Due to the inconstant intensity of the symptoms, their great variability, the correct prescription of therapeutic measures is a difficult task. With mild to moderate severity, outpatient treatment is possible, with severe cardiac neurosis, hospitalization is indicated.
Preference is given to etiological or pathogenetic therapy in combination with symptomatic means, tonic measures.
Given the characteristics of cardioneurosis, in its treatment there are a number of areas:
- Psychotherapy. Regardless of other provoking factors, pathology requires psychotherapeutic correction of the condition. Used cognitive behavioral therapy, hypnosis, relaxation methods. The complex of measures is aimed at reducing the feeling of fear, despair, helplessness, convincing the patient of the unfoundedness of his fears. The patient is explained the essence of the symptoms, the benignity of the disease, helps to form a position of active participation in the treatment process.
- Psychotropic drugs. In cases where mental disorders acquire a protracted nature or are not amenable to non-drug correction, psychotropic drugs are prescribed during the hospital stay and after discharge. The use of medicines of plant origin (valerian, motherwort) comes to the fore, with their ineffectiveness go to antipsychotics, antidepressants, tranquilizers.
- Drug therapy. In case of a diagnosed infection, antibiotics, antiviral drugs, and multivitamins are mandatory. When endocrine disorders prescribed hormonal agents. In case of moderate course of the disease, the therapy is supplemented with adrenoblockers, pulsation drugs.
- Physiotherapy. Physiotherapy techniques increase the effect of drugs, which in some cases reduces the dosage, speeds up recovery, and normalizes the work of the central nervous system. Used exercise therapy, reflexology, electrophoresis, electric, hydromassage. Respiratory syndrome requires the additional appointment of respiratory gymnastics.
Cardioneurosis is a chronic disease accompanied by disorders of the cardiovascular, respiratory and nervous systems, a decrease in the body’s resistance to physical exertion and stressful situations. In medical practice, the condition occurs in 30-40% of patients with symptoms characteristic of cardiac disorders, in 70% of patients entering emergency departments with suspected myocardial infarction and other life-threatening conditions with a similar clinical picture. Despite the significant prevalence of the disease, accurate statistical data regarding the occurrence are not available, as patients are often mistakenly treated for other neurological or cardiac pathologies. Patients under 40 years of age, predominantly female, are more likely to suffer.
Cardioneurosis is a psychosomatic illness that occurred against the background of disruptions of the autonomic nervous system under the influence of external factors. Manifested by violations of the cardiovascular system in the absence of organic changes. Patients complain of cardiac pain, palpitations, irritability, sleep disturbances. Cardioneurosis is diagnosed on the basis of the clinical picture after instrumental and laboratory tests that exclude other pathologies. Treatment includes a set of measures aimed at correcting the psychological state and eliminating provoking factors. According to the indications prescribed drug therapy.
Causes of cardioneurosis
Pathology belongs to the polietiologic diseases, therefore, determining the leading cause causes sufficient complexity. There are two groups of factors: predisposing and directly causing this condition.
A favorable background for the development of the disease in young people is the lability of the nervous system, hypersensitivity, a tendency to hysterical or depressive reactions, in the elderly – diseases of the central nervous system, provoking instability of psycho-emotional reactions. The role of hereditary predisposition, functional and morphological features of the organism is not excluded: lack of function of certain parts of the brain, individual differences in metabolism.
In the presence of background, the cause of the disease can be:
- Psychogenic factors. The development of pathology contribute to a state or event that has a pronounced negative emotional tint. These include some mental disorders at a neurotic level (neurosis, phobias), severe shocks experienced (natural disasters, catastrophes, loss of loved ones), acute and chronic stress, adverse socio-economic living conditions.
- Unstable hormonal background. More often, women suffer because of an imbalance of sex hormones: estrogen, progesterone. The likelihood of symptoms increases during puberty, menopause, pregnancy and childbirth, with the use of hormonal drugs (mainly – oral contraceptives), the formation of hormone-producing tumors. In men, cardioneurosis can be diagnosed during puberty, in the presence of endocrine disorders.
