Why is blood circulation impaired? What is circulatory failure. Symptoms of chronic circulatory failure

Initial (early) manifestations of insufficiency of blood supply to the brain observed in a number of diseases affecting the cardiovascular system, most often vegetative-vascular dystonia, hypertension and atherosclerosis.

Signs of initial insufficiency of blood supply to the brain

The first symptoms of deficiency manifest themselves during intense mental work, especially in conditions of fatigue - heaviness in the head, headache, dizziness, noise in the head. These symptoms force you to interrupt work and disappear during rest, but reappear when you try to start work. There is a slight decrease in attention and memory. First of all, memory for current events deteriorates, while professional memory and memory for the past do not decrease. Often emotional disorders come to the fore: increased irritability, nervousness, anxiety, unstable mood, tearfulness.

Over time, such disorders are observed more and more often. General weakness, “flickering spots” before the eyes, discomfort in the heart and other internal organs, staggering when walking, excessive sweating, and problems falling asleep do not allow one to lead an active lifestyle.

If the initial insufficiency of blood supply to the brain is not treated, the disease will progress and the following stages of vascular insufficiency will develop. Eventually, the damage to the blood vessels in the brain can become so severe that it leads to permanent brain damage such as stroke and dementia.

Diagnosis of initial manifestations of insufficiency of blood supply to the brain

To confirm the diagnosis, additional instrumental and laboratory testing is necessary.

Psychological research helps to determine characteristic changes in the emotional state (increased anxiety, depression), assess the degree of impairment of attention and memory. To identify early pathology of the vessels of the head, rheoencephalography, ultrasound Dopplerography of the great vessels of the head and transcranial ultrasound Dopplerography are used. Electroencephalography and computed tomography make it possible to determine the location of brain disorders and assess the degree of insufficiency of blood supply to the brain.

Correct diagnosis is the key to successful treatment.

Treatment of patients with initial signs of cerebral circulatory failure

First of all, the underlying disease against which the cerebrovascular accident developed should be treated: vegetative-vascular dystonia, hypertension and atherosclerosis. It is also necessary to lead a healthy lifestyle: give up bad habits, sleep in a well-ventilated area for at least 8-9 hours a day, walk at least 2-3 km daily. It is advisable to rest twice a year for 2 - 3 weeks. It is important to adhere to your diet; you should not overeat and eat before bed. It is necessary to avoid foods rich in animal fats, cholesterol, salt; A predominantly dairy-vegetable diet, boiled meat, and fish are recommended.

During drug treatment, groups of drugs are used that normalize blood pressure, blood circulation in the vessels of the head and improve the nutrition of brain cells.

Non-drug methods include physical therapy, physiotherapy and herbal medicine. A special place in helping patients is given

L. S. Manvelov, Candidate of Medical Sciences
V. E. Smirnov, Doctor of Medical Sciences, Professor

Research Institute of Neurology of the Russian Academy of Medical Sciences, Moscow

The diagnosis of “initial manifestations of insufficiency of blood supply to the brain” (IPNKM) is established in accordance with the “Classification of vascular lesions of the brain and spinal cord”, developed by the Research Institute of Neurology of the Russian Academy of Medical Sciences, if the patient has signs of a general vascular disease (vegetative-vascular dystonia, arterial hypertension (AH), atherosclerosis) There are complaints of headache, dizziness, noise in the head, memory impairment, decreased performance. Moreover, the basis for this diagnosis can only be a combination of two or more of the five listed complaints, which must be noted at least once a week for at least the last three months

The problem of prevention and treatment of early forms of vascular diseases of the brain is of great social and economic importance. Not only are they a serious risk factor for the development of cerebral stroke, one of the leading causes of disability and mortality, but they themselves significantly worsen the quality of life, and often reduce ability to work.

Secondary prevention, which is required by patients with initial manifestations of insufficiency of blood supply to the brain (IBC), includes measures to prevent both exacerbations of major cardiovascular diseases and vascular lesions of the brain.

Therapeutic and preventive measures for NPNCM can be schematically divided into the following types: work, rest and nutrition regimen; physiotherapy; diet, physio and psychotherapy; drug treatment and prevention. Most often, diet No. 10 is prescribed, taking into account anthropometric data and the results of a study of metabolic characteristics.

Treatment of patients with NPNCM should be carried out in three main areas:

• Impact on the mechanism of formation of insufficiency of blood supply to the brain,
• Impact on cerebral metabolism,
• Differentiated individual treatment depending on the clinical symptoms of the disease.

In patients with NPNCM in the early stages of the formation of the underlying vascular disease, rational employment, adherence to work, rest and nutrition regimens, cessation of smoking and alcohol abuse, and the use of drugs that increase the physiological defenses of the body are sometimes sufficient to compensate for the condition. In severe forms of the disease, complex therapy with extensive use of medications is necessary.

Therapy should be carried out aimed at eliminating foci of infection: odontogenic; chronic tonsillitis, sinusitis, pneumonia, cholecystitis, etc. Patients with diabetes mellitus should receive adequate antidiabetic treatment.

If treatment is not carried out regularly, the risk of developing acute cerebrovascular accidents, as well as dyscirculatory encephalopathy, increases significantly. Thus, according to our data, based on a seven-year prospective observation of 160 patients with hypertension with NPCCM (men 40-49 years old), transient cerebrovascular accidents (TCVA) developed 2.6 times more often, and cerebral stroke - 3.5 times more often in untreated patients. or those who were treated irregularly than those who were treated regularly and followed medical recommendations.

Drug methods of treatment and prevention of exacerbations of the underlying vascular disease

Vegetovascular dystonia. Therapy is carried out in accordance with the principles of dividing autonomic disorders according to sympathicotonic and vagotonic manifestations.

With increased sympathetic tone, a diet with limited proteins and fats, warm baths, and carbon dioxide baths are recommended. Central and peripheral adrenolytics and ganglion blockers are used. Alpha-blockers are prescribed: pyrroxan, redergin, dihydroergotamine, and beta-blockers: anaprilin, atenolol, tenormin, which have a vasodilating and hypotensive effect.

