7 types of vegetative-vascular dystonia: differences, symptoms, diagnosis.

Types of vegetative-vascular dystonia (VSD)

Depending on how the cardiovascular system reacts to a disorder of the autonomic nervous system, 4 types of VSD are conventionally distinguished: hypertensive, hypotonic, cardiac and mixed. A more detailed study of the signs of vegetative-vascular dystonia made it possible to identify 3 more types of disorder: vagotonia, cerebral-type VSD and somatoform dysfunction.

This typology is outdated, however, it allows you to classify all symptoms of VSD. The problem of diagnosing autonomic dysfunction is acute, and patients often become victims of ignorance or inattention of doctors. Let's figure out what symptoms may indicate the presence of one or another form of autonomic dysfunction.

Prevention of vegetative-vascular dystonia

The doctor will help eliminate the cause and manifestations of the disease, but only the patient himself can take care of maintaining his health.

During the period of remission, you must adhere to the basic rules:

• Walk more, move, play sports to the best of your ability.
• Eat fractionally and regularly in small portions.
• Include seasonal fruits, vegetables, and berries in the menu.
• Give up bad habits, including drinking strong tea and coffee.
• Have an annual medical examination.
• Treat any diseases in a timely manner.
• Avoid stressful situations.

VSD of cardiac type

In the cardiological (as well as in the hypertensive) form of autonomic dysfunction, the diagnosis will most likely show obvious sympathicotonia, that is, functional tension in the work of the sympathetic department of the ANS. A distinctive feature of VSD of the cardiac type is pain in the heart area (stabbing, pressing or burning sensations in the chest area). Signs may resemble those of an angina attack or myocardial infarction. But upon examination, cardiac pathologies are not detected.

The cardiac type of reaction to a vegetative-vascular disorder is characterized by: tachycardia, cardiac arrhythmia, false pain in the heart area, as well as respiratory arrhythmia and asthma attacks. It is important to understand that with VSD, pain in the heart area is not a harbinger of a heart attack and does not in any way affect the cardiovascular system, which will be confirmed by the patient’s echocardiogram. Cardiac rhythmography is very effective in diagnosing this type of VSD.

VSD of mixed type

Depending on how the cardiovascular system reacts to a disorder of the autonomic nervous system, the 3 types of VSD described above are conventionally distinguished. But, as a rule, vegetative-vascular dystonia includes several types of symptoms at once.

The mixed type is characterized by a combination of the above symptoms. Blood pressure “jumps”, a person feels sometimes depressed, sometimes irritated, sometimes experiences weakness, sometimes excessive emotional overexcitation, and his mood changes sharply. With a mixed type of VSD, the whole spectrum of symptoms can manifest itself: cardiac and respiratory arrhythmia, panic attacks, pain with vague localization. This type of autonomic disorder is the most common.

Clinic of the disease

Most often, at the beginning of the development of a pathology such as neurocirculatory dystonia, symptoms appear weakly and do not directly indicate damage to the autonomic system. The most common nonspecific symptoms are:

• headache;
• severe weakness;
• sweating;
• drowsiness;
• tinnitus and dizziness;
• panic for no reason;
• fainting and a feeling of impending loss of consciousness,
• mood swings;
• anxiety;
• changes in the functioning of the heart, manifested by a decrease or increase in heart rate;
• surges in blood pressure and temperature.
• Sleep disorders

An attack of neurocirculatory dystonia may occur: symptoms will include severe weakness, nausea, hypothermia, headache, abdominal discomfort, hypotension, sweating, etc.

In people over 50 years of age, exacerbation of neurocirculatory dystonia is often more pronounced: symptoms will be more varied and often include signs of existing chronic diseases.

VSD of vagotonic type

Vagotonia is characterized by a wide variety of symptoms, which can raise suspicion of serious diseases of the heart, endocrine or respiratory system, diseases of the gastrointestinal tract or even the psyche. A thorough examination does not reveal any pathologies in the organs and systems of the body. And as a “diagnosis of exclusion,” the patient is diagnosed with “VVD of the vagotonic type.” Indeed, a variety of symptoms that do not fit into a single pathological process are caused by vagotonia - hypertonicity of the vagus nerve (“vagus”). The vagus nerve regulates the activity of organs, glands and blood vessels, and an increase in its tone causes spasm of smooth muscles throughout all structures of the body.

