Method for predicting severity degree of autonomic dystonia syndrome

FIELD: medicine, cardiology.

SUBSTANCE: one should register a rhythmocardiogram, detect spectral values for variability of cardiac rhythm, calculate the value of autonomic index, calculate the value of autonomic tonicity by the following formula: AI/lnTp m sq. sec., where AI - autonomic index, lnTp - total power for the spectrum of variability of cardiac rhythm. At values above 3.1 one should diagnose severe flow of autonomic dystonia syndrome, at values being 3.1-2.2 - moderate flow of the mentioned disease, at values ranged 2.1-1.5 - light flow. The method enables to predict the development of hemodynamic disorders.

EFFECT: higher efficiency and accuracy of diagnostics.

3 ex

 

The invention relates to medicine, namely cardiology, and can be used in the diagnosis of the severity of the syndrome of a vegetative dystonia.

The relevance of the study of functional pathology of the heart, the main manifestation of which are the vegetative disorders, due primarily to the high morbidity, reduced quality of life and the need for differential diagnosis of this pathology with a number of other diseases (1). Since puberty, the incidence of autonomic disorders is 25 - 80% (2, 3). According to the results of large epidemiological studies performed by employees of the Department for the study of borderline mental disorders and psychosomatic disorders national mental health research center of RAMS, vegetative dystonia syndrome (cardiac neurosis) is found in 4.7% of patients in General medical network of different ages (4). A feature of autonomic pathology is that as an independent disease, it is quite rare and usually wears a secondary character. However, young people vegetative disturbances become the leading value, and elderly individuals is presented in an objective picture of somatic diseases (4). The complexity of all methods of diagnostics of a syndrome of a vegetative dystonia (SVD) is determined by the absence of a clear object the main criteria between the norm and begin pathological changes of the cardiovascular system (5, 6, 7).

According to modern concepts, many patients with SVD existing functional abnormalities of the cardiovascular system (CVS) can be a prestage of organic diseases such as coronary heart disease, hypertension, etc.(1, 8, 9, 10). In this regard, it is evident that for more careful monitoring and treatment it is necessary to identify patients with SVD, in which there is a predisposition and increased risk of cardiovascular diseases.

In modern medicine for verification clinically significant changes in the CCC uses the latest high-precision instrumental methods of diagnosis, such as Holter monitoring of ECG and blood pressure, echocardiography with Doppler ultrasonography, electrocardiography (ECG). However, most patients with borderline pathology application of these methods is uninformative and allows you to set the diagnosis only after functional loading tests (Bicycle ergometry, pharmacological, physical samples, etc.) (5, 6, 7).

There is a method of diagnosing the symptoms of the syndrome of a vegetative dystonia using Questionnaires for the symptoms of autonomic changes, which is filled examined the patient (5). Each symptom has a specified the number of points that is, depending on the importance of clinical manifestations that affect adaptive capacity. After mathematical processing of results total scores in healthy individuals should not exceed 15, in case of exceeding it is necessary to speak about the presence of SVD. This method is used for mass screening, often at the ambulatory stage, simple and quickly done. It allows you to evaluate the overall autonomic tone, which consists of existing vegetative violations by a particular system (5). This method helps to identify the presence of SVD as in patients presenting complaints, and those without any. The latter may serve as a risk factor that should be taken into account during preventive examinations.

The obvious disadvantage of this method is the subjective evaluation of one's own state of patients, which raises doubts about its accuracy. In addition, it is not possible to assess fully the orientation system of the autonomic manifestations of the cardiovascular system, does not allow to judge about the functional state of blood circulation apparatus, to determine the severity and respectively right to assign treatment.

There is a method of studying the autonomic status, developed Addelement (1981,1998) (5). It combines history, subjective is how do I get it, the results of objective research (ECG, arterial systolic and diastolic pressure, the number of heartbeats, the minute volume of blood) and vegetative status in a single table. In the future, after counting the total number of points characteristic for each received indication, all collected material is subjected to mathematical processing on the computer. When analyzing table special attention is given to integrative indicators (e.g. blood pressure, minute volume, and so on), which give an idea of vegetative changes within the system and the amount of indicators in different systems allows a better judge about the original vegetative tonus of the organism (5).

