A person turns to a cardiologist (or simply a therapist) for help either because his heart is affected by some agent (infection or fatty deposits), or when his heart “fails” due to mental anguish. But it must be said right away: in the latter case, the cardiologist has nothing to do here, since such a person’s heart is fine - well, it works a little differently, it’s not fatal, and it’s fixable if the corresponding mental torment is neutralized. Actually, the heart itself in such a “patient” remains intact, only its function, the autonomic regulation of its activity, is disrupted. And everything will be restored successfully, without consequences, subject to proper psychological treatment.

If the heart is really affected by the disease - it has a serious congenital defect, suffered from an infection, if, finally, the blood vessels, its blood supply clogged with fatty deposits, this can be easily detected using an electrocardiogram, ultrasound, various tests and other studies. If the heart suffers due to psychological overload, then apart from palpitations, rhythm disturbances or pain in the heart area (usually in this case, pinpoint pain), we are unlikely to detect anything serious. Well, the heart is racing, it’s straining more than necessary, and then what?! Nothing! He will partake and stop.

So, in the case of organic damage to the heart, either the heart muscle itself or the vessels that supply it suffer. In addition, a person may have a congenital heart valve defect, as well as a similar defect, but caused by an infection, when bacteria destroy the heart valves (which act as a kind of door in it). However, we will not consider the latter now - for some reason we are not usually afraid of myocarditis and destruction of heart valves. But heart attacks are a favorite pathology in our culture! We are afraid that our heart “won’t stand it,” that it will “break,” “tear,” or who knows what else might happen to it.

The history of a heart attack begins with hypertension and atherosclerosis. Hypertension is, by and large, simply an increase in blood pressure, i.e. For one reason or another, blood begins to be ejected more strongly by the heart and therefore puts more pressure on the walls of blood vessels. In itself, this is not dangerous; the vessels can withstand very high stress, since their walls are elastic, like rubber. But here atherosclerosis comes into play. The body needs fat to live, but processing it and turning it into something useful is not easy. With age, this ability of the body decreases, and therefore excess fat appears in the bloodstream. Where should he, the poor man, go? It prefers to settle on the walls of blood vessels in the form of so-called atherosclerotic plaques.

Sclerosis cannot be cured, but it can be forgotten.

F.G. Ranevskaya

The appearance of atherosclerotic plaques in the lumen of blood vessels narrows these lumens, and the vessels themselves begin to resemble old rusty pipes. Because of these fatty deposits, our blood vessels lose their former elasticity, and therefore now they cannot expand with the same success with which they did so before. Thus, the pressure on the walls of blood vessels increases, which accordingly leads to an increase in blood pressure numbers. It looks like you are watering your garden with a hose, narrowing its opening with your finger so that the water shoots out of it with greater pressure and over a greater distance. And everything would be fine, but these plaques (some of them) at a certain moment, under the influence of this increased blood pressure, can break away from the place of their fixation. And here two types of problems arise.

Happiness is good health and bad memory.

(Ingrid Bergman)

It is possible that if the plaque comes off “with meat”, a vessel injury will occur in the corresponding place, which will lead to its rupture. In this case, blood will pour out of the vessel and “flood” nearby tissues. A pipe burst in our apartment and flooded all our things. What happened to the things? They have fallen into disrepair. If such an incident occurs in the brain, the doctor will say that we have had a “hemorrhagic stroke.” However, another option is also possible: the plaque came off, but the vessel did not rupture, and it itself moved further along the bloodstream. Since the arteries in which atherosclerotic plaques settle tend to narrow as the blood flows, such separation and displacement of the fat plug ends in blockage of the vessel “downstream”, this is a “heart attack”. In this case, the normal blood supply to the corresponding organ stops; it “goes on a starvation diet,” which in medicine is called “ischemia.” An ischemic infarction can occur in the brain (here it will be called an ischemic stroke), and in the heart, and in the kidneys, and God knows where else.

Ischemic heart pain is angina pectoris, and it is caused by a narrowing of blood vessels thatsupply blood heart muscle, providing it with oxygen and nutrients. When such ischemia occurs, the heart tells us with pain that this nutrition is not enough. In this case, our main task is to dilate the blood vessels, and for this purpose, patients with coronary heart disease take nitroglycerin (or its analogues). Nitroglycerin causes the heart vessels to dilate, and in this case the blood can move on again. Moreover, nitroglycerin acts almost instantly, and therefore thanks to it, ischemic pain disappears within one to two minutes.

Although, of course, it is better to fight not the effect, but the cause. Therefore, starting from a certain age (from 45 years old), all educated people in civilized countries take special aspirin, which prevents the formation of fatty deposits on the walls of blood vessels. In addition, they are engaged in preventing the development of severe hypertension in themselves, and therefore, when its symptoms appear (when the pressure begins to remain stable in the range of 140/95 mm Hg and above), regularly, i.e. every day, take antihypertensive drugs (special medications that do not allow blood pressure to rise above the required level). The results are not long in coming - the life expectancy of people in civilized countries is twenty years higher than the Russian average.

Any physical (somatic) disease is actually a simple thing - there is an organ and it gets damaged, and therefore all sorts of unpleasant symptoms “come out”. However, as we already know, unpleasant symptoms can “come out” even in the case when the organ is not damaged, but only the autonomic regulation of its function is impaired. There is no justification to be afraid of bodily ailments - here, as they say, neither tears, nor, especially, anxiety will help the matter. All living organisms get sick, suffer and die. That is life. Our task is only to take the necessary measures in time to prevent these diseases (i.e., we need to maintain a correct lifestyle), and after they appear, take measures to ensure that the disease does not rush to “settle scores with us,” i.e. take the treatment that in this case medicine has recognized as the most effective.

That, in essence, is the whole story... There is nothing terrible in it, and timely treatment allows us to neutralize our enemies - atherosclerosis and hypertension. Let me note once again that heart attacks and strokes are only the consequences of these ailments, and very distant ones at that; neither one nor the other happens out of the blue. Yes, most of us will indeed die from cardiovascular pathology (we must die somehow!), but with the right approach to the matter, this will happen at an extremely old age, i.e. in a timely manner.

Since many of those suffering from VSD believe that they are under constant threat of “rupture” of the heart and blood vessels, we apparently need to clarify this issue. However, the most accurate and short summary in this case sounds very simple: “Bullshit!” If the vessel is not affected by atherosclerosis, if the heart has not yet experienced a single heart attack, if, finally, the blood pressure does not exceed 200, then expecting them to rupture is a thankless task. And for people who have been diagnosed with vegetative-vascular dystonia, everything is completely fine with atherosclerosis and hypertension - they simply do not exist.

At the same time, those suffering from VSD often “feel” that a vessel in their head or heart has either “already burst,” or “is about to burst,” or “should burst.” But the whole point is that they “feel” it! Here is the trick: a person simply physically cannot feel how a vessel “burst” in his head. We are only able to perceive the consequences of this misfortune, for example, stroke paralysis, but not the process. There are no receptors in the walls of blood vessels that perceive the state of this vessel! Whether he shrank or didn’t shrink, you can neither know nor feel! In other words, there are no sensors in the vessels that indicate their condition, and therefore all our “sensations” of this kind are fiction. In the same way, our “heartbeat” is to a large extent not a real heartbeat, but a heartbeat intensified by our attention to it.

Mustard without roast beef is not particularly interesting.

(Groucho Marx)

Most people who complain of palpitations, interruptions in heart function, and fluctuations in blood pressure do not detect corresponding disorders during a special examination (at least to the extent stated). At the same time, a large number of people who actually suffer from tachycardia, arrhythmia and hypertension are sometimes not even aware of this! It's all about increased attention: if you want and try hard, you may well feel the vessel pulsating in your finger. But think about it: if you are able to feel the vessels of your body (there are thousands of them!), and blood pressure, if it rises, then rises throughout the whole body at once, then you must manage to simultaneously feel the pulsation of all the vessels of your body at once! Of course, this is impossible. In other words, you feel one vessel only because you really wanted to feel it, this particular vessel. And this feeling is always distorted, “not true.”

Regarding a heart break... Of course, if you imagine a heart break, the picture turns out to be dramatic. And it seems that this is so natural: the man “did not survive the grief that fell on him and his heart was torn to pieces.” For some Turgenev or Tolstoy this may be a good metaphor, but for a doctor it’s rubbish! Heart ruptures do occur, but, firstly, rarely, and secondly, as a consequence of a long and serious illness, and VSD is not one of the latter. Indeed, if a person has experienced several heart attacks (as any electrocardiogram will show), then a so-called scar forms in his heart.

In general, the heart is a muscle sac, and a strong, powerful, dense muscle sac. During a heart attack, blood access to some part of this sac is stopped, the condition of the muscle here worsens, figuratively speaking, we can say that it has become leaky in this part. Afterwards, the body itself “patches” this “worn” with special connective tissue, and you can move on with your life. Of course, the elasticity and strength of our muscle bag in this damaged part decreases. And the more such “patched” parts on the heart, the higher the risk of it rupturing under the pressure of blood pressure. But if you are afraid that your heart will “break” (or “break”, or whatever else will happen to it), then you should have at least some such scars in your supply, i.e. Real heart attacks. And out of the blue, from vegetative attacks... Don’t even fool yourself!

And finally, the most paradoxical thing! Scientists conducted a special study, the essence of which was as follows. They found people who were diagnosed with VSD twenty years ago, and they selected precisely those who suffered from their “disease” in the most serious way, those who had painful attacks and had a distinct fear of death. Then they were subjected to a comprehensive medical examination: with the help of the most modern equipment, they were examined for the condition of their heart and blood vessels, brain and respiratory function, as well as everything else that could be looked at. The result was impressive! But what do you think?..

In all the subjects who had all the manifestations of VSD in their past and the corresponding diagnosis, the state of the body and its functions was (on average) significantly better than that of their peers. This seems strange... But, in reality, there is nothing strange about it. In fact, all those suffering from VSD constantly train their body with their endless “attacks”. Tachycardia, increased blood pressure and other body reactions characteristic of VSD are not much different from the loads to which people who regularly engage in their own health improvement through jogging and gymnastics expose themselves. It turns out that VSD is such a daily “charging without charging”!

Charging is nonsense. Healthy people don’t need to do it, but sick people shouldn’t.

(Henry Ford)

Of course, VSD is not the most optimal way to improve health and prevent cardiovascular diseases, but, damn it, it’s also an option! The only problem is that the mental state of people suffering from VSD is no good. Fear is not the best companion in life, much less the fear of death. And if we decide to treat VSD, which is so beneficial for health, then only in order to improve our mental and psychological state. But there is no risk to the life of a person suffering from VSD!

Whatever one may say, the human heart is the most sensitive organ, and it positively does not want peace. Any stress, any shock in life - good or bad - communicates itself to us through the intense work of the heart, i.e. heartbeat. And that's okay! Stress activates the body's functions to provide it with the high tone necessary for fight or flight. This is why a person’s heart begins to beat faster when under stress, or even lose its rhythm altogether.

Fortunately or unfortunately, in our human life there are almost no dangers from which one could escape in such a simple way - physical fight or flight. But the body reacts in an old, ancient, or more precisely, animal way. As a result, this function is overstrained: the heart is activated, but since this activity in fact turns out to be unnecessary and unproductive, malfunctions occur.

This is the fate of people who are fixated on their heart and it is precisely because of this, and not because of the weakness of this heart, who received a diagnosis of vegetative-vascular dystonia. VSD is not a heart disease, but a concern about the condition of this heart. That is why the “old” doctors did not call it by this outlandish term, but very simply - “neurosis of the heart.” Often, however, these palpitations actually look like real heart attacks.

What patients with vegetative-vascular dystonia call a “heart attack” has been called a “panic attack” all over the world for more than twenty years. Soon, I am sure, our doctors will give us such a diagnosis. But what is a “panic attack”? This is also a heart attack, but not pathological, but caused by psychological stress. The only problem is that we are not always aware of our stress. We often experience chronic stress, and therefore at the level of consciousness we manage to get used to it, but the body cannot boast of such conformity; its autonomic system continues to react in its usual way - by activating the cardiovascular system.

So it turns out that such a heart attack overtakes us in a situation that does not seem stressful to us, although in fact there is this stress, we just didn’t notice it. But since we overlooked it, but not the cardiac activity, fear arises: “What’s wrong with me?! Do I have a serious illness?! Am I going to die from this heart attack?!” We get scared, an even greater nervous load falls on the heart, and it begins to go crazy.

Then the situation develops, like in a bad detective story. First we rush to the doctors, wanting to save ourselves from heart attacks. However, doctors, as a rule, turn a deaf ear to us and report that, I quote: “Everything is fine!” Good order: the heart jumps out of the chest (sometimes even at night), and the doctor “washes his hands of it”! Shine! The Russian doctor diagnoses us with VSD and sends us to all four directions.

