Symptoms of vasospasm and treatment. Spasm of the coronary vessels of the heart and brain: symptoms, causes

Diagnosis and treatment.

Vasospasm (angio- or vasospasm) is a pathological contraction of the muscle fibers of the artery wall, causing a narrowing of the lumen and disruption of normal blood flow. Against the background of vasospasm, an acute lack of oxygen in the tissues occurs, which distinguishes it from the physiological narrowing of blood vessels (vasoconstriction) - an element of the internal regulation of blood movement through the capillaries and arteries.

The pathological process affects only arteries of the muscular and mixed types (divided by the content of smooth muscle cells). The elastic type (aorta and pulmonary arteries) is not affected. With vasospasm, the middle membrane of the vessel contracts, and the inner (intima) becomes corrugated and, protruding into the lumen, further disrupts blood flow.

The structure of various types of veins and arteries. Click on photo to enlarge

The mechanism of development of vasospasm is not fully understood. It is known to be associated with disruption of the movement of potassium, sodium and calcium ions through cell walls. With pathology, both types of channels for their movement are blocked, which leads to a failure in the regulation of contraction-relaxation processes in the artery wall.

This block is caused by two reasons, which can act both independently and jointly:

1. Biochemical changes at the level of hormones.
2. Disturbance of the innervation of the vessel wall with a predominance of sympathetic influence.

Against the background of vasospasm, the inflow of arterial blood, carrying oxygen and nutrients necessary for the normal functioning of tissues, an ischemic zone appears. This condition gives clinical manifestations, which depend on the area with impaired blood flow.

Vasospasm occurs in arteries of medium size or diameter, which is associated with their leading role in regulating blood circulation in the body. They're in to a greater extent respond to internal and external influences that normally cause vasoconstriction.

Visualization of vasoconstriction and vasodilation processes

Given the uncertainty of the development of pathological disorders during vasospasm, there is no possibility of a complete cure. Patients receive syndromic therapy, recommendations for eliminating risk factors and treating diseases of cardio-vascular system, if they are.

Angiospasm can go away on its own within 20–30 minutes, but discomfort from the symptoms of the disease, as well as an increased risk of developing acute blood flow disorders, usually require correction.

Patients with vasospasm are observed and treated by doctors of many specialties. Given the extent of the damage to the body, the help of a cardiologist, therapist, neurologist, ophthalmologist, vascular and general surgeon may be required.

Causes of vasospasm

The clear reasons causing the pathological contraction of the arterial wall are still unknown.

Characteristic symptoms

Symptoms of vascular spasm and the degree of deterioration in the patient’s well-being depend on the location of the pathological process and the presence of concomitant diseases.

If the somatic condition is satisfactory, then vasospasm in the fundus or abdominal cavity It is tolerated relatively well, although during the period of manifestations of the disease it is quite difficult to carry out any usual activities - a break is necessary.

Damage to the cardiac and cerebral arteries is more severe and limits the patient in any activity, causing significant psychological discomfort.

The peripheral type of spasm is distinguished by a progressive course with the gradual addition of changes in the tissues. Patients may become unable to work.

Coronary or cardiac type

Manifestations occur without connection with load or stress, often in the early morning hours. The duration of the attack is from 5 to 30 minutes. Multiplicity - from one per day to one every several months. Outside of attacks there are no symptoms of the disease.

Blood supply to the heart. Click on photo to enlarge

• Sudden, sharp, burning pain in the chest.
• Pronounced sweating.
• Frequent heart beats more than 100 per minute.
• Intense headache.
• Nausea, less often – vomiting.
• Reduced pressure.
• Shortness of breath at rest.
• Marked weakness.
• Impaired consciousness - from darkness to deep fainting.
• Paleness of the skin.
• Various forms of tachyarrhythmia - not always.

Cerebral or brain type

Usually there are no trigger mechanisms - a spasm develops against the background of complete health at any time of the day. In some patients, an attack occurs when there is a change in atmospheric pressure, consumption of certain foods or drinks, sudden sound or light exposure, or an increase in blood pressure. The duration of the attack is up to half an hour, sometimes longer.

Blood supply to the brain. Click on photo to enlarge

• Intense headache various localizations: from a certain zone or half to a diffuse form, extending to the entire scalp.
• The pain may spread to the neck, parotid and orbital areas.
• Any external influences often increase the intensity of the pain syndrome.
• Gagging or vomiting.
• Small black dots before the eyes, light flashes.
• Feeling of tingling, slight chills in different parts bodies.
• Loss of balance due to dizziness.
• Clouding of consciousness and psychotic disorders are rare.

Ophthalmic, or eye, type

The attack begins without a reason; it is impossible to predict its occurrence.

1. Sudden loss of vision.
2. The appearance of flies, lightning or dark spots before your eyes.

Mesenteric, or abdominal, type

Clearly associated with food intake: manifestations occur 20–40 minutes after eating. Due to disturbances in the absorption of nutrients, the patients' condition slowly progressively worsens.

Blood supply to the abdominal cavity. Click on photo to enlarge

• Pain in all parts of the abdomen with increasing intensity.
• Painful nausea, periodically vomiting food.
• Increased bowel movements, audible from a distance.
• Bloating.
• Copious loose stools within an hour or two after eating.
• Loss of body weight.
• Depression.
• Insomnia.

Peripheral type

Provoking factors: low temperature, nicotine, stressful situations. The attack of spasm lasts from several minutes to an hour in the later stages of the disease. Fingers and toes are affected, and sometimes the chin and tip of the nose.

• Numbness, tingling sensations in the hands and feet.
• Then the skin in the affected area turns pale.
• The end of the attack is characterized by pain syndrome and severe redness of the fingers.
• As the disease progresses, a slight bluish discoloration and moderate edema appear (addition of venous insufficiency).
• The extreme phase of the disease is characterized by tissue necrosis with the formation of ulcerations, necrosis of the fingertips and melting of bone structures.

Diagnostics

Vasospasm is a diagnosis of exclusion, that is, even with initial suspicions of arterial spasm, it is necessary to further examine the patient in order to exclude other diseases of the heart and vascular system.

Survey

It comes first in the diagnosis of all forms of vasospasm. During it, be sure to clarify:

1. All types of complaints.
2. The time of their appearance.
3. Presence of attack-provoking factors.
4. Diseases that the patient has had or is currently suffering from.
5. What medicinal and non-medicinal products he currently uses.
6. Presence of risk factors for vasospasm.
7. Features of work and rest.

Inspection

It is possible to identify only characteristic manifestations for the second and third phases of peripheral spasm. Other species do not have typical external symptoms.

In addition, indicators of the cardiovascular system (pulse, blood pressure, visual inspection accessible arteries, veins) in order to identify other diseases.

Laboratory research

There are no typical changes. In the abdominal type, a nonspecific pathology of internal metabolism is determined ( low level protein fractions, changes in electrolyte composition, decrease in hemoglobin levels).

Electrocardiography

Changes according to acute failure blood flow in the myocardium are detected against the background of a coronary type attack. They pass along with the end of the pain syndrome.

The study is supplemented with medicinal and physical tests. During spasm they are negative.

Other types of pathology occur without typical changes on the cardiogram. They may appear if the patient has other heart problems.

Daily ECG monitoring

Indicated for patients with suspected vasospasm of the cardiac arteries to detect an attack and determine the degree of rhythm disturbance.

Ultrasonography with duplex examination

Examine the heart, arteries of the neck, head and limbs to identify:

• atherosclerotic changes;
• thrombosis;
• structural anomalies;
• aneurysm.

True vasospasm does not manifest itself in any way outside of an attack of illness. In the peripheral type, an attack can be caused by conducting a cold test, which is used to verify the diagnosis.

Angiography

The most reliable method of studying the entire vascular system, allowing a definitive diagnosis of vasospasm.

Angiogram of a healthy and spasmodic vessel

Limited use is due to the need for special equipment and medical personnel.

Can be replaced by using the vascular program when performing any type of tomography.

Treatment methods

Angiospasm is a disease, the causes and mechanisms of which continue to be studied at the present time. Given this fact, it is not possible to completely cure the pathology. Some patients report a good response to treatment, while others have virtually no response. It is impossible to predict the effect of treatment.

How to relieve vascular spasm to achieve improvement is further in the article.

Conservative and medicinal methods

Also, vascular spasm partially relieves:

• acupuncture - insertion of thin needles into special reflexogenic zones, which causes relaxation of muscle fibers;
• physiotherapy - thermal procedures that cause expansion of the vascular network.

Surgical methods

If medications are ineffective or the disease progresses, surgical treatment is performed:

1. Crossing the Sympathetic nerve fibers, going to the area with vasospasm, or complete removal of the nerve ganglia.
2. Installation of vascular stents (specialized medical “nets” for mechanical expansion of the narrowing zone).

Forecast for life

There is no cure for the pathology. But treatment helps improve the patient’s well-being and reduce the risk of complications of the disease.

