hypotonic type develops, the main symptoms of which are:

Reduced blood pressure;
Rare pulse (bradycardia), which can quickly increase in speed (tachycardia);
Pain in the heart (cardialgia);
Dizziness;
Frequent fainting conditions, especially characteristic in the presence of neurocirculatory dystonia in children (mainly girls) during puberty;
Headaches associated with weather conditions, physical and mental stress;
Increased fatigue and low performance;
Biliary dyskinesia, which is associated with uneven and chaotic contraction of the gallbladder;
Digestive disorders (tendency to diarrhea and flatulence);
Violation of thermoregulation: decreased body temperature and prolonged low-grade fever due to infections in children;
Complaints of “shortness of breath” and “sighs”;
Tendency to allergic reactions;
Pale skin (marbling), cyanosis of the extremities;
Cold sweat.

Mixed type of NDC - when there is no agreement between departments

Video: how does NCD manifest itself?

Crises of neurocirculatory dystonia

Sweating and nausea;
Sudden weakness and darkening of the eyes;
Reduced blood pressure and body temperature;
Slowing heart rate.

After a vagoinsular crisis, the patient still feels tired and weak for several days, and is periodically dizzy.

Intense headache;
Pain in the heart;
Increased blood pressure and body temperature;
The appearance of chills;
Skin redness or pallor.

Video: how to deal with exacerbations of NCD?

Autonomic dysfunction and pregnancy

Disease or syndrome?

Preparing for military duty: NDC and the army

Are the complaints persistent?
Is blood pressure persistently high or low?
Do you have cardialgia and heart rhythm disturbances?
To what extent do NCD symptoms affect a conscript’s performance?

To study the health status of a young person, related specialists (neurologist, cardiologist, ophthalmologist, endocrinologist, otolaryngologist) are required to be involved.

Who does “Farewell of the Slav” sound like?

And yet: what to do with it?

Oddly enough, vegetative-vascular dysfunction does not like physical inactivity. And despite the fact that the manifestations of the disease are especially noticeable after physical activity, physical exercise not only does not harm the patient, but is also indicated. True, we should be talking about targeted, therapeutic physical education, dosed and deliberate.

Treatment prescribed by a doctor

Vitamin therapy and an antioxidant complex (Doctor Theiss, Gerovital, etc.) will be an excellent addition to general strengthening measures.

Video: expert opinion about NDC

How can traditional medicine help?

Strong tea and coffee are not recommended for the hypertensive type of NCD, but in the morning you can drink amazing tea prepared at home:

Dry blueberries, chokeberries, currants and barberries are taken in equal parts, ground, mixed and consumed, poured with boiling water.

With normal blood pressure levels and a downward trend, prepare infusions of elecampane and immortelle, drink freshly squeezed juices of carrots and rose hips. They say it helps a lot.

How is the diagnosis made?

General blood and urine tests, which do not deviate from the norm for this disease;
Blood pressure profile for 10-14 days to establish the type of NCD;
Ultrasound of the kidneys and heart to exclude independent diseases of these organs;
Rheoencephalography;
ECG, FCG, echoCG;
Consultations with an endocrinologist, otolaryngologist, neurologist, ophthalmologist.

In addition, to determine the cause, there is often a need for a detailed study of the function of the kidneys, adrenal glands, hypothalamus and thyroid gland.

Video: neurocirculatory dystonia in the talk show “Without a Prescription”

Contraindications to the use of Corvalol, pharmacodynamics, pharmacokinetics and instructions for use

Corvalol is a medication that contains alpha-bromoisovaleric acid, peppermint, some alcohol and phenobarbital. The main active ingredient of Corvalol is phenobarbital.

Mechanism of action

Phenobarbital has a sedative, hypnotic and anticonvulsant effect on the human body. Effects are highly dose dependent and range from sedation to sleep induction.

Phenobarbital, like other barbiturates, acts by binding to GABA A receptors. GABA is the main inhibitory neurotransmitter in the central nervous system (CNS) of mammals. The barbiturate binding site on the GABA-A receptor is different from the binding sites for GABA itself and benzodiazepines.

Like benzodiazepines, barbiturates increase the activity of GABA at the receptor. However, unlike benzodiazepines, they do not increase the likelihood of GABA-A opening, but rather cause the channel to remain open longer after GABA is attached.

Barbiturates also block AMPA receptors (a subset of glutamate receptors). Glutamate is the most important excitatory neurotransmitter in the central nervous system. This combination of enhancing the inhibitory action of GABA and blocking the excitatory action of glutamate well explains the depressant effect of these drugs.

Pharmacokinetics

Phenobarbital is almost completely absorbed into the body after oral or intramuscular administration. Maximum concentrations of phenobarbital in the blood are observed after oral administration after 6-18 hours, and after intramuscular administration - after 3-5 hours.

Maximum concentrations of phenobarbital in the brain after intravenous administration are achieved within 20-60 minutes. Concentrations of 15-25 mcg/ml are required for anticonvulsant activity. Concentrations above 40 µg/ml are considered toxic.