The desire to be treated is perhaps the main feature that distinguishes humans from animals.

William Osler

Now, without receiving any proper treatment, we begin to fear the repetition of these extremely painful heart attacks. However, it is precisely this fear that is, in fact, our main problem, since it is precisely this that creates excess stress on the heart. The result is not long in coming - heart attacks begin to appear with enviable regularity. The vicious circle closes, and the person finds himself alone with his problem: there was one - psychological, now there are two - both psychological and cardiac.

A panic attack is what a person experiences, simply put, it is an attack of panic, acute anxiety or fear; and “panic attack” is a medical diagnosis. What, you ask, is the difference? I answer: if you were simply scared once, that’s one thing, but if such attacks become more or less commonplace for you, then this means that this is already a “panic attack.” And, of course, such a “disease” can and should be treated not with heart medications, but with drugs that affect the emotional state. That is why throughout the civilized world, people suffering from “panic attacks” (read: VSD) are prescribed antidepressants with an anti-anxiety effect. And in Mother Russia, unfortunately, people are left alone with their problem.

Here is such a sad story, and not exclusive, but disseminated in the most indecent way, because at least every fifth person who comes to see a local doctor suffers from such heart attacks caused by psychological stress! However, the therapist’s refusal to provide assistance to such patients or the ineffectiveness of his assistance is a natural phenomenon. Since the cause of these heart attacks is not associated with organic damage to the heart (which a therapist can and should treat), but with the initial psychological stress and the person’s subsequent feelings about the attacks that occur.

A “panic attack” is an unpleasant thing, but not dangerous. And the panic that arises in a person who does not know what is happening to him is natural. However, we are reasonable beings to understand: people do have cardiovascular diseases, but VSD is not one of them. Whereas the panic that overcomes a person who does not know that he has become a victim of the “vegetative component” of his own stress is a mental state and, to put it mildly, not the most successful. It is with him, and not with his heart, that a person diagnosed with VSD must fight. And if we blame our hearts in this case, this is truly pure injustice! Not only is it not guilty of anything, but it is also in good physical shape!

A case from psychotherapeutic practice: a psychotherapist with a residence permit in St. Petersburg will remove... “I WILL SPOIL”

Fear of the unknown is the most powerful feeling. We inherited it from our animal ancestors and now we are almost unaware of it, but deep in the subconscious, the fear of the unknown continues to reign. Children are afraid of the dark, adults put off solving difficult issues for years and, under any pretext, continue to use previous tactics that do not bring them success - all these are manifestations of the fear of the unknown.

We are afraid of death, which is a sealed secret for us, but it is still the same fear of the unknown. Legends are made about death, religions promise salvation and eternal life - but this is only the work of the mind. The powerless mind seeks salvation from the powerful fear of the unknown, it comes up with explanations for the unknown, calms down, and this fear gradually deals a crushing blow to the human psyche.

When a person turns to a psychotherapist for help, the doctor can always find this fear of the unknown hiding behind the patient’s problem. In the endless struggle between consciousness and subconscious, the fear of the unknown takes on the most bizarre forms...

Lida went through a difficult period in her life. One year, her mother died in her arms, her beloved nephew died, and her husband... Lida’s husband changed a lot, he became cold and rude. And she went to a psychic - maybe he could tell her what to do? Lida’s expectations were not deceived; the verdict of a specialist in karmic laws sounded like a sentence: her husband had a mistress, and she brought “damage” to Lida. “It will get worse!” - the psychic warned and scheduled his sessions.

The psychic's predictions came true. That same day, upon returning home, Lida felt a terrible attack of suffocation, and her heart was beating as if it was about to burst. The son called an ambulance, and this time the matter turned out okay. Lida completely trusted her psychic and attended his sessions for more than five years. During this time, the husband's relationship with his mistress went wrong, although it did not stop completely. But Lida began to experience attacks of suffocation and palpitations regularly, and the fear of death began to haunt her relentlessly.

It is better to remain silent and appear a fool than to open your mouth and remove all doubt.

(Samuel Johnson)

Five years later, the psychic admitted his powerlessness - the “damage” imposed on Lida turned out to be too strong. He handed Lida over to his “colleague,” but he refused to help. Of course, this poor woman was now only worried about her illness, and she went to the doctors - to one, to another. People in white coats prescribed treatment, but there was almost no effect. The disease progressed, Lida was afraid to leave her home, and someone accidentally said: “You, Lida, should go to a psychotherapist.” Lida felt insulted, but by chance the opportunity came up to go to the Neurosis Clinic. Not trusting anyone, not knowing what to do or where to go, she agreed to be hospitalized...

When I first met Lida, she looked like a squeezed lemon. Almost seven years of severe neurosis, and all of it was just neurosis, were not in vain for her. She told me her story.

When a dark streak came in her life, Lida was looking for an answer to the question: “Why?” Why did my mother die so suddenly, why did my nephew die so absurdly, what happened to my husband? She wanted to hear the answer and received it from an unscrupulous person hiding behind knowledge of some magical laws. For five years he literally “milked” Lida, and when she could not pay the previous tariff, he sent her to another “healer”, who, of course, did not even get down to business.

The death of loved ones is a difficult experience. Lida felt fear when faced with the unknown, and the psychic intensified this fear with his “prediction” (from Lida’s story it was not difficult to guess that her husband was “taking sides”). Hearing that all her misfortunes were just the beginning, Lida’s fear intensified and manifested itself as a vegetative attack of suffocation and palpitations. In fact, this is a completely natural reaction of the body to stress, but Lida did not know about it. She thought it was the effect of “spoilage,” and so began her long journey down the wrong path.

Lida's attacks are common in the practice of any psychotherapist, although for general practitioners they sometimes seem like a mystery. The treatment for these attacks is well established, so we dealt with this stage quickly. Now she had to help Lida improve her family relationships.

Feeling sick, she “tied” her son to her, and he remained “tied” and cut off the “leash.” Lida openly blamed her husband for her illness, and now that her husband’s “honey period” with his mistress was over, she could no longer restore her previous relationship with him. Fear of death and “illness” made Lida completely lonely. There was a lot to comprehend, a lot to re-evaluate, and most importantly, to master the skills of constructive thinking and the laws of interpersonal relationships.

Now, almost five years have passed since then, Lida is married, but to another person - love, as you know, will unexpectedly appear when you are not expecting it at all. The relationship with her son improved, a grandson was born - a joy for the young grandmother. Everything is fine, but you can’t get seven years of your life back, and how would this story have ended if someone hadn’t suggested it and sent it to the Neurosis Clinic? What if she refused?.. Fear of the unknown forces us to make mistakes, but we are not at all obliged to make them.

The complaints of a person suffering from vegetative-vascular dystonia are not just a statement of the symptoms of the disease, it is a whole story! For a person suffering from uncertainty, any details are important - what, how, when, where... It seems to him that if he tells the doctor everything in detail, then his disease will be correctly understood by this specialist. And woe to the doctor who turned out to be an “indifferent formalist”!

But here the following must be said: every doctor knows what the autonomic nervous system is and how it behaves in a situation of stress, and therefore, if necessary, he himself will tell all his complaints for his patient, and will provide any details - what, how, when, Where. But since doctors do not consider vegetative-vascular dystonia a disease, they speak of it exclusively as a “disorder” or “impairment,” then one cannot expect attention from them.

If you want the doctor to be really concerned about your condition, then the disease with which you are contacting him must involve a risk to life (not his, of course, but yours). Patients with vegetative-vascular dystonia themselves see this risk in their “sore”, but in fact they only imagine this risk, it is a kind of illusion, a deception of perception.

But doctors are well aware that vegetative-vascular dystonia is a functional disorder (hereinafter I quote according to the official definition), “characterized by a benign course, a good prognosis and not leading to cardiomegalyor heart failure." In other words, no matter how much you want to die from it, you cannot die from it, and therefore there is no way to interest the doctor in these complaints. Moreover, as I already said, they are known to any doctor without a doubt. Let's announce the whole list...

When you are thirsty, it seems that you will drink the whole sea - this is faith; and when you start drinking, you’ll only manage two glasses at most—that’s science.

(A.P. Chekhov)

As you and I already know, autonomic dysfunction can unfold either in a sympathetic or parasympathetic manner. In the first case, palpitations, increases in blood pressure, sweating, constipation, low-grade fever, dry mouth, etc. will most likely be observed. In the second case, autonomic dysfunction is usually manifested by nausea, vomiting, loose and frequent stools, frequent urination, a decrease in blood pressure, bradycardia (a relative decrease in heart rate), a feeling of suffocation, a decrease in body temperature, etc. But most often, the failure of the autonomic system is of a mixed nature, and in this case, both of its departments “split off their numbers” - in turn and together.

However, the undisputed “leaders” in the list of complaints of patients with vegetative-vascular dystonia are: palpitations, interruptions in the functioning of the heart, pain in the heart area, fluctuations in blood pressure, difficulty breathing, dizziness, headaches and fainting, as well as sweating and (sometimes) feeling "paralysis". All these are reactions of the autonomic nervous system, and they are not dangerous for our health, although those suffering from VSD think so. Well, I'll try to explain what's what here...

Heartbeat

What appears to be a “palpitation” to a person may be normal, and not at all pathological, heart function. Our heart rate increases under any load, and this is natural, and psychological stress is exactly the same load as any other. [It is not without reason that game programs are shown on central television channels, where participants are eliminated from the game if their heartbeat numbers exceed a certain indicator - 120 or, for example, 130 beats per minute. Of course, they are excluded from the game not because there is a risk to their life, but because they were unable to cope with the stress they experienced.] A person may feel that his heart is “pounding”, “knocking”, “jumping out”, etc. etc. But, really, rarely do these numbers exceed 100-120 beats per minute, and this is not scary or dangerous at all. After jogging (for the purpose of recovery, as you understand), this figure can exceed 160 and 180 beats per minute!

I always tell my patients that it would be worse if they didn't have heart palpitations when they're stressed, because that would mean their autonomic nervous system isn't working. And so it works, very well! Sometimes a patient with VSD tells me: “How healthy am I?! I have a heartbeat!” What should I answer?.. If you don’t have a heartbeat, then consider yourself dead. The heart, you know, must beat. And with what frequency it beats, this really doesn’t matter significantly: well, 60, well, 120... It works! Eureka.

Interruptions in heart function

There is an extraordinary amount of confusion going on with this symptom! Many patients with VSD feel as if their heart from time to time “freezes,” “stops,” and “then starts again.” But, as a rule, all this only seems to them. For example, some of them told me that their heart “stopped” for periods of 10-20, or even 30 minutes. What simply cannot happen! Otherwise, it would be impossible to tell the doctor about this.

Unfortunately, the results of “self-measurements” of pulse are, as a rule, deeply erroneous. A person can be sure that his pulse exceeds 130, or even 200 beats per minute, but the “control measurement” I made shows that this, so to speak, “tachycardia” fluctuates between 70-80 beats per minute! With the same “success”, patients determine their extrasystole, which is actually absent. And this is a scientific fact! A special study showed that at least 44% of patients who indicated that they had interruptions in their heart function were cruelly mistaken in this, fortunately...

However, a patient with VSD can indeed have interruptions in the functioning of the heart, just like any other normal person. Functional disruptions in the functioning of the heart are natural and normal; after all, it is alive. Now I remember one study conducted on military pilots - these standards of physical, and even more so, cardiac health. So, at first an ECG was taken from one thousand pilots, and extrasystoles were found in 2.5% of them, i.e. They had few extrasystoles.

Then they all underwent 24-hour monitoring (this is when an ECG is taken throughout the day), and then the situation changed dramatically! A wide variety of heart rhythm disturbances were detected in 29% of pilots. Finally, they underwent ECG measurements at maximum physical exertion, and here all kinds of arrhythmias were found in 35% of healthy “palate specialists.” Moreover, all these pilots did not present any cardiac complaints, did not note any painful symptoms and did not have any cardiac diagnoses! So occasional heart rhythm disturbances are normal!

Pain in the heart area (cardialgia)

Pain in the heart area in patients with vegetative-vascular dystonia is a common occurrence, but it is significantly different from pain with angina pectoris (a truly serious heart disease). In a patient with angina pectoris, chest pain occurs in a clear connection with physical activity (depending on the severity of the disease, it begins when climbing stairs or from the sixth, or from the fourth, or from the second flight of stairs). In patients with VSD, such a strict dependence, let us assume obligatory and constant, is never observed, but it should have been if they actually had heart disease.

In a patient with angina pectoris, as a rule, there is a specific irradiation of heart pain - it radiates to the left arm or left shoulder blade, and the pain itself is most often localized behind the sternum, and over a wide area. It is precisely this kind of irradiation that does not occur in patients with VSD, and the “heart pain” itself occurs pointwise, in a specific place. Why? Yes, simply because this is not heart pain at all, but classic intercostal neuralgia, in which it is not the heart muscle that suffers, but a nerve, and not in the chest, but in the back, where it is pinched due to osteochondrosis. [We will continue the most detailed story about osteochondrosis and intercostal neuralgia in the book “A Remedy for Headaches and Osteochondrosis,” which is published in the “Express Consultation” series.]