In the peripheral form, the frequency of attacks decreases significantly when changing the climatic zone of residence, giving up nicotine and preventing hypothermia.

Surgical methods of treatment for abdominal type lead to a significant improvement in the quality of life of patients.

The coronary type without atherosclerotic changes in the arteries is accompanied by a risk fatal outcome in 0.5% of cases, if available, increases to 25%.

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Treatment and causes of vasospasms

Angiospasm or spasm blood vessels is a narrowing of the lumen of the arteries due to excessive prolonged contraction of the walls. The spasm is temporary - up to 20 minutes, but the consequences in this case can be severe.

Mechanism of the disorder

The electrochemical basis of spasm comes down to a disorder in the transport of metal ions - sodium, potassium and calcium. A lack of sodium and potassium leads to erratic contraction of smooth muscles, and the influx of calcium ions contributes to spasms of the walls and prevents lowering muscle tone.

Vascular angiospasm is local in nature, as a rule, in the area of ​​inflammation, thrombus, aneurysm, and does not extend to the entire bed of arterioles. However, as a result of the narrowing of the duct, the tissue area in the spasm zone does not receive sufficient oxygen and nutrition. With frequent repetition of this phenomenon, ischemia develops.

Spasm can be physiological or pathological in nature.

Physiological spasm

The narrowing of the lumen of a blood vessel is one of the body’s protective mechanisms. In open injuries and wounds, arterial spasm reduces blood loss. With cooling, bleeding the periphery reduces heat loss and allows you to focus on servicing more important internal organs.

In stressful situations - danger, narrowing of arterioles allows you to increase blood pressure. At the same time, adrenaline is released into the blood, mobilizing all the body’s forces for the upcoming fight.

Pathological spasm

Pathology is an excessive reaction to an irritating factor, incommensurate with the degree of irritation. If, during normal cooling, warm air quickly causes vasodilation, then a pathological spasm with the same external signs - white “alabaster” skin, blue discoloration, a decrease in the temperature of the skin, can occur at any time and is weakly related to the air temperature.

Angiospasm is the first stage of a disorder in the functioning of the cardiovascular system. Its signs cannot be ignored, which, unfortunately, happens quite often: spasms are short-lived and therefore seem harmless.

In fact, periodic “starvation” of tissue ends in failure:

• tissue swelling in the spasm zone increases. In this case, the permeability of the capillary walls is disrupted, which leads to protein loss;
• the walls of the venules are weakened, vascular paresis is possible, which automatically leads to impaired circulation;
• The more often vasoconstriction is observed, the more pronounced the signs of ischemia become. Partial or complete loss of organ functionality and the development of necrotic complications are possible.

Depending on the location of the zone, several types of vasospasms are distinguished:

• spasm of the vascular periphery - capillaries, small arterioles. IN to the greatest extent The hands are susceptible to this;
• channel narrowing great vessels– the consequences of such a spasm are much more noticeable and much more severe;
• vasospasm coronary vessels;
• cerebral vasospasm.

The clinical picture is associated with an ischemic organ and manifests itself as insufficient functionality.

Causes of vascular spasms

The mechanism of the disease is not well understood. In addition, it is not identical for different vascular regions.

The cause of pathological vasospasm is unclear, although there are a number of factors that stimulate the development of the disease:

• Smoking is one of the most potent external factors. Smoking leads to constant constriction of blood vessels and any other, weakest factor - a cold, for example, can lead to spasms;
• intoxication with carbon disulfide compounds and lead. Nowadays it is quite rare, as it occurs with constant contact with toxic substances;
• atherosclerosis - it is known that vasospasms most often occur in the area where there are atherosclerotic plaques;
• inflammation of blood vessels of various types;
• disorders of nervous regulation are the most extensive group, since the cause of disturbances can be a lot of factors, both internal and external: from a malfunction endocrine system to any neurosis.

Description of symptoms

The external manifestation of the disease is more noticeable if it is associated with a narrowing of the capillaries. In this case, the affected area acquires an alabaster-white color. Spasms of large vessels are noticeable only by deterioration in functionality.

• Angiospastic syndrome is characteristic of Raynaud's disease. It is sometimes called the “white fingers” symptom. Bleeding of the hands occurs, while the fingers become white, lose sensitivity, and become cold.
• Livedo reticularis - an area of ​​skin (usually on the thighs or ankles) acquires a uniform bluish tint, sometimes in the form of a mesh, the skin around the area turns pale and cold. The bluish tint is due to partial paralysis of the venules. Subsequently, the spasm leads to severe swelling of the affected area and the onset of necrotic processes.
• Spasm of the main artery - “commander's leg”. The picture is similar to Raynaud's disease, but extends to the entire lower limb. The leg becomes snow-white, the skin temperature drops noticeably. With prolonged spasm, the skin may acquire a bluish tint due to paresis of the venules.
• The symptoms of coronary spasm are identical to those of angina pectoris: pain behind the sternum, predominantly at rest rather than movement, is paroxysmal in nature.
• Cerebral vasospasm, as a rule, accompanies cerebral atherosclerosis, but also appears for other reasons. Its symptoms are caused by the affected areas of the brain.

Treatment of the disease

Self-medication is excluded. In the vast majority of cases, vascular spasms are associated with some other disease and are not so much an independent disease as an accompanying one. Without a thorough examination and diagnosis, it will not be possible to get rid of the disease.

Apply whenever possible conservative treatment. It consists of the following activities:

• treatment of the underlying disease – atherosclerosis, inflammatory processes, hypertension;
• restoration of normal nervous regulation;
• elimination of the consequences of temporary ischemia.

It should be noted that in the treatment of any ailments related to the functioning of the circulatory system, the participation of the patient is of great importance.

Sufficient physical activity, the use of physiological procedures - electrophoresis, ozokerite applications, hydrogen sulfide baths, not only have a beneficial effect on the condition, but also significantly help the medications.

The secret is very simple: movement activates blood circulation, and at the same time the possibility and risk of spasms is significantly reduced.

Medicines are prescribed according to the location of the disease. Thus, for cerebral vasospasm, antispasmodic drugs are used - No-spa, papaverine, for coronary spasm - nitroglycerin. To relieve symptoms, drugs that are calcium antagonists are prescribed - verapamil, thus preventing the influx of calcium ions into the cell walls.

Surgical intervention is performed if conservative intervention fails.

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Angiospasm: causes, symptoms and localizations, treatment, consequences

Angiospasm is a widely known phenomenon. There is not a person among us who has never heard of vasospasm, and many experience this phenomenon regularly. IN last years The number of patients with vascular spasms is steadily growing, and more and more young people are suffering from this dangerous and unpleasant condition.

Angiospasm (vasospasm) is a narrowing of blood vessels under the influence of various factors. It cannot be ignored, even if the usual methods of dealing with it are still effective, and taking the pill leads to improvement. It is worth remembering that each time, against the background of vasoconstriction, the tissues experience a lack of oxygen, and irreversible changes gradually develop in them. Spasm with thrombosis is especially dangerous, because it is a path to stroke or heart attack, which lead in the number of deaths worldwide.

The causes of vasospasm are varied; only a specialist can find them, a visit to whom should not be postponed. You should not get carried away with self-medication, as this can be dangerous due to the development of complications.

Causes of vasospasm

Among the main risk factors for vasospasm are:

• Smoking;
• Addiction to alcohol;
• Use large quantity strong coffee or tea;
• Errors in diet;
• Irrational daily routine with lack of sleep, physical inactivity, rare walks on fresh air;
• Physical and intellectual overload;
• Stress, emotional distress, depression.

In addition to the above, changing weather conditions can lead to vascular spasms, especially in weather-sensitive people, prolonged hypothermia, poisoning with heavy metals, narcotic substances (amphetamine, cocaine).

Only a few of us can boast of absolute health, proper routine and always in a good mood. The majority will find at least one of the risk factors, and even those who vigorously follow the principles of a healthy lifestyle are still susceptible to stress, physical and mental overload - this is required by the modern rhythm of life. With age, diseases appear that serve as the basis for vascular spasm - atherosclerosis, arterial hypertension, osteochondrosis, diabetes and others.

The mechanisms of vasospasm continue to be studied, and in different organs they may be different from each other, which is associated with the heterogeneity of the causes. It is believed that vascular spasm is based on a dysfunction of smooth muscle cells, in which they become overloaded with calcium and stop relaxing.

Manifestations of vascular spasm

Manifestations of vasospasm of arteries and microcirculation vessels depend on the localization of this process and duration. It is considered unfair to associate any ischemic phenomena in tissues with spasm when their cause is not precisely established, but this happens quite often and leads to overdiagnosis.

Among all forms of vascular spasm, the most important are the cerebral, coronary form, damage to the vessels of the extremities and eyes. The first two create the risk of severe complications and even death; you can live with the others, but the risk of trophic disorders with loss of organ function is still high. Let us dwell in more detail on individual variants of vasospasm and their symptoms.

