Cardiac neurosis
Introduction
Introduction to Cardiac Neurosis Cardiac neurosis, also known as cardiac neurosis, is a special type of neurosis. It is characterized by palpitations, chest pain, shortness of breath, and fatigue. It is characterized by other neurosis and is one of the most common cardiovascular diseases in the clinic. The disease accounts for more than 10% of patients with general cardiovascular symptoms. Palpitation is the most common symptom, pain in the precordial area, lack of air, poor breathing, short and irregular breathing, accompanied by chest pain, fatigue, dizziness, headache, blushing, insomnia, dreams, anxiety, irritability, Loss of appetite, nausea and vomiting, not positioning muscles, sweating of the ankle, numbness of hands and feet. basic knowledge The proportion of illness: 0.0006% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute left heart failure in the elderly
Cause
Causes of cardiac neurosis
Familial (30%):
The etiology of this disease is still unclear. Like the general neurosis, it is mainly due to excessive stress in work and life, anxiety or sharp contradiction between people. The cerebral cortex is strongly stimulated, which causes obstacles in the process of excitation and inhibition of the cerebral cortex, leading to the central nervous system. Neurological dysfunction, autonomic dysfunction, causing abnormal cardiovascular function. The same family or the same environment is prone to neurosis, and often the same family of parents, brothers, sisters have varying degrees of neurosis.
Iatrogenic (30%):
Misdiagnosis of non-organic heart disease as a heart disease due to a diagnosis or misinterpretation of medical staff, such as misdiagnosis of harmless heart murmur as mitral insufficiency, sinus arrhythmia as arrhythmia, temporary Elevated blood pressure as a high blood pressure disease can cause the patient to be overburdened, nervous, and anxious to induce the disease.
Nerve type introversion (10%):
The patient's emotional vulnerability, depression, sentimentality, mental stimulation or work stress can induce the disease.
Hi quiet less (10%):
The patient usually lacks exercise, and at the same time, he is more vigorous, the heart is heavier, the heart beats faster or the premature contraction occurs, and the heart is overly noticed.
Lack of awareness of heart disease (5%):
When a patient sees a family member or a colleague who has a heart attack or hears a heart attack patient who is dying, he or she is worried and can induce the disease.
Some symptoms such as heart palpitations, palpitation and beta receptor allergy syndrome (hyperfunction), it is believed that the body's allergy to beta receptor is one of the main causes of this disease.
Pathogenesis
The etiology of cardiac neurosis is similar to neurosis, and is thought to be related to factors such as constitution, nerves, behavior, external environment, and heredity. The patient's neurological type is often weak, and family members may have neurosis. Patients usually have a narrow range of activities, are indifferent to environmental matters, are not interested, and are more accustomed to suppressing their emotions, depression, anxiety and sorrow. When various external loads, stimuli or strains are mentally irritated or work is tight, often Can not adapt to this environment, easy to get sick or worsen symptoms, family members with more serious heart disease or sudden death due to heart disease can often induce the disease, but also because the patient lacks knowledge of heart disease, will Some physiological cardiovascular changes such as "physiological murmurs" by doctors, "sinus arrhythmia" and other misunderstandings, or incorrectly diagnosed as "heart disease" can often become a causative factor. On the basis of less physical activity, more mental work, and lack of exercise in the circulatory system, smoking, drinking tea or coffee causes a strong heart beat or Early beat, can often lead to heart patients produce too much attention to cardiac neurosis.
The cardiovascular system is regulated by the nervous and endocrine systems, in which the regulation of the nervous system plays a leading role, the sympathetic nerves accelerate the sinus node impulse, and the vagus nerve slows the sinus rhythm. When the central nervous system is dysfunctional, the sympathetic and vagus nerves The normal activities are also disturbed, and the function of the cardiovascular system is disordered, resulting in a series of sympathetic hypertonic manifestations. The mental, environmental and other stimuli can cause various physiological changes, mainly manifested by increased sympathetic activity and adrenal cortex. Increased hormone secretion, clinical studies have also shown that patients with this disease have abnormal reactions to exercise, psychological tests and pain stimuli, such as the maximum oxygen consumption during exercise is lower than normal and the difference between arteriovenous oxygen content and capillary blood flow slows down. , increased blood lactate, etc., propranolol and other adrenergic receptor blockers in the treatment of cardiac neurosis, the patient is accompanied by high dynamic circulation, such as increased left ventricular ejection speed Increased cardiac output, increased arterial pulsation and occasional increase in systolic blood pressure, treated with propranolol Now disappeared, further supporting the presence of the disease -adrenergic receptor function hyperactivity syndrome.