With this type of VSD, the activity of the parasympathetic part of the nervous system predominates (over the sympathetic), which will be confirmed by the diagnosis of CRH. A person becomes apathetic, unsure of himself, suspicious, suffers from hypochondria, suspecting that he has the most terrible and, perhaps, still unknown disease. Memory for specific things often deteriorates: numbers, dates, details, and mental activity decreases.

Physical symptoms are bradycardia, hypotension, vestibular disorders (dizziness and fainting), fatigue, shortness of breath, pale skin, cold extremities, non-localized pain in the abdomen and chest. Despite the broken state, the person experiences difficulty falling asleep and does not sleep well during the night. In advanced cases, patients experience panic attacks, depression and suicidal tendencies. Symptoms can appear in a complex manner, or they can be localized - when complaints are limited to one of the organ systems. The disease can be chronic or manifest itself in the form of outbreaks, vegetative crises, when the condition sharply worsens. In vagotonic children, the pathology also manifests itself in an abundance of allergic reactions.

Treatment of VSD

Drug treatment

Drug therapy is selected taking into account the patient’s specific complaints and the results of his examination. The doctor may prescribe medications:

• increasing or decreasing blood pressure;
• normalizing heart rate;
• eliminating headaches and insomnia;
• promoting active digestion, etc.

Treatment of vegetative-vascular dystonia in women may include taking hormonal medications if the cause of poor health is an imbalance in the body or cycle disorders.

Psychotherapy

An important role in the treatment of vegetative-vascular dystonia is played by stabilization of the patient’s psycho-emotional background. The doctor prescribes complex therapy for the underlying disease and may refer the patient to a consultation with a clinical psychologist. If VSD manifests itself in a mild form, dysfunction of the autonomic nervous system can be eliminated by simple lifestyle changes. The patient is advised to avoid stress, walk more, and get enough sleep. If necessary, mild sedatives of herbal origin are prescribed.

Physiotherapy

A course of procedures helps restore the tone of blood vessels, normalize metabolism, relieve inflammation and reduce pain. The frequency and duration of sessions are selected individually.

For the treatment of VSD use:

• laser therapy;
• magnetic therapy;
• inductometry with darsonvalization;
• electrophoresis with electrosleep.

Massage with acupuncture has a positive effect. During the session, the patient relaxes, the feeling of anxiety goes away, and stress subsides. Acupuncture should be performed by an experienced reflexologist. Using thin needles, he stimulates biologically active points on the human body. In addition to activating blood circulation and reducing muscle spasms, acupuncture promotes the production of cortisol and serotonin - hormones that directly affect a person’s emotional state.

Diet therapy

There is no special diet for the treatment of VSD. If the disease is accompanied by poor digestion or pathology of the gastrointestinal tract, the doctor will prescribe an appropriate menu. In other cases, patients are advised to adhere to the principles of proper nutrition. It is worth limiting the consumption of salt, smoked, fatty foods, fried foods, and fast food. You should not overeat at night so that an overfilled stomach does not affect your sleep. Preference is given to products rich in magnesium and calcium.

It is important to understand that vegetative-vascular dystonia is not a disease, but a symptom complex that may indicate incipient health problems. The peculiarity of the disorder is that the coordinated work of the doctor and the patient can significantly weaken the manifestations of the pathology or get rid of it altogether.

VSD of cerebral type

With vegetative-vascular dystonia of the cerebral type, the tone of the blood vessels in the brain is disturbed. The blood vessels spasm, which leads to disruption of blood supply and nutrition to the brain. Cells lack oxygen, and blood flow deteriorates.

The primary symptoms are headaches, dizziness, blurred vision, noise and pounding in the ears, and nausea. Other symptoms of VSD may also appear: pain in the heart, tachycardia, vascular instability (bouts of heat, sweating, pale skin), difficulty breathing, shortness of breath and a number of other symptoms. According to cardiac rhythmography data, VSD of the cerebral type will be expressed by hyperactivity of waves from the autonomic centers of the brain and, possibly, sympathetic waves.

Neurocirculatory dystonia: current issues of diagnosis and treatment

Neurocirculatory dystonia (NCD) is a disease that belongs to the functional group and is manifested by cardiovascular, respiratory and autonomic disorders, asthenia, poor tolerance to stress and physical activity. The disease progresses in waves, with periods of exacerbations and remissions, and has a favorable prognosis, since it does not develop congestive heart failure and life-threatening cardiac arrhythmias.

Data on the incidence of NCD are conflicting. In medical practice, the disease is diagnosed in a third of people examined for cardiovascular complaints. Young women are more often affected.