Cerebral vasospasm

Cerebral vasospasm is a sharp narrowing of the lumens of brain vessels, which underlies cerebrovascular pathology and leads to damage to nervous tissue. Persons already suffering from atherosclerosis, high blood pressure or its fluctuations are predisposed to such a spasm; more “harmless” causes are autonomic dysfunction, stress, and neuroses.

Among the causes of cerebral spasm, a special place belongs to osteochondrosis and other changes in the cervical spine, which are increasingly diagnosed in the young population of the planet. A sedentary lifestyle and lack of exercise cause degenerative changes intervertebral cartilage, compression of large vessels supplying the brain, in response to which small arteries and arterioles spasm.

With vasospasm of cerebral vessels, patients complain of:

Short-term spasms are limited to these symptoms, and long-term disruption of blood flow in the brain, especially in people with altered vascular walls, can occur similar to transient ischemic attacks and even strokes. If collateral blood flow in the brain is well developed, then there may be no signs of vasospasm at all.

Spasms may include nausea and vomiting, speech impairment, numbness, weakness of the limbs, short-term memory problems, and focal neurological symptoms. With vasospasm of the MCA (middle cerebral artery) and its branches against the background of a stroke or rupture of an aneurysm, paresis will be noted on the side opposite to the spasm, speech impairment or recognition disorders with damage to the dominant hemisphere of the brain.

Patients with neuroses and autonomic dysfunction at the time of spasm of the blood vessels in the head often experience severe anxiety, panic attacks, turn pale, and the headache is described as squeezing, as if “the head was placed in a vice.” There are often cases when the fear of a new attack and constant worry about this leads to an exacerbation of symptoms, because stress is an important risk factor.

Coronary vasospasm

Signs of vasospasm in the heart are, in fact, an attack of angina pectoris. Sudden and persistent narrowing of the coronary arteries leads to ischemia of the heart muscle and pain - retrosternal, compressive, radiating to the left arm. Such attacks often occur at rest, in sleep, when the patient is lying down - Prinzmetal's angina.

vasospasm during angina pectoris

It is important to remember that it is spasm that underlies “young” heart attacks that occur in people years of age without coronary atherosclerosis. Such a spasm is provoked by stress, hypothermia, the use of certain narcotic substances(cocaine).

Retinal vasospasm

Angiospasm of the retina is not an independent disease and most often accompanies hypertensive crises, Raynaud's disease, severe hypothermia, severe gestosis, diabetes mellitus. Usually there is an isolated spasm without structural changes in the vascular wall itself.

Patients with spasm of the arteries of the eyes complain of short-term “blurred” vision, discomfort, a feeling of “floaters” flickering before the eyes, often combined with a headache. These symptoms last no more than an hour, rarely longer, and when examining the fundus, the ophthalmologist will detect a narrowed central artery and its branches.

Peripheral vasospasm

Angiospasm of the limbs has been studied quite well. The peripheral type of vasoconstriction is characteristic of Raynaud's disease and syndrome, atherosclerosis of the great arteries, diabetic macro- and microangiopathy.

Manifestations of microcirculation disorders in the extremities are quite typical. Pallor, cyanosis, and coldness of the distal arms and legs are noted with peripheral spasm, and if large arteries are involved, the entire leg or arm may take on a similar appearance. At sharp violation Due to the lack of blood flow, the fingers may become almost white, sensitivity suffers, numbness and soreness appear, and the skin resembles marble. Prolonged and frequently repeated spasms of the vessels of the extremities lead to disruption of metabolic processes, including trophic ulcers and even gangrene.

Treatment

It's hard to imagine correct treatment such a multifactorial pathology as vasospasm, without a thorough examination. Only after knowing the cause of the spasm can you prescribe effective medicines, procedures or even surgery.

When diagnosing vasospasm of the cerebral arteries and its causes, CT and MRI, Doppler ultrasound, and possibly angiography are used, but according to strict indications. To exclude or confirm the vertebrogenic nature of cerebral vasospasm, an X-ray of the cervical spine or MRI is required, and an ultrasound scan of the neck vessels is performed to exclude their anatomical anomalies (hypoplasia, tortuosity). If Prinzmetal's angina is suspected, an ECG is required. Retinal angiospasm requires ophthalmoscopy.

In the treatment of vasospasm, both medications and non-drug methods are used, including regimen and diet. In case of complications it is indicated surgery. Important individual approach For each patient, prescriptions should be made by a doctor, taking into account the causes of vasospasm and concomitant pathology. Self-diagnosis and taking medications are unacceptable, even if a neighbor or relative advised something that always helps them. There are many causes of vasospasm, and what helps one may be contraindicated for another.

Drug treatment involves the prescription of drugs that relax the muscle layer of the vascular wall, eliminate nervous tension, reduce blood pressure, etc.

For cerebral vascular spasms, antispasmodics are often used in “pure” form or in combination with analgesics:

These drugs eliminate one of the main manifestations of cerebral vasospasm – headache. It is worth noting that for migraine, which also causes constriction of the blood vessels in the brain, antispasmodics are not recommended, as they can increase the pain. Such patients are prescribed specific therapy with drugs from the triptan group (sumatriptan), anti-inflammatory drugs (ibuprofen, nimesil) and caffeine-containing drugs (askofen).

With vasospasm of cerebral vessels in elderly people good effect can be obtained using nootropics, which not only cause vasodilation, but also improve the functioning of nerve cells. The most popular representative of this group is piracetam, which is prescribed for a long time, at least three weeks. For chronic cerebral ischemia with vasospasms, aminalon, sermion, cavinton, cinnarizine are indicated.

A special place in the genesis of vasospasm belongs to arterial hypertension, therefore, the fight against high blood pressure is the first action that needs to be taken in this category of patients. Depending on the form of hypertension and concomitant diseases, antihypertensive drugs are prescribed - ACE inhibitors, beta blockers, calcium antagonists. It is not worth dwelling on these drugs in detail, since only a doctor can prescribe a specific drug and select the correct dose.

For vascular spasms in young people exposed to stress, suffering from autonomic dysfunction, neurosis-like disorders sedatives. In principle, they will not interfere with elderly patients in combination with treatment prescribed by a therapist or cardiologist. Among the sedative over-the-counter medications, the most popular are valerian, motherwort, hawthorn, adaptol, afobazole, and herbal sedative fees, which can be purchased at any pharmacy.

Spasm of heart vessels is a serious problem, fraught with the development of a heart attack, especially in the presence of atherosclerosis of the arteries. If, against the background of already prescribed therapy for coronary heart disease, angina attacks appear, usually indicating vasoconstriction, then patients “grab” at nitroglycerin, Corvalol, validol. These medications relieve the symptoms of heart pain, but you need to be extremely careful in every case of cardialgia and regularly visit your doctor to adjust your medication. If a spasm of the heart vessels led to a heart attack, the patient felt a “dagger” pain in the chest, then it is better to call an ambulance and not engage in amateur activities.

Vascular spasms of the extremities can appear against the background of problems with the spine, diabetes, due to Raynaud's syndrome, inflammatory changes in the walls of blood vessels. To eliminate them, peripheral vasodilators (pentoxifylline, nicergoline), vitamins, and physiotherapeutic procedures to improve blood flow are prescribed.

Unfortunately, there are often cases when, against the background of a strong spasm, thrombosis develops - blockage of the lumen of a vessel with a blood clot. This is fraught with ischemia and death of tissue elements. Thrombosis of the blood vessels of the head and heart is especially dangerous, causing strokes and myocardial infarctions. Such patients, in addition to drug treatment, including thrombolytics, blood thinners, may need surgery - stenting, thrombectomy. During these interventions, the blood clot is removed, and a thin tube (stent) is installed into the lumen of the vessel, restoring normal blood flow.

Effective treatment of vascular spasm is impossible without adherence to a regimen, diet, and adequate physical activity. Most medications eliminate spasms, but do not affect the course of the underlying pathology and do not prevent repeated spasms. Dietary recommendations include limiting strong tea and coffee, fatty and spicy foods, and flour. The diet for vasospasm is very similar to that recommended for patients with atherosclerosis, because atherosclerosis is the main risk factor for spasm, hypertension, and thrombosis.

Adequate physical activity, walks in the fresh air, and feasible exercises at home can normalize blood circulation in general, improve heart function, and therefore prevent spasms. Sports activities are especially recommended for people who lead sedentary image life, engaged in intellectual sedentary work, patients with obesity.

A healthy lifestyle or the pursuit of it in an attempt to get rid of a spasm implies a refusal bad habits. Smoking has a strong vasoconstrictive effect, so it is better to give up this habit once and for all. Alcohol is an equally dangerous addiction. Even if friends claim that a glass of cognac or a glass of red wine perfectly dilates blood vessels, it is worth limiting their consumption to a minimum, especially for those who suffer from cardiac ischemia or encephalopathy.

At home, to relieve spasm of blood vessels in the head, you can use folk recipes– St. John's wort, lemon balm, strawberry, rose hips, thyme and hawthorn are good, but, of course, you should always consult a doctor, because herbs may be contraindicated in case of severe concomitant pathology.