And this nerve has absolutely nothing to do with the heart; it innervates the muscle that connects two adjacent (above each other) ribs. That is why the strength of these pains often depends on the movements of the chest, on the activity of breathing, and not at all on the actual physical activity, as it should have been if we were talking about a real heart disease that could lead to myocardial infarction.

And if our heart “pricks,” “pierces,” “pulsates,” “goes numb, like in a refrigerator,” “gives into the shoulder blades and arms, lower back and neck,” “heart spasms,” “a lump behind the sternum,” and in this case, “tingling”, “squeezing”, “sharp compression”, “squeezing”, “tension”, “stuffiness”, “burning” in the heart area, as well as the left hypochondrium, upper abdomen, “bloating” or, conversely, is felt , “emptiness” in the chest, then you can relax - these are by no means the pains that lead us straight “to the next world”, this is an unpleasant, but not dangerous, vegetative-vascular dystonia.

Fluctuations in blood pressure

When a patient tells me they are experiencing “blood pressure fluctuations,” I always ask about what they call “blood pressure fluctuations.” I have seen patients whose upper blood pressure numbers went well beyond 200, or even 250. Cases when the lower numbers in patients rose to 120-130 had no less psychological effect on me. But, really, in the first case, as a rule, it was always about the so-called “malignant type of hypertension,” and in the second, about serious kidney disease. And such numbers have never, never been, and never can be, seen in patients with VSD.

Those suffering from VSD may feel that a pressure of, for example, 135/95 mmHg is “high pressure.” But this is not only not high, it is generally normal pressure! The mildest - the first - stage of hypertension will not be diagnosed with such figures, and even if such figures are constantly maintained! And if the vessels do not rupture under a pressure of 250 mmHg, then at 160 there is no need to rupture at all, unless due to some capriciousness, but even then it is unlikely.

And one more thing, the rise in blood pressure itself is not a problem, the problem is damage to the vessels themselves, atherosclerotic damage, which we will discuss below. It is the famous atherosclerotic plaques that are dangerous to human life, since they can break away from the place of attachment - either causing a rupture of the vessel in this very place, or moving further along the vascular bed and clogging the vessel at the site of its narrowing.

But, have mercy, for this you need to have atherosclerotic plaques! And for such a thing, you need an appropriate age, certain metabolic disorders in the body and, finally, a doctor’s verdict, with which, you can believe me, if these plaques really exist, there will be no problems. All this will be determined during the first examination; doctors will not miss atherosclerosis. And to be afraid of the very fact of increased blood pressure despite the fact that there is no trace of atherosclerosis is, to say the least, strange!

As soon as science realized that emotion is primarily the physiological reactions of our body and without these reactions emotion is impossible, an idea immediately arose in some heads: to determine a person’s honesty using instruments that record the vegetative component of emotion. When we tell a lie, even if it is beneficial and necessary for us, we still experience pronounced internal resistance to our own lies. The point, of course, is not that in this case we suffer from the hardships of moral choice, but that we are afraid.

Yes, even in our early childhood we learned: our lies are invariably followed by punishment and retribution. “The secret always becomes apparent,” wrote Viktor Dragunsky in his “Deniska’s Stories.” Of course, this did not stop us from lying if necessary, but we became terribly afraid that our lie would be revealed, and then we would get “on the first day.” Throwing the hated porridge out the window, lying to the teacher that you didn’t feel well, did the assignment but forgot it at home, taught it but didn’t remember it - a sacred thing! But it’s terribly scary - they’ll find out, they’ll guess, and then, good thing, it’s lost...

So lies and fear go hand in hand with each other, and fear, as we know, is manifested by certain symptoms: palpitations, increased blood pressure, changes in the nature of external respiration, sweating. So if we measure these symptoms in a person who provides us with this or that information, we can determine whether he is lying to us or not. The one who tells the truth, by and large, has nothing to fear, or, at least, he should not have internal tension associated with the fear of exposure. And if there is, then there is probably something fishy here...

This method of “honesty” was first carried out by a scandalous scientist named Cesaro Lambroso, the author of the famous and sensational book “Genius and Madness.” At the end of the 19th century, he began to measure the blood pressure of suspects in a particular crime during interrogation. A couple of decades later, our compatriot A.R. Luria, who was a friend and colleague of L.S. Vygotsky (who is well known to those who have read my book “How to Get Rid of Anxiety, Depression and Irritability”) conducted similar experiments on murder suspects. True, A.R. Luria mainly measured the intensity of muscle tension in them and determined signs of impaired coordination of movements.

And already in the 20s of the 20th century, D. Keeler manufactured the first device for recording respiration, blood pressure and electrical activity of the skin during police investigations in Berkeley (California, USA). The success was stunning! Researchers determined with a probability of 80 and sometimes 90% of cases whether their test subject was lying or telling the truth. And the production of polygraphs (machines we call “lie detectors”) began to flow. A person who has nothing to hide will answer questions regarding a crime with the same calm as he would answer “ordinary” questions. Meanwhile, a possible criminal, wanting to lie so as not to give himself away, will become a victim of internal excitement, which will be easily caught by a polygraph.

But how do researchers find fear in their subjects? They measure the activity of the sympathetic nervous system. And if during such a special examination a person demonstrates a rapid pulse, an increase in blood pressure, irregular breathing, excessive sweating, etc., then it means that at that moment he is experiencing a strong negative emotion - first of all, fear. And if he is afraid, it means he has something to hide...

Why did I remember now about the polygraph? Of course, not because all sufferers of VSD should be suspected of committing some terrible crime, and therefore need to be tested with a lie detector. Of course not! But those suffering from vegetative-vascular dystonia themselves should think: what comes first in the symptoms that torment them - these symptoms themselves or the fear of their appearance? In other words, isn’t fear, internal tension, stress the true cause of our malaise? Perhaps we do not notice the stress we are experiencing, just as a criminal does not notice his own internal tension during a false answer to a provocative question for him?..

Labored breathing

This is also a symptom that throws patients with VSD out of balance - difficulty breathing, or a feeling of lack of air. Indeed, any problem with breathing naturally causes fear in a person - after all, this is a vital function of the body. But that’s what a person is all about, to “turn on” his brain at this moment and take advantage of its capabilities in order to correctly assess the situation. “Breathing difficulties” that occur with vegetative-vascular dystonia are purely a subjective sensation!

Firstly, if everyone around you “has enough air,” then there cannot be “not enough air” for someone who seems to have been deprived of it. In other words, if there is not enough air, then everyone should suffocate in such a situation. How long ago has this happened so that, for example, all the passengers of some subway car suffocated? Or, for example, how many cases do you know of someone suffocating while left alone in our domestic apartment? More people, in my opinion, died from drafts in them than from suffocation.

Secondly, there is a disease that actually manifests itself as asthma attacks, and the name of this disease is asthma. But this disease has strict criteria that make it possible to clearly determine whether a person suffers from asthma or not. And if the studies carried out (first of all, specific changes in the blood are important here) indicate the absence of appropriate criteria, then there can be no talk of asthma!

Finally, thirdly, attacks of shortness of breath can occur in people suffering from atherosclerosis of the coronary vessels, but in this case there is atherosclerosis of the coronary vessels, which is determined using a simple ECG study. If atherosclerosis is not found in us, then we do not have the right to real dyspnea of ​​the core. And the difficulties that we have with breathing cannot be qualified other than as a “subjective sensation”, i.e. it only seems to a person.

Yes, against the background of stress, we experience problems with breathing, but believe me, the body is an unusually tenacious creature and absolutely wants to live, so it will never allow such a failure to lead to any irreparable consequences. The fact that a person who is afraid of suffocating out of the blue really breathes ineffectively is not a question. He is breathing ineffectively in the sense that he could breathe better. However, all this is again not fatal - he is breathing!

Life, gentlemen of the jury, is a complicated thing, but, gentlemen of the jury, this thing opens as simply as a box. You just need to be able to open it. He who cannot open it disappears.

(Ilya Ilf and Evgeny Petrov)

True, during a panic attack some people try to breathe with their stomach - i.e. swallow air instead of inhaling it (i.e. letting it into the lungs). But, really, this is an exceptional initiative, which can be easily and simply stopped if desired. In addition, some “specialists” suffering from VSD, during their “attack”, forget that air sometimes needs to be not only inhaled, but also exhaled. When they have a “feeling of lack of air,” they inhale, inhale, inhale, but do not consider it necessary to exhale. But our chest is not dimensionless, so if you want to inhale well, you need to exhale well before doing so, thereby freeing up space for a new portion of air. It is, in fact, these two mistakes that constitute the “feeling of lack of air,” which, fortunately, is in abundance for everyone in this world. And to wrap up this topic about the feeling of a “lump in the throat,” the feeling that “your breath has been taken away,” that it has “cut off,” “stalled,” “choked.” All these sensations are associated with banal muscle spasms, characteristic of stress loads. During times of stress, as we remember (and a “panic attack” in itself is stress), a person experiences natural muscle tension. And there are muscles in both the pharynx and larynx, so there is nothing strange in the fact that something is “squeezed” and “strained” there. However, there is nothing wrong with that. Well, the body cannot kill itself, it cannot! Something tensed in my throat, a feeling of a lump arose - so what?! Why not breathe, for what reason?!

Dizziness, headaches, fainting

Dizziness and fainting are what patients with VSD are very often afraid of, and headaches are what they traditionally suffer from. I must immediately make a reservation that headaches are a natural phenomenon in the case of VSD. Muscle tension (especially in the vessels of the neck), characteristic of stress, and disruption of the autonomic regulation of vascular function that accompanies VSD cannot but lead to one or another manifestation of physical suffering in the brain.

But, fortunately, all these troubles do not pose any threat to human health. We cannot experience such a muscle spasm that will lead to complete compression of the blood vessels, and therefore pain may occur, and dizziness may occur, but there is no way to die in this way. A similar situation arises with vegetative tone. No matter how badly it is broken, there will be no big trouble. Discomfort - yes, but troubles - no.

Autonomic imbalance can indeed lead to dizziness if the work of the sympathetic part of the autonomic nervous system is painfully enhanced. When we experience a cerebral vascular spasm, the brain does not get better; its blood supply becomes less efficient. This is unpleasant, but not at all a disaster, since at the same time there is a rise in pressure, so that even despite the narrowing of the lumen of the vessels, a real deficiency of nutrients and oxygen does not occur in the brain. If parasympathetic tone predominates in us, then the vessels, on the contrary, dilate as blood pressure decreases. Thus, the opposite situation arises here: the pressure is less, but the clearance is wider. Dizziness may occur, but that’s all.

There are two ways to easily glide through life: believe everything and doubt everything. They both relieve us of the need to think.

(Alfred Korzybski)

Regarding “fainting states,” your humble servant has a lot of prejudices. The fact is that there is such a phenomenon in medicine: “loss of consciousness”, or “unconscious state”. It can develop, for example, in the case of severe traumatic brain injury or painful shock. However, what is fainting is, by and large, unknown to science. Severe dizziness, an attack of weakness - this is all right! It's clear. But fainting?.. Fainting, rather, comes from the realm of literature, and deeply artistic one at that. The fact that it seems to a person that he has “lost consciousness” is only an illusion to him; the fact that it seems to him that he is “about to lose consciousness” - even more so.

Indeed, a feeling of stuffiness, lightheadedness, etc. “-you” is, of course, a nuisance, but you don’t need to lose your head! Well, things got worse... What should I do? It will pass, it won't go anywhere. But if you get worried, if you immediately start looking for a place on the sidewalk where to lie down, this is a problem! In this case, the fear only becomes greater, and the vegetative discomfort only increases. The consequences are clear - we will suffer, as well as live, and accordingly. In any case, the fear of fainting is much worse than fainting itself, even if it happens... for a couple of seconds.

Weakness

The feeling of weakness, by and large, comes in two forms: either we are physically so weakened that we no longer understand anything, or we are psychologically so exhausted that our own body ceases to obey “its commander in chief.” The weakness of a person suffering from VSD, as you might guess, is from the second group. His body is bubbling and working tirelessly, and therefore it is quite difficult to recognize him as physically weakened. Perhaps he is tired, but why?! The reason is emotions and all sorts of bad thoughts that, they say, I will die soon and no one will come to my grave.

However, vegetative imbalance is really an unpleasant thing. And if your body is exhausted (the reason doesn’t matter here), then it wants rest, and if we don’t give it to it, then it takes it itself - to the extent that it can take it. This, in fact, is the weakness that a person with VSD experiences so often and so unjustifiably acutely. Well, such weakness only tells us that we need to rest, and at the same time it also clearly hints: “Stop torturing the cat!” I don’t think there’s any need to explain who the “cat” is here.