Etiology and pathogenesis

Among the predisposing factors, hereditary and constitutional characteristics, personality traits, periods of hormonal changes (dyzovarial disorders, abortion, pregnancy, menopause), and lifestyle are important. Factors causing the disease: psychogenic (neuro-emotional stress, unfavorable socio-economic conditions), physical and chemical influences (insolation, hot climate, vibration), chronic intoxication, including alcohol and tobacco, infections of the upper respiratory tract and nasopharynx , physical inactivity, mental and physical fatigue.

The interaction of these factors leads to disruption of neurohormonal-metabolic regulation. The leading link appears to be damage to the hypothalamic structures that play an integrative role. Dysregulation manifests itself in the form of dysfunction of the sympathoadrenal and cholinergic systems, changes in the sensitivity of peripheral receptors, when a hyperactive response is noted to the usual secretion of catecholamines. The functions of the histamine-serotonin and kallikreinin systems and water-electrolyte metabolism are disrupted. Microcirculation processes are inhibited, which leads to tissue hypoxia.

A disorder of the neurohormonal regulation of the heart leads to an incorrect response to stimuli, which is expressed in inappropriate tachycardia, fluctuations in vascular tone (increased or decreased blood pressure), an increase in cardiac output (hyperkinetic type of blood circulation), spasms of peripheral vessels.

Classification

There is a working classification by V.I. Makolkin and S.A. Abbakumov.

• Etiological forms:

– essential (constitutional-hereditary); – psychogenic (neurotic); – infectious-toxic; – associated with physical stress; – caused by physical and professional factors.

• Clinical syndromes:

– cardialgic; – tachycardial; – hypertensive; – hypotonic; – peripheral vascular disorders; – vegetative crises; – respiratory; – asthenic; – myocardial dystrophy.

• Severity:

– light; – average; – heavy.

Diagnostics

Manifestations of the disease are polymorphic, the severity of symptoms is variable. In some cases, they resemble signs of other cardiovascular diseases, which can make it difficult to recognize NCD.

1. Pain in the heart area (aching, stabbing) is noted. Their duration varies: from instant (“piercing”) to monotonous, lasting for hours and days. The pain is localized in the area of ​​the apex of the heart, less often - just below the left subclavian region or parasternally. Migration of pain is noted. The occurrence of pain is associated with overwork, anxiety, weather changes, and alcohol intake. In women, pain sometimes occurs during the premenstrual period. Pain can also occur during vegetative paroxysms (crises), accompanied by palpitations and increased blood pressure (BP), usually accompanied by a feeling of anxiety and decreased mood. Paroxysmal intense pain is accompanied by fear and vegetative disorders in the form of a feeling of lack of air, sweating, and a feeling of internal trembling. Patients willingly take tincture of valerian or hawthorn. Taking nitroglycerin does not relieve pain.
2. Some patients complain of rapid shallow breathing, a feeling of incompleteness of inspiration, and a desire to inhale deeply (“sad sigh”). There may be a feeling of a “lump” in the throat or squeezing it. It is difficult for the patient to be in a stuffy room; there is a need to open the windows. These phenomena are accompanied by a feeling of anxiety, dizziness, and fear of suffocation. This syndrome can be interpreted as a manifestation of respiratory or heart failure.
3. Patients note palpitations, sensations of increased heart activity, accompanied by a feeling of pulsation of the vessels of the neck and head, appearing at the moment of exertion or excitement, and sometimes at night, from which the patient wakes up. Palpitations are provoked by excitement, physical activity, and alcohol intake.
4. Asthenic syndrome is expressed in decreased performance, a feeling of weakness, and increased fatigue.
5. Peripheral vascular disorders are manifested by headaches, “flickering spots” before the eyes, dizziness, and a feeling of coldness in the extremities.
6. Patients may report fluctuations in blood pressure (decrease or increase, usually not exceeding 160–170/90–95 mmHg). In addition, periods of elevated blood pressure are short-lived.
7. Some patients report an increase in body temperature to 37.2–37.5°C, differences in temperature in the right and left armpits, and a decrease in the temperature of the skin of the extremities (“icy hands”).
8. Vegetative crises are manifested by trembling, chills, dizziness, sweating, a feeling of lack of air, and unaccountable fear. Such conditions usually occur at night, last from 20–30 minutes to 2–3 hours and often end with excessive urination or loose stools. Such conditions usually resolve on their own or with medications (sedatives, beta-blockers). Over time, the severity of symptoms decreases, crises appear less frequently and may disappear completely.