- Physical, chemical effects. The disease develops as a result of chronic overwork, including in people of mental labor on the background of hypodynamia. The provoking factors are the constant effects of vibration, noise, direct sunlight, temperature changes, as well as chronic intoxication with household poisons, heavy metal salts, narcotic substances and certain groups of drugs, alcohol and caffeinated beverages.
- Infectious processes. Focal infections of the upper respiratory tract and nervous system mainly lead to cardioneurosis: chronic tonsillitis, sinusitis, rhinosinusitis, pharyngitis, tracheitis, acute respiratory diseases, meningitis, encephalitis, neurosyphilis, neuritis of various localization. The causative agents of infections can be viruses, bacteria, fungi, protozoa
Pathogenesis of cardioneurosis
The constant complex effect of exogenous and endogenous factors is the cause of an imbalance in the complex mechanism of regulation of the activity of the heart and blood vessels.
The coordination role is played by the hypothalamus, therefore the mismatch between the signals of the hypothalamic zone and the cerebral cortex becomes the initial link in the pathology. Dysregulation provokes an increase in the activity of the sympathoadrenal and cholinergic systems, an increase in the sensitivity of peripheral receptors.
All this leads to an excessive organ response to signals from the central nervous system, metabolic disorders, which manifests itself in inadequate situations: tachycardia, tachypnea at rest, ineffective contractions of the heart, impaired vascular tone, up to peripheral spasm, increased blood pressure. Malfunctions of neurohumoral regulation often appear on the background of physical or emotional stress.
Classification of cardioneurosis
The generally accepted classification of cardioneurosis is absent. In clinical practice, the division of the course of the disease according to severity is used, taking into account a number of criteria: heart rate, presence and frequency of vegetative-vascular crises, localization and intensity of pain, dependence of symptoms on physical exertion.
There are three severity of pathology:
- Easy flow. The ability to work and social activity of the patient are fully preserved, there is a slight decrease in the ability to perform hard work. Sternum pain is moderate, appears after psycho-emotional or physical exertion, paroxysms are absent. Respiratory disorders practically do not affect the patient’s condition, no violations on the ECG are detected. Drug therapy is usually not required.
- Moderate flow Much of the time symptoms are absent or mild, in the period of exacerbation the ability to work decreases until its temporary loss. Pain syndrome pronounced, not having a clear connection with the loads, there may be vascular crises. Tachycardia appears suddenly, the pulse rate is more than 100 beats per minute. Drug therapy is recommended.
- Heavy current. Characteristic persistent multiple symptoms affecting several organs and systems. Disability is critically reduced or absent, constant tachycardia, arrhythmias, high blood pressure are detected. There is marked shortness of breath, swelling of the lower extremities, insomnia. Requires systematic medication.
Symptoms of cardioneurosis
Symptomatology is variable, varies considerably in severity. Manifestations of the disease are not specific, which significantly complicates the diagnosis. The onset of a sudden, with a large number of symptoms, the intensity of which depends on the causative factor, the general condition of the patient. After severe stress, cardioneurosis develops acutely, and against the background of infection or overwork, gradually. Patients complain of chest pains of various kinds (stabbing, burning, arching, aching), the duration of which varies from a few seconds to hours or days.
The pain does not have a clear localization, it can migrate to the scapular zone, neck, epigastrium, lower back, and organs of the perineum. Pain syndrome usually occurs on the background of physical stress, overwork, emotional experiences, alcohol intake, premenstrual period in women. Intense pain is accompanied by anxiety, fear, a sense of lack of air, sweating, and is not relieved by nitroglycerin.
Patients may notice an increase in breathing, its superficial character, feeling of incomplete inhalation, feeling of a lump in the throat. There is a need for fresh air, because of which, while in the room, patients try to open the windows. Against the background of respiratory disorders, there is often a feeling of increased heart rate, interruptions in the work of the organ, and pulsation of the neck vessels is found.
Performance decreases, increasing chronic weakness, fatigue. Disorders in the regulation of peripheral vascular tone manifest themselves in the form of headache, dizziness, cold feeling in the limbs. Perhaps a temporary increase in blood pressure to 160/90 mm. Hg Art., an increase in body temperature to 37.5 ° C. The picture of the vegetative crisis consists of chills, dizziness, sweating, feelings of lack of air, fear. The condition usually develops at night, lasts from half an hour to 3 hours, ends with abundant urination, loose stools. The frequency of crises – from one attack per month to 1-2 per year. Over time, the frequency and intensity of symptoms decrease.
