Bradyarrhythmia mcb. What is sinus heart bradycardia, what are its causes, symptoms, and should it be treated? Other cardiac arrhythmias

With such a phenomenon as sinus bradycardia, almost every person faces.

In this case, you should be aware of in which cases this can be a variant of the norm, and in which it can be a dangerous pathology of the heart.

If the signs of arrhythmia are regular, this is a reason for a mandatory visit to the doctor.

Under this type of pathology is meant an underestimated, in comparison with the normal value, the number of contractions of the heart muscle per unit time (less than 60 beats per minute). The sinus node is responsible for the occurrence and maintenance of the contractile rhythm. Normally, it generates from 60 to 90 conductive impulses per minute, each of which causes one heartbeat. Thus, the correct healthy pace of myocardial work is set.

What is it that happens to the rhythm in sinus heart bradycardia? With this, the generation of impulses is carried out at a lower frequency, the heart contracts less often. So there are violations of blood circulation, leading to hypoxia (oxygen starvation).

There are two types of sinus arrhythmia:

physiological;
pathological.

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

constant physical activity (sports, hard work);
night sleep;
long stay in the cold;
finding the body in a prone position for more than a day.

Heart rate (HR) with physiological sinus bradycardia - at least 50 beats per minute without violations of the time intervals of the rhythm and other clinical symptoms.

Pathological arrhythmia in itself is not an autonomous disease, but only a consequence of other existing pathologies. At the same time, an inconsistent, irregular pulse is recorded, accompanied by a deterioration in the general condition of the body.

ICD code 10

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

Normal rhythm and sinus bradycardia on ECG

Signs on the ECG

Bradycardia can be detected according to the electrocardiogram (ECG) - a graphical representation of myocardial biopotentials. Distinctive features of arrhythmia in this case will be the following indicators:

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

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

Vertical position of the EOS

Along with the analysis of the ECG, 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, its orientation in the plane of the chest. The position of the EOS in the norm can be:

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

With violations of the heart rate, as well as the presence of myocardial diseases, the EOS deviates to the left or right.

So, 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.

EOS deviation to the left indicates left ventricular hypertrophy due to similar causes associated with heart pathologies.

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

Symptoms

A slow heart rate leads to oxygen deficiency 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 harm 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, neuroses are the causes of the extracardiac nature of the 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, the latter often wonder what it is. If a person is healthy, then such disorders are natural, not requiring special treatment. Violation of the sinus contractile rate, caused by physiological causes, does not cause significant harm to the body. Confused pulse can be observed in healthy women during pregnancy. In most cases, no therapy is required. The exceptions are constant attacks and deterioration in the general condition of the pregnant woman.

Slow heart rate is inherent in older people, as 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 work 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 the future life will depend on it.

Teenagers

For newborns and young children, a heart rate of more than 80 beats per minute is characteristic. In adolescents (from 12 years old), the heart rate is normal from 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 sinus rhythm disturbance is said to exist if:

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

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

Athletes

Sinus bradycardia in athletes is not uncommon. This is due to the fact that with regular physical exertion, 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 transcribing the ECG. In adolescents and adults who are professionally involved in sports, mild or moderate sinus bradycardia is recorded. For such sinus bradycardia, a vertical or semi-vertical EOS is characteristic, which is characteristic of thin people of an athletic build.

Consequences

Mild or moderate sinus bradycardia due to physiological causes is not life-threatening 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, stimulating extraordinary heart contractions.

In professional athletes, the heart undergoes significant changes associated with hypertrophy of its departments. 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 toddlers of preschool age. When registering a heart rate significantly below normal, urgent medical attention is required, since hypoxia in this case can be fatal.

Violation of the sinus contractile rhythm in pregnant women, in the case of existing pathologies, can lead to serious disorders in the life 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.

What is dangerous?

The question of why sinus bradycardia of the heart 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 found, then immediate treatment and constant monitoring by a cardiologist will be required. Ignoring the recurring symptoms of arrhythmia can lead to their aggravation and the progression of untreated diseases.

Sinus abrupt bradycardia is dangerous because of the suddenness and transience of symptoms that can lead to cardiac arrest.

The arrhythmia provokes attacks of the Morgagni-Adams-Stokes Syndrome, which are life-threatening if there is no pacing. Resuscitation therapy not carried out on time will lead to disability or death of the patient. Therefore, people suffering from such a pathology should first of all know how dangerous sinus bradycardia is.