The severity of the course is determined by a combination of various parameters: the severity of tachycardia, the frequency of vegetative-vascular crises, pain, and tolerance to physical activity.

Physical examination

Many signs of cardiovascular and autonomic disorders are revealed, but they are not very specific. Some patients resemble those suffering from hyperthyroidism (brilliant eyes, anxiety, tremors), others, on the contrary, are sad, with dull eyes, and adynamic. Increased sweating of the palms, legs, and armpits is also common. Hyperemia of the face, skin, chest, easily occurring dermographism or even “nervous” urticaria are detected in many patients at the first examination; unmotivated and very lively “play of the pupils” is often encountered. The high reactivity of the vascular system is evidenced by persistent dermographism. The limbs are cold, sometimes pale, bluish. Frequent, shallow breathing is noted, patients predominantly breathe through the mouth (and therefore the mucous membranes of the upper respiratory tract often dry out). Many patients cannot make a forced exhalation. In some patients, increased pulsation of the carotid arteries is detected as a manifestation of a hyperkinetic state of blood circulation.

By palpation in the precordial region, especially in the III–IV intercostal space along the midclavicular line and on the left parasternally, areas of pain in the intercostal muscles are determined (in 50% of cases), usually during periods of exacerbation of the disease. When auscultating the heart, an additional sound in systole is often heard at the left edge of the sternum and at the base of the heart (at its beginning - an ejection sound, and at the end - a systolic click).

The most common auscultatory sign is systolic murmur (approximately 70% of cases). This noise is very typical - weak or moderate, with a large area of ​​sound from the apex of the heart to the base (maximum sound in the III-IV intercostal space at the left edge of the sternum).

A feature of the pulse in people with NCD is its lability: the ease of tachycardia occurring with minor emotions and physical effort. Tachycardia often occurs during an orthostatic test or increased breathing. In many patients, the difference in pulse in clino- and orthostasis can be 100–200% of the original one. The pulse rate in people with NCD reaches 120–130 beats/min. Episodes of supraventricular tachycardia and paroxysms of atrial fibrillation are rare.

Blood pressure is labile, so it is better not to rely on the results of a single measurement. Often the first measurement shows a slight excess of the upper limit of normal, but after 2–3 minutes the pressure returns to normal limits. Asymmetry of blood pressure on the right and left extremities can be determined. On palpation of the abdomen, in 1/3 of cases, mild diffuse pain is noted in the epigastrium or around the navel.

Treatment

1. Etiological treatment

It is necessary to eliminate the impact of stressful situations (normalize family relationships, eliminate conflict situations at work). In the infectious-toxic form of NCD, an important role belongs to the sanitation of the oral cavity, treatment of foci of chronic infection, and timely tonsillectomy. In case of NCD caused by physical and professional factors, it is necessary to exclude occupational hazards, and in some cases - rational employment.

2. Rational psychotherapy, auto-training

Often it can be much more effective than drug treatment. The doctor must explain to the patient the essence of the disease, emphasize its benign nature, favorable prognosis and the possibility of recovery. In some cases, it is advisable to conduct psychotherapy in the presence of the patient’s relatives in order to inform them about the essence of the disease and the possibility of its cure. The patient should be taught self-hypnosis formulas to reduce the unpleasant subjective manifestations of the disease. Self-hypnosis should be combined with auto-training and muscle relaxation.

3. Normalization of disturbed functional relationships of the limbic zone of the brain, hypothalamus and internal organs

3.1. Use of sedatives

Valerian and motherwort herb have not only a calming effect, but also a “stem” effect, that is, they normalize the function of the brain stem and hypothalamus. Valerian root or motherwort herb is taken in the form of infusions (10 g per 200 ml of water) 1/4 cup 3 times a day and at night for 3-4 weeks.

3.2. Treatment with tranquilizers

Tranquilizers have anxiolytic properties, relieve feelings of fear, anxiety, and emotional tension. Elenium is prescribed at 0.005–0.01 g 2–3 times a day. Diazepam (Seduxen, Relanium) - prescribed in a dose of 2.5-5 mg 2-3 times a day, with a pronounced feeling of fear, the single dose can be increased to 10 mg; the drug reduces the frequency of sympathoadrenal crises. Phenazepam is a highly active tranquilizing drug, it is recommended to take 0.5 mg 2-3 times a day. Oxazepam (Nozepam, Tazepam) - taken 0.01 g 2-3 times a day. Medazepam (Mezapam, Rudotel) - taken 0.01 g 2-3 times a day. Tofisopam (Grandaxin) is a daily tranquilizer, used 0.05–0.1 g 2–3 times a day. Tranquilizers are taken for 2–3 weeks; they are especially indicated before stressful situations. In recent years, drugs such as Afobazole (a daytime over-the-counter tranquilizer that does not cause drowsiness) and Tenoten (a homeopathic drug containing microdoses of antibodies to the brain protein S-100) have begun to be used.