Cardiologist

Higher education:

Cardiologist

Kuban State Medical University (KubSMU, KubSMA, KubGMI)

Level of education - Specialist

Additional education:

“Cardiology”, “Course on magnetic resonance imaging of the cardiovascular system”

Research Institute of Cardiology named after. A.L. Myasnikova

"Course on functional diagnostics"

NTsSSKh them. A. N. Bakuleva

"Course in Clinical Pharmacology"

Russian medical Academy postgraduate education

"Emergency Cardiology"

Cantonal Hospital of Geneva, Geneva (Switzerland)

"Therapy Course"

Russian State Medical Institute of Roszdrav

Angiospasm, better known as vasospasm, is a narrowing of the lumen of blood vessels as a result of prolonged and excessive contraction of their walls. The spasm doesn't last for a long time- as a rule, a spasmodic attack lasts up to 20 minutes and at first does not cause concern in a person. Despite this, vasospasm can lead to serious consequences. In this article we will look at the causes, symptoms, and methods of treating vasospasm that occurs in the lower extremities.

Mechanism and causes of pathology

The main reason why a spasmodic reaction occurs lies in the biochemical processes of the body. When the transport of calcium, sodium and potassium ions is disrupted, frequent contraction of smooth muscles occurs, as well as spasm of the vascular walls, as a result of which muscle tone remains high all the time.

As a rule, vasospasm is localized and occurs only in the area of ​​lesions - inflammatory processes, aneurysms, blood clots, without affecting the entire bloodstream. As a result of the fact that the lumen of the vessels narrows, tissue areas in the area where vasospasm occurs do not receive sufficient oxygen and nutrients, which are transported by blood. If this phenomenon becomes permanent, ischemia may occur.

Physiological spasm

A spasm can be physiological in nature - this is one of the types of the body’s protective reaction. Thus, such a physiological reaction can appear as a result of trauma or injury (even with minor damage to the tissue of the arms and legs). A similar reaction occurs during severe hypothermia, in which the spasm performs a protective function - saving heat to ensure blood circulation in other, more important organs.

Pathological spasm

Pathological spasm occurs as a massive reaction to a certain irritating factor. For example, when the legs or arms are hypothermic, the heat causes a fairly rapid expansion of the vascular walls, but in the case of pathology, severe blanching of the skin surface appears.

Angiospasm is the first signal indicating a disturbance in the functioning of the cardiovascular system. This phenomenon is often ignored due to the fact that it does not cause much discomfort and does not last for a long time. But over time, spasms can lead to a number of negative consequences:

• Frequent spasms lead to increased tissue swelling;
• The walls of blood vessels are weakened, which ultimately leads to poor circulation;
• Ischemia gradually develops, which can cause loss of functionality of the damaged organ, as well as necrotic changes.

Most often, vascular spasm of the lower extremities is observed. It can occur both as a result of narrowing of the vascular periphery, and as a result of spasm of the great vessels. In more rare cases, cerebral or coronary vasospasm may occur.

Why does vasospasm occur?

At the moment, the mechanism of occurrence of the pathology is not fully understood, and the occurrence of spasmodic reactions in different parts of the body has a different origin. Despite this, the following factors are identified that influence the development of vasospasm:

1. Smoking. Most dangerous factor, which leads to frequent vasoconstriction.
2. Poisoning with lead and carbon disulfide compounds.
3. Atherosclerosis. The presence of atherosclerotic plaques is one of the direct factors in the development of vasospasm.
4. Various inflammatory vascular diseases.
5. Disturbances in the functioning of the nervous system. A broad group that includes both endogenous and exogenous factors— disturbances of the endocrine or hormonal system, neuroses, frequent stress, etc.

Symptoms of vasospasm

The initial symptoms are best noticeable when there is poor circulation in the peripheral vessels and capillaries. As a rule, the following symptoms of vasospasm occur:

• White finger syndrome or Raynaud's disease appears. It is characterized by bleeding of the extremities (both arms and legs), fingers become marble-white, sensitivity disappears and tissue temperature decreases.
• Livedo reticularis. On the surface of the tissues, most often in the leg area, some areas become bluish in color, and the surrounding skin becomes pale.
• Severe swelling. Most often occurs as a result of the development of livedo with ongoing spasms.
• Cramps. If the spasms become permanent, a cramp may appear in the limb in which the blood circulation is impaired.
• Spasms of the great vessels lead to the appearance of such a symptom as “commander’s leg”. The phenomenon is very similar to Raynaud's disease, but the whitening of the tissue is observed over the entire surface of the legs, and not just the fingers or feet. With prolonged spasms, the skin may become bluish.

If the vessels are narrowed not only in the area of ​​the lower or upper extremities, but also large vessels in the body area, a number of other symptoms may appear, such as attacks of headaches, visual impairment and cognitive abilities during cerebral spasm, pain in the body and disturbances in the functioning of the somatic system. system in case of spasms in the torso area.

Treatment of vasospasm

It is prohibited to conduct self-treatment pathology. In 95% of cases, vasospasm does not occur as an independent disease, but as a secondary symptomatology of another disease. Without a thorough diagnosis and clinical trials it is impossible to get rid of the pathology.

As a rule, conservative treatment is used, which consists of diagnosing diseases or factors that provoked the appearance of vasospasm. To eliminate the narrowing of the lumen of blood vessels, measures such as identifying and treating the underlying disease (atherosclerosis, hypertension, inflammatory processes), restoring the functioning of the nervous system and eliminating the negative consequences that have developed as a result of the existing pathology are used.

Vasospasm of the brain is a disease that requires the closest attention, since any violation cerebral circulation can lead to very severe consequences. But how can you correctly recognize that you are experiencing a spasm? After all, if you look carefully at the symptoms, then at first glance it may seem that they are very diverse and not similar to each other. And the whole point is that the symptoms of spasm cerebral vessels vary depending on which part of the brain the spasm is localized in. So let's talk about this in more detail.

Treatment of cerebral vasospasm

Treatment will only be effective if you yourself are ready to take a fresh look at your usual lifestyle. You may have to reconsider and change a lot. Thus, most often people who abuse alcohol, smokers and suffer from diabetes suffer from cerebral vascular spasms. Therefore, you will first need to give up your bad habits, and, of course, get serious about treating the underlying disease.

In addition, when treating cerebral vasospasm, it is necessary to observe correct mode day, go to bed on time and do not sit at the computer at night. Equally important for the treatment of vascular spasm is a balanced, proper diet. You should not eat chocolate, mayonnaise, fatty cottage cheese and sour cream, strong black tea, milk from a village cow, fatty and smoked sausage, white bread, cakes and pastries.

On the contrary, unprocessed thermally processed food, seafood, fish, all fresh vegetables, as well as seaweed, porridge with milk and green tea are shown.

Treatment of vasospasm folk remedies

Take rowan bark, finely chop it and pour boiling water at the rate of 200 g per 1 liter of water. Place over low heat and simmer for about 2 hours. Let it brew until the broth cools, strain and take 2 tablespoons before meals to treat vasospasm.

In the same way, hawthorn fruits are also good for treating cerebral vasospasm. To prepare the infusion, take 1 tablespoon of crushed fruits, pour 250 ml of boiling water over them and let stand for about 1 hour. Then strain and drink. Take 250 ml twice a day, morning and evening before bed. This infusion not only helps with vascular spasms, but also cleanses them well, and also significantly improves well-being. You can also brew St. John's wort, nettle, Birch buds, as well as a mixture of these herbs in equal parts.

To treat spasms, grate the onion and squeeze the juice out of it. In total you will need 1 glass onion juice. It should be mixed with the same amount of honey, refrigerated and taken one tablespoon before meals 3 times a day.

Symptoms of cerebral vasospasm

Spasms of cerebral vessels can occur in any, even quite at a young age. In most cases, they are associated with osteochondrosis of the cervical spine, when the artery that passes through here and supplies the brain is unexpectedly compressed by moving vertebrae. And although the brain receives additional nutrition, for example, from the carotid arteries, such a sudden restriction of blood supply can lead to spasm.

However, this phenomenon can also be caused by lack of sleep or permanent violation regime, drinking alcohol or a phenomenon called vascular crisis. In older people, cerebral vasospasm can be caused by an unexpected surge in pressure or even a change in weather. Sometimes cerebral vasospasm can be caused by malformations developing in the vessels or indicate a tumor.

Whatever the cause of vascular spasm, the sensations that a person experiences can hardly be called pleasant. Symptoms of cerebral vasospasm include severe headaches, loss of spatial orientation, partial memory loss, and even problems with speech. If you experience such spasms regularly, then you should definitely consult a doctor and undergo an examination of the vessels of the brain and cervical spine using magnetic resonance imaging, as well as an ultrasound scan of the neck. Only after this will it be possible to say exactly why cerebral vasospasm occurs; treatment is prescribed only by a doctor, in accordance with the test results obtained.