Treatment

Before making a diagnosis of sinus bradycardia, the doctor conducts a set of diagnostic measures to identify the type of arrhythmia, its causes and features of genesis. Diagnostics includes:

description of complaints and anamnesis of the disease;
Ultrasound of the heart;
laboratory blood test;
Holter monitoring.

Based on the collected information, 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, first of all, will 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 give himself first aid aimed at restoring normal heart rate: drink a cup of strong coffee, tea or take drops that speed up 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, surgical intervention.

Preparations

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

anticholinergics (atropine). Used as an emergency aid intravenously;
adrenomimetics (izadrin). It is prescribed in the form of tablets or inhalations, if the patient has a fixed fact of temporary respiratory arrest;
bronchodilators (eufillin);
cardioprotectors, antioxidants (riboxin, mexidol);
activators of metabolism in cardiomyocytes (actovegin, mildronate);
nootropics (piracetam);
multivitamins.

Taking medications is carried out only as prescribed by the doctor, in the dosage and frequency indicated by him. Self-medication, in this case, is life-threatening!

With the ineffectiveness of the drug therapy and the serious condition of the patient, an operation is performed to install a pacemaker - a device that sets the correct heart rate.

The use of folk remedies

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

Do they take to the army with such a diagnosis?

The answer to the question of whether they are taken into the army if sinus bradycardia is recorded depends on the possible causes and the severity of the symptoms. A healthy young man who does not have serious diseases, but with a fixed arrhythmia, is fit for military service, since there is no threat to his life (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) during exercise (category 2 - limited fit).
Severe symptoms of arrhythmia with weak physical exertion (category 3 - not suitable).
Severe symptoms even with complete inactivity (category 4 - exempted 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 violation cannot be ignored.
Slow heart rate in many cases is a normal condition in the absence of pathological prerequisites. It does not cause significant concern and does not require special treatment.
If a slow heartbeat is accompanied by any progressive disease, then 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, there is a decrease in heart rate by 30%.

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

R00.1

Classification. Extracardiac SB (neurogenic). Causes: massage of the carotid sinus, pressure on the eyeballs (Ashner reflex), increased ICP (for example, meningitis, brain contusion, subarachnoid hemorrhage, cerebral edema), Meniere's disease, intubation, peptic ulcer of the stomach and duodenum, myxedema. Organic SB: atherosclerosis of the coronary arteries, myocardial infarction, myocarditis, degenerative and fibrotic changes in the sinus node (see Weak sinoatrial node syndrome). Medicinal SB: quinidine, b - blockers, sympatholytic drugs (for example, reserpine), calcium channel blockers (for example, verapamil), cardiac glycosides, morphine. Toxic SB: sepsis, jaundice, uremia, typhoid fever, organophosphate poisoning. Sat athletes: heart rate at rest 40-35 per minute, even in the daytime. The reason is the peculiarities of neurovegetative regulation of cardiac output in people engaged in hard physical work or professional sports.

Symptoms (signs)

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

Diagnostics

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

Treatment

Treatment. With a combination of moderate SB with arterial hypotension - belladonna preparations, for example, Zelenin drops, bellataminal, bellaspon (contraindicated in glaucoma). Treatment of severe SB - see Weak sinus - atrial node syndrome.

ICD-10. R00.1 Bradycardia, unspecified

With the accumulation of fluid in a certain area of the head, the patient is diagnosed with high intracranial pressure (ICP), in which the circulation of CSF 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 overvoltage and injury. Liquids have constant pressure. At the same time, its frequent renewal is observed, as a result of which it moves to different parts of the skull. But if the fluid has accumulated in one intracranial region, then the indicator of intracranial pressure rises. A person is diagnosed with increased or decreased intracranial pressure. The change manifests itself for various reasons (more often after an injury), and in any case, the patient needs the help of a doctor.

Norm of intracranial pressure

Indicators of intracranial pressure depend on how much CSF 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 a special liquid around it - cerebrospinal fluid. Healthy people produce about a liter of fluid per day. The rate is different for each age group. In children under two years of age, the normal ICP is up to 6 mm Hg. st, 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 norm of ICP is 5-7 mm Hg. Art. If this indicator is higher in an adult or a child, this indicates a disturbed functioning of the body. According to ICD-10, the disease has the code G93.2.