3.3. Combined drugs "Belloid" and "Bellaspon"

They reduce the excitability of adrenergic and cholinergic structures and have a calming effect on the hypothalamic area of ​​the brain. They are a kind of “vegetative correctors”, normalizing the function of the autonomic nervous system. Belloid - 1 tablet of the drug contains 30 mg of butobarbital, 0.1 mg of belladona alkaloids, 0.3 mg of ergotoxin. Prescribed 1 tablet 2-3 times a day. Bellaspon (Bellataminal) - 1 tablet contains 20 mg of phenobarbital, 0.3 mg of ergotamine, 0.1 mg of belladonna alkaloids. Prescribed 1-2 tablets 2-3 times a day.

3.4. Antidepressants

They are indicated primarily for depression. Masked depression is possible, when the depression itself is “masked” by various somatoneurological disorders. Such masked (primary) depression should be distinguished from secondary depression in NCD. The use of antidepressants should be differentiated. In the case of anxious, agitated depression, amitriptyline (Triptisol) 50–75 mg/day is indicated; for asthenic forms of depression - imipramine (Imizin, Melipramine) 50–100 mg/day. For severe hypochondriacal symptoms, Teralen 20–40 mg/day and Sonapax 30–50 mg/day are prescribed. For mild depression, Azafen can be used at a dose of 0.075–0.125 g per day. More modern drugs include citalopram (Cipramil), fluoxetine (Prozac), paroxetine (Rexetine), pirlindole (Pyrazidol). Doses of antidepressants should be “titrated”, starting with small ones (1/2 tablet per dose) and gradually increasing to optimal ones. Treatment lasts about 4–6 weeks. As depression improves, the antidepressant dose is reduced.

3.5. Nootropic drugs

They improve energy processes and blood supply to the brain, increase resistance to hypoxia, activate intellectual functions, improve memory, which is especially important for patients with NCD who are engaged in mental activity. Indicated in the presence of signs of adynamia, asthenia, and hypochondriacal disorders. They can be used as adjuncts in the treatment of depressive conditions resistant to antidepressants. Piracetam (Nootropil) - prescribed in capsules or tablets of 0.4 g 3 times a day for 4-8 weeks. If necessary, you can increase the dose to 0.8 g 3 times a day. More modern and powerful means are Phenotropil, Pantocalcin. Picamilon has a mild effect and is well tolerated.

3.6. Cerebroangiocorrectors

They normalize cerebral circulation, which has a positive effect on the functional state of the limbic zone of the brain and hypothalamus. These remedies are especially appropriate for angiodystonic headaches, dizziness, and cervical osteochondrosis.

Cavinton (vinpocetine) - used in tablets of 0.005 g, 1-2 tablets 3 times a day for 1-2 months.

Stugeron (cinnarizine) - prescribed in tablets of 0.025 g, 1-2 tablets 3 times a day for 1-2 months.

Instenon forte - 1 tablet 2 times a day for at least 1 month.

4. Reducing the increased activity of the sympathoadrenal system

Normalization of the tone of the sympathoadrenal system is a pathogenetic method of treating the hypertensive variant of NCD, characterized by high sympathicotonia. For this purpose, beta-blockers are used.

The most commonly used is propranolol (Anaprilin, Inderal, Obzidan) in a daily dose of 40 to 120 mg. The course of treatment with beta-blockers lasts from 2 weeks to 5-6 months, on average 1-2 months. After achieving a therapeutic effect, the dose is reduced by half or three times. During periods of improvement, beta-blockers can be discontinued.

Phytotherapy

It helps normalize the hypothalamic-visceral relationship, the activity of the cardiovascular system, and sleep. The following fees are recommended.

Collection No. 1: chamomile (flowers) 10 g, lily of the valley (flowers) 10 g, fennel (fruits) 20 g, peppermint (leaves) 30 g, valerian (root) 40 g. Pour two teaspoons of crushed collection into 1 tbsp. . water, leave for 3 hours, boil, cool, strain. Take 40 ml (2.5 tablespoons) 5 times a day.