Complications of cardioneurosis
Cardioneurosis rarely provokes serious complications. With a long course of the disease leads to violations in the mental and social spheres – hypochondria, phobias, depressive reactions, deterioration of the quality of life, restriction of activity. In the absence of adequate therapy, the pathology can adversely affect the condition of the patient’s heart and blood vessels.
There are indications of an increase in the likelihood of developing hypertensive and ischemic disease, various types of arrhythmias, which causes morphofunctional changes in the myocardium with a violation of its excitability, conduction, automatism, contractility. The result of these processes is a persistent reduction in coronary circulation, which increases the risk of heart attack.
Diagnosis of cardioneurosis
Diagnostic measures are carried out by general practitioners and cardiologists; when a significant neurotic and functional component is found, a psychiatrist, psychotherapist, and neurologist are attracted to the examination. Symptoms of cardioneurosis are fairly obvious, but its similarity with signs of other cardiac pathologies requires the exclusion of organic lesions of the heart and blood vessels, other somatic diseases.
Comprehensive diagnosis includes:
- Survey, inspection. The data are rather scarce, non-specific. Cardioneurosis indicates the appearance of the first symptoms at a young age, their duration, the relationship with stimuli. Acrocyanosis, tremor of the fingers, restless behavior, pallor or reddening of the skin can be detected. On palpation, there is increased sweating, cold extremities. Often found enhanced pulsation of the carotid arteries, sore ribs, intercostal spaces. The dimensions of the heart during percussion are unchanged. Auscultation reveals rhythm disturbances, gives an idea of the frequency of contractions, additional tones and noise. When measuring blood pressure, its lability is noted, asymmetry on the right and left hand is possible.
- Electrocardiography. The ECG makes it possible to assess the frequency, the nature of the rhythm, detect arrythmia, arrhythmia, and intracardiac conduction disturbances, eliminate organic damage (myocardial ischemia, damage to the heart muscle by toxic agents). When conducting an ECG with bicycle ergometry, changes on the tape during neurosis of the heart correlate with a decrease in working capacity and an increase in symptoms.
- Echocardiography. EchoCG is used to exclude valve damage, organic heart abnormalities (additional chords, cavities in the ventricles). The size of the chambers, the thickness of their walls, which in cardiac neurosis usually correspond to the norm, are estimated. In individuals with severe disease, there may be a decrease in cardiac output, the overall speed of the heart fibers, which indicates a violation of the contractile function of the myocardium.
- Laboratory research. In the clinical and biochemical analysis of the blood, there is no elevated level of leukocytes, ESR, C-reactive protein, acute phase factors, which allows rheumatoid fever and other immunopathologies to be excluded. The levels of ALT, AST, myoglobin, troponins as markers of myocardial damage are important. A change in the physiological ratio of electrolytes is necessary for the differential diagnosis of arrhythmia.
The diagnosis is made in the presence of certain criteria: the duration of preservation of symptoms, due to the characteristic provoking factor, the severity of the psycho-emotional component, the absence of somatic pathologies. Differential diagnosis of cardioneurosis is performed with diseases that give a similar clinical picture with the leading symptom in the form of chest pain: coronary heart disease, myocarditis, myocardial infarction, dissecting aortic aneurysm, pleurisy. Differentiation is carried out with pathologies with frequent irradiation of pain in the chest: hepatic colic, acute pancreatitis, and a stomach ulcer. Particular attention is paid to the exclusion of rheumatic lesions of the heart, valve system.
Prognosis and prevention of cardioneurosis
For cardioneurosis, the development of severe complications is uncharacteristic, with timely complex therapy, the prognosis is favorable. The pronounced clinical symptoms worsen the quality of life of patients, which requires constant monitoring and therapeutic measures.
Prevention includes maintaining a healthy lifestyle, eliminating bad habits, moderate physical activity in accordance with age and health status, proper nutrition, timely treatment of infectious diseases.
An important point is the correction of hormonal levels in women, especially during menopause. If possible, avoid excessive physical, mental and emotional stress, stressful situations.