In cases of insufficiency of sympathetic tone, a diet rich in proteins is indicated; salt and radon baths, cool showers. Effective drugs that stimulate the central nervous system: caffeine, phenamine, ephedrine, etc. Improve the sympathetic activity of lemongrass tincture 25-30 drops per day, pantocrine - 30-40 drops, ginseng - 25-30 drops, zamanikha - 30-40 drops, calcium supplements (lactate or gluconate 0.5 g three times a day); ascorbic acid - 0.5-1.0 g three times; methionine - 0.25-0.5 g two to three times a day.

When parasympathetic activity increases, a low-calorie but protein-rich diet and pine baths (36°C) are recommended. They use drugs that increase the tone of the sympathetic system. Belladonna preparations, antihistamines, and vitamin B6 are used.

If the parasympathetic system is weak, the following have a positive effect: foods rich in carbohydrates; coffee; strong tea; low temperature sulfide baths (35°C). Increase parasympathetic tone with cholinomimetic drugs, cholinesterase inhibitors: prozerin 0.015 g orally and 1 ml of 0.05% solution in injections, mestinon 0.06 g, potassium preparations: potassium chloride, potassium orotate, panangin. Sometimes small doses of insulin are used.

Dividing the syndrome of vegetative-vascular dystonia by the nature of its manifestations (predominance of sympathetic or parasympathetic activity) is not always possible. Therefore, drugs that act on both peripheral parts of the autonomic nervous system and have both adrenergic and cholinomimetic activity have found widespread use in practice: belloid, bellaspon, ergotamine preparations.

Arterial hypertension. Therapeutic and preventive measures for hypertension should primarily be aimed at eliminating or correcting risk factors that contribute to the development of the disease, such as psycho-emotional stress, smoking, alcohol abuse, excess body weight, sedentary lifestyle, diabetes mellitus.

It is necessary to limit the consumption of table salt to 4-6 g per day (1/2 teaspoon), and in case of severe hypertension - even to 3-4 g.

Currently, five classes of antihypertensive drugs are considered the most effective for the drug treatment of hypertension: beta blockers, angiotensin-converting enzyme (ACE) inhibitors, diuretics, calcium antagonists and alpha blockers. The report of the WHO Expert Committee provides recommendations for the selection of the initial drug for the treatment of hypertension, presented in Table.

Complex antihypertensive drugs are effective: brinaldix, adelfan-ezidrex, trirezide K, etc. However, they have negative side effects of their ingredients: reserpine, thiazide diuretics and hydralazines. These drugs can be used during exacerbation of hypertension, but in the future it is necessary to select an individual maintenance treatment regimen. Therapy for the malignant form of hypertension should begin in a hospital.

Do not increase the dose of an initially effective drug multiple times if it no longer controls blood pressure reliably. If the prescribed medicine turns out to be ineffective, it needs to be replaced. It is better to add small doses of another antihypertensive drug than to increase the dose of the first one. The effectiveness of treatment increases when using the following combinations of drugs:

• A diuretic in combination with a beta blocker, alpha blocker or ACE inhibitor.
• A beta blocker in combination with an alpha blocker or a dihydropyridine calcium antagonist.
• ACE inhibitor in combination with a calcium antagonist. To achieve maximum results, in some cases it is necessary to use a combination of not only two, but also three antihypertensive drugs.

If in patients with moderate to severe hypertension, blood pressure does not decrease within a month of combined treatment with two or three drugs, it is considered to be resistant. The reasons for resistance are very diverse: irregular drug intake, insufficiently high doses, ineffective drug combinations, use of pressor drugs, increased blood plasma, the presence of symptomatic hypertension, excessive consumption of table salt and alcohol. The “white coat” effect is known (an increase in blood pressure in a patient in the presence of a doctor or nurse), which can create the impression of resistance. The most serious causes of treatment resistance are an increase in blood plasma in response to a decrease in blood pressure, kidney disease and drug side effects. In a number of patients with resistant hypertension, the use of loop diuretics, a combination of ACE inhibitors and calcium antagonists has a positive effect.

It is believed that the hypotensive effect is achieved with a persistent decrease in blood pressure in patients with mild hypertension (140-179/90-104 mm Hg) to a normal or borderline level (below 160/95 mm Hg), and with moderate and severe Hypertension (180/105 mm Hg and above) - by 10-15% of the initial values. A sharp decrease in blood pressure due to atherosclerotic lesions of the great vessels of the head, which occurs in 1/3 of patients with hypertension, can worsen the blood supply to the brain.

After selecting therapy, the patient is invited for examinations until an adequate reduction in blood pressure is achieved. This ensures that blood pressure is kept at an optimal level and risk factors are under control. A gradual and careful decrease in blood pressure significantly reduces side effects and complications of antihypertensive therapy.

When a stable decrease in blood pressure is achieved, the patient should be invited for repeated examinations at intervals of 3-6 months. Antihypertensive therapy is usually carried out indefinitely. However, after long-term adequate control of blood pressure levels, a careful dose reduction or discontinuation of one of the combined drugs is allowed, especially in individuals who strictly adhere to the recommendations for non-drug treatment.

Atherosclerosis. To treat patients with atherosclerosis, it is necessary first of all to identify high levels of serum cholesterol (CS) and take measures to correct it.

The main drugs used in the treatment of patients with NPNCM

A special role belongs to drugs that have a combined effect on blood supply and metabolism of the brain, as well as on central hemodynamics and rheological properties of blood. Cavinton (vinpocetine) 0.005 g is used; cinnarizine (stugeron) - 0.025 g; xanthinol nicotinate (teonicol, complamin) - 0.15 g; parmidine (anginine) - 0.25-0.5 g; sermion - 0.005-0.03 g; tanakan - 0.04 g - three to four times a day.