Prevention
Cardiac neurosis prevention
1. To educate patients to understand the nature of the disease to relieve the patient's ideological concerns, medical workers should treat patients with sympathy and concern, gain their trust, and must firmly tell patients that their heart is completely normal after diagnosis is confirmed. .
2. Work with the patient's family to improve the patient's living and working environment to avoid various factors that can cause the disease to worsen, create favorable treatment conditions, and enhance the patient's confidence in fighting the disease.
3. Encourage patients to adhere to work and physical exercise, daily life, and avoid fatigue and stressful work.
Complication
Cardiac neurosis complications Complications, acute left heart failure in the elderly
The patient is extremely nervous and does not dare to rotate the position, or there is tenderness in the ribs, soft tissues and surface skin of the precordial area. Difficulty breathing, patients often feel insufficient air, poor breathing, short and irregular breathing, accompanied by chest pain, indoor crowds or poorly ventilated places are prone to attack, often sigh style after breathing feel comfortable or face the window to breathe fresh air . However, deep breathing for a long time may cause numbness, dizziness, dizziness, tremors, and even convulsions in the limbs.
Symptom
Symptoms of Cardiac Neurosis Common Symptoms Systolic murmur palpitations, dizziness, tachycardia, fatigue, angina, heart rate, anxiety, loss of appetite, chest pain
Symptoms are repeated and variable, but there are few positive signs, and autonomic dysfunction is the main manifestation.
1. palpitations are the most common symptoms, conscious heartbeat, pulsation and discomfort in the anterior region, more obvious in sports or emotional excitement, purely subjective feelings of the patient, objective examination without any findings, but sometimes visible apical beats are more powerful, or sinus Sexual tachycardia, occasional atrial or ventricular premature contraction or transient paroxysmal supraventricular tachycardia, mild activity can make the heart rate disproportionately significantly faster, patients often do not dare to move.
2. Pain in the precordial area is self-explanatory as angina pectoris, but its location and nature are different from typical angina pectoris. The pain site is not fixed, and it is limited to a small area of the apical region and the left breast area. It can also be under the sternum or right chest or On the chest and back, the pain is a tingling or knife-cut pain that lasts for a few seconds or a slight pain that lasts for hours or days. Sometimes the pain can be radiated to the outside of the left forearm or finger pain. The pain is not related to labor. After the activity, After mental fatigue, even when there is rest, pain occurs. Some patients can relieve the pain when they press the painful part or the left lateral position. Other patients are nervous and do not dare to rotate the position, or the anterior rib, soft tissue and its surface. The skin has tender points.
3. Patients with dyspnea often feel insufficient air, poor breathing, short and irregular breathing, accompanied by chest pain, indoor crowds are crowded or poorly ventilated places are prone to attack, often sigh style feels comfortable after breathing or facing the window fresh breath Air, but deep breathing for a long time can appear numbness, dizziness, dizziness, tremors and even convulsions in the hands and feet. This is excessive breathing, blood carbon dioxide concentration is reduced, mild respiratory alkalosis occurs, so-called hyperventilation syndrome When breathing is difficult to lie down, it is different from heart dyspnea.
4. Symptoms of neurasthenia often complain of fatigue, dizziness, headache, blushing, insomnia, dreams, anxiety, irritability, loss of appetite, nausea and vomiting, no positioning of muscles, sweating of the ankle, numbness of hands and feet, etc. .
5. Physical examination is often weak, anxiety or depression, indifferent face, sweaty palms, shaking hands, some patients have low fever of about 37.5 °C, blood pressure is slightly elevated and volatility, which may be related to body temperature regulation of central and vascular movement Central dysfunction, heart rate increase, sinus arrhythmia, apex beat strong and powerful, the first heart sounds hyperthyroidism, apical area can smell 1/6 ~ 2 / 6 soft systolic murmur, or sternal left edge 2 ~ 3 intercostal 2/6 systolic murmur, occasional premature contraction, knee reflex, most of the scratch test, no change in cardiac X-ray examination, no specific changes in ECG, sinus tachycardia, sinus Sexual arrhythmia, occasionally II, III and aVF lead T wave flat or lightly inverted, when the time is hidden, double secondary ladder or active plate load test positive is not uncommon, propranolol (propranolol) test Most of them can slow down the heart rate, the ECG ST-T changes back to normal, and the exercise test turns negative.
6. Classification According to the results of cardiac function test, cardiac neurosis can be divided into two types: 1 sympathetic nerve excitability: 73.4%, with fast heart rate, high blood pressure; 2 vagus nerve excitability: 26.6% With a slow heart rate and low blood pressure.