Collection No. 2: motherwort (herb) 20 g, valerian (root) 20 g, calendula (flowers) 20 g, cumin (fruits) 20 g, dill (seeds) 20 g. Pour 1 teaspoon of collection with 1 glass of boiling water, leave for 2 h, strain. Take 1 tablespoon 4-5 times a day.

Collection No. 3: hawthorn (flowers) 20 g, lily of the valley (flowers) 10 g, hops (cones) 10 g, peppermint (leaves) 15 g, fennel (fruits) 15 g, valerian (root) 20 g. 1 tablespoon crushed collection, pour 1 glass of cold boiled water, leave in a cool place for 3 hours, then boil, cool, strain. Take 1/4 cup 4 times a day 20 minutes before meals.

Improvement with herbal medicine occurs after 2–3 weeks, but a lasting effect is achieved only in the case of long-term regular use of herbal infusions (for 6–8 months). After 1–2 months, if you feel well, you can take breaks for 7–10 days, and after the break change the fees. For preventive purposes (even in satisfactory condition), it is recommended to take the mixture for 2 months, 2 times a year - in spring and autumn.

A modern combined herbal medicine with a sedative effect is Persen. It consists of valerian root, peppermint and lemon balm. Rhizomes with valerian roots contain essential oils with monoterpenes, sesquiterpenes and less volatile valeric acids, gamma-aminobutyric acid (GABA), glutamine and arginine, used for increased nervous excitability, have a sedative effect and improve sleep.

Melissa leaves have a calming and carminative effect.

The active ingredients contained in lemon balm leaves are essential oils, monoterpene aldehydes such as geranium oil, neroli oil and cedrate oil, flavonoids, glucosides, monoterpenes, tannins (rosmarinic acid), triterpene acids and bitter substances. Peppermint leaves have an antispasmodic effect on the smooth muscles of the gastrointestinal tract, as well as a choleretic and carminative effect. The main active ingredients found in peppermint leaves include menthol essential oil, flavonoids, phenolic acid and triterpene acid.

Persen is used as a sedative for increased nervous excitability, sleep disorders, insomnia, irritability; feeling of internal tension. Persen is available in two dosage forms - Persen tablets and Persen forte capsules. For adults and adolescents over 12 years of age, the drug is prescribed 2-3 tablets or 1-2 capsules. The drug is taken 2-3 times a day.

For insomnia - 2-3 tablets or 1-2 capsules an hour before bedtime.

For children aged 3 to 12 years, the drug is prescribed only under the supervision of a doctor and only in the form of tablets. The dose depends on the patient’s body weight, on average 1 tablet 1–3 times a day.

The decision on the advisability of using the drug during pregnancy (especially in the first trimester) and lactation (breastfeeding) should be made only after assessing the expected benefit to the mother and the potential risk to the fetus and child.

The duration of treatment is not limited. Even with long-term use of tablets or capsules, there is no dependence.

When Persen is discontinued, withdrawal syndrome does not develop.

When using the drug, the reaction rate may decrease, so taking it before activities that require increased attention is not recommended.

We have experience with a course of using the drug “Persen” for 3 weeks in 16 patients, 10 of whom had cardiac-type NCD, 6 had asthenoneurotic syndrome due to somatic diseases. The age of the patients ranged from 25 to 45 years, among them there were 3 men and 13 women. In the control group (n=10), comparable in gender and age to the main group, an alcoholic tincture of valerian was used, 30 drops 3 times a day.

During the treatment, it was found that in the Persen group, the level of anxiety on the Taylor scale decreased significantly more quickly, the Kerdo autonomic index normalized, the severity of cephalgia and cardialgia on the visual analogue scale (VAS) decreased, and the quality of life (QoL) increased compared to the comparison group .

Physiotherapy, balneotherapy, massage, acupuncture

In order to regulate the central nervous system and reduce the manifestations of cardialgia syndrome and extrasystoles, electrosleep is used. To obtain a calming effect, it is prescribed with a frequency of 10–25 Hz, from 20 to 40 minutes daily, the course of treatment is 15 sessions. For NCD of the hypotonic type, electrosleep is prescribed with a gradually increasing (after 3–4 sessions) pulse frequency (10–40 Hz).

