VASCULAR INSUFFICIENCY — the morbid condition which is characterized by decrease in a tone of smooth muscles of vascular walls that leads to development of arterial hypotension, disturbance of venous return and intake of blood from depot.
This state was studied in Russia by E. I. Blumenau (1891) and E. V. Gaultier (1899), in France — P. Poten (1897), A. Vakez (1915), in Germany — Myuntser (E. Munzer, 1910), Hertz (M. of Herz, 1916), in England — Bishop (Bishop, 1904 — 1906). In 1931 Mr. A. Ferranini in detail described a wedge, symptoms special patol. states (the general fatigue, weakness, tendency to faints, decrease in portability of an exercise stress), having connected them with vasodepression, but not with damage of a myocardium. In 1941 E. Page suggested to call this state A. Ferranini's syndrome. However various scientists treated, classified and called this state differently, nevertheless the term «hypotonia» which is put forward by Paul prevailed (G. Pol, 1923, 1933). It, and in the subsequent B. E. Votchal (1941, 1956), N. A. Kurshakov (1947) and V. F. Zelenin (1956) opposed mixing of the concepts «tone» and «tenziya». Interest in this question increased in 50 again — the 60th are 20 century. In domestic and foreign literature there were V. A. Valdman (1950) works, E. V. Gembitsky, 1951, M. S. Obraztsova (1957), N. S. Molchanov (1964), Leffler (W. Loffler, 1951), Shvart-tsa (N. Svartz, 1953), etc., the devoted pathologies of a vascular tone. But still different researchers use various names for definition of this state: bradikardicheski-hypotonic syndrome, neurocirculatory dystonia, hypotension, chronic vascular insufficiency, hypotonic syndrome, hypotonic state. There is no unanimity of views and on its pathogeny.
The page of N can be system when all are involved in process or the majority of vascular areas, and regional (a varicosity of extremities, vasodilatation of an abdominal cavity at build-up of pressure in a small circle of blood circulation — Larin's reflex — Shvigka).
The page of N can be observed at overfatigue, neurosises, functional and organic lesions of pituitary system, in particular at Simmonds's disease (see. Pituitary cachexia), Shikhen's syndrome (see Shikhen a syndrome), at damage of adrenal glands — an addisonovy disease (see). Persistent and acute infections, pernicious vomiting of pregnant women, vomiting at a pyloric stenosis can also promote S.'s emergence N.
In S.'s development by N the leading role is played by disturbance of regulation of a vascular tone of the neurogenic, neuro and humoral or endocrine nature, and also change of unstriated muscles of a vascular wall. At the same time all components of regulation of a vascular tone work is interconnected.
Disturbance of nervous control of a vascular tone can be connected with pathology of vasomotor centers of c. the N of page (in the 30th G. F. Lang noted proximity of hypotonia to neurosises) and can arise at defeats of century of N of page, napr, at Shai's syndrome — Dreydzhera (see Shai — Dreydzhera a syndrome). A number of researchers connects decrease in a tone of vessels with increase in activity of a parasympathetic nervous system. So, after switching off of activity of a sympathetic nervous system at a sympathectomy, use of ganglioblokator or adrenoblockers transition to vertical position can cause a collapse. Neurohumoral factors influence a vascular tone through specific receptors. At increase in fabrics and blood of concentration of vasodilating substances, such as a histamine (see) etc., the tone of vessels decreases. Reduction of products of corticosteroids (see), including and Aldosteronum (see), at various diseases also promotes vasodepression. Loss of ions of sodium (see), calcium (see), acidosis (see), intoxication is caused by decrease in a tone of smooth muscles of small vessels (arterioles, venules, precapillaries) and development of vascular insufficiency. In formation and regulation of a vascular tone the most important role is played by estuarial departments of precapillary arterioles, an endothelium to-rykh is a receptor for the vasoactive substances brought by blood and through mio-endothelial contacts transfers information to smooth muscles of vessels, changing thereby its tone. Certain role, hl. obr. in acute S.'s emergence the N, plays reduction of volume of the circulating blood.