This method is not sufficiently accurate, as when assessing autonomic tone in the cardiovascular system through thorough analysis of subjective and objective symptoms, instrumental data, including ECG, it is not possible with a high degree of accuracy to determine the severity of autonomic disorders (11).

As the prototype is taken a method for the diagnosis of SVD using spectral indices of HRV - VLf, Lf, Hf, ratio of balance of sympathetic and parasympathetic activity of Lf/Hf, calculated at carrying out daily monitoring of ECG (9). This method marks the changes of the studied parameters at VDS aims to you the effect of the nature of the flow (paroxysmal or permanent). When paroxysmal for SVD marked predominant sympathetic influence on heart rate, a decrease of the spectral characteristics at all frequencies of the spectrum of VLf=1521±225, Lf=207±246, Hf= 648±177, an increase in Lf/Hf=2.0±0.4. Permanent option flow is characterized by the predominance of the parasympathetic influences VLf=2413±227,Lf=1659±270, Hf=1521±522, Lf/Hf=2.0±0.5 (9).

However, this method is not without disadvantages, the main of which is the loss of precision due to the duration of observation (24 hours), during which the vegetative crisis (sympathoadrenal, car-weselny)may not occur. Due to the presence of many unaccounted researcher factors influencing heart rate variability, reduced the accuracy of the obtained results and their interpretation. The method does not allow to identify the severity of SVD and accordingly to perform a correct treatment.

To improve the accuracy of diagnosis of syndrome of a vegetative dystonia, by identifying its severity calculate vegetative index (Cerdo)determine the spectral indices of HRV (Hf, Lf, VLf, Hfn, Lfn, Tp) and calculate the indicator of autonomic tone in the cardiovascular system, which is the ratio of the magnitude of the vegetation index (VI) to total monotonicty (Tp (MS 2)), he values assess the severity.

The method is as follows:

The examined individuals after clinical studies, including the measurement of systolic and diastolic blood pressure, counting the number of heart contractions alone taking into account age-related changes (6), identify the symptoms of the syndrome of a vegetative dystonia with generalized character and permanent flow. Next in patients with SVD calculation vegetative index Cerdo (VI) according to the formula (5) VI=(1-D/R)·100, where D is the value of diastolic blood pressure,

R - the number of heartbeats.

Then for objectification level of autonomic influences carry out the calculation of the spectral indices of heart rate variability (HRV) under standard conditions according to the standard technique and the existing criteria (11, 12) with subsequent computer analysis and automatic calculation necessary for the study of HRV spectral indices. Obtained in absolute units and expressed in MS2values are subjected to logarithmic transformation.

In further calculates the indicator of autonomic tone based on known vegetation index and the total power of the spectrum - ln Tr. Calculate the indicator of autonomic tone as the ratio vegetative index and C is aceniu total power spectrum (EI/lnTp (MS 2)). This indicator is integral and characterizes as heart rate variability as a whole and reflects the direction of autonomic influences on the cardiovascular system, gives you the ability to judge the severity of the SVD and to predict the occurrence of hemodynamic changes.

The obtained parameters are interpreted as follows:

1. The values of the indicator of autonomic tone (VI/lnTp (MS2)) >3,1 obtained due to the reduction of the total power spectrum and register positive elevated values VI, should be considered as severe SVD, be regarded as a state of inadequate autonomic tone in the cardiovascular system, at which the probability of development of hemodynamic disturbances after the load test is 67% and require medical treatment.

2. The values of the indicator of autonomic tone (VI/lnTp (MS2)) 3,1-2,2 obtained due to the reduction of the total power spectrum - lnTp (MS2and the availability of reduced positive values VI, should be viewed as medium severity. Be considered as a state with respect to adequate autonomic tone in the cardiovascular system, in which the occurrence of hemodynamic disturbances after the load test is possible in 19% of cases, and predskazuemaja valuable the th negative result is 81%, require sanatorium treatment, a course of physical therapy.