In cases of increased cerebral vascular tone in the spastic type of REG, antispasmodic and vasoactive agents are recommended. It is advisable to prescribe aminophylline 0.15 g three times a day. As a result, as a rule, the general condition of patients improves, headaches and dizziness decrease or disappear, and positive changes in rheographic and Doppler sonographic parameters are noted. Patients with unstable vascular tone are prescribed Belloid, Bellaspon, Grandaxin. For hypotension of cerebral vessels and signs of venous insufficiency, stimulating drugs are recommended: eleutherococcus, zamanikha, Leuzea rhizome, pantocrine, duplex, ginseng, tincture of Chinese lemongrass, aloe - and venotonic drugs: troxevasin, aescusan, anavenol, venoruton.

Due to the fact that vascular disease of the brain is often preceded or accompanied by cardiac dysfunction, patients are prescribed drugs that improve coronary blood flow, antiarrhythmics, and cardiac glycosides according to indications. For functional disorders of the heart in patients with NPCM, hawthorn in the form of a liquid extract, 20-30 drops four times a day, has a beneficial effect.

Currently, of the agents that have a positive effect on the rheological properties of the blood coagulation and anticoagulation system, aspirin is the best studied and most widely used. The main disadvantage of this drug is its irritating effect on the gastrointestinal tract. Therefore, it is recommended to take it once in a daily amount of no more than 1 mg per 1 kg of weight. For this purpose, trental 0.1 g, dipyridamole - 0.25 g and methindol - 0.025 g are also used three times a day. In addition, these agents prevent destabilization of the cell membranes of neurons during cerebral ischemia, suppress edema and swelling of the endothelium, increase blood flow to the brain, facilitate venous circulation and have an antispasmodic effect, which ultimately determines their effectiveness for secondary prevention and treatment of vascular diseases of the brain. A number of other drugs also have an antiplatelet effect: papaverine, no-spa, alpha- and beta-adrenergic blockers, etc.

For memory and attention disorders, to increase mental and motor activity, treatment with nootropil (piracetam) 0.4 g, encephabol (pyriditol) 0.1 g, aminalon 0.25-0.5 g two to four times a day is recommended , injections of Cerebrolysin 5.0 ml intravenously or intramuscularly and other means of similar action.

If there are manifestations of a neurosis-like syndrome, tranquilizers are prescribed: chlozepid (Elenium, Napoton) 0.005-0.01 g three to four times, sibazon (Seduxen, Relanium) - 0.005 g once or twice, phenazepam - 0.00025-0.0005 g and mezapam (rudotel) - 0.005 g two to three times a day; sedatives: preparations of valerian, motherwort, peony tincture, etc.

Of the methods of physical therapy, electrophoresis of drugs is most often used using the reflex-segmental (collar) transorbital Bourguignon method, as well as the general method of exposure in both the usual and bipolar ways. Favorable results were noted in treatment with electrophoresis of a 10% solution of acetylsalicylic acid and a 7.5-10% solution of potassium orotate from a 40-50% universal solvent - dimexide using a general method of exposure: longitudinally on the spine with application of electrodes to the collar , interscapular and lumbosacral areas - 8-12 procedures per course.

A new method of treatment is the electrophoretic administration of stugeron in the form of transcerebral reflex iontophoresis of a 0.5% solution. In patients with cephalgia, it is advisable to carry out three or four procedures of endonasal electrophoresis with a 0.1% dihydroergotamine solution before this.

For patients with impaired venous outflow, a method of transcerebral electrophoresis of a 5% solution of troxevasin has been proposed. The combined use of electrophoretic and oral administration of stugeron and troxevasin makes it possible to influence all parts of the vascular system of the brain: arterial tone, microcirculation and venous outflow.

For headaches and autonomic disorders, iodine electrophoresis is used using the collar method, and for neurotic conditions and hyposthenia, novocaine electrophoresis is used. Bipolar electrophoresis of iodine and novocaine is recommended for neurasthenic syndrome, a tendency to dizziness, and pain in the heart. For sleep disturbances and increased general excitability, electrophoresis of bromine and iodine, diazepam or magnesium according to the Vermeule method, and electrosleep are used. Electrophoresis of dallargin has a positive effect on the reflexogenic zones C-4 - T-2 and T-8 - L-2.

It should be emphasized that drug therapy has a number of limitations: side effects, allergic reactions, addiction to drugs, and a decrease in their effectiveness with long-term use. In addition, it is necessary to take into account the possibility of complete insensitivity of patients to a particular drug. Therefore, the use of non-drug treatment methods is of great importance.

Non-drug methods of prevention and treatment for NPNCM

The treatment complex includes diet therapy, active motor regimen, morning hygienic exercises, physical therapy, swimming in the pool, and sports games. If you are overweight, an underwater shower massage is performed. With concomitant osteochondrosis of the cervical spine - massage of the collar area.

Effects of alternating low-frequency magnetic fields and sinusoidal modulated currents on reflexogenic zones and muscle groups of the cervical, collar and waist areas, upper and lower extremities, taking into account daily biorhythms, are successfully used.

Reflexology methods are increasingly being introduced into practical healthcare: acupuncture, moxibustion, electroacupuncture, and exposure to laser radiation. In patients with NPNCM, as a result of treatment with these methods, the general condition significantly improves, subjective disorders decrease or disappear, there is a positive dynamics of REG and EEG indicators, which is explained by the normalizing effect of reflexology on metabolic processes, an increase in physical and mental tone, and the elimination of vegetative-vascular disorders. If the tone of the cerebral veins is increased, a course of microwave irradiation (8-12 sessions) is recommended for reflexogenic zones and acupuncture points.

Hyperbaric oxygenation is considered as a universal component of pathogenetic therapy for vascular diseases of the nervous system, which makes it possible to stabilize the pathological process, reduce treatment time and improve the prognosis. In the process of barotherapy, the general condition of patients, sleep, memory improve, asthenia, psycho-emotional disorders, headaches, dizziness, and autonomic disorders decrease.

A persistent clinical effect and long-term remissions were observed in patients with NPNCM who received complex treatment including hyperbaric oxygenation, acupuncture and physical therapy.

Hydroaeroionotherapy is used both as an independent method and in combination with other types of physiotherapy and medications. It is advisable to use oxygen therapy in the form of oxygen cocktails, which has a general stimulating effect and improves the functional state of the nervous system. The combination of aeroion therapy and oxygen therapy gives a greater clinical effect: well-being and memory improve, headaches disappear, vestibular and emotional-volitional disorders decrease. These treatment methods can be used not only in a hospital, but also in a clinic.