Cerebral vasospasm

Spasm of the anterior cerebral artery

The anterior cerebral artery supplies food to the medial parts of the frontal lobes of the brain, and also supplies part of the parietal lobes, the anterior parts of the hypothalamus and subcortical formations. Therefore, if a spasm occurs here, then the symptoms will be characteristic of insufficient blood supply to these areas. A decrease in blood flow in the anterior cerebral artery can combine quite a few complex symptoms, or can be completely asymptomatic.

The most common symptom of nutritional deficiency in this area is memory problems. Depending on the exact period of nutritional depletion, these amnestic disorders can be either very pronounced, up to almost complete loss of memory, or insignificant, only appearing from time to time. If at the same time affected frontal lobes brain, the patient may experience difficulties with speech, as well as impaired control of activities.

If the blood supply to the basin of this artery is disrupted as a result of cerebral vascular spasm, the patient may have poor orientation in time or place, he may experience emotional instability, decreased criticality and other symptoms characteristic of mental disorder. The thing is that prolonged fasting of these areas of the brain, as well as the associated hypoxia, does not allow the patient to maintain full mental activity.

Middle cerebral artery spasm

If we are talking about the middle cerebral artery, then when spasm of cerebral vessels manifests itself here, the symptoms of this disease turn out to be somewhat different. The patient has a mixed form of aphasia, and in addition, he begins to experience certain difficulties in motor activity, it is difficult for him to organize movements in space, and he also has vision problems. If memory impairments are observed, they correspond to those brain zones that fall into the basin of a given artery. It is difficult for the patient to perceive speech addressed to him; he does not understand well what exactly you are asking him to do.

Internal carotid artery

Spasms involving the internal carotid artery, in their own way clinical picture resemble a spasm of cerebral vessels belonging to the basin of the middle cerebral artery. This is understandable, since this artery is, in fact, one of the branches of the internal carotid artery. Only the signs of this disorder have somewhat less pronounced symptoms. Apparently, this is due to the fact that disturbances in the internal pine artery system simply do not completely cover those areas of the brain that are controlled by the middle cerebral artery. As for memory impairments, they are almost identical.

As you can see, spasm of each individual cerebral artery has its own set of symptoms. This is understandable, because each part of the brain is responsible for performing its own task. Therefore, an experienced neurologist can only guess based on the totality of the patient’s complaints at what point it is necessary to look for disorders leading to vasospasm. However, all symptoms of cerebral vasospasm must be confirmed by the results of further studies.

ANGIOSPASM (angiospasmus; Greek angeion - vessel and spasmos - spasm) - pathological narrowing of the lumen of the arteries with a sharp limitation or even cessation of blood flow in them due to excessive contractions of the vascular muscles for given hemodynamic conditions. The immediate consequence of vasospasm is tissue ischemia in the area of ​​the spasmodic artery. In this way, vasospasm differs from physiological vasoconstriction, which provides an adequate (for certain hemodynamic conditions) reduction in capillary blood flow.

Story

Claude Bernard (1851) was one of the first to observe vasospasm in an experiment by irritating the branches of the sympathetic nerve galvanic current. By the end of the 19th century, an idea had developed about the role of vasospasm in the occurrence of transient circulatory disorders in a number of pathological conditions, which became widespread among clinicians at the beginning of the 20th century. This was facilitated, in particular, by the introduction into clinical practice of methods for studying vascular tone, disturbances of which could explain some of the clinically obvious hemodynamic disorders determined by morphological studies. Subsequently, many clinical symptoms of hypertension, atherosclerosis, vasculitis, autonomic neuroses became not always justified explained as manifestations of vasospasm. And at present, the term “angiospasm” is sometimes used unjustifiably widely. It is most often mistakenly used in following cases: 1) to explain the nature of any acute regional circulatory disorders, although other probable causes cannot be excluded (hypotension of arteries or veins, blood stasis, hemorrhage, etc.); 2) to indicate physiological vasoconstriction or even just a physiological increase in arterial tone without narrowing of the lumen; 3) to explain the nature of the established decrease in blood flow through the organ without excluding the connection of this decrease with other reasons (decrease in central blood pressure, organic obstruction of the artery lumen, etc.). Sometimes it is not taken into account that even visible transient narrowing of the artery (during capillaroscopy, direct observation of vessels through a “window” in an experiment, angiography, etc.) and transient ischemia are not always caused by vasospasm; they may be, in particular, a consequence of shunting blood through arteriovenous anastomoses proximal to the observed vessel narrowing.

Due to the exaggeration of the role of vasospasm in the pathology, therapeutic measures aimed at eliminating suspected vasospasm are not always effective or even worsen the condition of patients; on the other hand, antispasmodic properties are attributed to a number of drugs only on the basis of their therapeutic effect in conditions that are unprovenly regarded as manifestations of vasospasm.

Study of the clinical role of vasospasm in circulatory pathology in individual bodies methodologically very difficult for a person. This especially applies to cerebral vasospasm and spasm of the coronary arteries of the heart. Therefore, points of view on the role of vasospasm in human diseases are different. For example, along with the traditional idea of ​​vasospasm as the leading link in the pathogenesis of angina pectoris, there is a tendency to completely deny its pathogenetic role. Raab (W. Raab) called the concept of vasospasm in relation to angina a temporary hypothesis, the need for which, in his opinion, was no longer necessary due to the discovery of the effect on myocardial hypoxia caused by catecholamines. However, many clinicians cannot explain a number of cases of angina by any other reasons other than vasospasm, and in support of its role they cite a number of arguments, including the positive therapeutic effect of increasing coronary blood flow after the administration of myotropic drugs such as papaverine in doses that do not affect myocardial metabolism . A.V. Smolyannikov and T.A. Naddachina (1963) describe morphological changes in the small and intramural arteries of the heart, which are considered a consequence and evidence of functional disorders of the coronary circulation. The role of cerebral vasospasm has not been fully studied. (see below). A study of the tone of cerebral arteries and veins during cerebral vascular crises using orbital plethysmography showed that in patients with hypertension (among the contingent of therapeutic departments), cerebral vasospasm as a leading or additional link in the pathogenesis is observed in less than 15% of all crises.

Experimental models of vasospasm are reproduced mainly in animal species that are not characterized by hypertension and atherosclerosis, and these diseases are most often considered to contribute to the development of vasospasm in humans. Therefore, not all conclusions about the pathogenesis of vasospasm obtained from experimental models can be accepted for analysis of circulatory pathology in humans, although the most general mechanisms of regulation of vascular tone in humans and animals are the same. Apparently, under special pathological conditions, the basis for the development of vasospasm in the brain can be physiological arteriotonic reactions associated, in particular, with disorders of the autoregulation of cerebral blood flow. Thus, it is known that a physiological increase in the tone of the arteries of the brain, which prevents excessive blood flow, is observed in people with an increase in blood pressure or when an obstacle is created to the outflow from the veins of the head (in animals, such a reaction was noted by G. I. Mchedlishvili and L. G. Ormodadze) in response to increased pressure in one of the venous sinuses. Therefore, cerebral vasospasm, unlike other causes of cerebral crises in hypertension, is usually observed either in patients with persistent high blood pressure during a period of sharp increase in arterial hypertension, or it develops in the culminating stage of a crisis caused by congestion in the veins of the brain. Completely similar models of such vasospasm have not been obtained in animal experiments. Being functional in nature, vasospasm develops not only when primary disorders external (nervous and humoral) vasomotor regulation; in some cases, it apparently determines the clinical dynamics of organic vascular diseases (atherosclerosis, thrombosis, embolism, and so on), in which the development of vasospasm is facilitated by a change in the reactivity of the affected vascular wall. The latter circumstance is of particular clinical importance. It is assumed that in altered vessels vasospasm develops more easily from exteroceptive stimulation or as a result of viscerovisceral reflexes; Perverted vasomotor reactions to physiological stimuli (for example, vasospasm in response to thermal stimulation) and pharmacological agents are also possible.

The role of intoxication and occupational hazards - smoking, lead and carbon disulfide intoxication - has been noted in the occurrence of vasospasm.

For vasospasm in the extremities, often reflecting the initial stages of organic angiopathies (see Angiotrophoneurosis, Raynaud's disease), the pathogenic role of frostbite and repeated cooling is noted.

Pathogenesis

Angiospasm can occur only in arteries whose walls contain a well-developed muscle layer that overcomes intravascular pressure during contraction and sharply narrows the lumen of the vessel. This reduction in the lumen is achieved by thickening the intima of the vessel due to a significant shortening of the perimeter of the media, and the internal elastic membrane wriggles, and the endothelium protrudes into the lumen of the vessel.

If under normal conditions two conjugate processes occur in the smooth muscle cells of blood vessels under the influence of contractile stimuli - contraction and necessarily subsequent relaxation, then with vasospasm relaxation is impaired and as a result the artery remains in a state of sharp narrowing for a long time. Long-term muscle contraction requires energy expenditure. Even a sharp vasospasm, difficult to eliminate during life, naturally disappears after death, when the metabolism in the arterial wall stops. Therefore, during autopsy of corpses, vasospasm itself cannot be detected (only the ischemic changes in tissues caused by it during life remain), which was one of the reasons for denying the possibility of vasospasm, for example, in the brain.