In case of hypertensive syndrome, electrophoresis of 5–10% solution of sodium or potassium bromide, 5% solution of magnesium sulfate, 1% solution of Euphyllin, 2% solution of papaverine, 1% solution of Dibazol, Anaprilin (40 mg per procedure) is performed using the general effect method or the collar method methodology.

For hypotension, caffeine electrophoresis can be used. Procedures lasting 10–20 minutes are carried out at a current strength of 5–7 mA, every other day. The course of treatment is 15 procedures. For severe asthenia, a galvanic collar according to Shcherbak is used, the duration of the procedure is 10–20 minutes, every other day, the course of treatment consists of 15–20 procedures. In case of pronounced manifestations of cardiac syndrome, electrophoresis of a 5–10% solution of Novocaine, 0.5–1% solution of nicotinic acid is recommended, preferably using the general effect method or the cardiac method (electrodes are placed on the heart area and in the interscapular region).

In case of arrhythmic syndrome, electrophoresis of a 5% solution of Novocaine, 2% solution of Panangin or Anaprilin is prescribed according to the cardiac technique. In case of pronounced clinical manifestations of hypothalamic dysfunction and vegetative-vascular paroxysms, intranasal electrophoresis of Relanium can be recommended. The course of treatment is 10 procedures.

Water procedures have a positive effect on patients with NCD. Various showers, douches, dry and wet wraps are used. Valerian, pine, oxygen, nitrogen and pearl baths (temperature 36–37°C) lasting 8–15 minutes have a pronounced sedative effect. Baths are prescribed every other day, the course of treatment is 10–12 baths.

With a sharp predominance of excitation, cardiac and arrhythmic syndromes, hydroprocedures at an indifferent temperature (35–36°C) are indicated; with hypotensive ones, lower temperatures (32–33°C) are indicated. For hypertensive and cardiac types of NCD, radon, hydrogen sulfide, and iodine-bromine baths are recommended; in the hypotensive variant - carbon dioxide, iodine-bromine. The water temperature in all baths is 35–36°C, duration is 8–15 minutes, baths are prescribed every other day, the course of treatment is 10 baths.

With a pronounced predominance of excitation processes, radon and nitrogen baths have the best effect; with asthenia, carbon dioxide baths. Radon and iodine-bromine baths are also advisable for osteochondrosis. If cerebral symptoms predominate, local baths are recommended as a distraction procedure: foot baths (fresh, mustard), water temperature in the bath is 40–42°C, duration is 10–15 minutes. For the same purpose, paraffin applications are prescribed on the feet (paraffin temperature 50–55°C) for 20–30 minutes every other day, a course of 10 procedures.

Aeroionotherapy has become widespread in the treatment of patients with NCD. Aeroionizers are used for individual (“Ovion-S”) and collective use (“Chizhevsky’s chandelier”). In the process of air ionization, air ions are formed with a predominance of air ions of a negative sign. Patients are located at a distance of 70–100 cm from the device, the session lasts 20–30 minutes, during which time the patient inhales air charged with negative ions. The course of treatment is 12–14 sessions. Under the influence of aeroionotherapy, there is a decrease in blood pressure (by 5–20 mm Hg), a decrease in heart rate, an increase in gas exchange, an increase in oxygen consumption, the disappearance of insomnia, a decrease in headaches, and weakness.

Massage has a positive effect on patients with NCD. Patients benefit from a restorative massage; careful massage of the cervical and thoracic spine is recommended for osteochondrosis of these sections. An effective method of treating NCD is acupressure, which can be performed by the patient himself and his relatives.

Acupuncture normalizes the functional state of the central and autonomic nervous system; eliminates vegetative-vascular dystonia; increases the body's adaptive capabilities; improves metabolism and function of internal organs; has an analgesic effect, relieves cephalgia and cardialgia; normalizes blood pressure. Acupuncture can be carried out using the classical method or in the form of electroacupuncture. Usually the inhibitory version of IRT is used with a gradual increase in the number of points. The first course includes 10 sessions, after a 2-week break the second course is prescribed and after 1.5 months - the third course.

In acupuncture, to restore the functions of the central nervous system, relieve emotional stress, and obtain a sedative effect, the points Tzu-san-li (36E), Shen-men (7C), and Shen-ting (24VG) are used. To relieve pain in the heart area, headaches with their reflection on the muscles of the neck and face, the analgesic effect of the tian-tu points (22VС), san-yin-jiao (6RP), feng chi (20VВ), bai-hui (20VG) is used ), Wai-Guan (5TR), to reduce blood pressure - Wai-Guan (5TR), Nei-Ting (44E), to normalize heart rate - San-Yin-Jiao (6RR). Under the influence of IRT, a significant improvement in condition is observed in 65–70% of patients.