A method of training therapy using intermittent hypoxic exposure is proposed: inhalation of an air-nitrogen mixture containing 10% oxygen.

For neurosis-like syndrome, which is detected in a significant number of patients with NPNCM, psychotherapy is recommended. Its most important tasks are to develop in patients the correct attitude towards the disease, adequate psychological adaptation to the environment, and increase the effectiveness of medical and social rehabilitation. Psychotherapy involves the active participation of the patient in all its stages and should begin from the first appointment. In cases of severe manifestations of cerebrasthenia, hypnotherapy is successfully used. Using autogenic training is effective. The best results are achieved with combined treatment with tranquilizers and antidepressants with psychotherapy and autogenic training.

Of great importance is the complex step-by-step therapy of patients with NPNCM, which includes inpatient treatment, sanatorium-resort treatment and outpatient observation. Sanatorium-resort treatment is most appropriate to carry out in sanatoriums of the cardiovascular or general type, without changing the climatic zone, since due to a decrease in adaptive capabilities, patients with NPNCM spend significant time on acclimatization, which shortens the period of active treatment, reduces the durability of its effect, and in some cases even worsens the condition.

The main treating and dispensary doctor for patients with NPNCM should be a local (shop) general practitioner. The neurologist is assigned the responsibility of consultant to these patients. Clinical observation and course treatment, the duration of which is 1-2 months, should be carried out at least twice a year (usually in spring and autumn).

Work ability

Patients with NPNCM are usually able to work. However, sometimes they need easier working conditions, which are recommended by the VKK: exemption from night shifts, additional loads, correction of the work regime. Patients are referred to VTEK in cases where working conditions are contraindicated for them due to health reasons. They cannot work in a caisson, under altered atmospheric pressure, in hot shops (steelmaker, blacksmith, thermal operator, cook), under constant significant psycho-emotional or physical stress. If transfer to another job is associated with a decrease in qualifications, then disability group III is established.

This group includes patients in whom, due to an increased need for blood flow to the brain (intense mental work, overwork, etc.), blood flow compensation does not occur fully enough.

Clinical indicators of initial manifestations of insufficiency of blood supply to the brain are the presence of at least two of the following seven symptoms:

1. headache,
2. dizziness,
3. noise in the head
4. memory disorder,
5. decreased performance,
6. increased, often inappropriate irritability,
7. sleep disturbance.

It is characteristic that the appearance of any two symptoms (out of the listed seven) occurs in patients at least once a week during the last 3 months before seeing a doctor.

The basis of the initial manifestations of insufficient blood supply to the brain is most often observed atherosclerosis of cerebral vessels, arterial hypertension, vegetative-vascular dystonia (cerebral angiodystonia). Damage to the main arteries of the head, deterioration of central hemodynamics, decrease in stroke volume of the heart, and deterioration of the outflow of venous blood from the brain are also important.

Thus, already the initial manifestations of insufficiency of blood supply to the brain are associated with certain morphological changes in the cardiovascular system of the body, and therefore many authors consider this condition as a clinical variant of chronic cerebral circulatory insufficiency.

In the first stage - the stage of subclinical manifestations of insufficiency of blood supply to the brain - there are usually no complaints from patients or they are very vague. However, objectively, some signs of vegetative-vascular dystonia can be noted: tremor of the eyelids and outstretched fingers, moderate hyperreflexia, dysfunction of the cardiovascular system (angiodystonia, arterial hypertension, etc.). Neuropsychological studies reveal in such patients some impairment of memory and attention.

In the second stage - the stage of initial manifestations of insufficient blood supply to the brain - the clinical signs of the disease are also unspecific and resemble a “neurasthenic” syndrome: decreased performance, irritability, memory impairment, headaches, dizziness, sleep disturbance, uncertainty and anxiety. Vegetative-vascular dystonia and instability of blood pressure are noted. Individual organic neurological symptoms may be detected. There are usually no complaints about visual impairment or they are very vague: fatigue during prolonged visual work, seeing “flying spots” in the field of vision, etc.

There is a definite connection between the asthenoneurotic syndrome of the initial manifestations of insufficiency and the nature of the cerebral process. In atherosclerosis, asthenic manifestations predominate: weakness, apathy, fatigue, decreased attention, memory, intellectual and physical performance. Hypertension is accompanied by increased anxiety and fear. On the part of the fundus, there may be changes characteristic of arterial hypertension: angiopathy and angiosclerosis of the retinal vessels.

To diagnose vascular pathology of the brain, including initial manifestations, various non-invasive (“direct”) research methods are widely used. These include: Doppler ultrasound, rheoencephalography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, recording of visual evoked potentials, electroencephalography, neuro-ophthalmological, otoneurological and other research methods.

Additional “indirect” research methods include: determination of lipid metabolism, hemorheology, cellular and humoral immunity, electrocardiography, biomicroscopy and fundus photography, etc.

The diagnostic value of the listed methods is different. The method of Doppler ultrasound of cerebral vessels turned out to be especially valuable, and at the same time simple. In 40% of patients with initial insufficiency of blood supply to the brain, occlusive lesions of the main arteries of the head and connecting arteries of the arterial circle of the brain were detected. It should be noted that often occlusive processes in the great vessels of the head are asymptomatic. T. N. Kulikova et al. In patients with initial manifestations of blood supply to the brain, both spasm of the cerebral arteries and compensated stenosis, mainly in the vertebral arteries, were detected.

Disturbances in cerebral hemodynamics are also indicated by asymmetry of the linear velocity of blood flow, fluctuations in the circulatory resistance index, changes in collateral circulation, as well as stenosis of the internal carotid artery. When detecting hemodynamically significant stenosis of the cerebral arteries using computed tomography or magnetic resonance imaging, it was possible to detect morphological changes in the vascular system and brain tissue that went beyond just the initial changes in the disturbance of blood supply to the brain.