Examine
Cardiac neurosis
1. There is no abnormality in cardiac X-ray examination.
2. Electrocardiogram often has sinus tachycardia, atrial or ventricular premature beat or non-specific ST segment and T wave changes, most of which are ST segment J point depression or horizontal sample down, T wave low level, two-way or Inverted, ST-T wave changes are limited to II, III, aVF or V4 ~ 6 lead, and are easier to change, sometimes disappear, sometimes worse, heart rate increases often make ST-T wave abnormal aggravation, and heart rate When slowed down, the ST-T wave can completely return to normal.
3. It is not uncommon for double-step or active plate exercise load test to be positive. Most of the -adrenergic blockers such as propranolol can slow heart rate, relieve or disappear symptoms, and change ECG ST-T wave. Return to normal, and make the exercise load test negative, after acupuncture people to meet the point, ST-T wave changes can return to normal.
Diagnosis
Diagnosis and diagnosis of cardiac neurosis
diagnosis
According to the above-mentioned symptoms of cardiovascular system dysfunction, the signs are less, non-specific, plus the performance of systemic neurosis, and the evidence of structural heart disease can not be found by detailed systemic and cardiovascular system examinations. It can make a diagnosis of cardiac neurosis, but it is necessary to eliminate organic heart disease as much as possible. On the contrary, it should be vigilant to misdiagnose this disease as organic heart disease. In addition, the initiality of some organic heart disease can be objectively unchanged. Evidence, and organic heart disease can also be associated with cardiac neurosis, or the latter occurs on the basis of the former, so the diagnosis must be cautious, based on clinical manifestations and laboratory tests to determine the severity of cardiovascular disease, and nerves The ingredients occupied by the disease.
Differential diagnosis
1. Hyperthyroidism due to palpitations, nervousness, hyperhidrosis, irritability, increased heart rate, increased heart beats, hand tremors and other similar cardiac neurosis, but hyperthyroidism mostly has goiter, check serum T3, T4 and thyroid The 131I rate is increased and can be identified.
2. Patients with angina pectoris with angina pectoris as the main manifestation should be differentiated from angina caused by coronary heart disease or aortic stenosis. Typical angina pectoris is common with sternal pain, which is tight in the chest and suffocation can be radiated to The left shoulder or the inside of the left arm usually lasts for 2 to 3 minutes. Stopping the activity or sublingual nitroglycerin is quickly relieved. It is often induced by fatigue and tension. The heart neurosis is not fixed. It is a transient tingling and knife cutting. Pain or persistence (hours) pain, nitroglycerin is often ineffective, can be distinguished, but many coronary heart disease early, angina is not typical, especially in menopausal women, ECG also has ischemia changes (ST segment decline, T Wave low or inverted) At this time, there is a certain difficulty in differential diagnosis. It can be used as propranolol (propranolol) test. Oral 20mg or 2.5mg added to 25% glucose solution after 10ml dilution and intravenous slow injection, respectively, at 30min and 60min Review of ECG, ST-T changes in patients with coronary heart disease, and ST-T abnormalities in patients with cardiac neurosis disappeared. Most people think that propranolol test has differential diagnosis and can be used for coronary angiography or nucleus if necessary. Myocardial imaging to help diagnosis.
3. Mitral valve prolapse syndrome This disease is often caused by mitral mucus-like degeneration or papillary muscle ischemia caused by mitral valve prolapse, the symptoms are different, often heart palpitations, chest tightness, shortness of breath, pain in the precordial area , knife-like pain, with tachycardia, similar to cardiac neurosis, especially young women, to rule out mitral valve prolapse syndrome, auscultation systolic non-ejection click and systolic murmur, is the second tip The characteristics of the valve prolapse syndrome, echocardiography can be seen in the mitral systolic CD segment of the arch-shaped abnormal posterior movement or mitral anterior or anterior systolic detachment into the left atrium is characterized, identification is not difficult.
4. Chronic infectious diseases Some insidious infections, such as extrapulmonary tuberculosis, chronic urinary tract or liver, biliary tract infections, palpitations, shortness of breath, dizziness, fatigue, increased heart rate, low fever and other symptoms are confused with cardiac neurosis. However, elevated blood sedimentation, leukocytosis and abdominal ultrasonography or CT examination can find lesions, which is helpful for identification.
5. Rheumatic fever, heart disease, heart disease, heart rate, first heart sound hyperthyroidism and systolic murmur, low fever and rheumatic fever, but the fever of this disease is low, no migratory joint redness, swelling, pain, rash, Accelerated erythrocyte sedimentation rate and serum anti-streptolysin "O" increase and other signs can be identified.