The page of N can be acute and chronic. Acute S. of N is shown in the form of a faint (see), a collapse (see) and shock (see). Prikhron. Pages of N the most frequent complaints are the general weakness, increased fatigue, weight in the head, headaches, blackout and unconscious states upon sharp transition from horizontal to vertical position. The capriciousness, irritability, affective instability is quite often observed. An asthma at an exercise stress is sometimes noted, a cold snap and a pricking of fingers of hands and legs. Often vegetative disturbances in the form of perspiration, the expressed red dermographism come to light (see). Pallor and slight cyanosis of skin and mucous membranes, «marble skin» (sometimes only on extremities), the hypostases in the mornings connected with decrease in a tone of veins and a venous plethora, disappearing at the movement are noted. Temperature of skin is usually reduced, hands cold, wet, muscles are poorly developed. Pulse is labile, small filling, it is often accelerated. By the ABP it is lowered to 100/60 — 70/50 mm of mercury., labile. Pulse pressure usually does not exceed 30 — 35 mm of mercury. Heart can be the small sizes («pendulous heart»). Small systolic noise at a top is sometimes listened. Vascular reactions in response to Cold, thermal and electric irritants are sharply weakened, are absent or are perverted. Spastic reaction of vessels to adrenaline (see. Adrenalinic test) at such patients comes and reaches a maximum considerably later, than at healthy faces. Decrease in peripheric resistance and reduction of rate of propagation of pulse wave is noted. Venous pressure is moderately increased. An ECG usually without features. At a biochemical blood analysis decrease in secretion of 17 oxycorticosteroids (see) and 17 ketosteroids is observed (see).
One of forms C. of N is the carotid sinus syndrome (a hyperreflexia of a carotid sine), patol. changes at Krom are connected with a hyperexcitability of the reflexogenic zone located in a vascular wall in the field of division of the general carotid artery into internal and outside carotid arteries. This zone takes part in level control of the ABP. At novocainization of this area, and also at an obliteration of the general carotid artery as a result of atherosclerosis death of receptors of this zone and disappearance of a reflex is noted. Momentum transfer is carried out through the vagus nerve (see) exerting impact both on a tone of vessels, and on action of the heart that can lead to expansion of peripheral vessels and deposition in them of blood, and also to delay of action of the heart up to its stop.
The carotid sinus syndrome can develop at atherosclerotic defeat of the general carotid arteries, at the tumors which are localized in sinocarotid area at surgeries in the field of bifurcation of the general carotid arteries. The sharp turn of the head, a hard collar of a shirt, cough, a natuzhi-vaniye, a prelum of field of bifurcation of the general carotid arteries during the shaving or attempt to stop an attack of a Bouveret's disease, a postural change of a body, an exercise stress, and also sharp increase in the ABP can become his reason. Quite often the syndrome develops suddenly, for no apparent reason.
Depending on the leading symptom distinguish cardial and inhibitory (a cardial depressor - nuyu) a form, or vagal type, a vasodepressor form, or depressor type, a cerebral form, or cerebral type, and the mixed form of a carotid sinus syndrome. At a cardial and inhibitory form the expressed bradycardia is noted (see) up to a cardiac standstill, edge can be followed sinoaurikulyarny, atrioventricular or an intraventricular block (see the Heart block). At a vasodepressor form the ABP as a result of dilatation of peripheral vessels without the expressed bradycardia sharply decreases. The cerebral form is shown by a faint with the dizziness preceding it, nausea, a ring in ears, the poshatyvaniye, a vision disorder which is shown scotoma (see) or a temporary blindness. At the mixed form the combination various a wedge, signs is observed.
Chronic S.'s treatment N is carried out taking into account the disease which caused it. Besides, apply sedatives (Trioxazinum, bromides), small doses of caffeine, Securininum, drugs of the Chinese magnolia vine, ginseng, eleuterokokk, Cordiaminum in drops or injections, sometimes Cortinum, and also an electrophoresis with a phenylephine hydrochloride, medical (turpentine) bathtubs, massage, LFK, hypnosis, etc. At a carotid sinus syndrome administer the drugs of atropine (at vagal type) or adrenaline (at depressor type). Sometimes the effect of this or that treatment allows to establish type of a syndrome.
See also Hypotension arterial, Dystonia vascular, Cardiovascular insufficiency, the Tone.
Bibliography: See bibliogr. to St. Cardiovascular insufficiency .
E. I. Sokolov, S. A. Harkov.