In patients with initial manifestations of insufficient blood supply to the brain, the electroencephalogram reveals diffuse changes in the biorhythms of the brain: a decrease in the amplitude and regularity of the alpha rhythm, a general disorganization of biopotentials, and local disturbances of electrogenesis are possible.

When examining patients with initial manifestations of insufficient blood supply to the brain, several techniques should usually be used - Doppler ultrasound, rheoencephalography, electroencephalography, electrocardiography.
The state of the body’s vascular system can be directly judged by the state of the arterial and venous network of the bulbar conjunctiva and the vessels of the fundus. The completeness of intraocular blood circulation is determined by rheoophthalmography. For the same purpose, ultrasound Dopplerography of the internal carotid artery and orbital vessels is used.

To diagnose the initial manifestations of insufficient blood supply to the brain, it is important to identify signs of atherosclerosis of vessels of extracerebral localization - fundus arteries, coronary arteries of the heart, obliterating atherosclerosis. Also important is the instability of blood pressure with its periodic rises and hypertrophy of the left ventricle of the heart.

Some authors identify a violation of intraocular circulation under the name ocular ischemic syndrome. This syndrome is characterized by a stable set of symptoms of ischemic damage to the membranes of the eye and carotid arteries. Ocular ischemic syndrome is observed 4-5 times more often in men than in women, and occurs at the age of 40-70 years. Two types of course of this syndrome have been established: acute and primary chronic, and the clinical course of these two forms of the disease is different.
The acute type of the syndrome is characterized by an acute onset, unilateral damage, a sharp decrease in vision, up to transient monocular blindness (amaurosis fugax). From the fundus side, manifestations of occlusion of the central retinal artery or its branches, as well as ischemia of the optic nerve, are possible. In this case, obstruction of the internal carotid artery on the side of the affected eye is often detected.

Using Doppler ultrasound, the authors identified various hemodynamically significant changes in blood flow in the vessels of the eye, characteristic of acute and chronic manifestations of ocular ischemic syndrome. In the acute type of the syndrome, there is a pronounced decrease in blood flow in the central nervous system, a flattening of the peak of the systolic wave of the Doppler spectrum of blood flow, a decrease in the maximum systolic velocity (V s) of blood flow by 2 times, a decrease in the final diastolic velocity (V d) of blood flow by 5 times and an increase in the resistance index (R ) 1.5 times compared to the norm.

The primary chronic type of ocular ischemic syndrome is characterized by a gradual decrease in vision in both eyes against the background of progressive stenosis of the internal carotid arteries, narrowing of the ophthalmic artery and intraocular vessels. The chronic course manifests itself in the form of chronic ischemic neuropathy of the optic nerve, retinopathy and choriodeopathy.

In the chronic type of ocular ischemic syndrome, there is a moderate decrease in blood flow in the central nervous system, a decrease in V s by 1.5 times and V d by 3 times compared to the norm. Impaired intraocular circulation can lead to a significant decrease in visual function, and to prevent this, adequate treatment is necessary: ​​medication or surgery (reconstructive surgery on the internal carotid arteries).
The course of the disease is slowly progressive.

Treatment of cerebrovascular insufficiency: new surgical technologies. artificial vessels

At the Russian Institute of Surgery named after. Vishnevsky, in recent years, many new methods of treating cerebrovascular insufficiency have appeared.

Options for operations were developed. If previously one type of surgical intervention was standard, now doctors have several sets of measures in stock.

Depending on the condition of a particular patient, preference is given to one of the available options.

In addition, doctors now have the opportunity to use artificial vessels. This, in particular, is a Russian development: artificial vessels are made in St. Petersburg. These vessels work well.

As for each patient, it is necessary to once again point out the need for timely prevention: the most important thing is to undergo ultrasound examinations and not wait for carotid artery stenosis and stroke to occur. Most patients die in such cases. You should go to the doctor when there is still little concern. This is a top priority.

Every person over forty years old should regularly (once every six months or year) examine their blood vessels that supply the brain.

The problem does not develop rapidly, so it is enough to be examined at least once a year. A person over 50 years old should definitely do this! Now there are appropriate diagnostic centers in Moscow and other cities.

The activity of our body directly depends on its circulatory system. Circulatory disorders are an abnormal condition in which the supply of tissues with oxygen and essential nutrients deteriorates due to changes in the properties and volume of blood in the vessels. The result of this is the development of hypoxia and a slowdown in metabolic processes, leading to the occurrence of a large number of diseases.

Systemic and pulmonary circulation

Heart failure, circulatory disorders and circulatory disorders - all these concepts characterize the same condition, in which not only changes occur in the contractile function of the myocardium of the left and right ventricles, but also peripheral circulatory lesions are observed, spreading to the entire body.

The heart is the central circulatory organ of the body. From the left atrium, arterial blood enters the left ventricle, then during heart contractions, blood enriched with oxygen and nutrients is pushed out of the ventricle into the aorta, moves through the arteries, branches into arterioles and ends up in capillaries, entangling all organs like a web. Through the walls of the capillaries, nutrition and gas exchange occur in the tissues; the blood delivers oxygen and receives carbon dioxide and metabolic products. From the capillaries, venous blood is transferred through the veins to the right atrium, where the systemic circulation ends. In the pulmonary circle, venous blood, entering the capillary bed of the lungs, is enriched with oxygen and freed from metabolic products, then returns through the pulmonary veins to the left atrium. If at some stage of blood movement or in the cardiac circle a circulatory disorder occurs, the consequence of the damage is the occurrence of various diseases.

Types of Circulatory Disorders

The circulatory system is conventionally divided into central and peripheral. Anomalies of the central system are caused by disturbances in the functioning of the heart and large blood vessels. Lesions in the peripheral system are caused by structural and functional disorders of these vessels. Circulatory disorders are divided into the following types: hyperemia, ischemia, bleeding, thrombosis, embolism, shock.

Chronic and acute circulatory disorders are also distinguished. Chronic pathologies develop over a long period of time with the gradual development of atherosclerotic plaques on the inner surface of the arteries, leading to their narrowing until complete obliteration. Occlusive lesions of the vessels of the lower extremities can cause the development of necrosis.