Sweating, chills andsubfibrility

Sweating, chills and low-grade fibrosis are the same. All of them are caused by the work of the autonomic nervous system and, in general, serve one thing - thermoregulation. Maintaining the desired body temperature is a very important thing. The fact is that a huge number of chemical reactions are constantly taking place in our body, which, as we remember from school, often require one or another temperature regime. This, in fact, is why our body needs a constantly burning “alcohol lamp”, and with a strictly defined flame temperature.

However, there is nothing terrible in temperature fluctuations, the play here is quite large, and most importantly, there is a system of heat sinks and heat drives. Sweating, for example, is a way to lower body temperature, and subfibrility is a way to raise it. When we sweat, moisture appears on our skin, which, evaporating, cools these very covers. With vegetative failures, a strange situation often arises - the body sweats excessively, but only in areas. These zones are known - the palms and armpits, less often the neck, groin area, etc.

Subfibrillation is a body temperature elevated to 37.0-37.5 ° C (a rise in temperature serves to accelerate metabolic processes in the body, which is natural in situations of stress). Special centers of the brain are responsible for this, and the occurrence of subfibrillation is due to their decision that, supposedly, the existing body temperature is insufficient for the level of stress in which this body is located. Perhaps, of course, they overdid it, but that’s okay, they’ll float and float and stop - they won’t go anywhere.

Chills are, accordingly, a state when the body is looking for the temperature it needs, trying to get into the required temperature corridor that corresponds to the required intensity and speed of metabolic processes. The condition is unpleasant, but it regulates the heat supply!

And there are other options to choose from...

It must be said that VSD is only one of the variants of autonomic dysfunction that occurs against the background of stress. We have already remembered another “terrible” diagnosis - diencephalic crisis, but the list of such pseudo-illnesses does not end there. The autonomic nervous system innervates all organs of our body, and therefore there is gastric VSD, intestinal VSD, blood VSD, and even VSD of a sexual nature!

A person experiencing stress is able to fixate on a variety of symptoms of his vegetative ailment. If he is fixated on the state of his heart, then he will have classic vegetative-vascular dystonia; if he is focused on his “paralysis,” then most likely he will be diagnosed with a diencephalic crisis; if he has a feeling of lack of air (what seems to him like “suffocation”) , then doctors will say that it is “neurogenic asthma.” There are, of course, other options...

In some people, emotional stress leads to certain shifts in the system that regulates the degree of permeability of small blood vessels (capillaries). In this case, the main symptom of stress will be “unreasonable bruises” and bleeding up to the so-called “bloody sweat”.

Health is when you have pain in a different place every day.

(F.G. Ranevskaya)

Other people experiencing stress and on the verge of neurosis fall into a state that is manifested either by a complete loss of appetite (this is in the case of an excess of sympathetic function), or, on the contrary, by causeless “eating” (this is in the case of stimulation of the parasympathetic system). The result is either weight loss or weight gain.

You can, however, become fixated on nausea, which sometimes ends in vomiting. Nausea and vomiting are unpleasant things, and therefore fixation on them often leads to terrible consequences: a person is constantly worried, worried, and as a result, his condition only worsens. In such cases, doctors talk about gastritis, gastroduodenitis, sometimes about the esophageal reflex, but in reality it’s neurosis and nothing more.

However, the gastric tract has not only a top, but also a bottom. For some, this “bottom” becomes a stumbling block - diarrhea or, on the contrary, constipation are in these cases the main culprits in the triumph of autonomic dysfunction. Frequent, relatively loose stools or constipation and flatulence in such people are often more unpleasant than serious. A person who is concerned about the functioning of his gastrointestinal tract may pay so much attention to it that a failure in the functioning of this tract is simply inevitable. However, whenever our consciousness interferes with the functioning of physiological functions, we have problems. In this case, doctors call this problem “irritable bowel syndrome.”

There are those, among other things, who are fixated on the frequency of their urination. This may seem strange to some, but those who have made this physiological function their main problem are not laughing. Under stress and with increased blood pressure, our kidneys actually produce more urine per unit of time than in a calm state. This circumstance can provoke a strong and sudden “urge to urinate”; the latter can happen in an inconvenient place and at the wrong moment (for example, in transport). As a result, a person begins to worry that this “embarrassment” will happen again under similar circumstances. And this anxiety is already stress, which is precisely what contributes to this embarrassment; there is also fixation, which intensifies all our sensations...

In short, a vicious circle closes: stress - increased blood pressure - increased kidney function - the urge to urinate in inconvenient circumstances - embarrassment (of one kind or another) - fear that this embarrassment will happen again - stress when similar circumstances arise - increased blood pressure - increased kidney function - howling to urinate - classic neurosis (you can’t leave the house, and all you can think about is only one thing - no matter how embarrassing we have with the toilet). This is how troubles happen...

Finally, the matter is decided by sexual dysfunctions of the same - vegetative - nature. In men, the sympathetic response can manifest itself in premature ejaculation and decreased potency. In women - low secretion of the glands of the genital organs, increased excitability in the absence of psychological readiness for sexual contact. All this, of course, does not contribute to the quality of life in any way, sexual problems arise, then interpersonal conflicts, then fixation on “symptoms”, fears... and now neurosis unfolds before us in all its glory.

By the way, against the background of exhaustion in the presence of long-term and debilitating autonomic disorders, sexual dysfunctions appear on their own, and in this case they look simple - “I don’t want anything,” “I don’t want anyone,” “I won’t do anything.” In short, a person’s libido decreases, and hello.

Muscle spasms, cramps, changes in skin sensitivity

We have described the main symptoms of autonomic imbalance, but, as already mentioned, stress, like any strong emotion, is not only psychology, not only autonomics, but also the state of the muscles. The muscles here are almost the only “nail” on which “everything rests”, because they are the ones who should “take us out of the battlefield”, and when you are in a situation of stress, it means that it seems to you that you are in the epicenter of a battle , and therefore I want to “tick from here until something happens.”

Muscles are a separate topic altogether, and we will return to it later as a separate topic. Now let's talk about symptoms. So, stress - both obvious and hidden from our consciousness - is impossible without muscle tension, but we cannot always realize the muscle tension that has arisen in us. Since a decent person should not show his heels at the first opportunity and his fists at the second, then, accordingly, a paradoxical situation arises: there is tension, but it is unknown where to put it. Here the muscles of decent people flex as best they can - we experience muscle spasms, cramps, tics, etc. There is nothing supernatural about this.

But if your muscle cramps, as it seems, out of the blue (and it always seems like this if your own stress is not obvious to you), the stupidest thoughts come to mind: “What’s wrong with me? Why don't my own hands and feet obey me? Maybe it’s a stroke?!” From such a “bold idea”, of course, it becomes even worse, even more terrible, and the muscle spasm only intensifies.

On the other hand, muscle tension naturally entails a change in the sensations emanating from those muscles. A tense muscle feels much different than a relaxed muscle. Often it is not felt at all! If you now remember the traditional plot from Russian fairy tales, which tells how, from the “puffing” of the Serpent-Gorynych, Ivan first found himself ankle-deep in the ground, then knee-deep, and then waist-deep, then you will be able to understand what we are talking about.

If you read the tale carefully, it is difficult not to notice one striking oddity. At some point, Ivan, who, as they say, is waist-deep in the ground, suddenly breaks away and moves in one direction or another. Now imagine that you are buried waist-deep in the ground. Can you take off and run? Do you need time to dig out? Without a doubt, it takes both time and digging. Doesn't this mean that Ivan was not buried? I answer with authority: that means!

The fact is that against the background of stress, muscle sensitivity changes (and Ivan, for example, as you might guess, was under stress when this monster began to breathe on him). Overstraining muscles can actually lead to the opposite effect: a person begins to feel as if his legs have become weak, completely relaxed, or even paralyzed.

If you don’t know whether to run or stay in place, but the need to perform one action or another is obvious, then in the legs both those muscles that are responsible for bending them (the so-called flexor muscles) and those that are responsible for extension (the so-called extensor muscles). What should the brain think in such a situation? It is incomprehensible to him, and he makes a cardinal, albeit incorrect, decision for himself: he begins to assure us that the leg muscles are not tense at all, i.e. relaxed, felt like cotton wool, or completely paralyzed.

Of course, there is no talk of any paralysis here! And in the mentioned fairy tales, no one buried the main character. There was simply a momentary tension in the flexor and extensor muscles, and the brain thought and thought and decided that the legs were not tense at all. Yes, if you “stopped in your tracks,” and fear can sometimes have a similar effect, then it may well seem to you that “your legs are not listening to you.” Some of us interpret the latter in a peculiar way: “If your legs don’t obey you, it means paralysis, it means a stroke!” Does that mean? Fear doesn't care about this, his eyes are big and his mind is short.

Changes in skin sensitivity, which are often found in people suffering from VSD, are from the same story as psychological “paralysis” of the limbs. But the mechanism of such sensations is still somewhat different than in the case of muscle tension, although the latter play a primary role in it. A tense muscle affects all nearby tissues, including those nerve endings that are responsible for skin sensitivity.

Compression of these nerve endings “from the inside”, i.e. not from the surface of the skin, but from the muscles, leads to strange effects. A person may experience a feeling of numbness (with tense muscles, figuratively speaking, you can “sit your leg” without sitting down), tingling, goosebumps, etc. Since similar symptoms often occur in a person who has suffered a stroke, it is probably not strange that that thoughts about such a disease creep into the head of a person suffering from VSD.

It is no use saying, “We are doing our best.” You must successfully accomplish what is required.

(Winston Churchill)

The fact that such a conclusion is erroneous is quite obvious, because in a stroke patient a specialist identifies a whole complex of specific symptoms that a person suffering from VSD simply does not have. But, among other things, he has no knowledge of what this “complex” is like. He can be sure that his symptoms are quite enough. And if a person experiences dizziness, headaches, a feeling of a pulsating vessel in the head, as well as muscle spasms, cramps, “woolly legs” and changes in skin sensitivity, he may well think that - “That’s it!”

But this, of course, is not all, and the doctor will tell him about this. It would also be good if this doctor told the sufferer that he has a neurosis... However, our doctors are afraid to say such things to people, since most of us continue to be in the prehistoric belief that “neurosis” is such a name-calling . And that’s why doctors talk to their patients about either vegetative-vascular dystonia or diencephalic crisis (this term means the same thing and is often used in Russia). The last phrase coming out of the doctor’s mouth is often perceived by an ignorant person as a “death sentence.” But in reality we are talking about an ordinary neurosis or, if you like, about VSD, but with a predominance of not so much vegetative as muscle symptoms.

Each of those who at one time received a diagnosis of vegetative-vascular dystonia, apparently, noticed the embarrassment with which the doctor gives this verdict to the patient. A person who has such a rich collection of symptoms at his disposal and does not know about their true origin, of course, believes that the doctor must, simply must, find some serious heart (or, at worst, some other) disease in him. Well, at least it’s something! Apparently, it was for this purpose that, in fact, this “ominous” diagnosis of “vegetative-vascular dystonia” was invented - scary, incomprehensible and sounds threatening. [In the most fatal cases, such a “patient” can only be given the most peaceful and harmless, in fact, diagnosis of osteochondrosis, which, in essence, is only a consequence of chronic stress. The latter in this case, paradoxically, is a person’s fear for his own health. Truly, you never know where you will find it or where you will lose it. Read about the details of this disease and the means to combat it in the book “A Remedy for Headaches and Osteochondrosis,” published in the “Express Consultation” series.] There is simply no other explanation for this, if I may say so, there is simply no diagnosis!

One way or another, the doctor’s embarrassment is understandable, because the situation is really stupid. Just think: here it is not the doctor who is trying to convince the patient that he is sick (this is what usually happens when it comes to real illnesses), but the patient who demands that the doctor reward him with a diagnosis. And it seems to a person suffering from VSD that if a doctor gives him some “terrible” diagnosis, then he will immediately become less afraid. After all, if it is clear what kind of disease you have, then it can be treated. And as long as it is unknown what it is, there will be no correct treatment. How great is this misconception!

In fact, if you have been diagnosed with a serious cardiac pathology, then most likely this disease is chronic, and its treatment, accordingly, is only auxiliary in nature, i.e. It is impossible to cure such a disease, and if there is one thing doctors can do, it is to reduce its manifestations and slow down its progress. That is, there is nothing encouraging in real cardiac pathology, while the diagnosis of vegetative-vascular dystonia literally means the following - there is nothing to worry about, you will live a long time, albeit painfully. The last clarification, however, only applies until we cure our neurosis.

However, I would like to talk now not about the doctor’s embarrassment, but about what confuses him when he examines a patient with vegetative-vascular dystonia.