Angiospasm may be based on two pathogenetic variants. Angiospasm occurs either when there is excessive vasoconstrictor stimulation of the arterial wall by a nervous or especially humoral route (for example, vasospasm of the arteries of the retina and brain at the beginning of a migraine attack), or when the function of the arterial wall itself changes in such a way that even ordinary vasoconstrictor influences cause its contraction like vasospasm. Local organic, metabolic, functional changes in tissues often play a decisive role in the pathogenesis of vasospasm. Thus, spasm of the cerebral arteries is often observed near aneurysms or subarachnoid hemorrhages; with Raynaud's disease, the walls of the digital arteries become highly sensitive to the effects of cold due to local disturbances, since vasospasm also occurs after vascular denervation.

Not all arteries can be equally susceptible to vasospasm. Angiospasm detected by X-ray contrast angiography in the brain, heart and limbs is localized mainly in large-caliber arteries. However, X-ray contrast angiography cannot be considered an adequate method for studying vasospasm, in particular because there are no contrast agents that are completely indifferent to blood vessels and do not themselves cause vascular reactions. IN clinical practice Symptoms of vasospasm are noted mainly in medium-sized arteries. Apparently, the tendency to develop vasospasm depends on functional features arteries, in particular from their typical functional behavior in regulating blood circulation. In general, vasospasm should develop more easily in those parts of the vascular system where vasoconstrictor innervation is better developed, where endogenous vasoconstrictor agents (catecholamines, serotonin, vasopressin, etc.) act more strongly physical factors environment (cold) and, finally, where vasoconstriction is a typical type of vascular response in physiological and pathological conditions.

Due to the lack of adequate methods for studying vasospasm and lack of knowledge about the mechanisms of smooth muscle contraction, the pathogenesis of vasospasm in most organs remains poorly understood until recently. It is known that the cause of vasospasm can be changes in different links of the complex chain of processes that carry out the mechanism of contraction and relaxation of vascular smooth muscles. Based on the available experimental data, the following possible mechanisms are identified in the pathogenesis of vasospasm:

1. Stimulation of intensive and long-term synthesis of endogenous vasoconstrictor substances such as alpha-adrenergic agonists (see Catecholamines), serotonin (see), etc. in the arterial wall, which leads to its long-term contraction. For example, in relation to the internal carotid artery, it was shown that vasospasm can occur as a result of the mobilization of serotonin in the arterial wall under the influence of foreign proteins circulating in the vascular lumen.

2. A disorder of the normal destruction of endogenous vasoconstrictor substances in the arterial wall, for example, when the function of monamine oxidase, which destroys catecholamines and serotonin, is impaired (in experiments, this is achieved by pharmacological inhibition of monamine oxidase, for example, iproniazid or nialamide).

3. Disruption of the normal function of muscle membranes. In non-contracted muscle, the membranes are polarized due to the active transfer of ions through them (potassium - into the cell, sodium - out). Membrane depolarization is one of the essential parts of the process preceding the contraction of myofilaments, after which, thanks to active ion transport (the work of the “sodium-potassium pump”), membrane polarization is restored (repolarization) and myofilaments relax. If the processes leading to the repolarization of muscle membranes are disrupted, then the arterial wall remains contracted for a long time. Such disorders may depend on pathological or age-related changes in the membranes of vascular smooth muscle cells, disturbances in enzymatic reactions that actively transport potassium and sodium ions through cell membranes, and from disruption of other processes involved in membrane repolarization.

4. Disruption of the normal transport of calcium ions in smooth muscle cells. After depolarization of muscle membranes, calcium ions are transferred inside the myofilaments and cause their shortening - smooth muscle cells contract, that is, calcium ions are the trigger mechanism for contraction. The subsequent removal of calcium ions from myofilaments causes the process of their relaxation. Thus, disruption of the release of calcium ions from myofilaments (due to dysfunction of the “calcium pump”) can cause vasospasm. It has been found that the antispasmodic effect of some drugs, for example. papaverine, methylxanthines (theophylline, caffeine and others), is carried out through the release of calcium ions bound in the myofilaments of the smooth muscle cells of the arteries.

5. Angiospasm may also depend on disruption of the relaxation process of myofilaments due to changes in their proteins. The immediate causes of such disorders are poorly understood.

Clinical picture

Clinical signs of vasospasm are nonspecific; they are associated with its localization and consist mainly in disorders of the function of ischemic tissue. The degree of functional disorders is proportional to the degree and duration of vasospasm.

It is believed that vasospasm in the coronary artery system forms the clinic of angina pectoris (see) and can be the cause of myocardial infarction (see) with its corresponding symptoms; spasm of the mesenteric vessels is manifested by abdominal toad (see); spasm of the cerebral arteries underlies the pathogenesis of some variants of cerebral crises and strokes with characteristic symptoms of focal neurological disorders. The development of vasospasm in muscle organs is often expressed by pain in the ischemic zone with irradiation along the corresponding segment of somatic innervation.

The course of vasospasm is most studied when it is localized in the vessels of the extremities. Short-term vasospasm of the digital artery causes a sharp pallor and coldness of the finger with impaired pain and tactile sensitivity from local paresthesia to anesthesia. This set of symptoms is characterized as a “dead finger” (digitus mortuus). Similar signs develop throughout the entire limb with vasospasm of its arteries, usually accompanying their organic damage. The alabaster (statue-like) pallor of the leg that develops in such cases is a symptom referred to as “commander’s foot.” In the case of prolonged vasospasm of the arteries of the extremities, the appearance of distal cyanosis is observed, sometimes distributed evenly, sometimes in the form of a cyanotic mesh, giving the impression marble leather. The appearance of cyanosis is caused by paresis of venules in the ischemic zone and is noted only when blood can enter them through anastomoses from veins in which blood flow continues, or when some minimum level of capillary blood flow is maintained due to partial patency of the spasmodic arteries. With digitus mortuus, cyanosis is usually absent, but it often occurs with ischemia of large areas of the limbs. Following cyanosis, some swelling of the tissue develops, caused by an increase in capillary permeability to proteins due to membrane hypoxia. At the next stage, necrobiotic processes develop - the faster, the greater the gap between the tissue's need for oxygen and the amount of blood flow. In the heart muscle, where the need for oxygen is high, foci of dystrophy develop after several minutes of ischemia.

Diagnosis

Diagnosis of vasospasm in internal organs diagnosed based on the dynamics of symptoms characteristic of the acute development of ischemia (angina pectoris, abdominal pain). Peripheral vasospasm is objectively recognized by a decrease in local temperature, the magnitude of which is determined only by the intensity of arterial inflow.

The differential diagnosis of vasospasm with forms of ischemia of an organic nature is difficult, especially in cases where vasospasm develops against the background of obstructive angiopathies. As a differential test, the dynamics of blood flow are examined under the influence of thermal stimuli (for vasospasm in the extremities) and pharmacological agents. With mixed genesis of ischemia, the share of vasospasm in it is determined by the degree of increase in blood flow in response to the vasodilator effect. In clinical conditions, plethysmography (see), rheography (see), local thermometry is used to diagnose vasospasm of various localizations.

Cerebral angiospasm is a narrowing of the cerebral arteries, leading to disruption of the nutrition of the nervous tissue of the brain.

Since the beginning of the last century, spasm of cerebral vessels began to explain the pathogenesis of cerebral crises (see).

Since the 20s of the current century, this theory began to be criticized, since there was no convincing evidence of the possibility of spasm of the cerebral arteries. The theory of cerebral vasospasm is contrasted with the theory of cerebrovascular insufficiency, proposed in 1951 by D. Denny-Brown, according to which the basis of transient and persistent disorders of cerebral circulation is not vasospasm, but insufficient blood supply to atherosclerotic narrowed cerebral vessels during a fall blood pressure. This theory has supporters and is based on clinical, pathological and experimental data, but it cannot be considered universal.

To date, a lot of evidence has accumulated in favor of the existence of cerebral vasospasms and their importance in the pathogenesis of cerebral circulatory disorders. In experiments, through observation through a “window” in the skull, it was shown that mechanical, chemical influences, as well as a sharp rise in blood pressure, can cause cerebral vascular spasm.

With migraine, hypertension and other diseases, a person may experience spasm of retinal vessels originating from the internal carotid artery system. One can think about the possibility of similar phenomena in the vessels of the brain. Spasms of cerebral vessels have been noted during brain surgery, as well as during cerebral angiography. In cerebral atherosclerosis, the degree of damage to cerebral vessels varies in different parts of the brain, and with mild changes in the vessel, the possibility of its spasm remains.

Cerebral vasospasm can cause transient ischemia of a region of the brain; in other cases, it leads to plasmorrhagia in the wall of small vessels, followed by hyalinosis, or causes softening of the brain. Both can be the result of a hypertensive crisis.