Acute lesions of the circulatory system are usually a consequence of cardiovascular failure, but also occur against the background of damage to the central nervous system, endocrine diseases and other pathologies. Acute circulatory disorders include strokes and cerebral vein thrombosis.

Causes of the disease

Poor circulation is one of the symptoms of a large number of diseases of the cardiovascular system. Conventionally, all the causes of pathology can be divided into five groups:

• Compression;
• Traumatic;
• Vasospastic;
• Caused by the occurrence of tumors;
• Obliterating.

Also, the cause of the anomaly may be the presence of infectious diseases, hormonal imbalances, hypertension, diabetes, and renal failure. Favorable factors for the development of circulatory disorders are burns, aneurysms, and Raynaud's phenomenon.

Clinical picture and symptoms of circulatory disorders

The clinical picture of the disease with different types of its manifestation has its own characteristics; let’s consider some of the symptoms of circulatory disorders:

• Hyperemia. Dilatation of the blood vessels of the body with an excessive increase in blood filling. It is manifested by a change in the color of the skin at the site of damage to the vessel as a result of filling with blood, acquiring a pink-red color. The patient feels pulsation and increased temperature in the affected area;
• Bleeding. The release of blood from a vessel, when its walls rupture, can be external or internal, arterial bleeding is pulsating, bright scarlet in color, venous bleeding is dark red, and with capillary bleeding, pinpoint bleeding from small vessels is observed;
• Ischemia. A reduced supply of arterial blood to the vessels is manifested by a feeling of pain in the affected organ due to a lack of oxygen supply and the accumulation of metabolic products;
• Thrombosis. A blood coagulation disorder, in which the lumen of the vessel is blocked by a thrombus, there may be complete or partial blockage. The consequence is a slowdown in the outflow of blood from the affected area, with swelling, cyanosis of the skin, and pain;
• Embolism. Blocking of the lumen of the vessel with foreign particles such as pieces of adipose tissue, microorganisms, air bubbles. The symptoms are the same as for thrombosis;
• Shock. A clinical condition caused by a decrease in blood supply to tissues due to impaired autoregulation of the microcirculatory system. It manifests itself as destructive changes in internal organs; if blood circulation is disrupted, it can lead to rapid death.

Also often with peripheral damage, the following symptoms of circulatory disorders are observed: pain, tingling, feeling of chilliness and numbness in the extremities, dizziness, tinnitus, memory impairment, weakened vision, sleep disturbance. The symptoms are most pronounced after physical activity, the degree of their manifestation also depends on the severity of the disease.

Treatment of circulatory disorders

To diagnose the disease, blood tests, MRI examinations, duplex scanning, consultations with an ophthalmologist and other specialists are used. Treatment of circulatory disorders depends primarily on determining the cause and type of pathology. For blood flow disorders identified at the initial stage of development, adequate drug treatment is prescribed; in addition, experts recommend regular physical exercise to strengthen the heart muscle and improve blood supply to organs and tissues. It is necessary to adhere to a special diet low in fat and salt, it is important to lose excess weight and give up bad habits. Following all recommendations along with the course of therapy has an effective effect on the body. In case of acute circulatory disorders, treatment is carried out using surgical methods to restore vascular patency. Such methods are: arterial plastic surgery, bypass surgery and vascular prosthetics, embolectomy; indirect revascularization operations are used to improve blood circulation in the extremities.

Circulatory disorders can and must be treated by following all the prescriptions of specialists; ignoring the disease or attempting self-medication can lead to disability.

The health of the entire body depends on the state of the cardiovascular system. Impaired local circulation will inevitably affect systemic hemodynamics, and vice versa. Circulatory disorders are always a consequence of other diseases. In turn, insufficient blood supply to tissues leads to new diseases.

Circulatory disorders can be local and general (systemic) in nature. The cause of general disorders is disruption of the heart or changes in the properties and volume of blood. Local abnormalities are usually associated with structural damage and decreased vascular functionality.

Most often we encounter impaired blood flow in the lower extremities. It is affected by the condition of peripheral veins and arteries. Changes in them occur under the influence of external factors and internal pathologies.

At-risk groups

Blood circulation in the legs is impaired primarily due to the increased load experienced by the peripheral vessels. More often there is a disorder of venous circulation. At risk are people who have at least one of the factors that increases the likelihood of developing pathology.

An increased risk of developing venous pathology is present in young women. High heels, pregnancy, and static loads on the lower extremities associated with work contribute to the early appearance of varicose veins. In older people, poor blood supply to the legs can be caused by long-term use of antihypertensive drugs - beta-blockers.

Types of pathology

The circulatory system is divided into central (heart, aorta, carotid arteries, pulmonary trunk, portal hepatic and vena cava), peripheral (arterioles and venules) and microcirculatory (capillaries and small lymphatic vessels).

Circulatory disorders of the legs are classified as pathologies of the peripheral and microcirculatory system and are divided into two types:

• arterial insufficiency - acute and chronic ischemic syndrome;
• venous insufficiency - acute and chronic.

Acute arterial insufficiency is a violation of vascular patency due to thrombosis or thromboembolism. Parietal blood clots enter the arteries during myocardial infarction, atrial fibrillation, and heart valve defects. The cause of chronic arterial insufficiency is growing atherosclerotic plaques that gradually block the lumen of the vessel. Etiological factors are vascular diseases: obliterating endarteritis, thromboangiitis obliterans, Raynaud's disease (or syndrome), obliterating atherosclerosis.

These diseases cause stenosis and complete closure of the lumen of the arteries as a result of prolonged spasm, leading to damage to the vascular walls, the development of inflammation, and the formation of blood clots and cholesterol plaques.

Violation of acute venous circulation occurs due to rapid blockage of the deep veins - common femoral or iliac. Causes: thrombosis, trauma, ligation of large veins, thrombophlebitis. Thrombosis can develop during pregnancy, due to obesity, a tumor in the pelvic area, or as a result of prolonged bed rest.