Firstly, a doctor examining a patient with symptoms of VSD is confused by his lack of “organic pathology.” Our body, as you know, consists of different organs. These organs may fail for one reason or another. And this is always manifested by a set of specific identifiable signs. Relatively speaking, if you are diagnosed with a gastric ulcer, then the doctor, in the process of his diagnostic work, must detect this ulcer in you (for example, using gastroscopy), as well as a very specific set of symptoms.

If the patient’s pain does not resemble ulcerative pain, i.e. arise at another time, in another place and under other circumstances, and, in addition, do not respond in any way to specific treatment, then doubts arise regarding the correctness of the alleged diagnosis. If, finally, the ulcer is not detected during gastroscopy, then it is clear that this person has no trace of a gastric ulcer, and the pain, accordingly, is associated with some other pathology.

About the same situation arises in the case of vegetative-vascular dystonia. Many people who suffer from it believe that they may be at risk of a myocardial infarction or stroke, in addition, they may suspect that they have epilepsy, and in the most complex cases, myocarditis, cancer (including a brain tumor), AIDS and more. in a mortar. But each of these diseases has exactly the same “organic substrate” and exactly the same, very definite, list of symptoms, and if neither one nor the other is found (and the latter - symptoms - in strict combination with each other), the doctor, Of course, he cannot make this diagnosis for his patient.

The doctor knows what diseases a person may have and asks about these diseases. At this time, certain work is happening in his head: he finds out this or that information, sifts through it, highlights the main thing, clarifies the details and, if the resulting volume of data does not meet the necessary criteria, closes the issue with a clear conscience.

Exactly the same as in the given example with gastric ulcer, a patient with VSD does not have a specific reaction to the medications used for supposed serious illnesses. In other words, if you use a drug that cannot help but help in the case of a certain pathology, and it does not help, then, accordingly, you cannot count on an appropriate diagnosis, since you do not have this disease. However, some people who suspect, for example, the possibility of a heart attack, believe that nitroglycerin helps them. Nitroglycerin should really help with coronary heart disease, and it simply must do this within the next one or two minutes. If it “helps” after five minutes, then you can relax - you don’t have any coronary heart disease.

On the other hand, doctors are alarmed by the effectiveness of such “heart” drugs as Corvalol andvalocardine, as well as phenazepam, since all of them are not cardiac, but psychotropic. Accordingly, the appropriate conclusion suggests itself here - if psychotropic drugs help, i.e. drugs that affect the psyche, then the disease, apparently, in this regard, but not the heart. None of these drugs can do anything with spasm of the vessel, as well as with its blockage. If, of course, they eliminate fear and internal tension, then the vessels, of course, will dilate, but in any case they will not get rid of the sclerotic plaque.

The next point that causes some confusion among doctors is the relatively young age of the patients. The fact is that the pathology that people suffering from VSD usually suffer from does not occur at a young age. And the one that occurs at this young age (by the way, a person’s youth, according to the World Health Organization, lasts up to 40 years) is either not as scary as some people think, or, fortunately, is simply unknown to such amateur diagnosticians.

Simply put, heart attack and stroke do not happen at a young age. And those people who allegedly “burned out” at a young age under the “watchful eye of unprofessional doctors”, apparently, either really had a serious pathology that cannot be cured, but also cannot be missed (for example, blood cancer); or did not show up at all for appointments with specialists, which does not apply to those suffering from VSD. In general, whatever one may say, all the worries here are both meaningless and unjustified.

When a doctor says: “You are still very young for a heart attack,” he is not at all trying to “discourage” his patient. The fact is that for a heart attack you really need atherosclerosis, and atherosclerosis is one of the mechanisms of aging, and it simply does not start before the age of 40. Death, by and large, is a genetic program; we can say that we have a kind of timer in our chromosomes, and when we cross the youth line (the forty-year mark), the aging mechanism starts. Then it begins to slowly unwind, and the first symptoms of this “unwind” should be expected no earlier than 50-55 years. [Some people are confused by the fact that the average life expectancy of Russians fluctuates around 60 years, and therefore it seems logical to think that the mechanisms of aging work here earlier, in the rest of the world. This is the wrong conclusion. "Average life expectancy" is the life expectancy of all people divided by the number of people. For example, the average life expectancy of two people, one of whom died at the age of one, and the other at 80 years old, will be 40. Of course, all this has absolutely nothing to do with the mechanisms of aging. If Russia had a different infant mortality rate, if 40% of the country's population did not suffer from alcoholism (with all the ensuing consequences) and if, finally, we did not rank first in the world in the number of suicides per capita (and people commit suicide more often people are young), then our “average life expectancy” would be different.]

Finally, doctors cannot but be confused by the behavior of people suffering from VSD. And they really behave completely differently from ordinary patients. Firstly, it is impossible to force a person suffering from severe somatic pathology to see a doctor, especially in Russia. Secondly, even if by some miracle he ends up seeing a doctor, he will endlessly claim that the doctor is exaggerating the severity of his illness. Thirdly, force the real patient to take care of his health, i.e. Leading a healthy lifestyle and taking medications is an incredibly difficult task. Of course, such incidents do not happen to patients under the heading of VSD, since they are concerned about their health, and pathologically.

And the very last thing. How do you think a person experiencing, for example, a real heart attack, and not a vegetative attack, will behave? He will try not to move, will demand that everyone leave him alone, and will flatly refuse to call an ambulance. Honestly! This is why a significant number of heart attacks are detected by doctors using ECGs during routine examinations several years after they occurred. Our people endure their heart attacks on their feet, our people are strong and calm (in this sense, at least), but because of some nonsense (like a vegetative crisis) our public is capable of crawling out of their skin. There's nothing you can do about it - neurosis! And both of them. Some people need to be treated, but they don’t go to doctors and don’t take treatment, while others don’t need it, but they will beat all medical thresholds and try everything that medicine has ever come up with. Neurosis, in a word, neurosis!

Noise proves nothing. A chicken, having laid an egg, often clucks as if it had laid a small planet.

(Mark Twain)

Everything that we discussed above testifies: vegetative-vascular dystonia is not a disease of the cardiovascular system at all, but simply such, admittedly, a very unfortunate way to experience your stress. And if a person in this case has problems, then these are problems not with the heart or blood vessels, but with the head, more precisely, in the head, in other words, this is a psychological problem. In addition, we found out that there is no threat to life in vegetative-vascular dystonia, it only scares, but cannot harm in any way. To put it bluntly, he behaves like a toothless dog - a lot of noise, no harm. And if there is any threat in this “bully”, then there is only one - it’s painful to live with it! So what is she, if not neurosis?! Neurosis is what it is! By the way, it used to be called “neurosis of the heart.”

Previously, doctors were zemstvo doctors, they looked at the whole person, did not see him divided into anatomical parts, but observed all the interconnections of the human body and therefore understood perfectly well what and where the wind was blowing in such a case. Now doctors have become “narrow specialists” and, as a rule, they see only that part of our body for which they are responsible (cardiologists - the heart, pulmonologists - the lungs, neurologists - the nervous system). The rest, unfortunately, is of little interest to them, and the result turns out to be appropriate. In general, we have begun to treat our patients much better, but the fact that a significant part of our illnesses is “from nerves” has somehow been forgotten. But nerves are such a thing! You will forget about them, but they will not forget about you.

Well, let's look at our body in its connection with our psyche...

Many people suffering from VSD are absolutely sure that doctors are not listening to them and do not want to enter into the situation. Perhaps in some cases doctors really don’t take their job too seriously. I myself, being at times someone’s patient, am not always delighted with the way the doctor works. In other words, sometimes there is something to complain about. But, really, where patients suffering from VSD find fault, as a rule, doctors do everything right.

Let's take a specific example. My patient Alina is 19 years old; for two years now she has been rushing (literally) to doctors, expecting that she is about to die of a heart attack. This in itself is strange - the fact that she is literally running around. All patients with atherosclerosis, who are truly at risk of a heart attack, walk slowly, because they simply cannot move quickly, their health does not allow it. And Alina is running around. And here's how...

Alina lives in an area that in St. Petersburg is called the “old fund”, and her apartment is not typical and is arranged in a very unique way. The house faces a small square at an angle, and its two walls form an acute angle at this square. Alina’s apartment is located in such a way that the window of her room looks out onto one street leading to the mentioned square, and the kitchen looks out onto another street, also leading to the same square.

When you don't know what to do, come to your senses.

(Yu.Z. Rybnikov)

So, every time Alina has a “heart attack”, it begins to seem to her that she only has a few minutes left to live, she opens the windows both in her own room and in the kitchen (and regardless of the time of year), and then, while waiting for the ambulance, he begins to run from the room to the kitchen and back, leaning out of the open windows and trying to understand whether the ambulance has already arrived or not.

What is the mystery behind this strange behavior? The answer that Alina offered me explains everything. Since she, that is, Alina, does not know from which side of the house the ambulance will arrive, she tries to find out with a similar maneuver. Then, when the car is finally discovered on the wrong side, i.e. not where her front door is, Alina shouts from above, from the seventh floor, that, comrades, go around the house!

The driver obediently circles the house, the doctors go up to the seventh floor, enter Alina’s apartment and ask her: “Where is the patient?” Alina, of course, reports: “I’m sick!” To which the doctor, without saying anything more, turns and goes home. Strange? Unclear? But the doctors are absolutely clear - if a person is able to run from room to room and shout something from the seventh floor to the people below, then you can be sure: the heart attack “for which” these doctors were called, this “patient” does not have at all. It’s just technically impossible!

If the patient really wants to live, doctors are powerless.

(F.G. Ranevskaya)

A person with a heart attack moves from a chair to a bed with great difficulty, and he absolutely cannot run, jump, scream, or wave his arms! And patients with VSD, if they need it, are able to walk to the ambulance substation themselves. By the way, one of my patients, Nikolai, 32 years old, did just that. He lived nearby, just two tram stops away, and therefore every time he had another “attack,” he reasoned like this: “By the time they get to me, I’ll have time to get to them twice.” And he got there! He walked two tram stops to the ambulance substation... If he really had a myocardial infarction, then such a “voyage” would have been the last in his life.

Of course, being in a state of anxiety, which requires not passivity, but, on the contrary, activity and action, it is easier to run than to sit still. But if you have a real cardiovascular pathology, then the question does not arise in this way at all. Not only is there no time for running, but getting on your feet is a big deal! But, of course, both Svetlana and Nikolai were angry with the doctors... And only when their neurosis was cured, when the attacks stopped, they finally realized how ridiculous such activity was and how right the doctors were who reacted to their behavior so definitely. [All the psychotherapeutic techniques necessary for this are described by me in the books “Happy by Your Own Will”, “How to Get Rid of Anxiety, Depression and Irritability”, published in the “Pocket Psychotherapist” series, as well as in the practical manual “The Remedy for Fear”, published in "Express Consultation" series.]

The devil is not as scary as his little one
Folk wisdom

The statistics are disappointing: up to 80% of the world's population suffers from one or another manifestation of VSD, and almost a third of them need qualified medical care. It is noteworthy that women are more susceptible to the disease than men. We can say that VSD is the scourge of modern humanity, the price to pay for the mind, career and material wealth that is so difficult for us to get, doctors say.

There are many myths associated with the diagnosis of vegetative-vascular dystonia. Indeed, if your blood pressure is fluctuating, your stomach hurts, you don’t have enough air and your heart is burning, cutting and jumping out of your chest, where can you suspect psychological problems? Obviously we are talking about diseases of the heart, lungs and stomach. And we begin our long journey to cardiologists, gastroenterologists, and therapists. The medications they prescribe do not bring relief, and often it even gets worse. As a rule, what helps is the favorite since Soviet times, corvaldin and phenazepam, which are not recommended to be used throughout the civilized world, to put it mildly. This is how the journey of every VSD student begins...

- Doctor, what’s wrong with me?
- I don’t know... Let’s write “VSD”.

Let's figure out what vegetative-vascular dystonia is?

Did you know that according to the International Classification of Diseases (ICD-10), there is no such disease as vegetative-vascular dystonia?! In the presence of vegetative-vascular dystonia syndrome, the diagnosis of somatoform autonomic dysfunction of the heart and cardiovascular system is made by excluding diseases such as hypertension, coronary heart disease, etc. That is, when serious organic diseases and pathologies are excluded as a result of the examination, the doctor makes a diagnosis of VSD, which actually says that you are healthy (!!!), you just have impaired autonomic function. It turns out that we become victims of the “vegetative component” of our stress; there is nothing wrong with our organs, their regulation is simply disrupted. And for VSD, it is not the heart, stomach, head and lungs that need to be treated, but the psyche using psychotherapeutic techniques. There is a diagnosis, but there is no disease! With which I congratulate you!