Back to index

Causes of changes in ICP

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

Back to index

Symptoms in adults

Back to index

Symptoms of intracranial pressure in a small patient

Increased cranial pressure in childhood is associated with hydrocephalus, in which too much CSF accumulates 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 directly, but downwards. 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: a small patient often cries, sleeps poorly, becomes irritable and capricious;
frequent vomiting, after which it does not get better;
there is a visual impairment;
strabismus appears, eyeballs move little;
due to impaired consciousness, a coma may occur;
convulsions appear;
head size changes
limbs move worse, and in some children they completely stop functioning;
when eating food, the patient burps.

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, while the consciousness of a small patient is disturbed, until the development of a coma. In such cases, the chance of death increases. In other cases, signs of intracranial pressure in a child develop gradually.

Back to index

Rules for measuring ICP

When measuring intracranial pressure, special sensors are used.

In order to measure the internal craniocerebral pressure, special sensors are used in the clinic. A hydraulic ventricular system is used to check for ICP in the cerebral ventricles. They are internally injected with a catheter that is connected to the system. In this case, treatment is possible. To measure indicators in the parenchyma, sensors are inserted into the frontal or temporal area. Also, intracranial pressure can be determined indirectly by measuring it in the spinal subarachnoid zone, located in the cingulate region.

Back to index

Diagnosis of the disease

Method	Description
Ultrasonography	With the help of ultrasound, it examines the structural features of the brain, determines the indicators of ICP and the causes of deviations. Contraindicated in children who have an overgrown fontanel.
Fundus examination	The fundus is examined due to the fact that the optic nerve swells due to an increase in ICP. In this case, the vessels cease to pulsate and hematomas appear.
MRI	Magnetic resonance imaging should be done to study the structure of the brain regions. With the help of the method, it is possible to find out in time about the presence of a malignant or benign neoplasm, assessing its size and localization.
Carrying out electroencephalography	Using the method, indirect information is detected, but if the patient has clear signs of increased pressure in the head, then these data play an important role.
Blood analysis	Blood tests make it possible to assess the state of the blood, determine the leukocyte count and identify the onset of inflammatory processes.

Back to index

Therapeutic measures for illness

Medical therapy

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

To reduce elevated ICP or, conversely, to increase and restore the patient's condition, the doctor prescribes a conservative treatment complex. For treatment, sedatives are prescribed, drugs to normalize the condition of the vessels. Diuretics are also prescribed, under the influence of which there is an outflow of fluid and intracranial pressure indicators are slightly reduced. But with their help, strong ICP cannot be permanently eliminated. If the patient wants to drink a medicine that is self-selected, there will be a risk of complications.

Back to index

Treatment with folk methods

Alternative methods of treatment are safer than the use of drugs, because they do not contain chemical compounds. To do this, use herbal infusions or decoctions that remove signs of illness. 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 insisted for a week, then filtered. Take the infusion should be 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 grass and pour half a liter of hot water, after which they insist for an hour, squeeze. You need to drink a decoction once a day.

Back to index

Surgical intervention

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

The disease can be cured with the help of surgery in cases where it appeared due to tumors, injuries or hydrocephalus. The disease is treated with bypass surgery, the purpose of which is to remove excess cerebrospinal fluid. With the help of 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.

Back to index

Negative consequences

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

Back to index

Prevention and prognosis

In order for ICP to not be permanently elevated, the patient must remember about prevention. To do this, it is recommended to monitor the daily regimen, play sports, get rid of signs of ailments in time, and monitor the diet. The patient should stop drinking alcohol and smoking, which adversely affect the condition of the vessels. As practice shows, if the patient turned to the doctor on time in the presence of unpleasant symptoms, then the prognosis is positive. But in the absence of therapy, the risk of death increases.

Neurocirculatory dystonia: causes, signs, types, treatment

Obviously, the essence of the numerous names of the syndrome of neurocirculatory dystonia (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, autonomic dystonia syndrome) begins in the pubertal 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 violation 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 innervation of the 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 adaptation of the body to external conditions.

The work of all systems is ensured by the balanced behavior of its two departments: sympathetic and parasympathetic. With the predominance of the function of one department over another, there is a change in the work of individual systems and organs. The adaptive abilities of the body with such a phenomenon, of course, are reduced.

Interestingly, damage to some organs and malfunction 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, so the form of NCD depends on the predominance of a particular part of the ANS (sympathetic or parasympathetic).

Lead to disease

The question of why someone is sick and someone is not is inherent in NDC as well as in other diseases. In the etiology of neurocirculatory dystonia, the main factors can be distinguished:

The combination of several or all factors together leads to the body's response to stimuli. This reaction is due to the formation of pathological conditions, which are manifested by violations:

metabolic processes;
Innervation of internal organs;
Work 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.