Chronic venous insufficiency is caused by primary and secondary factors. Primary are congenital anomalies in the form of weakness of the vascular wall, arteriovenous fistulas, and weakness of connective tissue. Secondary factors: diseases of the endocrine system, varicose veins, insufficiency of venous valves after thrombophlebitis, pregnancy, accumulation of fluid in the abdominal cavity.

Symptoms

Symptoms of circulatory disorders of the lower extremities depend on the type and depth of vascular damage.

Clinical manifestations of venous insufficiency

Symptoms and signs of acute deep venous thrombosis:

• bursting pain;
• persistent swelling of the lower leg or entire limb;
• the skin becomes glossy and a venous pattern appears on it;
• pain is felt on the inside of the limb along the thrombosed vein;
• when dorsiflexing the foot, pain occurs in the shin;
• the diseased limb is colder than the healthy one.

With chronic venous circulation disorders, symptoms increase gradually. At the compensation stage, which can last for years, they are practically absent. An external sign is convoluted, protruding veins. At the next stage, the legs become swollen, begin to tire quickly, bursting pains and night cramps appear in them. At the stage of decompensation, itching, severe swelling of the feet and legs, severe varicose veins, acute pain and trophic changes in the skin (pigmentation, thinning, hair loss) occur. Further, progressive venous insufficiency leads to disruption of tissue trophism and necrosis. As a result, trophic ulcers are formed.

Manifestations of venous insufficiency

Symptoms of arterial insufficiency

Acute and chronic disturbance of blood supply in arterial insufficiency is manifested by general clinical symptoms:

• the temperature of the affected limb decreases;
• the skin acquires a marbled color, becomes pale, and when changing from a horizontal to a vertical position, the pallor is replaced by a crimson color;
• Below the site of arterial blockage, the pulse cannot be felt, but above this site it intensifies;
• a symptom of empty superficial veins appears;
• tactile and pain sensitivity decreases;
• limb function is impaired until complete failure.

Acute arterial occlusion is manifested by additional symptoms. Their severity depends on the caliber of the affected vessel. Patients complain of acute pain below the site of artery blockage, numbness and weakness of the limb. With thromboembolism, the patient’s general condition worsens, an increased heart rate, cyanosis of the lips and mucous membranes, increased breathing are observed - a state of shock occurs. If the patient is left without medical care, limb ischemia and gangrene rapidly develop.

Chronic arterial obstruction is classified according to the stages of the disease with a specific clinical picture. At the first stage (functional compensation), there is intermittent claudication, pallor and coldness of the skin on the affected leg, a long-lasting white spot after pressing, pain when walking 0.5–1 km.

The stage of subcompensation is manifested by transient symptoms of ischemia - when walking 200–300 m, pain appears, and at rest it disappears. Patients complain of coldness and paleness of the feet. At the third stage, blood circulation is decompensated. It is difficult for the patient to walk even 25 m, hair falls out, the skin dries out, the nails on the affected leg become deformed, and the pulsation in the foot disappears. Foci of necrosis appear on the fingers. The fourth stage is the appearance of ulcers and foci of dry gangrene, the pain becomes intense, the foot swells and turns blue.

Diagnostic criteria

The examination allows you to make a preliminary conclusion about the presence of pathology. The patient is interviewed for specific complaints. The comparative temperature of the extremities is determined by palpation. In appearance - the degree of tissue nutritional disturbance. When listening, a systolic murmur indicates arterial stenosis, while a systodiastolic murmur indicates an arteriovenous fistula. Instrumental examinations:

• thermography - symmetrical temperature measurement of both legs;
• rheovasography - shows the blood supply to the tissues in the area under study;
• Ultrasound Dopplerography of blood vessels allows you to see the movement of blood through the vessel;
• oscillography records pulse fluctuations in the walls of blood vessels, a reduced indicator indicates a circulatory disorder;
• Phlebo- and arteriography make it possible to determine the location of the blockage.

Impaired arterial circulation in the legs is also established using functional tests:

The diagnostic criterion for venous circulation syndrome is swelling that occurs during the day and goes away at night, the disappearance of complaints when the affected leg is placed in an elevated position, nagging pain in a standing position and its relief in a sitting position.

Thrombosis is indicated by tension in the limb, pain when pressing on the venous trunks, and increased heart rate at normal local temperature. The Lowenberg test - palpation of the vein for tenderness - is used for early diagnosis of thrombosis. Objective symptoms of phlebitis are the occurrence of pain when pressing on the inner side of the sole, pressure on the lower leg and back of the thigh, calf and popliteal fossa.

Improving blood flow through lifestyle changes

The first thing that can significantly alleviate the condition of poor circulation is changing your lifestyle. And this must be done when the first signs of pathology appear.

Physical activity

How can physical exercise help improve blood circulation in the legs? An active lifestyle is especially important in case of venous insufficiency. By contracting, the calf muscles promote the movement of venous blood from the periphery to the center, eliminating blood stagnation in the lower extremities. Normalizing venous outflow helps improve arterial blood supply. The best form of physical activity is walking. The exercise therapy doctor will develop an individual gymnastic complex depending on the degree of damage and the physical capabilities of the patient. Swimming, cycling, and water aerobics are useful.

Quitting smoking and alcohol

Vascular health is important for blood circulation. Cigarettes contain about 4,000 chemical compounds. They affect the biochemistry of the body. As a result of negative processes, the walls of blood vessels are damaged and thinned. Tars increase blood viscosity and the risk of blood clots. Nicotine increases blood pressure, strength and heart rate, causing spasm of medium and small blood vessels.

Alcohol is no less dangerous for the circulatory system. It first dilates and then constricts blood vessels. As a result, the veins of the lower extremities expand. Having a diuretic effect, alcohol flushes essential minerals from the body. Giving up bad habits reduces the risk of developing vascular pathology several times.

A healthy diet significantly reduces the likelihood of circulatory disorders and improves blood flow if pathology already exists. Products containing silicon will help restore blood circulation. It is necessary for the synthesis of collagen and elastin and strengthening of vascular walls. To do this, the diet must include cereals, legumes, and corn.