The main thing that a person with VSD needs to understand is:

1. No one has ever died from VSD (the attacks are unpleasant, but that’s all).
2. When diagnosed with VSD, there are no serious physical diseases of any organ that affects the VSD.
3. With VSD, we become hostage to our anxieties and habits. Let's learn to react to them correctly - let's forget about VSD.

A case from one's life:

One day before the New Year, I was getting ready to decorate the Christmas tree after work. But since the work day turned out to be busy, and I was very tired, I didn’t want to decorate the Christmas tree. But, being an obligatory person, I still forced myself to go decorate the forest beauty. And what came of it? Exactly 5 minutes later, I began to have a severe stomach cramp. The pain was so strong that there was no talk of any Christmas tree anymore. I had to lie down. And who defeated whom? Thus, over time, I realized THAT YOU NEED TO BE FRIENDS WITH YOUR BODY. The body is cunning. If you force him, he will still get out of it and put you to bed, but he will do it through illness.

As the wonderful Australian psychologist Andrew Matthews writes in his book “Live Easy!”:

This is how life works. First, they throw small stones at us to give something like a first warning. When we ignore these pebbles, bricks fly at us. Ignore the brick and you'll be crushed into dust by a huge boulder.
If we are able to be honest with ourselves, we can always tell when we did not pay attention to these warnings. But sometimes we have the audacity to ask: “Why did all this fall on me?”

In fact, with vegetative-vascular dystonia we pay for our inattention to our own mental health. Therefore, it is very important to learn the right attitude towards life, develop positive thinking and improve the quality of your life!

Vegetative-vascular dystonia (VSD) is a symptom complex of diverse clinical manifestations that affects various organs and systems and develops as a result of deviations in the structure and function of the central and/or peripheral parts of the autonomic nervous system.

Vegetative-vascular dystonia is not an independent nosological form, however, in combination with other pathogenic factors, it can contribute to the development of many diseases and pathological conditions, most often having a psychosomatic component (arterial hypertension, coronary heart disease, bronchial asthma, peptic ulcer, etc.). Vegetative changes determine the development and course of many childhood diseases. In turn, somatic and any other diseases can aggravate autonomic disorders.

Signs of vegetative-vascular dystonia are detected in 25-80% of children, mainly among urban residents. They can be found at any age, but are more often observed in children 7-8 years old and adolescents. More often this syndrome is observed in girls.

Vegetative-vascular dystonia. Causes

The reasons for the formation of autonomic disorders are numerous. Of primary importance are primary, hereditarily determined deviations in the structure and function of various parts of the autonomic nervous system, most often traced through the maternal line. Other factors, as a rule, play the role of triggers that cause the manifestation of existing latent autonomic dysfunction.

The formation of vegetative-vascular dystonia is largely facilitated by perinatal lesions of the central nervous system, leading to cerebral vascular disorders, impaired cerebrospinal fluid dynamics, hydrocephalus, damage to the hypothalamus and other parts of the limbic-reticular complex. Damage to the central parts of the autonomic nervous system leads to emotional imbalance, neurotic and psychotic disorders in children, inadequate reactions to stressful situations, which also affects the formation and course of vegetative-vascular dystonia.

In the development of vegetative-vascular dystonia, the role of various psychotraumatic influences (conflict situations in the family, school, family alcoholism, single-parent families, isolation of the child or excessive care by his parents) is very important, leading to mental maladaptation of children, contributing to the implementation and strengthening of autonomic disorders. Equally important are frequently recurring acute emotional overloads, chronic stress, and mental overstrain.

Provoking factors include a variety of somatic, endocrine and neurological diseases, constitutional anomalies, allergic conditions, unfavorable or sharply changing meteorological conditions, climatic features, environmental distress, imbalance of microelements, physical inactivity or excessive physical activity, hormonal changes during puberty, non-compliance with diet and etc.

Of undoubted importance are the age-related characteristics of the rate of maturation of the sympathetic and parasympathetic parts of the autonomic nervous system, the instability of brain metabolism, as well as the inherent ability of the child’s body to develop generalized reactions in response to local irritation, which determines the greater polymorphism and severity of the syndrome in children compared to adults. Disorders that have arisen in the autonomic nervous system lead to various changes in the functions of the sympathetic and parasympathetic systems with impaired release of mediators (norepinephrine, acetylcholine), hormones of the adrenal cortex and other endocrine glands, a number of biologically active substances (polypeptides, prostaglandins), as well as disorders sensitivity of vascular α- and β-adrenergic receptors.

This causes a great variety and varying severity of subjective and objective manifestations of vegetative-vascular dystonia in children and adolescents, depending on the age of the child. Their autonomic changes are often multi-organ in nature with a predominance of dysfunction in any one system, most often in the cardiovascular system.

Classification of vegetative-vascular dystonia

To date, no generally accepted classification of vegetative-vascular dystonia has been developed. When formulating a diagnosis, take into account:

• etiological factors;
• variant of autonomic disorders (vagotonic, sympathicotonic, mixed);
• prevalence of autonomic disorders (generalized, systemic or local form);
• organ systems most involved in the pathological process;
• functional state of the autonomic nervous system;
• degree of severity (mild, moderate, severe);
• nature of the course (latent, permanent, paroxysmal).

Symptoms of vegetative-vascular dystonia

Vegetative-vascular dystonia is characterized by diverse, often vivid subjective symptoms of the disease that do not correspond to the much less pronounced objective manifestations of a particular organ pathology. The clinical picture of vegetative-vascular dystonia largely depends on the direction of autonomic disorders (predominance of vago- or sympathicotonia).

Vagotonia

Children with vagotonia are characterized by many hypochondriacal complaints, increased fatigue, decreased performance, memory impairment, sleep disorders (difficulty falling asleep, drowsiness), apathy, indecisiveness, fearfulness, and a tendency to depression.

Characterized by a decrease in appetite in combination with excess body weight, poor tolerance to cold, intolerance to stuffy rooms, a feeling of chilliness, a feeling of lack of air, periodic deep sighs, a feeling of a “lump” in the throat, as well as vestibular disorders, dizziness, pain in the legs (usually at night). time), nausea, unmotivated abdominal pain, marbling of the skin, acrocyanosis, pronounced red dermographism, increased sweating, sebum secretion, tendency to fluid retention, transient swelling under the eyes, frequent urge to urinate, hypersalivation, spastic constipation, allergic reactions.

Cardiovascular disorders are manifested by pain in the heart area, bradyarrhythmia, a tendency to decrease blood pressure, an increase in heart size due to a decrease in the tone of the heart muscle, and muffled heart sounds. The ECG reveals sinus bradycardia (bradyarrhythmia), possible extrasystoles, prolongation of the P-Q interval (up to atrioventricular block of the I-II degree), as well as a shift of the ST segment above the isoline and an increase in the amplitude of the T wave.

Sympathicotonia

Children with sympathicotonia are characterized by temperament, short temper, mood swings, increased sensitivity to pain, easy distractibility, absent-mindedness, and various neurotic states. They often complain of a feeling of heat and a feeling of palpitations. With sympathicotonia, an asthenic physique against the background of increased appetite, pallor and dry skin, pronounced white dermographism, coldness of the extremities, numbness and paresthesia in them in the morning, an unmotivated increase in body temperature, poor heat tolerance, polyuria, and atonic constipation are often observed. There are no respiratory disorders, vestibular ones are uncharacteristic. Cardiovascular disorders are manifested by a tendency to tachycardia and increased blood pressure with normal heart sizes and loud heart sounds. The ECG often reveals sinus tachycardia, shortening of the P-Q interval, displacement of the ST segment below the isoline, and a flattened T wave.

Cardiopsychoneurosis

If cardiovascular disorders predominate in the complex of existing autonomic disorders, it is permissible to use the term “neurocirculatory dystonia”. However, it should be borne in mind that neurocirculatory dystonia is an integral part of the broader concept of vegetative-vascular dystonia. There are three types of neurocirculatory dystonia: cardiac, vascular and mixed.

Cardiac type of neurocirculatory dystonia(functional cardiopathy) is manifested by rhythm and conduction disturbances (sinus bradycardia, extrasystole, paroxysmal and non-paroxysmal tachycardia, atrioventricular block of the 1st-2nd degree), disturbances in the processes of ventricular repolarization (nonspecific changes in the ST segment), and some forms of mitral valve prolapse.

Neurocirculatory dystonia of vascular type accompanied by arterial hypertension (neurocirculatory dystonia of the hypertonic type) or hypotension (neurocirculatory dystonia of the hypotonic type).

Mixed type of neurocirculatory dystonia has elements of both cardiac and vascular types with various combinations of their symptoms.

The course of VSD in children

Vegetative-vascular dystonia in children can occur latently, occurring under the influence of unfavorable factors, or permanently. The development of vegetative crises (paroxysms, vegetative storms, panic attacks) is possible. Crisis states occur during emotional overload, mental and physical stress, acute infectious diseases, sudden changes in weather conditions and reflect a breakdown in the autonomic regulation system. They can be short-term, lasting several minutes or hours, or long-term (several days) and occur in the form of vagoinsular, sympatho-adrenal or mixed crises.

Vagoinsular crises are accompanied by suddenly developing pallor, sweating, a decrease in body temperature and blood pressure, nausea, vomiting, abdominal pain and severe bloating, and occasionally angioedema. Possible syncope, attacks of pain in the heart (pseudoangina syndrome), migraine or shortness of breath, reminiscent of an attack of bronchial asthma.

Sympathoadrenal crises are accompanied by a feeling of anxiety and fear of death, chills, headache, tachycardia (often paroxysmal), increased blood pressure, increased body temperature (up to 39-40 ° C), dry mouth, frequent urination, and polyuria.

Vegetative-vascular dystonia has some features in children of different ages. Thus, in preschoolers, autonomic disorders are usually moderate, subclinical, with a predominance of signs of vagotonia (increased tone of the parasympathetic part of the autonomic nervous system). In adolescents, vegetative-vascular dystonia is more severe, with varied and severe complaints and frequent development of paroxysms. An increase in vagal influence in them is accompanied by a significant decrease in sympathetic activity.

Diagnosis of vegetative-vascular dystonia

Already when collecting anamnesis, a family history of autonomic disorders and psychosomatic pathology is revealed. At the same time, in the families of patients with vagotonia, bronchial asthma, gastric ulcer, neurodermatitis are more often detected, and in cases of sympathicotonia - hypertension, coronary heart disease, hyperthyroidism, and diabetes mellitus. The history of children with vegetative-vascular dystonia often reveals an unfavorable course of the perinatal period, recurrent acute and chronic focal infections, and an indication of connective tissue dysplasia.

The state of the autonomic nervous system is determined by the initial autonomic tone, autonomic reactivity and autonomic support of activity. The initial autonomic tone, which characterizes the direction of functioning of the autonomic nervous system at rest, is assessed by analyzing subjective complaints and objective parameters, ECG and cardiointervalography data. Indicators of autonomic reactivity and autonomic support of activity (results of various tests - clinoorthostatic, pharmacological, etc.) allow a more accurate assessment of the characteristics of autonomic reactions in each specific case.

In the diagnosis of vegetative-vascular dystonia, an important role is played by EEG, EchoEG, REG, rheovasography, which allows assessing the functional state of the central nervous system, identifying changes in cerebral and peripheral vessels, and intracranial hypertension.

If rhythm and conduction disturbances, changes in the ST segment are detected on the ECG, the necessary pharmacological tests, Holter ECG monitoring, etc. are carried out. In case of vegetative-vascular dystonia, consultations with a neurologist, ENT doctor, ophthalmologist, endocrinologist, and in some cases, a psychiatrist are necessary.

Since vegetative-vascular dystonia is not a nosological form of the disease, but the result of dysfunction of various brain structures, damage to the endocrine glands, internal organs, etc., the etiological factor (if identified) must be placed in the first place when making a diagnosis. also facilitates targeted therapy.

Differential diagnosis of vegetative-vascular dystonia

Differential diagnosis makes it possible to exclude diseases that have symptoms similar to vegetative-vascular dystonia.

In the presence of cardiac complaints accompanied by objective changes in the heart, in particular systolic murmur, it is necessary to exclude rheumatism, which has quite characteristic diagnostic criteria. In this case, one should take into account the frequent combination of autonomic disorders with signs of connective tissue dysplasia, the clinical manifestations of which together resemble not only rheumatic carditis, but also congenital heart defects and non-rheumatic carditis.

If elevated blood pressure is detected, it is necessary to conduct a diagnostic search aimed at excluding primary and symptomatic arterial hypertension.

Respiratory disorders (shortness of breath and especially attacks of suffocation) that occur during crisis reactions in children with vegetative-vascular dystonia are in some cases differentiated from bronchial asthma.

In the presence of febrile reactions, it is necessary to exclude acute infectious disease, sepsis, infective endocarditis, as well as oncological pathology.

In the presence of pronounced psychovegetative symptoms, it is necessary to exclude mental disorders.