3. The values of the indicator of autonomic tone of 2.1 and 1.5, calculated on the basis of slabopolozhitelnym, null, lobotrachelini values VI and the high values of the total power spectrum - lnTp (MS2) be interpreted as a mild case, not requiring medical interventions. Be considered as the state with adequate vegetative effects on the cardiovascular system, which is not accompanied by disturbances of hemodynamics after load test.

4. The values of the indicator of autonomic tone less than 1.5 be considered as normal.

The indicator of autonomic tone has been tested on 97 young people, among whom 25 had severe, 28, with an average degree of gravity, 27, with a slight variation of currents and 17 formed the group with normal values (table. 1).

Table 1

The values of the indicator of autonomic tone
The indicator of autonomic toneYoung people (n=97)
Severe N=25The average degree of severity N-28Easy for N-27Norm

N=17
VI/lnTp (MS2)>1 3,1-2,22,1-1,5<1,5

Example 1

Young girl S. (23 years) complained of feeling palpitations, the feeling that can lose consciousness in a stuffy room, sleep disorders, redness of the face for any emotion, decreased performance, feeling of shortage of air. When clinical examination of this patient's organic pathology has been excluded, blood pressure (100/60), the number of heartbeats = 100 per minute. On the basis of complaints and data of objective examination suggested the diagnosis of SVD. Calculation of indices of HRV showed a reduction in the total power spectrum lnTp=7,02 (MS2). VI=(1-60/100)·100=40. The indicator of autonomic tone (40/7,02) was 5.6. Given the fact that the values of the indicator of autonomic tone of the patient more than 3.1, it was classified in the group with severe and high risk of hemodynamic disorders.

To determine the tolerance to physical load run load test on the Bicycle Ergometer. The test was terminated at the 3rd minute when a threshold power of 50 watts (300 KGM/min) due to fatigue, BP 150/90 mm Hg, pulse rate 140/min, tolerance to physical load was regarded as low. In the recovery period, there was echocardiographic examination using the standard method, which also revealed a decrease in ejection fraction (EF), is largely systolic shortening (FS), inadequate increase in cardiac output (CO), blood, heart (CI) and stroke index (SI), combined with increased total peripheral vascular resistance (SVR). The patient is the recommended course of therapy. However, after 3 weeks of research on the above scheme revealed previous changes (clinical manifestations, and instrumental). Subsequently, the patient underwent a course of treatment selective β - blockers (corvitol) for 3 weeks, against which noted the disappearance of palpitation, feeling of shortage of air, increase efficiency. HELL 110/70, pulse rate 80 per minute Registered the increase in the total power spectrum lnTp (7,1 MS2), the reduction of VI to 13. The value of the indicator of autonomic tone corresponded to 1.8. When performing echocardiography in the recovery period after exercise revealed adequate offered load, the change in hemodynamic parameters.

Example 2

Young girl Century (22 years) complained of increased sweating and shortness of breath with excitement, feeling heartbeat, fatigue. When clinical examination of this patient's organic pathology has been excluded, AD (115/65), the number of heartbeats = 82/min On the basis of complaints and objective data about the surveys suggested the diagnosis of SVD. Calculation of indices of HRV showed a reduction in the total power spectrum lnTp, which amounted to (7,03 MS2). VI=(1-65/82)·100=21. The indicator of autonomic tone (21/7,03 MS2) was 2.9. Given the values of the indicator of autonomic tone within 3,1-2,2, the patient was diagnosed SVD moderate severity.

To determine the tolerance to physical load run load test on the Bicycle Ergometer. Test terminated at the 3rd minute when the threshold power is 75 watts (450 KGM/min) because of the achievements submaximal HR age=173/min, BP 150/80 mm Hg, exercise tolerance was assessed as average. In the recovery period performed echocardiographic examination using the standard method. Decreased ejection fraction (EF), stroke volume of the heart (SV).

The patient was recommended to undergo a course of physical therapy. After 3 weeks of research on the above diagram showed a reduction in VI to 8, increasing the total power spectrum lnTp to 7.3 MS2and indicator of autonomic tone VI/lnTp (MS2) to 1.1. Conducting a load test helped to identify adequate load increase indicators of systolic heart function, decrease SVR.