The inconsistency of the work of the systems ultimately leads to a response of the vessels - their spasm. Thus, the manifestation of neurocirculatory dystonia begins.

Video: neurocirculatory dystonia - Dr. Komarovsky

Types of NDC

Each neurocirculatory dystonia proceeds differently. The essence of these phenomena lies in the predominance of a certain department of the autonomic nervous system and in the formation of the type of NCD. For one, the heart hurts or “jumps out”, for the other, the head is spinning, as soon as the ambient temperature changes by a degree or two. And, if God forbid, excitement, stress or a sudden change in the weather - there is generally an uncontrollable reaction. The symptoms of neurocirculatory dystonia are bright and varied, but the sensations are always unpleasant.

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

Treatment of neurocirculatory dystonia is long, 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 pressure and pulse;
Neurocirculatory dystonia of a mixed type, it’s hard to keep track of how and when everything will turn around. The worst thing is that the patient does not know in advance and with a shudder is waiting for either an increase or a decrease in pressure.

Hypertensive type 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 division (sympathicotonia) and is expressed:

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 intermittent;
Mitral valve prolapse on ultrasound 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;
Lack of function of the lacrimal glands ("dry tear");
Mood changes (longing and melancholy);
Rapid fatigue.

Hypotonic type of NCD

With the predominance of the parasympathetic division of the autonomic nervous system (vagotonia), neurocirculatory dystonia develops according to the hypotonic type, the main features of which are:

Decreased blood pressure;
A slow pulse (bradycardia) that can quickly increase (tachycardia)
Pain in the heart (cardialgia);
dizziness;
Frequent fainting, especially characteristic in the presence of neurocirculatory dystonia in children (mainly girls) in the puberty period;
Headaches associated with weather conditions, physical and mental stress;
Increased fatigue and low performance;
Dyskinesia of the biliary tract, which is associated with uneven and chaotic contraction of the gallbladder;
Digestive disorders (tendency to diarrhea and flatulence);
Violation of thermoregulation: a decrease in body temperature and prolonged subfebrile condition with infections in children;
Complaints about "shortness of breath" and "sighs";
Tendency to allergic reactions;
Pallor of the 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 divisions 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 neurocirculatory dystonia of a mixed type include symptoms characteristic of both hypotonic and hypertonic types. What part of the autonomic nervous system, at what point will prevail, 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, over time can “enrich” with symptoms and in young people give more vivid vegetative manifestations in the form of crises. Attacks in neurocirculatory dystonia also depend on its type, although they often do not have a clear picture of belonging, but are of a mixed nature. High activity of the parasympathetic division of the ANS can give a vagoinsular crisis, which is characterized by the following symptoms:

sweating and nausea;
Sudden weakness and darkening of the eyes;
Decreased blood pressure and body temperature;
Slow heart rate.

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

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

Intense headache;
Heartache;
Increased blood pressure and body temperature;
The appearance of chills;
Redness of the skin or the acquisition of pallor.

Video: how to deal with exacerbations of NCD?

Autonomic dysfunction and pregnancy

Although pregnancy is a physiological state, it is then that neurocirculatory dystonia can manifest itself, which proceeds latently (hidden), because during pregnancy the body is rebuilt and prepares for the birth of a new life. The hormonal background, the regulator of all pregnancy processes, undergoes significant changes. The internal organs "stack" in a different way, making room for the ever-increasing uterus. And all this is under the control of the autonomic nervous system, which did not always cope even without such a load, but here ...

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

The reaction to everything that is “wrong”, tears for every reason, pain in the heart and tantrums, a decrease in blood pressure, and it’s better not to go into transport ... Pregnant women often experience a feeling of lack of air and stuffiness, and those with neurocirculatory dysfunction even know “the smell of fresh whiffs."

But it may not be so bad and you should not be upset. Many cases of disappearance of manifestations of NCD after childbirth have been noted. What is the reason for this - either "putting things in order" in the body of a woman, 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, then the vegetative-vascular complex recedes.

Disease or Syndrome?

Talking about vegetative-vascular disorders, about how to call them after all, scientific minds have not decided. Vegetative-vascular dystonia is considered a more correct name, as it expresses the pathogenesis of the disease. The most recent trend in the definition of this condition was the syndrome of vegetative dystonia, which from this 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 resulting from inadequate behavior of the autonomic nervous system (inconsistent and non-equilibrium interaction of two sections of the ANS: sympathetic and parasympathetic). It is unlikely that people who are well acquainted with this complex of symptoms will “feel better” from this, but today it is so.