Not all cases of ischemic softening in cerebral atherosclerosis are explained by the mechanism of cerebrovascular insufficiency. Some of them may be of angiospastic origin, since a pathological examination does not reveal occlusion in the supply vessels, their patency for blood flow is preserved.

In atherosclerosis, in the late stages of hypertension and other vascular diseases of the brain, the nervous apparatus of the blood vessels is affected, and inadequate vasomotor reactions may occur, mostly in the form of a reflex narrowing of the arteries of the brain and blood vessels; Sometimes their primary reflex expansion is also possible. Factors that cause irritation of cerebral vascular receptors have not yet been well studied. This may be the effect of high blood pressure, microembolism, changes in blood chemistry, and more.

At various diseases cerebral crises have a different pathogenetic basis, which should be taken into account when carrying out therapeutic measures. Thus, a number of cerebral crises in hypertension may be based on the mechanism of cerebral vasospasm, and in cerebral atherosclerosis, in some cases cerebral crises are of angiospastic origin, in others they are caused by cerebrovascular insufficiency.

Treatment and prevention

Treatment and prevention of vasospasm coincide in part with the treatment and prevention of the main diseases that accompany vasospasm (neurosis, hypertonic disease, atherosclerosis, vasculitis). Smoking tobacco is excluded. Sanitation of infectious foci is carried out. In case of vasospasm against the background of high blood pressure, effective antihypertensive therapy is necessary (rauwolfia preparations, α-methyldopa, guanethidine derivatives). The possibility of vasospasm as a consequence of the viscerovisceral reflex must be taken into account. Thus, with S.P. Botkin’s “cholecysto-coronary syndrome”, angina attacks are sometimes eliminated after cholecystectomy.

Direct relief of vasospasm has its own characteristics in its individual forms (see Crises, Raynaud's disease, Angina). There are no universal antispasmodic drugs for blood vessels in all areas. Medicines are selected individually for each patient, taking into account regional differences in vascular response and the possibility of a paradoxical response to pharmacological agents. Nitrites, for example, are most effective for coronary vasospasm, but they tend to slow blood flow in the cerebral arteries. With cerebral vasospasm, the likelihood and degree of antispasmodic effect decreases in the next series of drugs (with intravenous administration): vincamine (at a dose of 10-20 mg); no-spa (2% solution - 2-4 ml); papaverine (2% solution - 2 ml - slowly!); caffeine (10% solution - 2-3 ml) or aminophylline (2.4% solution - 10 ml).

For peripheral vasospasm, the use of heat (immersion of the affected limb in warm water), novocaine blockade in the area of ​​the roots of the corresponding segments, according to indications - intra-arterial administration of a 0.25% solution of novocaine (10 ml) or no-shpa (2% solution - 3 ml).

Prevention

Prevention of vasospasm in the extremities involves eliminating repeated cooling, training vascular reactions by alternately placing the extremities in cold and warm water (their temperature difference is increased by 1° every day) for 1-2 minutes each, 5-6 times during one procedure (the course continues two to three weeks); prescription of nicotinic acid, pancreatic preparations (depot-padutin, increpan), ATP, angiotrophin.

Surgical methods of treatment (sympathectomy) and alcoholism sympathetic nerves are indicated mainly for vasospasm against the background of organic angiopathies (see Alcoholization, Sympathectomy).

Bibliography

Votchal B. E. and Zhmurkin V. P. Some data on the pharmacodynamics of the tone of the veins and arteries of the brain, Cor et vasa (Praha), v. 10, no. 1, p. 11, 1968, bibliogr.; they, Pharmacological approach to the problem of pathology of vascular tone, Klin, med., t. 46, No. 10, p. 10, 1968, bibliogr.; Mchedlishvili G.I. Pathogenesis of vasospasm, Pat. physiol. and experiment. ter., No. 2, p. 6, 1974, bibliogr.; Somlyo A. P. a. Somlyo A. V. Vascular smooth muscle, Pharmacol. Rev., v. 20, p. 197, 1968, bibliogr.

A. cerebral

Bogolepov N.K. Cerebral crises and stroke, M., 1U71; Transient disorders of cerebral circulation, ed. R. A. Tkacheva, M., 1967; Schmidt E. V. Stenosis and thrombosis of the carotid arteries and cerebrovascular accidents, M., 1963; Meyer J. S., Waltz A. G. a. Gotoh F. Pathogenesis of cerebral vasospasm in hypertensive encephalopathy, Neurology (Minneap.), v. 10, p. 735, 859, 1960.

V. P. Zhmurkin; G. I. Mchedli-shvili (pat. physical), R. A. Tkachev (neur.).

Angiospasm is also called vasoconstriction. The word spasm itself means spasm or convulsion. And the word vasoconstriction specifies: Vaso is a vessel and the Latin constrictio means tightening or narrowing. This results in a narrowing or convulsion of blood vessels (more precisely, the vascular wall).

The vessel wall is a muscle that can change the lumen of the vessel, which affects blood flow parameters. This ability is called a compensatory mechanism.

For example, a person bleeds as a result of an injury. Of course, the coagulation system comes into play. However, controlled vasospasm will make it possible to narrow the vessels, thereby reducing blood flow, which will reduce blood loss.

On the other hand, vasospasm may result from developing pathology, which can have a bad effect on the general condition of the body.

A spasm, or spastic reaction, is a sudden contraction of striated or smooth muscles, which is not characterized by rapid, immediate relaxation.

Due to the fact that human vessels contain a muscular wall, which includes smooth muscles, the process of spasm development is also characteristic of blood vessels.

Thus, vasospasm (vasospasm, vasoconstriction) is a narrowing of blood vessels of various sizes, which leads to circulatory disorders and metabolic processes in organs and tissues.

Important! Each new spasm, repeated in the same area of ​​the vessel, increases the narrowing of the vascular lumen and increasingly leads to a lack of oxygen, worsening ischemia, and the development of necrosis.

Angiospasm is more local in nature. Most often, this phenomenon develops in areas of blood clots, inflammatory reactions, aneurysms, emboli of various types.

Reasons for the development of vasospasm

The leading causative factors in the development of vasospasm are the following:

• Smoking is the strongest factor in the development of pathology.
• Alcohol addiction.
• Taking drugs.
• Disorders of neuroendocrine regulation.
• Atherosclerosis.
• Arterial hypertension.
• Diabetes mellitus and other diseases of the endocrine system.
• Osteochondrosis.
• Unbalanced nutrition leading to obesity and metabolic disorders.
• Abuse of tea and coffee.
• Non-compliance with the daily routine.
• Low physical activity.
• Rare exposure to fresh air.
• Overload of the body of a physical and mental nature.
• Stress.
• Depression.
• Meteor dependence.
• Prolonged hypothermia.
• Prolonged exposure to the open sun.
• Poisoning with certain chemical compounds.
• Inflammatory vascular diseases.
• Neoplasms.
• Connective tissue diseases.

Important! Many smokers, already at the beginning of smoking a cigarette, feel pain, most often in the heart, left arm, leg or head. This occurs due to the development of a sharp spasm of blood vessels, which becomes the cause of the development of pain. This is how blood vessels react to nicotine, which instantly activates the sympathetic nervous system and stimulates the release of adrenaline.

How does vasospasm develop?

The basis of vasospasm is the dysfunction of smooth muscle cells in the vessels, which leads to excessive accumulation of calcium and loss of the ability to relax. Arteries are most often affected by this manifestation. Such reactions arise due to stimulating processes of the vasomotor center, which is located in the medulla oblongata.

Nerve impulses that pass to the walls of blood vessels “force” the walls of blood vessels to shrink and reduce the vascular lumen.

But, since there are many reasons for the development of vascular spasm, in each special case development process pathological condition will be different.

Common pathogenetic reactions will be:

• Any reason for the development of a spastic vascular reaction leads to a disruption in the transport exchange of calcium, sodium and potassium ions across cell membranes.
• Violation balanced composition electrolytes lead to a failure in the regulation of contractions of the muscular walls of blood vessels.
• The constant entry of calcium into the cells, its accumulation, leads to the fact that the vessels come into a state of spasm, and the relaxation process does not occur quickly, which does not allow the processes of reducing vascular tone to be realized.

Important! When developing vasospasm, it is necessary to take into account that such a manifestation can be both physiological and pathological.

Angiospasm in a healthy person

Moreover, in stressful situations, especially life-threatening ones, this phenomenon saves a person’s life, as it stimulates the release of adrenaline, mobilizing and bringing all the person’s forces into maximum activity.

This mechanism is triggered by irritation of the vasomotor center in the medulla oblongata, from which information is sent to the vessels, leading to vasoconstriction and increased blood pressure.

Important! Thanks to physiological vasoconstriction, a compensatory decrease in the capacity of the vascular bed is realized.

Venous spasm in trauma is one of the most important adaptive reactions, since with its help a person is able to tolerate a lack of circulating blood volume of up to 25%. However, it does not develop arterial hypotension, which helps the patient overcome severe hypovolemic shock.