The half-life of phenobarbital depends on age, liver function, and urine pH. In newborns it is 3-7 days, in children under 6 years old 2-3, and in adults – 2-4. Plasma protein binding ranges from 40 to 60%.

The bioavailability of the drug is determined by its galenic properties; for Corvalol it ranges from 80 to 100%.

Phenobarbital is metabolized primarily in the liver. The intermediate pathway leads through addition to glucuronic acid and excretion through bile. 10-40% of phenobarbital is excreted unchanged from the body in the urine. About 10-20% of the drug is excreted in the stool. Due to the acceleration by phenobarbital of the synthesis of certain chemical compounds that destroy the enzyme cytochrome P450 3A4, the period of elimination of it and other drugs is reduced.

The LD 50 in mice was determined to be 323 mg/kg (oral) or 234 mg/kg when administered intraperitoneally. The corresponding data for the rat were 660 and 190 mg/kg. In cats, an LD 50 of 175 mg/kg was observed after oral administration, and in rabbits it was 185 mg/kg after intravenous administration.

What should you take Corvalol for?

Indications for use of Corvalol:

Epilepsy;
Vegetative-vascular dystonia with hypertension (VSD);
Cardioneurosis;
Herpes;
Toothache;
Irritable bowel syndrome;
Insomnia;
Rapid heartbeat (tachycardia);
Epileptic seizure (solution for injection);
Preparation for anesthesia.

The medicine does not help prevent or treat febrile seizures. Recently, Corvalol has ceased to be prescribed as a sleeping pill because safer alternatives have become available.

Corvalol: instructions for use, drops

The form of release of the drug is a bottle with liquid contents, tablets, gelatin capsules. It is worth noting that the drug is not used externally or parenterally.

Corvalol should be taken twice a day, 30 drops. It is recommended in medicine to begin treatment for adult men and women with a lower dosage of 15 drops, and then increase it to a therapeutic one. The duration of therapy with Corvalol depends on the underlying disease, the severity of the patient’s condition, and the tolerability of the drug components.

With constant use, Corvalol can cause both physical and dangerous mental dependence, so it should only be used under the guidance of a doctor. It is important to take a break to reduce the risk of addiction. The drug can affect mental functions (memory, intelligence and emotions). This can have a harmful effect on children's health, so it is not recommended to give Corvalol to a child.

The dosage of Corvalol is determined by the attending physician. The drug is available by prescription in pharmacies. Corvalol should not be taken at home with alcohol. Alcoholic drinks can increase the effect of phenobarbital. The combination may also reduce the ability to breathe normally. As a result, the patient may fall asleep at night and not wake up.

Important! Only a specialist can choose the right treatment regimen and determine its duration.

Analogues of the drug

Trade names of Corvalol substitutes:

Valocordin;
Hawthorn;
Motherwort;
Valerian;
Validol;
Phenobarbital in ampoules (foreign production);
Corvaldin.

Contraindications

Phenobarbital should not be used for:

Hypersensitivity to phenobarbital or other barbiturates;
Acute alcohol intoxication, poisoning with sleeping pills, opioids;
Stimulant poisoning;
Problems with blood vessels;
Atrial fibrillation (ICD-10 code: I48);
Hyperkinetic heart syndrome;
Bradycardia (rare pulse);
High blood sugar;
Arterial hypotension (low blood pressure).

Phenobarbital should only be given after careful consideration of the risks/benefits and with close monitoring in the following cases:

With porphyria;
Patients with severe renal or hepatic dysfunction;
Patients with damaged heart muscle;
A history of alcohol or barbiturate dependence;
Patients with respiratory diseases;
For affective disorders;
In case of disturbances of consciousness.

Pregnancy and lactation

Phenobarbital can have a teratogenic effect. Children whose mothers were treated with phenobarbital had severe birth defects. Phenobarbital crosses the placental barrier and should only be used during pregnancy after a careful risk/benefit assessment. Treatment with phenobarbital can cause folic acid deficiency, which favors the development of defects. Therefore, folic acid must be taken before and during pregnancy.

It is recommended to monitor fetal development using ultrasound, as well as determining the concentration of α-fetoprotein. Phenobarbital passes into breast milk. The concentration in mother's milk ranges from 10 to 45% of the content in the blood. Women treated with high doses of phenobarbital should not breast-feed.

Side effects

The incidence of side effects is about 23% in adults overall. Serious side effects leading to treatment interruption occur in approximately 4% of cases. The following side effects are very common (≥10%): unwanted heavy sedation and fatigue (drowsiness, prolonged reaction time), dizziness, headache, incoordination (ataxia), confusion, sexual dysfunction and potency problems (impotence). In some cases, control over aggression is greatly reduced. Phenobarbital can raise the level of white blood cells in the blood.

Residual effects from the drug may affect reaction time in the morning after evening administration of phenobarbital. In children and elderly patients, agitation (paradoxical reactions accompanied by anxiety, aggressiveness and disorientation) often occurs (1-10%). With prolonged use in high doses, dependence may develop. If you suddenly stop taking Corvalol after prolonged use, withdrawal symptoms may occur.