Many questions are raised by vegetative-vascular dysfunction when it is time to repay the debt to the Motherland. How are neurocirculatory dystonia and military service compatible? As the manifestations are varied, so should be the approach.

Preparing for Military Duty: NDC and the Army

Of course, some are so eager to join the ranks of the defenders of the Fatherland that they forget about the disease. Or are they hiding? Others, on the contrary, having an entry in the NDC card since childhood, are trying to save themselves from military duties. In this regard, the commission's approach should be objective and diversified. On the one hand, seeing a conscript for the first time, who does not make any complaints and “rushes into battle”, who is given out only low or high (below 100/60 or above 160/100) pressure and obvious autonomic disorders on the “face”, in breathing and heart rhythms, you can satisfy his desire. However, a qualified commission should find out for the first time, periodically or permanently. The same is the case with those who make a lot of complaints, and only meager entries in the children's card speak of illness. Of course, there is an average: the clinic is evident and complaints indicating the presence of autonomic disorders. In all cases, the task of the commission is to find out:

Are the complaints persistent;
Whether persistently increased or decreased blood pressure;
Are there cardialgia and cardiac arrhythmias;
To what extent NDC symptoms affect the work capacity of the conscript.

Allied specialists (neurologist, cardiologist, ophthalmologist, endocrinologist, otolaryngologist) are necessarily involved in studying the state of health of a young person.

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

To whom does "Farewell of the Slav" sound?

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 the autonomic innervation, then the conscript is not subject to military service and receives a military ID with a mark of unsuitability under Art. 47 "a".

Similarly, the commission treats those young men who clearly have persistent vegetative-vascular disorders with an increase or decrease in pressure, there are clear signs of heart rhythm disturbance, and pain in the heart is permanent.

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

And yet, what to do with it?

You can talk about neurocirculatory dystonia for a long time and a lot, since there are numerous names for this pathology, and this diversity allows. 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 more names. After all, changing the name will not affect the well-being of the patient.

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 education not only does not harm the patient, but is also indicated. True, we should talk about purposeful, physiotherapy exercises, dosed and deliberate.

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

Patients should pay special attention to the 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 a team for yourself and others.

No matter how trite it may sound, but here a significant role belongs to the diet. Neurocirculatory dystonia "does not like" neither spices, nor spicy dishes, nor alcohol. Anything that excites the nervous system can aggravate the course of the process, so it is better to avoid excesses and not be loaded. But potassium-rich foods (eggplants, potatoes, bananas, prunes and apricots) will “like” the “capricious” nervous system.

Treatment prescribed by a doctor

Drug treatment for neurocirculatory disorders is highly desirable to be carried out with general health measures and physiotherapy. Therapeutic massage, electrophoresis with sedatives on the collar zone, electrosleep and circular shower will help strengthen the nervous system and give positive emotions that patients with neurocirculatory dystonia so need.

And what a wonderful procedure - acupuncture. Using it, you can for a long time to refuse medicines and feel great only thanks to the annual repetition of acupuncture. Supplied in neuromuscular bundles, thin gold or platinum needles will lead to a long and stable remission, and the disease will recede ...

Vitamin therapy and an antioxidant complex (Dr. 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 are prescribed by him. No advice from friends and 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 it will help a patient with high blood pressure, but it can have a detrimental effect on the condition of a person with low blood pressure, so it is unlikely that Egilok (beta-blocker) will be indicated for the hypotonic type. Drugs that regulate the heart rhythm are serious and require special care, so "amateur" in such cases is useless.

Often, patients with autonomic disorders are 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 - alcohol infusions of these plants are very familiar to patients with neurocirculatory dystonia, they are constantly stored in the home first aid kit and perform the function of an "ambulance".

Video: expert opinion on NDC

How can traditional medicine help?

The variety of recipes for the treatment of folk remedies for neurocirculatory dystonia is even more striking than the variety of clinical manifestations. Contrasting souls, breathing exercises of Tibetan monks and the Austrian healer Rudolf Breuss are undoubtedly wonderful, but for some reason people prefer Russian "creation" more. A popular drink from the church "Cahors" and a mixture of juices of garlic, lemon, beets, carrots and radishes, flavored with natural honey, is passed "from mouth to mouth and from generation to generation."