Pathological vasospasm

Pathological reactions leading to vasospasm develop when the body incorrectly recognizes incoming signals. In the medulla oblongata system, a violation of coordination functions occurs, which leads to impaired control of the vascular walls. The vascular center loses control over the processes of relaxation and contraction of blood vessels, which causes the development of ischemia in various organs.

Long, constant, protracted episodes of vasospasm trigger a number of reactions that have a damaging effect on organs:

• In the ischemic zone, small venules come into a state of paresis, and this in turn causes a violation of local blood circulation.
• Since permeability in the capillary walls increases, this causes increased protein loss and the development of tissue edema.
• After this, especially if the cause is not eliminated in a timely manner, loss of function of the ischemic area is observed with the subsequent development of necrosis.

Important! Even the smallest signs must be paid attention to, since vasospasm in the initial stages goes unnoticed, subsequently leading to serious causes, including death.

How does vasoconstriction manifest?

The most dangerous are spasms of blood vessels in the brain, heart, eyes, arms and legs. In order to understand how to recognize this or that process in the human body, we should dwell in more detail on the types of vasospasm.

Angiospasm of cerebral vessels (cerebral)

Cerebral vasospasm is accompanied by a sharp narrowing of cerebral vessels, leading to damage to the nervous tissue. Most patients with atherosclerosis are susceptible to this, arterial hypertension, autonomic disorders, nervous disorders.

Also, such attacks can develop against the background of complete rest and health of the person.
The leading causes of cerebral vasospasm are:

• Osteochondrosis, in particular cervical.
• Changes in the cervical spine.
• Low mobility leading to degeneration of intervertebral cartilage and compression of blood vessels.
• Change in atmospheric pressure.
• Eating certain types of foods.
• Sharp light and/or sound stimuli.

Clinically this is expressed by the following symptoms:

• Headache.
• Dizziness.
• Nausea varying degrees expressiveness.
• Weakness, increased fatigue.

The listed symptoms are characteristic of short-term spastic reactions, but prolonged and frequent stay of blood vessels in a state of pathological spasm leads to persistent disruption of blood flow in the brain, which is realized in:

• Transient ischemic attacks.
• Strokes.

Important! With good development of collateral circulation, signs of vasospasm may be absent.

Angiospasm of heart vessels (coronary)

Coronary vasospasm is the basis of angina attacks, which is accompanied by persistent, sudden narrowing of the coronary vessels. This, in turn, leads to myocardial ischemia and the development of typical chest pain of a compressive nature with irradiation to the left arm.

Such attacks are not associated with stress or stress. They develop most often early in the morning and last no more than 30 minutes. The number of such attacks depends on the severity of vascular spasm. In this case, symptoms characteristic of rest angina develop:

• Heavy sweating.
• Anxiety.
• Sharp, sudden pain in the heart area.
• Increased heart rate.
• Severe headache.
• Nausea, sometimes accompanied by vomiting.
• Possible disturbance of consciousness.
• The appearance of shortness of breath at rest.
• Pallor.

Important! Narrowing of coronary vessels without pronounced atherosclerosis most often becomes the cause of myocardial infarction at a young age. Most often this occurs under the influence of drugs, stress, and hypothermia.

Vasospasm of retinal vessels

• Raynaud's disease.
• Arterial hypertension.
• Diabetes.
• Severe gestosis.
• Excessive hypothermia.

Important! Retinal vascular spasm can develop spontaneously, for no apparent reason.

During the development of retinal vasospasm, patients present the following complaints:

• Flashing of flies before the eyes.
• Unpleasant sensations in the eye area.
• Transient decrease in vision.
• Blurred vision.
• Headache.

As a rule, such changes in vision last no more than one hour, much less often - more than an hour.

Peripheral vasoconstriction

This reaction is an integral part of the following conditions:

• Raynaud's disease/syndrome.
• Atherosclerosis of large arterial vessels.
• Diabetic angiopathy.
• Smoking.
• Stress.

Clinically this is expressed by the development of:

• Pallor, acquisition of cyanosis.
• Coldness of the distal parts or completely of all upper and/or lower extremities, depending on the caliber of the affected arteries.
• Impaired sensitivity.
• Development of numbness, pain, tingling.
• The appearance of a marbled skin tone.
• Formation of trophic ulcers.
• Development of gangrene.
• The appearance of livedo reticularis.

Mesenteric vasospasm

It has a clear connection with food intake, as it appears within 15–40 minutes. Develops mainly due to impaired
absorption of various nutrients. Accompanied by the following clinical signs:

• Increasing pain throughout the abdomen without clear localization.
• Prolonged nausea.
• Vomiting of undigested food is possible.
• Increased intestinal peristalsis.
• Flatulence.
• The appearance of severe diarrhea 2–3 hours after eating.
• Progressive weight loss.
• Nervous disorders such as depression.
• Sleep disturbance.

In general, all manifestations of vasospasm can be divided into three categories depending on the severity of the process:

• Severe - characteristic of damage to the coronary and large cerebral vessels.
• Moderate – damage to vessels of medium and small caliber.
• Peripheral – involves small-caliber vessels.

Vascular spasm in children

• Improper lifestyle of the mother during pregnancy.
• Injuries during childbirth.
• Intrauterine infections.
• Difficult birth.
• Congenital vascular pathology.
• Use of a vacuum extractor during childbirth.
• Emotional overload in a child.
• Hormonal changes in the child's body.
• Fatigue due to high mental activity.
• Sedentary lifestyle.
• Infections.
• Heat.

Symptomatically, vasospasm in children is expressed by the development of certain signs:

• Increased anxiety.
• Impaired appetite up to its absence.
• We're crying.
• Insomnia.
• Insufficient weight gain.
• Loss of body weight.
• The appearance of headaches.
• Decreased vision.

Important! In children, often with age, subject to a regimen, a healthy lifestyle, and proper nutrition, protective mechanisms develop that allow the vascular walls to recover.

First aid for vasospasm

In many cases, vasospasm can be eliminated at home, but it is important to remember that this does not eliminate its main cause.
cause, but only the symptom, which is a sign of some disease, is stopped.

In order to relieve vascular spasm, it is necessary to perform the following manipulations:

• Wash with cold water.
• Take a horizontal position.
• Drink an antispasmodic drug (but - spa, spasmalgon, baralgin, aspirin, etc.) in combination with Corvalol and/or valerian infusion.
• Massage the temples and back of the head.
• Drink warm sweet water.
• In case of severe hypothermia, it is necessary to vigorously rub your arms and legs.

But, in order to effectively influence vascular spasm, complex treatment and medical supervision are necessary.

Diagnostics

• Collection of anamnestic data.
• Visual inspection.
• Blood test for hemoglobin level, total protein and its fractions, electrolyte composition of the blood.
• Ultrasound of the heart, neck, head.
• Angiography.
• X-ray examination of the neck.
• MRI in vascular mode.
• Ophthalmoscopy.

After detecting a focus/foci of pathology, it is necessary to begin treatment immediately.

Treatment of vasospasm

Therapy for vasospasm is long-term and complex. There are several approaches to this:

• Drug treatment.
• Physiotherapeutic methods.
• Surgery.

The main purpose of using medications is to relieve spasms, pressure, and eliminate nervous tension. The following groups of drugs are used for this:

• Antispasmodics, pure or combined - tempalgin, but - spa, etc.
• Triptans (sumatriptan) are prescribed for migraines when conventional antispasmodics are not indicated.
• Products containing caffeine (ascophene).
• NSAIDs – ibuprofen, paracetamol, nimesulide.
• Nootropic drugs – piracetam, Cavinton, cinnarizine.
• Antihypertensive drugs of various groups for arterial hypertension, ischemic heart disease, atherosclerosis.
• Lipid-lowering therapy for confirmed elevated levels cholesterol and its fractions.
• Sedative therapy, which is selected strictly individually.
• Nitroglycerin (as indicated).
• Vasodilating agents that are effective for peripheral vasospasm (pentoxifylline).
• Thrombolytics, antiplatelet agents for the development of thrombosis.
• Vitamins.

Physiotherapeutic methods are also effective and in many cases demonstrate excellent results:

• Acupuncture.
• Massage.
• Electrophoresis.
• Oxygen treatment.
• Physiotherapy.
• Darsonvalization.

If the above methods of treating vasospasm are ineffective, only surgical intervention is necessary:

• Intersection of sympathetic nerve fibers that pass to the source of spasm.
• Complete removal of nerve nodes.
• Stenting.
• Thrombectomy.

But even the most effective and best treatment will not be successful without maintaining a healthy lifestyle, quitting smoking and alcohol, sufficient time in the fresh air, hardening, and physical activity.

Prevention

As already stated above, the basis for the prevention of vasospasm is maintaining a healthy lifestyle.

The best option is to comply with the standards and requirements for patients suffering from atherosclerosis and arterial hypertension, since these diseases are accompanied by vasospasm.