Lean meat, zucchini, prunes, eggs, garlic are suppliers of equally important substances that reduce the risk of developing thrombosis and phlebitis. Vegetables and fruits are a source of vitamins and minerals that are necessary for normal blood circulation. Products with synthetic additives and those that increase cholesterol levels are excluded from consumption.

Obesity is the main enemy of the cardiovascular system. To improve blood circulation, you need to get rid of extra pounds. This can be done by reducing the calorie content of food to 1500 kcal per day.

Massage and acupuncture

With the help of lifestyle correction and non-drug treatment methods, the condition of the cardiovascular system can be significantly improved and blood flow in the lower extremities can be normalized. Massage and acupuncture will help you do this. Massage is permissible in the initial stages before the formation of trophic ulcers. The procedure helps eliminate venous stagnation, dilates arteries, which improves nutrition and oxygen delivery to tissues.

Lumbar massage relieves varicose pain in the lower extremities. Poor, slow blood circulation in the legs causes cramps, swelling, and heaviness. You can get rid of these symptoms and also prevent the appearance of varicose veins with foot massage. Acupuncture for venous circulation disorders is performed in the area of ​​the spleen and stomach. As a result, pain is reduced and venous nodes are reduced.

Drug therapy

In case of acute disturbance of the arterial circulation of the lower extremities, emergency assistance is provided - injections of painkillers and cardiac drugs. The leg is immobilized, covered with ice, and the patient is urgently transported to the surgical department. Drug treatment is carried out within the first 1.5–2 hours from the onset of the disease. It is designed to restore pain sensitivity and reduce ischemia. If there is no result, an operation is performed. In the future, thrombolytics and antispasmodics are used:

• anticoagulants of direct and indirect action (Heparin, Phenilin);
• fibrinolytics (Urokinase, Streptokinase);
• vasodilators (Papaverine, Carbacholine);
• antioxidants to improve local metabolism in the ischemic area.

Conservative treatment of chronic arterial insufficiency is aimed at preventing the deepening of the atherosclerotic process and the severity of the pathology. To improve blood circulation in the legs, vascular medications are prescribed. Therapy includes:

• vasodilators (Naftidrofuril) - dilate peripheral arteries, improve oxygen supply to tissues, reduce intermittent claudication syndrome;
• antiplatelet agents Aspirin and Clopidogrel - reduce the risk of blood clots;
• statins (Atoris) - lower cholesterol levels;
• antihypertensive drugs (ACE inhibitors - Enalaprin, Ramipril, Losartan) - alleviate the course of the disease, dilate blood vessels, improve blood supply to tissues;
• angioprotectors (Pentoxifylline) - improve microcirculation, reduce blood viscosity and the ability to aggregate platelets, and also increase the elasticity of red blood cells.

In acute deep vein thrombosis, heparins, fibrinolytics, and ointment compresses are used as emergency treatment. For thrombophlebitis, antibiotics are prescribed. Chronic venous insufficiency is treated conservatively only if there are contraindications to surgery and at the initial stage of the disease. Phlebotonics are used - Detralex, Phlebodia 600, Antistax.

Surgical methods

Impaired blood circulation in the legs is treated surgically if there is no result from conservative therapy.

Operations for insufficiency of arterial blood supply

If arterial circulation in the extremities is impaired, surgery is indicated for critical or acute ischemia of the lower extremities. Revascularization or restoration of blood flow is carried out in several ways - bypass surgery, balloon angioplasty, and stent installation. Bypass surgery involves creating a bypass for blood flow.

The intravascular technique involves installing a balloon on a narrowed section of the artery using a catheter.

If the method is insufficient, a stent is installed - a metal spring structure.

Stent installation

Operations for impaired venous outflow

If venous circulation is impaired, the optimal surgical technique is selected. Indications: insufficiency of venous valves of the saphenous veins and trophic disorders. Methods used:

• removal of affected veins;
• sclerosis of blood vessels;
• ligation of perforating veins in case of their insufficiency.

Folk remedies

Folk remedies for restoring venous circulation as an auxiliary therapy have a beneficial effect on blood vessels. The choice of herbs is based on their medicinal properties - venotonic, diuretic, anti-inflammatory. With their help, you can eliminate or reduce symptoms - relieve pain, swelling, heaviness, and prevent the formation of blood clots.

Treatment of circulatory disorders of the lower and upper extremities through herbal decoctions and infusions consists of taking them orally or using them as homemade ointments and rubs. Constant or course use of folk recipes strengthens blood vessels, reduces blood viscosity, and relieves spasms. An effective remedy is daily hot foot baths with pine needles and sea salt. They can be alternated with herbal baths made from infusions of oregano, nettle, blackcurrant leaves and chamomile.

A healing mixture of citrus fruits (lemon and orange) and honey is useful not only for vascular diseases. This is an excellent source of vitamins. Potato decoction cleanses blood vessels in case of obliterating atherosclerosis. Elderly people need to be careful when choosing herbs, since many of them are contraindicated for hypertensive patients and heart patients.

Prognosis and consequences of circulatory disorders

Impaired blood supply to the legs due to atherosclerosis, which occurs without obvious symptoms, increases the risk of myocardial infarction and stroke by an average of 40%. The likelihood of death from cardiovascular complications increases by 2–6 times. Diabetes mellitus significantly aggravates the course of the disease. In its absence and proper treatment, the progression of the pathology slows down and the condition stabilizes for a long time.

A complication of venous insufficiency is pulmonary embolism. If left untreated, trophic ulcers and gangrene threaten patients with any type of circulatory failure of the lower extremities.

Preventive measures

The best prevention of vascular disorders is a healthy lifestyle. For people at risk, doctors recommend constantly using ointments and gels to improve the condition of blood vessels and maintain them in working condition. Products for external use often contain a plant base - horse chestnut extract, red grape leaves, biolavonoids, salicylates. The most popular drugs are Troxevasin Neo, Lyoton, Troxerutin, Venoton. They enhance peripheral blood circulation and improve the condition of vascular walls.

Women at risk of developing varicose veins should give up high heels and the habit of sitting cross-legged. As a preventative measure, you can use compression stockings. Flat feet require constant attention to your feet. They will benefit from daily massage.