Treatment with adaptogens

Patients with NCD are very sensitive to weather changes, the usual regime of physical activity, and are poorly adapted to negative psycho-emotional situations. Adaptogens are herbal preparations that have a tonic effect on the central nervous system and body functions as a whole, increase endurance to physical and mental stress, resistance to respiratory viral infections, and have a beneficial effect on metabolic processes and the immune system.

Ginseng tincture - prescribed 20-25 drops 3 times a day; Eleutherococcus extract - 20-30 drops 3 times a day; Schisandra tincture - 25-30 drops 3 times a day; Aralia tincture - 30-40 drops 3 times a day; Saparal (sum of glycosides-aralosides obtained from Aralia roots) - 0.05 g 3 times a day.

In addition to adaptogens of plant origin, Pantocrine (liquid alcohol-water extract from the unossified antlers of deer, wapiti or sika deer) is also used - prescribed 30 drops 3 times a day; Cigapan (extract from male reindeer antlers) - 1 tablet 2 times a day.

Adaptogens can increase blood pressure; if it increases, it is necessary to reduce the dose of the drug or discontinue it; may have a stimulating effect on the patient, so the last dose of the drug should be taken several hours before bedtime; a course of treatment with adaptogens lasts about 3–4 weeks; 4–5 such courses can be carried out throughout the year; It is advisable to carry out a course of treatment in anticipation of an influenza epidemic, during periods of unstable weather (especially in autumn and spring), during intense mental and physical work.

Correction of weather dependence

Patients with NCD are very sensitive to weather conditions, and under unfavorable weather conditions their condition worsens significantly. Selection and clinical examination of these patients is recommended; notification of adverse weather and preventive measures; the day before, on this and the next day, it is recommended to take adaptogens; it is also advisable to use vitamin E 100 mg 1-2 times a day for 3-4 weeks. In order to adapt to the cold, the patient may benefit from hardening, as well as contrast showers, foot baths, swimming in cool water, air baths, light clothing in the cool season, cold baths (18–22°C) followed by intensive rubbing with a towel.

Spa treatment

In this case, the following are used: rest, therapeutic nutrition, climatic and landscape influences, mineral waters, sea bathing, balneotherapy, physiotherapy, health path. Patients with NCD are sent to the resort at any time of the year. Resorts with a mild climate without sudden changes in atmospheric pressure are preferable. For example, these are resorts in Latvia (Riga seaside), Lithuania (Palanga), Estonia (Tartu), Leningrad and Kaliningrad regions, Lettsy (Belarus), the southern coast of Crimea (Yalta), Sochi. Treatment is effective in sanatoriums, as well as in local suburban sanatoriums.

Literature

1. Makolkin V.I. Neurocirculatory dystonia // Ter. archive. 1995. T. 67, no. 6. pp. 66–70.
2. Makolkin V.I., Abbakumov S.A. Diagnostic criteria for neurocirculatory dystonia // Klin. honey. 1996. No. 3. pp. 22–24.
3. Makolkin V.I., Abbakumov S.A., Sapozhnikova A.A. Neurocirculatory dystonia (clinic, diagnosis, treatment). A manual for practitioners. Cheboksary. 1995. 249 p.
4. Pokalev G. M. Neurocirculatory dystonia. Nizhny Novgorod: Publishing house NGMI. 1994. 298 p.

V. V. Skvortsov , Doctor of Medical Sciences A. V. Tumarenko , Candidate of Medical Sciences O. V. Orlov Volgograd State Medical University , Volgograd

Somatoform dysfunction

With somatoform dysfunction, a person usually complains about a specific organ or group of organs that are regulated by the autonomic nervous system. These may be complaints about the cardiovascular, gastrointestinal, respiratory or genitourinary systems. The patient associates his condition with a physical disorder, but based on the results of the examination, the doctor finds no reason for it. The true cause of the malaise is a disruption in the functioning of the autonomic nerve centers. In addition to subjective localized pain, heaviness, burning or tension, specific symptoms of VSD can be easily identified among the patient’s complaints.

The variety of symptoms of autonomic dysfunction makes it difficult for the doctor to get to the root cause of the disease. Therefore, in addition to collecting anamnesis, it is important to conduct instrumental studies of the functioning of the autonomic nervous system. Find out more about diagnosing autonomic disorders.