However, for the treatment of NDC folk remedies, one should not forget about pressure, so folk healers also recommend different treatments. For example, with increased blood pressure, people use infusions of mint leaves and white birch, calendula flowers and dill seeds. Alcoholic infusions of magnolia and white mistletoe well reduce 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 berries of blueberries, chokeberries, currants and barberries are taken in equal parts, ground, mixed and consumed, filled with boiling water.

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

Of course, valerian root (you can take it orally, you can do baths), hawthorn, hot milk with honey at night - everyone knows. Such folk remedies are, perhaps, in every home, even where there are no neurocirculatory disorders.

How is the diagnosis established?

The syndrome of vegetative dystonia is not based only on the patient's complaints. Before the doctor makes a diagnosis, the patient must pass tests and undergo instrumental examinations, so the main stages "on the way" to the NDC will be:

General blood and urine tests, which do not deviate from the norm in this disease;
BP profile within 10-14 days to determine the type of NCD;
Ultrasound of the kidneys and heart to exclude independent diseases of these organs;
Rheoencephalography;
ECG, FCG, echocardiography;
Consultations of an endocrinologist, otolaryngologist, neurologist, ophthalmologist.

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

Excludes: bradycardia NOS (R00.1) complicating conditions. abortion, ectopic or molar pregnancy (O00-O07, O08.8). obstetric surgery and procedures (O75.4) neonatal arrhythmia (P29.1)

I49.0 Ventricular fibrillation and flutter

I49.1 Premature atrial depolarization

Premature atrial contractions

I49.2 Premature depolarization from 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 Cardiac arrhythmia, unspecified

Diltiazem (Diltiazem): instruction, application and formula

Russian name

Diltiazem

Latin name of the substance Diltiazem

Diltiazemum ( genus. Diltiazemy)

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

Pharmacology

Pharmacological action - antianginal, hypotensive, antiarrhythmic.

It 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, it inhibits the formation of an action potential and uncouples the excitation-contraction process. Reduces myocardial contractility, reduces heart rate and slows down AV conduction. Relaxes vascular smooth muscle, lowers OPSS. 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 both in the horizontal and in the vertical position. Rarely causes postural hypotension and reflex tachycardia. Does not change or slightly reduces the maximum heart rate during exercise.

Long-term therapy is not accompanied by hypercatecholaminemia, an increase in the activity of the renin-angiotensin-aldosterone system. Reduces 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 at a concentration that does not cause a negative inotropic effect. Efficiency in supraventricular tachycardias is associated with an increase (by 20%) in the effective and functional refractory period of the AV node and a prolongation of the conduction time in the AV node (with a normal heart rate, the effect on the AV node is minimal). Slows ventricular rate in patients with high ventricular rate with atrial fibrillation and flutter. Restores normal sinus rhythm in paroxysmal supraventricular tachycardia, interrupts the circulation of excitation of the re-entry type in nodal tachycardia and tachycardia with reciprocal conduction, incl. WPW syndrome e. Long-term use is accompanied by a slight increase in the sinoatrial PR interval on the ECG. With the syndrome of weakness of the sinus node, it significantly increases the duration of the sinus cycle. With atrial fibrillation and flutter under conditions of bolus administration, it effectively lowers heart rate (by at least 20% in 95% of patients). The action usually occurs within 3 minutes and reaches a maximum within 2-7 minutes. The slowing of the rhythm persists for 1-3 hours. With prolonged infusion, 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 % within 3 min. In patients with severe changes in the myocardium of the left ventricle (heart failure, myocardial infarction, hypertrophic cardiomyopathy), it does not change contractility, final diastolic blood pressure in the left ventricle and pulmonary capillary wedge pressure. It 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. Able to cause regression of left ventricular hypertrophy in patients with arterial hypertension. In usual therapeutic doses, it does not affect mortality, however, in patients with signs of pulmonary congestion, it increased the incidence of cardiovascular complications by 40%. In patients with acute myocardial infarction on the background of thrombolytic therapy with a plasminogen activator, it increased the frequency of hemorrhagic complications by 5 times.