Treatment of vegetative-vascular dystonia

Treatment for vegetative-vascular dystonia should be complex, long-term, individual, taking into account the characteristics of autonomic disorders and their etiology. Preference is given to non-drug methods. These include normalizing the daily routine, eliminating physical inactivity, dosed physical activity, limiting emotional influences (TV shows, computer games), individual and family psychological correction, as well as regular and balanced nutrition.

Therapeutic massage, acupuncture, and water treatments have a positive effect. The features of physiotherapeutic effects depend on the form of autonomic disorders (for example, for vagotonia, electrophoresis with calcium, caffeine, mesatone is prescribed, and for sympathicotonia - with aminophylline, papaverine, magnesium, bromine).

If non-drug treatment is insufficiently effective, individually selected drug therapy is prescribed with a limited number of drugs in minimal doses with a gradual increase to effective ones. In the complex therapy of vegetative-vascular dystonia, great importance is attached to the treatment of chronic focal infection, as well as concomitant somatic, endocrine and other pathologies.

Sedatives are widely used (preparations of valerian, motherwort, St. John's wort, hawthorn, etc.), as well as tranquilizers, antidepressants, nootropics (for example, phenibut, carbamazepine, diazepam, amitriptyline, piracetam, pyritinol).

The use of glycine, pantogam, glutamic acid, and complex vitamin and microelement preparations often has a beneficial effect.

To improve cerebral and peripheral blood circulation and restore microcirculation, vinpocetine (for example, Cavinton), cinnarizine, nicotinic acid, and pentoxifylline (for example, Trental) are used.

In case of sympathicotonia, it is possible to use ß-blockers [propranolol (for example, anaprilin, obsidan)], in the presence of vagotonic reactions - psychostimulants of plant origin (preparations of eleutherococcus, schisandra, zamanika, etc.).

Children with intracranial hypertension are treated with dehydration therapy [acetazolamide (diacarb) with potassium preparations, glycerol]. In the complex therapy of vegetative-vascular dystonia, great importance is attached to the treatment of chronic focal infection, as well as concomitant somatic, endocrine or other pathology.

With the development of vegetative paroxysms in severe cases, along with the use of non-drug methods and oral drug therapy, parenteral administration of tranquilizers, neuroleptics, beta-blockers, and atropine is necessary, depending on the nature of the crisis. Dispensary observation of children with vegetative-vascular dystonia should be regular (once every 3-6 months or more often depending on the form, severity and type of course of the syndrome), especially in transition seasons (spring, autumn), when it is necessary to repeat the examination and indications to prescribe a set of therapeutic measures.

Prevention of vegetative-vascular dystonia

Prevention is a set of preventive measures aimed at preventing the action of possible risk factors, preventing the progression of existing vegetative shifts and the development of paroxysms.

Forecast

With timely detection and treatment of autonomic disorders and consistent implementation of preventive measures, the prognosis is favorable. The progressive course of vegetative-vascular dystonia can contribute to the formation of various psychosomatic pathologies, and also leads to physical and psychological maladjustment of the child, adversely affecting the quality of his life not only in childhood, but also in the future.

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Elena Reshetnikova

The article is very informative, I learned a lot from it. Thank you for making the text of the article accessible not only to doctors, but also to the common man. I will try to pay special attention to the state of health of my son, who is 7 years old, as I learned from the article that vegetative-vascular dystonia is more often observed in children of this age.
Please tell me whether an enlarged thyroid gland (diffuse goiter of the second degree without dysfunction) can cause vegetative-vascular dystonia?

A good article, although many things are not clear (to me, as not a doctor), concluded that it is necessary to be examined, since I found similar symptoms. I would like to ask the doctor: I have autoimmune thyroiditis, lately my heart hurts after I get nervous, and sometimes just from a depressed state. I'm very impressionable. Could this be signs of vegetative-vascular dystonia?

Good evening! I was a little nervous today. I drank barboval and an infusion of sedative herbs. It went away a little, but unpleasant sensations appeared: there was a buzzing and hissing in the ears, then weakness, then wobbly legs, then there was pressure and compression in the head. There were often attacks of VSD. Now my heart has begun to ache, sometimes with tingling, a slight weakness in my hands and a buzzing in my head. Blood pressure is normal, sometimes it rises to 135/80 (normal is 120/70). But when I lie down, it drops to normal. Pulse 94. Are such conditions dangerous and how to stop them?

Zakhodyakin P.S.

Good afternoon Such conditions, if we talk about VSD, are not dangerous... they are more terrible for the patient than harmful to health, as they arise due to an imbalance in the parts of the autonomic nervous system, hence complaints like yours! Such conditions need to be stopped with a set of preventive measures: - avoid stress, maintain a normal daily routine, vitamins (gr B), sedatives, acupuncture, etc.

Natalya Konovalova

I HEARD THAT VSD DEVELOPES AS A RESULT OF MENTAL FATIGUE OR MENTAL TRAUMA. OUR GRANDMOTHER WHEN GETS NERVOUS ALWAYS DRINK A GLASS OF WATER WITH A SMALL AMOUNT OF SUGAR. TELL THE DOCTOR IS IT TRUE THAT A VEGETOVASCULIST MY DYSTONIA IS COMPLICATED BY DISCIRCULATORY ENCEPHALOPATHY. IS THIS SERIOUS? HOW TO PREVENT COMPLICATIONS? THANK YOU IN ADVANCE!

Hello, I have a question for you. Recently, about 3 weeks ago, I was diagnosed with Vegetative-vascular distance. Actually, the only thing that bothered me was that I don’t have enough air, it’s hard to breathe, but it doesn’t always happen like attacks, both in calm and with excitement, and high blood pressure mainly140 at 80, but sometimes higher, not much more, nothing bothered me. They prescribed treatment (Grandaxin in the morning and evening, vitamin B1 and B6 injections, glucose + ascorbic acid, piracetam, as well as eglonil) at present I stopped injecting eglonil because I completed the course of 6 injections, I started drinking piracetam in capsules, and I’m still injecting the rest. No positive result has been achieved yet; it seems to me that the lack of air is less frequent, but attacks still occur. Three days after the start of the course of treatment there were no attacks at all, and then again. The doctor tells me if it happens the same way, he will put me in the hospital. My question to you is how long does the treatment last (how long should the symptoms go away) what is treated in the hospital and is it curable at all?

K.Yu.Galkin

Hello! This is a serious but not fatal disease. It takes a long time to be treated. The problem lies in the personality of the patient, in his internal, often sexual problems. If you combine psychotherapy and treatment with pills, you will be cured. If not, you will take the pills for a very long time. By the way, it is better to go to a day hospital.

Hello, I'm 19 years old, I study at university. It all started very abruptly. About a year and a half ago, one Sunday morning I woke up and felt a dull, burning pain in the area of ​​my heart that radiated to my neck. I sat at the computer all day, but it kept hurting. And then in the evening the first Panic attack suddenly began: I lay down on the bed, my head was spinning, my vision was dark, there was fog in my head... all this was accompanied by growing fear. In general, they called an ambulance, but by the time they arrived I was already feeling better. They injected me with noshpa and told me to go to the clinic. I was thoroughly examined there and the therapist wrote osteochondrosis and some kind of dystonia, but not VSD, and they prescribed validol, glycine and sedatives. It was the beginning of spring. And I always had semi-numb hands and felt pressure and burning in the area of ​​my heart. I drank everything that was prescribed every day and somehow it all went away. But after about half a year, panic attacks started again and continue to this day. I didn’t attach much importance to this, because... I've already learned to deal with them. And I also noticed that they begin exactly when I go to bed: the pain in the heart area begins to increase and it becomes difficult to breathe... well, and all the other symptoms of VSD. I can suddenly wake up not yet from a deep sleep due to the fact that there seems to be a lack of oxygen. I live with this somehow and I want to deal with it and get rid of it. By the way, there is also a dull pain in the lumbar region, but not in the back but on the sides, as if in the kidneys or a little higher. And pain in the back of the back, near the beginning of the neck or just below.

Good evening, dear specialists. I have a question for you: I have been suffering from VSD with PA for quite a long time. I've been feeling pretty bad all day today. Some kind of weakness, nausea, unpleasant sensations in the head. The pressure was within normal limits, the maximum was 136/70. Heart rate is normal all day. On the fifth day I take half a tablet of Cipralex, prescribed by a neurologist, and from the seventh day I switch to a whole tablet. In the evening, going to the bathroom, an incomprehensible feeling filled my head. It didn’t seem to hurt anything, but it was so unpleasant. It feels like your ears are full and you are under water. I closed my nostrils and exhaled air to make it easier, but my ears did not unblock. After 30 seconds everything returned to normal. I took my blood pressure, 137/70, on the other arm 120/70. Then, after half a minute, I measured it again. On all hands 118/68. When I felt this way in the bathroom, I was afraid that I would probably lose consciousness, or that it was a stroke and I had lost my hearing. I immediately decided to go to bed. Many people told me that with VSD with PA, the vessels become very weak, and they are susceptible to strokes. What could be wrong with me and why? How dangerous is this? Please clarify. Thank you very much and look forward to a detailed answer!

Hello, doctor. I really need your help. I am 17 years old.. Help me, please. At the beginning of November... first I had the flu.. after that.. I was prescribed Erespal for a cough... and that day, when I took it... (I took 1 tablet 3 times) I felt very bad... suffocation, legs, arms were shaking, they were generally cold... dizziness, lump in the throat... I thought everything... they called an ambulance , due to the flu, they took me to the hospital.. (due to pneumonia). There they told me that I had autonomic dysfunction... i.e. VSD...that it’s from nerves..but everything was always fine with my nerves...they gave me glycine there..and later they prescribed phenazepam..(because I felt like there was something in my throat).I then I didn’t know... that phenazepam was so dangerous... of course they gave me 1/4... but it seemed to be better... I felt good at home for a week, and a week later... at first, when I chewed, my muscles started to get tired quickly... I thought it will pass... but after 2 days... I couldn’t swallow anything... it even happened that food almost got stuck in my throat, I couldn’t swallow... sometimes it’s even difficult for me to swallow water... since the hospital is recommended see a psychotherapist... I went to the clinic to see a psychiatrist... she said that I couldn’t swallow, my muscles hurt... she prescribed me haloperidol 2 drops + water, eglonil 1/8, finlepsin 1/4, PC-merz 1/2. ... I’ve been taking it for 4 days now, it still doesn’t go away... when I chew, the muscles of the face and neck weaken, the head starts to hurt, especially in the back and temples, pressure in the face, ear, nose, tension, as if My eyes are popping out right now... I can’t eat at all, today I went to see a neurologist, she told me to also do a CT scan of the brain, and the date is January 21, do I need to do it? Is it better to do it earlier?? It can’t be from the blood vessels of the brain brain... or is it really the nerves? What else do I need to examine? And how long will the treatment last?? Approximately?
She also told me to go to some hospital, but I don’t know where...?? Should I go to the hospital or is it better to go home?

Galkin K.Yu.

Hello, Sonya! Judging by your complaints, you have somatoform dysfunction of the autonomic nervous system. In particular, this is a “hysterical lump” (a feeling of a lump in the throat, causing difficulty swallowing, etc.). Treatment for this condition is complex and, unfortunately, long-term. In terms of psychotherapy, classical hypnosis can help you. In general, treatment should be carried out by a teenage psychiatrist. There is no dependence on the medications prescribed to you. The main thing is to believe in a good result, and it will definitely happen after a while.
It is impossible to answer some of your questions from a distance. For example, go to the hospital. I believe that a day hospital is suitable for you, but the details of hospitalization should be discussed with your doctor. Regarding computed tomography. I myself went through it at one time and did not notice any harm. Another question: how much do you need it? This is again decided by the attending physician. In such conditions, treatment can be long. Consult with your parents about further treatment tactics. Good luck to you.

Patients with vegetative-vascular dystonia live poorly, but for a long time - there is a lot of truth in this medical joke. This strange attack can greatly complicate life, sometimes turning it into hell, and at the same time pose no threat to life. Even with completely healthy internal organs, people suffering from VSD can feel so bad that they feel like real disabled people. The most offensive thing is that those around them begin to consider them malingerers - in fact, how can you trust a person who claims that his heart hurts despite an excellent cardiogram? Even some doctors believe that VSD does not exist. Who should you trust and why then does a person feel so bad?

What is VSD

VSD is one of the most mysterious diseases. It seems to be there, and it seems to be not. Some doctors believe that such a disease does not exist and that completely different diseases are hidden under the mask of VSD, which simply have not been identified and are not treated. Other doctors, on the contrary, believe that this disease exists, and it is associated with a violation of the regulatory function of the autonomic nervous system. But this failure can be caused by a variety of reasons, ranging from infectious diseases to hereditary predisposition, neurasthenia and liver diseases.

