Spasm of blood vessels (vasomotor spasm)

Description:

Vasomotor spasm (angiospasmus; Greek angeion a vessel + spasmos a spasm, a spasm) — passing pathological narrowing of a gleam of arteries owing to excess intensive and long reduction of muscles of a vascular wall. And. — one of options of acute vascular dystonia (vascular crisis). Investigation And. fabric ischemia in the pool of a spazmirovanny artery is.

    The term "vasomotor spasm" should not be applied to designation of physiological vasoconstriction and the more so — physiological increase in a tone of arteries without narrowing of a gleam. Has no scientific justification and the tendency which extended in the middle of 20 century to connect with And. manifestations of local disorders of circulation if their nature is not established. In practice it leads to hyper diagnosis and not always justified appointment sick antispasmodics.

Symptoms of the Spasm of blood vessels (vasomotor spasm):

Clinical picture A. depends on its localization and consists mainly in manifestations of the broken function of ischemic fabric (for example, in muscular bodies — pain in an ischemia zone with irradiation on the corresponding segment of a somatic innervation).

    Current And. it is most studied at its localization in vessels of extremities. Short-term And. a manual artery at a disease and Reynaud's syndrome (see Reynaud a syndrome) sharp blanching and a cold snap of a finger with disturbance of painful and tactile sensitivity — from local paresthesias to anesthesia causes. Such set of symptoms is characterized as "a dead finger" (digitus mortuus). Similar signs develop on all extremity at the spasm of the main arteries which is usually accompanying their organic lesion. The symptom alabaster (as at a statue) pallor of a leg in such cases is designated as "the commodore's leg". In case of prolonged And. extremities there is distal cyanosis, sometimes uniform, sometimes in the form of the cyanochroic grid making an impression of marble skin. Emergence of cyanosis is caused by paresis of venules in an ischemia zone. At digitus mor tuus cyanosis usually is absent, but he often is at ischemia of big sites of extremities. After cyanosis some puffiness of fabric caused by increase in permeability for proteins of capillaries develops (owing to a hypoxia of membranes).
At the following stage necrobiotic processes and rather develop, than the gap between the need of fabric for oxygen and blood inflow size is more.

    Coronary And. it is shown by Printsmetal's stenocardia — the heavy attacks of pains behind a breast arising at rest it is frequent in position of the patient lying, in the period of a night dream. During an attack characteristic changes of an ECG (see Stenocardia), sometimes symptoms of acute focal dystrophy of a myocardium come to light.

    Cerebral And. it is observed often at atherosclerosis of vessels of a brain and is the cornerstone of a pathogeny of ischemic option of cerebral crisis at patients with an idiopathic hypertensia. Distinctive symptoms of this option from other acute cerebral angiodystonias are the focal neurologic disturbances characteristic of a zone of the ischemia of a brain corresponding to the pool of a spazmirovanny artery (see. Hypertensive crises). At patients with brain atherosclerosis such disturbances can be caused not And., and mechanisms of so-called cerebrovascular insufficiency — decrease in a blood-groove in a zone of an arrangement of an atherosclerotic plaque when falling the ABP (for example, orthostatic), cardiac disturbances. Presence of the last, registration of the reduced ABP, including at orthostatic tests, helps the differential diagnosis.

    The vasomotor spasm in abdominal organs has no specific clinical manifestations. The vasospasm of a mesentery is shown by a belly toad.

Reasons of the Spasm of blood vessels (vasomotor spasm):

Vasomotor spasms can be observed in various vascular regions, usually at the diseases which are followed by defeat of vessels and their nervous device (atherosclerosis, vasculites, aneurisms, etc.) or disturbance of neurohumoral regulation of a vascular tone (an idiopathic hypertensia, a hypothalamic syndrome, a pathological climax, neurosises, etc.). The etiological role of smoking, intoxications by lead, carbon sulfur, and in development is noted And. in extremities — frostbites and repeated coolings. And. quite often defines clinical dynamics of organic vascular diseases (atherosclerosis, thromboses, embolisms, etc.), complicating their current. Long And. in a brain (cerebral And.), in heart (coronary And.), in a retina of an eye can become the reason of serious circulatory disturbances in these bodies up to development of a stroke, a myocardial infarction, vision disorders.

    The pathogeny of a vasomotor spasm is studied insufficiently, for arteries of different vascular regions it is not identical, but the general for the mechanism of development of any And. the disorder of function of membranes of smooth muscle cells of a vessel consisting in disturbance of exchange transport through membranes of calcium ions, sodium, potassium that breaks normal alternation of phases of muscular contraction and relaxation is. The accelerated and strengthened depolarization of membranes, the increased inflow to cells of free calcium ions promote development intensive muscular reductions, and the delay of processes of repolarization of membranes (normal the muscle preceding relaxation) causes long stay of an arterial wall in the reduced state. To such disturbances can give frustration of an innervation of vascular walls, an imbalance in products and destruction of humoral regulators of a vascular tone, and also hypersensitivity of receptors of a vascular wall to normal vasopressor influences that is quite often caused by local changes of her metabolism in zones of an inflammation, hems, damage by blood clot, etc. It is known, for example, that cerebral And. it is often observed near an arrangement of an atherosclerotic plaque, aneurism, subarakhnoidalny hemorrhage; coronary And. often arises in a zone of thrombosis of a coronary artery.

    Opportunity neurogenic And., which is observed in arteries of extremities and can probably develop in arteries of an abdominal cavity, it is not confirmed for brain arteries so far. A hyper sympathicotonia role in an origin coronary And. also remains hypothetical. Coronary And. does not arise during an exercise stress (i.e. at activation of a sympathetic nervous system), does not act, as a rule, a-adrenoblockers, and in an experiment is caused by noradrenaline only under certain conditions (for example, at simultaneous use of b-adrenoblockers) there are more bases to assume a pathogenetic role of activation of vagal influences since coronary And. at the person usually arises in the conditions of rest and the possibility of its provocation is shown by metasincaline. Dysfunction of an endothelium of coronary arteries, regulating local balance humoral vazodilatiruyushchy (prostacyclin) and vasopressor (serotonin, Pg2a, A2 thromboxane) substances can be of great importance. A2 thromboxane belongs to the strongest vasoconstrictors, and local increase in its products (as well as insufficient synthesis of prostacyclin) can be the cause of a coronary spasm.

Treatment of the Spasm of blood vessels (vasomotor spasm):

Treatment and prevention match partially treatment and prevention of basic diseases to which A. Isklyuchayetsya tobacco smoking accompany. Sanitation of the centers of persistent infection is carried out. At And. against the background of the raised ABP use of antihypertensives is necessary.

    Direct stopping And. has the features at its separate forms, for example at hypertensive crises, Reynaud's syndrome, stenocardia. In many cases vasoactive antagonists of calcium — Phenihydinum (nifedipine, Adalatum, Corinfarum) are effective. Drugs select individually taking into account regional distinctions in reaction of vessels. Nitrites, for example, are most effective at coronary And., but they, as a rule, negatively influence a blood stream in brain arteries. At cerebral And. at intravenous administration Nospanum, a papaverine, an Euphyllinum can be effective винкимин.

    At peripheral And. quite often grinding and warming of a sore extremity, novocainic blockade help with a zone of roots of the corresponding segments; intra arterial introduction of 10 ml of 0,25% of solution of novocaine or 3 ml of 2% of solution of Nospanum.

    Surgical methods of treatment — a sympathectomy (see. Functional neurosurgery) and alcoholization of sympathetic nerves are shown generally at And. against the background of organic angiopatiya.