Searching for the cause of development of somatoform vegetative dysfunction in patients with coronary heart disease

The goal. To examine patients with somatoform autonomic dysfunction who were urgently taken to the hospital with symptoms of coronary heart disease, to identify the cause of their pathology by examining the spinal column with a magnetic resonance imaging scanner. Materials and methods of research. The study was conducted in the city of Makhachkala, hospital No. 2, on the basis of the department: outpatient therapy, cardiology and general medical practice, from 2021 to 2023. 84 patients, men (n=34) and women (n=50) aged 23–62 years, were selected for the study. All patients were admitted urgently or planned to the department of cardiology, therapy and neurology with various preliminary diagnoses. All patients were tested with A. M. Vein›s questionnaire to identify autonomic dysfunction. The study was conducted in accordance with the standards of the Declaration of Helsinki. Before inclusion in the study, patients were informed about all the nuances of the examination and signed a written agreement. Results. We used the Wein questionnaire, which is used to determine the severity of autonomic dysfunction in patients with somatoform autonomic dysfunction, to select them among patients with a presumptive diagnosis of coronary heart disease. It should be noted that the Wayne questionnaire coped with its task, but with a slight deviation of 5.34%, and the error was not so significant p0.05), ventricular 11 to 29 (p>0.05). An examination on a magnetic resonance imaging scanner revealed that spinal pathology in the 1st group was detected in n=40 (97.6%) cases, in the 2nd group in n=59 (65.5%), the deviation value was p < 0.05. Degenerative-dystrophic diseases of the spine were observed in both groups, but diseases such as ankylosing spondylitis, rheumatoid arthritis, and hemangioma significantly predominated in patients with somatoform autonomic dysfunction, deviation p < 0.05. It turned out that 30.6% of patients with somatoform autonomic dysfunction are admitted to the hospital erroneously with a diagnosis of coronary heart disease; significant differences were p < 0.05. Conclusion. Thus, the study allows us to conclude that at present the somatic approach to the treatment of diseases continues to dominate, denying the central role of psychological factors in etiopathogenesis. It is psychologists in many civilized countries who help patients with somatoform autonomic dysfunction, and the patient, knowing about his illness, first of all calls his psychologist, and not an ambulance. Long-term study of the history of somatoform autonomic dysfunction — multiple interpretations of the diagnosis, the problem of functional disorders and a large amount of accumulated evidence could reduce the burden at all stages of medical care. Improving the quality of life of patients with somatoform autonomic dysfunction remains relevant to this day, linking spinal pathology and somatoform autonomic dysfunction into one whole. Then we can expect success from new conceptual approaches to the diagnosis and treatment of somatoform autonomic dysfunction.

1. Chutko L. S., Kornishina T. L., Surushkina S.Yu. et al. Autonomic dysfunction syndrome in children and adolescents. Journal of Neurology and Psychiatry named after. S. S. Korsakov, 2019, Vol. 118, No. 1, pp. 43–49 (In Russ.).

2. Tamas R., Perczel-Forintos D., Mate O. et al. Treatment of somatic symptom disorder in childhood: evidencebased psychotherapy interventions // Orv Hetil. 2020. Vol. 161, No. 25. Р. 1050–1058.

3. Domschke K, Kirchhof P, Zwanzger P. Coincidence of paroxysmal supraventricular tachycardia and panic disorder: two case reports // Ann. Gen. Psychiatry. 2020. Vol. 9. Р. 13.

4. Belenkov Yu.N., Oganova R.G. Autonomic dysfunction of the heart. Cardiology, 2020, Vol. 4, pp. 1158–1168 (In Russ.).

5. Zaitseva Zh.G., Zaitseva O.I., Kolodyazhnaya T.A. Somatoform dysfunction of the autonomic nervous system in adolescents: autonomic homeostasis and reactivity of erythrocyte membranes. Medical news, 2021, Vol. 13, No. 5, pp. 264–284 (In Russ.).

6. Khabchabov R.G., Makhmudova E.R., Abdullaev A.A. et al. Assessment of the quality of life and functional state of the cardiovascular system in patients who have recovered from COVID 19. Current problems of medicine, 2021, Vol. 4, No. 44, pp. 373–382 (In Russ.).

7. Sivyakova O. N., Konyuk E. F. Diagnosis and treatment of neurocirculatory dystonia. Russian Journal of Cardiology, 2019, Vol. 1, pp. 44–47 (In Russ.).

8. Chukhlovina M.L. Features of the pathogenesis, diagnosis and treatment of panic attacks in young people. Neurology, neuropsychiatry, psychosomatics, 2020, Vol. 12. No. 3, pp. 37–41 (In Russ.).

9. Popova E.P., Bogova O.T., Puzin S. N. et al. The importance of the autonomic nervous system in the pathogenesis of atrial fibrillation. Russian Journal of Cardiology, 2020, Vol. 25, No. 7, рр. 3663–3667 (In Russ.).

10. Kutashov V.A. Modern approach to the treatment of autonomic disorders in patients under stressful conditions. Medical Council, 2018, Vol. 18, pp. 21–29 (In Russ.).

11. Melnikova E.A., Smirnova S. N. Treatment of neurotic, stress-related and somatoform disorders in a sanatorium. Doctor.Ru, 2022, Vol. 21, No. 8, pp. 44–51 (In Russ.).

12. Eröksüz R., Forestier F. B.E., Karaaslan F. et al. Comparison of intermittent and consecutive balneological outpatient treatment (hydrotherapy and peloidotherapy) in fibromyalgia syndrome: a randomized, single-blind, pilot study // Int. J. Biometeorol. 2020. Vol. 64, No. 3. P. 513–520.

13. Pinheiro М.В., Ferreira M.L., Refshauge K. et al. Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta-Analysis // Arthritis Care and Research. 2018. Vol. 12, No. 7. P. 137–154.