Example 3

The young man A. (20 years) complained of polysensorial when excited, redness of the face, prone to headaches, shortness of breath in a stuffy room. When clinical examination of this patient's organic pathology has been excluded, AD (125/70), HR=80/min On the basis of complaints and data of objective examination suggested the diagnosis of SVD. Calculation of indices of HRV showed a reduction in the total power spectrum lnTp, which was 7.1 MS2. VI=(1-70/80)·100=12,5. The indicator of autonomic tone (12,5/7,1 MS ) was equal to 1.7. Given the values of the indicator of autonomic tone, within the limits of 2.1 and 1.5, was diagnosed SVD with a slight current.

To determine the tolerance to physical load run load test on the Bicycle Ergometer. The test was terminated at the 3rd minute when a threshold power of 125 watts (600 KGM/min) due to reaching the maximum load, the HELL 155/80 mm Hg, heart rate of 133/min, tolerance to physical load was regarded as high.

In the recovery period performed echocardiographic examination using the standard method. Identified an adequate increase in ejection fraction (EF), the degree of systolic shortening (FS), percussion (CO) and minute volume (SV), stroke (SI) and heart (CI) indices, adequate reduction in SVR.

On the basis of obtained results it was determined that the patient does not need the implementation of the medical-fizkulturnikneri and medical treatment.

Literature:

1. Romasenko L.V., Vedenyapin O.Y, verbena AV description psychosomatic relations in patients with neurocirculatory dystonia // Proceedings of SSC for social and forensic psychiatry named. Vpostalskogo, MMA. Sechenov. - 2002. - 4. No. 1. - P.24-25.

2. Belokon N.A., Rozanov V.B. have been heart Disease and blood vessels in children: a Guide for physicians. - M.: Medicine, 1987. - T. 1. - P.30-32.

3. Levin LI Adolescent medicine: a Guide for physicians. - SPb.: Special literature, 1999. - 200 S.

4. Wayne A. M. Autonomic disorders: Clinical-Diagnosis-Treatment. - M: Medical information Agency, 1998. - P.54-55.

5. Ivanov SV, NMHC RAMS Psychosomatic disorders in cardiology. HEART journal for clinicians Volume 1, No. 4, 2002. C-172.

6. Makolkin V.N., Abakumov S.A. Neurocirculatory dystonia in therapeutic practice. - M.: Medicine, 1980. - 192 S.

7. Pokalen G.M. Neurocirculatory dystonia. - Nizhny Novgorod: publishing house of the ngma, 1994. - 299 S.

8. Ananin F. W. the Bioregulation of man: a Monograph in 10 volumes. - M.: Publishing House. investigative Agency "Glasnost" and Biomedinvest, 1994. - T.1. - 104 S.

9. Macheret EL, Murashko NK, Shepherd TI the heart rate Variability depending on the type of the current syndrome of a vegetative dystonia // Bulletin of Arrhythmology. - 2000. No. 16. - P.17-20.

10. Bags A.P. Functional (neurogenic) heart disease. - The lower the rd Novgorod: publishing house of the ngma, 1999. - 204 S.

11. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability. Standards of Measurements, Physiological Interpretation, and Clinical Use. Circulation 1996. - No. 93. - P.1043-1065

12. Malliani A. Physiological interpretation of the spectral components of heart rate variability (HRV) // Bulletin of Arrhythmology. - 1998. No. 9. P.47 - 56.

13. Avalov I.S., Graciansky N.A., Plovers YA.. heart rate Variability in acute coronary syndromes: implications for the assessment of the prognosis of the disease (part 2) // Cardiology. - 1997. No. 3. - P.74-81.

The way to diagnose the severity of the syndrome of a vegetative dystonia, including the determination of the spectral indices of heart rate, characterized in that the calculated value of the vegetation index and calculate the indicator of autonomic tone by formula VI/lnTp, MS2where VI - vegetative index lnTp - total power spectrum of HRV, and when the metric value >3,1 diagnosed with severe syndrome of a vegetative dystonia, with values of 3.1-2,2 - moderate, with values of 2.1 and 1.5 - easy for.



 

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