Well (more than 90% of the dose) is absorbed from the gastrointestinal tract. Bioavailability is 40% (pronounced effect of "first pass" through the liver). C max is reached in 2-4 hours (table), 3.9-4.3 hours (caps. 180 mg), 5-7 hours (table. retard), 6-14 hours (caps. prolong.). The volume of distribution is 5.3 l/kg. T 1/2 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). It binds to plasma proteins by 70-80% (40% - with acidic alpha-glycoprotein, 30% - with albumin). The action develops within 3 minutes with a rapid on / in the introduction, after 2-3 hours (caps. prolong.) Or 30-60 minutes (table.) when administered orally. The duration of action when taken orally is 4-8 hours (table) and 12-24 hours (caps. prolong.). Metabolized in the liver by deacetylation, demethylation with the participation of cytochrome P450 (in addition to conjugation). The two major metabolites found in plasma after oral administration are deacetyldylthiazem and desmethyldilthiazem. The deacetylated metabolite has the properties of a coronary vasodilator (plasma concentration is 10-20%, activity - 25-50% of that of diltiazem), is capable of cumulation. 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%). In the urine, 5 metabolites and 2-4% of the unchanged drug are determined. Penetrates into breast milk. With prolonged oral administration, bioavailability increases and clearance decreases, which leads to an increase in therapeutic effects and side effects.

According to the results obtained in 21-24-month experiments on rats and mice and in bacterial tests in vitro, does not possess carcinogenic and 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, a decrease in the survival rate of newborn rats and the development of skeletal anomalies. At doses 20 or more times higher than those recommended for humans, it increased the frequency of stillbirths in experimental animals.

It can be used in transplantation: after kidney transplantation (prevention of graft failure), during immunosuppressive therapy (to reduce the nephrotoxicity of cyclosporine A).

The 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 pectoris (if there are contraindications to the appointment 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 congestion in the lungs, left ventricular ejection fraction less than 35-40%), incl. in acute myocardial infarction, sinus bradycardia (less than 55 bpm), sick sinus syndrome (if no pacemaker is implanted), sinoatrial and AV block II-III degree (without pacemaker), WPW syndrome and Lown-Ganong-Levin syndrome with paroxysms of atrial fibrillation or flutter (except for patients with a pacemaker), pregnancy, breastfeeding.

Application restrictions

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

Use during pregnancy and lactation

Contraindicated in pregnancy.

At the time of treatment should stop breastfeeding.

Side effects of Diltiazem

From the side of 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 (separate cases).

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

From the side of 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 (separate cases).

Interaction

Increases plasma levels of carbamazepine, theophylline, cyclosporine A, digoxin. May enhance the inhibitory effect of anesthetics on contractility, conduction and automatism 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, symptoms of heart failure. Antihypertensive drugs enhance the hypotensive effect. Diltiazem solution is incompatible with furosemide solution.

Overdose

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

Treatment: gastric lavage, administration of activated charcoal, plasmapheresis and hemoperfusion using activated charcoal. Antidote properties are calcium preparations (calcium gluconate) when administered intravenously, symptomatic therapy - the introduction of atropine, isoproterenol, dopamine or dobutamine, diuretics, fluid infusion. At high degrees of AV blockade, electrical pacing is possible.

Dosage and administration

inside, without chewing 30 mg 3-4 times a day; if necessary - up to 240 mg / day. Against the background of impaired renal or hepatic function, in the elderly, the initial dose is 60 mg / day in 2 divided doses. Dosage forms of prolonged action: 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 per day. The maximum daily dose is 360 mg.

Diltiazem Substance Precautions

Against the background of taking dosage forms of prolonged action, it is not recommended to / in the introduction of beta-blockers. Caution should be used to normalize the heart rhythm in patients with impaired hemodynamics or in conjunction with drugs that reduce peripheral vascular resistance. myocardial contractility and conduction. Parenteral administration is possible with the availability of funds and equipment (including a defibrillator) for emergency care. With prolonged intravenous administration, constant monitoring of the 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 2 times or more compared to that in the unchanged nearest section.

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

Violations of the blood lipid spectrum 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 violation that remains for life and makes a person "neither sick nor healthy."

Why does this happen?

Lead to disease

The question of why someone is sick and someone is not is inherent in NDC as well as in other diseases. In the etiology of neurocirculatory dystonia, the main factors can be distinguished:

The combination of several or all factors together leads to the body's response to stimuli. This reaction is due to the formation of pathological conditions, which are manifested by violations:

metabolic processes;
Innervation of internal organs;
Work 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.

The inconsistency of the work of the systems ultimately leads to a response of the vessels - 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 pressure and pulse;
Neurocirculatory dystonia of a mixed type, it’s hard to keep track of how and when everything will turn around. The worst thing is that the patient does not know in advance and with a shudder is waiting for either an increase or a decrease in pressure.

Hypertensive type 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 intermittent;
Mitral valve prolapse on ultrasound 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;
Lack of function of the lacrimal glands ("dry tear");
Mood changes (longing and melancholy);
Rapid fatigue.