VSD has many names, as well as many faces. It is also hidden under the names of neurocirculatory dystonia, or dysfunction, vegetative dystonia, it can be called cardioneurosis, vegetative neurosis. Because the disease has many names, symptoms and manifestations, it is treated by a number of specialists: cardiologist, neurologist, endocrinologist, psychotherapist and psychiatrist. Seven nannies have a child without an eye - VSD continues to be the most mysterious disease. And what helps some sufferers has no effect on others.

So, it is completely unclear whether this is a separate disease or a set of symptoms (syndrome), but many suffer from this scourge, and women are 2 times more likely to suffer from this scourge. And almost 25% of patients who consult a cardiologist about heart pain have a completely healthy heart - obvious VSD.

VSD is actually an imbalance between the sympathetic and parasympathetic systems of the autonomic nervous system, which regulates the activity of internal organs. Unconscious and automatic activities - blood pressure, heartbeat, hormone release, and so on. As a result, at the slightest critical situation, the body begins to react inadequately to stimuli. And a vegetative crisis or attack occurs, so well known to all vegotonics - sharp fluctuations in pressure, dizziness, heartbeat, excitement. The autonomic system gives conflicting orders, the glands secrete hormones that are not currently required, the organs begin to prepare for stress in the complete absence of it. And everything leads to poor health in complete health.

People can go to doctors in circles for years, researching the causes of illnesses and becoming disillusioned with medicine. A cardiologist, endocrinologist, neurologist will not find any abnormalities in health, all tests will show that there are no organic lesions of the heart and brain. But there are symptoms, and we will talk about them on our website.

Who suffers from VSD

As a rule, VSD mainly affects emotional people, with a very, as doctors say, labile, that is, unstable, nervous system. This type very easily displays inadequate vascular reactions to everything - from physical activity to stress and weather.

It can appear at any age. But almost always those who suffer from it in adulthood discovered the first symptoms in childhood or early adolescence. And most often, the first symptoms appear during the period of hormonal changes in adolescence. In women, VSD can appear and worsen during any period of hormonal upheavals - during pregnancy and after it, during the restructuring of the body during menopause.

It can also be a consequence of illness and disruption of the endocrine glands. Although here everything remains unclear - whether the disorder causes VSD or the failure of the regulatory function of the autonomic system causes disruption of the endocrine glands.

It is assumed that heredity also plays a role. Parents with VSD have a high risk of having a child who will also subsequently suffer from the same disease. Flowers delivered in Moscow. Flor-boutique - flower delivery in Moscow. . Excellent flowers at reasonable prices. Delivery within the Moscow Ring Road is free!

What causes VSD

In addition to hereditary or non-hereditary weakness of the autonomic nervous system, other factors can cause VSD. Infectious diseases, including influenza and tonsillitis, can cause a failure of the regulatory ability of the autonomic system. Injuries, especially concussions, can also lead to this. A sedentary lifestyle leads to the fact that the blood vessels, due to lack of load, begin to work poorly and symptoms of dystonia appear.

There is a theory that states that symptoms of VSD are caused by improper functioning of the digestive system, especially chronic gastroduodenitis. After a course of treatment for gastroduodenitis, the symptoms of dystonia disappear. This theory was put forward back in the 50s of the last century, and there is information about successful cases of healing of VSD after treatment by a gastroenterologist.

A psychologist can help here too. In a number of people, VSD is caused by mental causes. Neurosis-like conditions lead to dystonia. Psychotherapists suggest the existence of a deep connection between secret fears and the appearance of VSD. A number of experts claim that a strong fear of death, expelled into the subconscious, can lead to the development of vegetative-vascular dystonia. In the same way, fear of life can give its symptoms.

Symptoms of VSD

She has many symptoms. But according to groups of symptoms, different types of VSD are distinguished.

If problems mainly arise with the heart, then VSD follows the cardiological type; If you have breathing problems, use respiratory. The cerebral type gives headaches; digestive disorders are a gastroenterological type; visceral leads to disruption of thermoregulation.

Often, the same person experiences several different types of VSD.

For cardiac type, arrhythmia, palpitations, dizziness, fainting, pressure surges. Based on how the pressure changes, VSD is classified into hypotonic, hypertonic or mixed type.

With VSD of the hypertensive type, sharp causeless increases in blood pressure, anxiety, palpitations, chills with cold extremities, and panic attacks are observed. With VSD of the hypotonic type, weakness, dizziness, fainting, drop in pressure, sweating, and lightheadedness appear. With a mixed type, these symptoms can change each other, exhausting a person and leading to loss of performance.

A panic attack is especially frightening for many, when suddenly, without any reason, an attack begins - pressure surges, increased heart rate, lightheadedness, dizziness, an uncontrollable attack of fear of death. A panic attack can last for several minutes or hours. In severe cases, the help of a doctor is required.

When cardiac symptoms predominate, VSD is often called neurocirculatory dystonia (dysfunction). An attack of VSD of the cardiological type is terribly frightening because it can resemble a heart attack. A person feels pain in the heart, he develops a feeling of fear, blood pressure can rise to high numbers and drop to low ones. Almost 30% of emergency calls for a possible heart attack occur precisely because of an attack of vegetative-vascular dystonia.

Many accuse the unfortunate person of malingering and suspiciousness and even stop paying attention to his complaints, considering him a manipulator. Meanwhile, he really feels very bad. Moreover, such people are actually in great danger. They themselves get used to the fact that all these sensations are associated with VSD and a panic attack. And if they actually have a heart attack, they may not see a doctor in time, considering the symptoms to be a normal attack of VSD.

Many people suffering from VSD report difficulty breathing, a lump in the throat, sore throat, and shortness of breath. In fact, this is not shortness of breath in its classic form.

With the gastroenterological type, the stomach often hurts for no apparent reason. In this case, a person can go to doctors and undergo detailed examinations. As a result, nothing will be revealed. In this case, many are given a vague diagnosis of “irritable bowel syndrome”, and that’s where it ends. In this case, VSD is characterized by unstable stools, digestive disorders, poor appetite, even its complete absence.

The cerebral type can cause numbness in the limbs, goosebumps, pain in different parts of the body for any reason. This is very frightening for many, because the person begins to suspect that he is having a stroke.

In women, VSD can cause disruptions in the menstrual cycle, and in men - erectile dysfunction.

Emotionally and psychologically, patients with VSD suffer from frequent mood swings, suspiciousness, increased anxiety, fatigue, drowsiness or overexcitation, problems with memory and concentration, and insomnia. In this case, the help of a psychologist or psychotherapist is necessary. Unfortunately, people with VSD turn to a psychologist last.

How to cope with a panic attack and VSD

At the onset of an attack with surges in blood pressure and palpitations, you can drink a glass of water, to which you add 50 drops of tincture of valerian/motherwort and eleutherococcus. Taking no-shpa and glycine tablets will help.

To get rid of a strong heartbeat, you need to close your eyes and press your fingers on your eyeballs for a minute. Massaging your fingers and neck will help normalize blood pressure.

In fact, simple methods are effective. A daily routine, proper nutrition and an active lifestyle will help reduce the number of attacks and make them less severe. Daily walks of at least half an hour help keep VSD within limits.

VSD is a disease so many-sided that it is simply impossible to describe all its symptoms. And despite the fact that it does not threaten life, it makes it much more difficult, since the person is afraid of attacks and does not know at what point he will feel bad again. Therefore, it is best not to delay your visit to the doctor and start treating the disease in a comprehensive manner.

Vegetovascular dystonia, or VSD for short, is a special diagnosis that old-school doctors love and are very disliked by doctors who read modern literature and know what evidence-based medicine is.

And all because there is no such diagnosis: it is not in the International Classification of Diseases International Classification of Diseases, 10th Revision (ICD-10). Meanwhile, it constantly appears on cards; there are entire groups, forums and websites dedicated to the treatment of VSD.

Where does dystonia come from?

The autonomic nervous system is that part of the nerve cells that is responsible for the functioning of internal organs. To simplify, we can say that this is that part of the system whose activities we do not influence. The autonomic nervous system controls heart rate, digestion, and blood pressure. Dystonia, in theory, means that something has gone wrong in this system.

Patients are bothered by specific, although completely different, symptoms. Someone complains of a rapid pulse and trembling hands. Some people experience dizziness and chest pain. Patients suffer from fatigue or insomnia, and sometimes both. Sometimes abdominal pain and much more are added to the bouquet. At the same time, neither cardiologists nor gastroenterologists see any deviations, and neurologists don’t see them either. This is how VSD appears.

Patients are not pretending, they actually have problems. Only all these symptoms, both together and separately, arise not because of vegetative-vascular dystonia, but because of other diseases that remain undiagnosed. Often they need to be treated not by a neurologist, but by a neurologist - these are neuroses, panic attacks and anxiety disorders.

What to do when diagnosed with VSD

Writing about vegetative-vascular dystonia with evidence is a thankless task, because, as you might guess, since there is no such diagnosis, then no studies have been conducted on this topic that would meet the requirements of evidence-based medicine.

If only some The Lancet would publish an article about how a non-existent diagnosis affects the health of the population in Russia! But until this happens, we asked neurologist Nikita Zhukov what to do if your diagnosis is vegetative-vascular dystonia.

Nikita Zhukov

Nikita, I am one of those patients whose card had the inscription VSD on it. I don’t even know why exactly I was diagnosed with this. Why is this possible?

Because this is the main diagnostic cesspool of all Russian medicine: VSD can be diagnosed to any patient for almost any complaint. Therefore, it is not surprising that you do not even know why you were given it, this is a common thing. Most likely, the doctor himself doesn’t know either. There is an unspoken rule: if you don’t know what diagnosis to make, make a VSD.

I come to the doctor with complaints, he says that I have VSD. I know that this can't happen. What should I do? What doctors, besides a neurologist, should I contact?

Well, there are two options.

1. Aggressive: Try to make the doctor feel like an idiot and learn something. You need good knowledge of the issue, journalistic arrogance and a desire to change the world for the better (as you can see, not a word about healing).
2. Look for a neurologist who does not diagnose VSD; in 2017 there are already enough of them. That’s exactly how we advertise: “No VSD, homeopathy or physiotherapy!” You can try going straight to a psychotherapist, but with them it’s still worse than with neurologists.

Is there a movement towards evidence-based medicine? Roughly speaking, if I say: “Doctor, I don’t believe in VSD, I don’t have to be prescribed,” will the doctor be able to understand such a position? What's the chance of that?

Of course, not everything is so hopeless! There is OSDM.org, a bunch of popularizers (like me, kek), a Cochrane branch is opening in Kazan, large private clinics have begun to understand that evidence-based medicine is good, and even the Ministry of Health has made scientifically based guides (there, of course, there is umifenovir, the better known like Arbidol, but there is also a lot of reasonable stuff).

I come to the clinic, leave a lot of money for examinations, waste time, and then the doctor writes that I have VSD. What questions should you ask at the beginning of your appointment to prevent this from happening?

The key word here is questions. You must ask questions about all the doctor’s actions, and a competent specialist must answer them clearly. I really should! Is an examination really necessary? Is it possible to do without it and what will happen then? What does the doctor want to see in him? What if he doesn’t see it?

What should those people who have been treating VSD for many years do right now? Could it be that another disease is progressing because of this?

Theoretically, yes, but I have not encountered this and I think it is unlikely: experienced patients with VSD have all possible examinations several times, which practically eliminates the possibility of missing some serious condition.

- A person is treated for a long time for VSD, but it helps him. Is this just a placebo effect?

Yes, if this is a typical “treatment of VSD”, because it, in principle, involves therapy with fuflomycins, which have only one effect - a placebo.

No, if the doctor prescribes some sane drugs (in such cases, these are usually antidepressants), but does not change the diagnosis for any reason, because the patients themselves often adore VSD, cherish these three letters and will never give them up.

Let’s say a neurologist writes SVD (somatoform autonomic dysfunction, F45.3) instead of VSD, but the treatment is ineffective. What prescriptions indicate that it is time to change doctors?

The diagnosis F45.3 is one of the suitable, modern and correct replacements for the VSD. But here you need to pay attention to the letter F: this is a psychiatric diagnosis. Accordingly, if along with it you are not given antidepressants or anti-anxiety medications, then either the doctor is a fool or one of two things.

- The only way out is to look for another doctor? Does the patient have any other ways to somehow influence the situation?

You will never prove to a doctor that he is wrong if you are not a doctor, which, however, is typical for any other specialty. I think it’s worth taking a different route and taking advantage of the benefits of the information age: collecting and leaving reviews of doctors, looking for word of mouth and some “Doctors without VSD” registries. Quite a few patients come to me who say right out of the gate: “I came to you because I’ve been diagnosed with VSD for ten years, but they say about you that you don’t do it.”

If you need to learn more about diagnoses that do not exist and learn to distinguish proven medicine from shamanism, we recommend Nikita Zhukov’s books about the most persistent medical misconceptions and myths.