Hypotonic type of NCD

With the predominance of the parasympathetic division of the autonomic nervous system (vagotonia), neurocirculatory dystonia develops according to the hypotonic type, the main features of which are:

Decreased blood pressure;
A slow pulse (bradycardia) that can quickly increase (tachycardia)
Pain in the heart (cardialgia);
dizziness;
Frequent fainting, especially characteristic in the presence of neurocirculatory dystonia in children (mainly girls) in the puberty period;
Headaches associated with weather conditions, physical and mental stress;
Increased fatigue and low performance;
Dyskinesia of the biliary tract, which is associated with uneven and chaotic contraction of the gallbladder;
Digestive disorders (tendency to diarrhea and flatulence);
Violation of thermoregulation: a decrease in body temperature and prolonged subfebrile condition with infections in children;
Complaints about "shortness of breath" and "sighs";
Tendency to allergic reactions;
Pallor of the 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;
Decreased blood pressure and body temperature;
Slow heart rate.

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

Intense headache;
Heartache;
Increased blood pressure and body temperature;
The appearance of chills;
Redness of the skin or the acquisition of 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;
Whether persistently increased or decreased blood pressure;
Are there cardialgia and cardiac arrhythmias;
To what extent NDC symptoms affect the work capacity of the conscript.

Allied specialists (neurologist, cardiologist, ophthalmologist, endocrinologist, otolaryngologist) are necessarily involved in studying the state of health of a young person.

To whom does "Farewell of the Slav" sound?

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 education not only does not harm the patient, but is also indicated. True, we should talk about purposeful, physiotherapy exercises, dosed and deliberate.

Treatment prescribed by a doctor

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

Video: expert opinion on 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 berries of blueberries, chokeberries, currants and barberries are taken in equal parts, ground, mixed and consumed, filled with boiling water.

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

How is the diagnosis established?

General blood and urine tests, which do not deviate from the norm in this disease;
BP profile within 10-14 days to determine the type of NCD;
Ultrasound of the kidneys and heart to exclude independent diseases of these organs;
Rheoencephalography;
ECG, FCG, echocardiography;
Consultations of an endocrinologist, otolaryngologist, neurologist, ophthalmologist.

In addition, often to determine the cause, there is 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 drug 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. The effect is highly dose dependent and ranges 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 GABA activity 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 has been attached.

Barbiturates also block AMPA receptors (a subgroup of glutamate receptors). Glutamate is the most important excitatory neurotransmitter in the CNS. 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 in the body after oral or intramuscular administration. The maximum concentration of phenobarbital in the blood is observed after oral administration after 6-18 hours, and after intramuscular administration - after 3-5 hours.

The maximum concentration of phenobarbital in the brain after intravenous administration is reached after 20-60 minutes. Concentrations of 15-25 μg/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, in Corvalol it ranges from 80 to 100%.

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

The mouse LD 50 was determined to be 323 mg/kg (po) or 234 mg/kg ip. 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, 185 mg/kg after intravenous administration.

Why should I take Corvalol?

Indications for Corvalol's use:

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

The drug does not help in the prevention and treatment of febrile seizures. Recently, Corvalol has ceased to be prescribed as a sleeping pill because safer alternatives have appeared.

Corvalol: instructions for use, drops

Forms of release of the drug - a bottle with liquid contents, tablets, gelatin capsules. It should be noted that the drug is not used externally or parenterally.

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

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

The dosage of Corvalol is determined by the attending physician. The drug is dispensed by prescription in pharmacies. Corvalol should not be taken at home with alcohol. Alcoholic beverages 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 correctly, determine its duration of use.

Drug analogues

Trade names for 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 pressure).

Phenobarbital should only be given after careful consideration of the risks/benefit and under 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 barbituric addiction;
Patients with respiratory diseases;
With affective disorders;
With 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 placenta 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 malformations. Therefore, folic acid must be taken before and during pregnancy.

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

Side effects

The frequency of side effects is about 23% in adults in general. Serious side effects leading to treatment interruption occur in about 4% of cases. The following side effects are very common (≥10%): unwanted severe sedation and fatigue (drowsiness, prolonged reaction time), dizziness, headache, incoordination (ataxia), disorientation, sexual dysfunction and problems with potency (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 the reaction time in the morning after the evening use 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. With a sudden discontinuation after prolonged use of Corvalol, withdrawal symptoms may occur.