Neuro Praxis Düsseldorf

Circulatory disorders

The autonomic nervous system adjusts the heart and circulation to all demands of everyday life. Blood pressure optimization by adjusting the pulse as well as narrowing or widening of the blood vessels in the circulatory system. Circulatory disorders can cause a variety of complaints. In the case of complaints such as dizziness, black vision, nausea and sweating, a disturbance of the circulatory system, an impending collapse or impending fainting is quickly thought of.

Not infrequently, chronic circulatory weakness can also be accompanied by headaches, tiredness, difficulty concentrating or a feeling of heaviness in the shoulders and legs. If it is a neurological cause or a disturbance of the circulatory regulation, the complaints mentioned mostly occur when standing upright (i.e. in orthostasis) or are reported immediately after getting up from lying down or crouching.

How do I avoid dizziness and fainting? Where can I sit or lie down if necessary? How do I stay awake and focused? - People with circulatory disorders ask themselves these questions every day. That is why we take the time for you to explain exactly how you can strengthen your circulation and avoid dizziness. treatment example circulatory disorders

Complaints and symptoms

The most common symptom of circulatory dysfunction is dizziness. Typically dizziness occurs in an upright position. If the circulatory regulation fails, the blood supply to the brain is reduced. Usually there is a diffuse dizziness, drowsiness or emptiness of the head. There is a risk of fainting. This means a short-term loss of consciousness. Due to the sudden slackening of the muscles, if you faint, you typically fall. At the beginning of the examination after fainting, it must be clarified whether it was a cardiac arrhythmia or other heart disease rather than a circulatory disorder. Epilepsy must also be ruled out as a possible cause of loss of consciousness.

It's not always dizziness or fainting. Circulatory disorders can also be accompanied by difficulty concentrating, tiredness or a racing heart. A carefully conducted anamnesis, the knowledgeable inquiries about all typical complaints often lead to the diagnosis of a certain form of circulatory disorder.

With the help of blood pressure and pulse examinations while lying down and standing (Schellong test) or with the help of the tilt table examination, different forms of circulatory disorders can be distinguished.

With a detailed discussion about the complaints, previous illnesses, triggering situations, the possible causes of fainting or the temporary loss of consciousness can be focused on a few diagnoses that are in question.

The classic forms of circulatory dysfunction include:

  • orthostatic hypotension, i.e. low blood pressure when standing,
  • the vasovagal syncope, i.e. the reflexively occurring fainting
  • Postural tachycardia, i.e. massive acceleration of the heartbeat while standing.

Orthostatic hypotension

Orthostatic hypotension, i.e. the sharp drop in blood pressure while standing, is the most common form of circulatory disorders in people over 75 years of age. This type of circulatory disorder is caused by a drop in blood pressure after changing from lying down to standing. Immediately after getting up or a few minutes later, the eyes may become dizzy or black. In principle, a short-term faint can also occur.

A thorough search often reveals not just one but several causes for orthostatic hypotension, such as:

  • Lack of fluids and / or salt, e.g. in the context of acute infections, diarrhea.
  • Antihypertensive drugs or drugs with antihypertensive side effects.
  • Diseases that can impair cardiovascular functions: diabetes mellitus, chronic kidney failure, heart failure, aortic valve stenosis, cardiac arrhythmia, long-term high blood pressure, diseases of the adrenal glands
  • Neurological diseases that affect the autonomic (autonomic) nervous system: such as Parkinson's, polyneuropathy or certain dementias.

In the context of chronic neurological diseases such as Parkinson's, polyneuropathy or dementia, even very low blood pressure can go unnoticed for a long time while standing. On the one hand, this is due to the fact that typical symptoms of a circulatory disorder such as dizziness, nausea, cold sweating are rarely described. Orthostatic hypotension can more often become noticeable during the day after long periods of standing with a feeling of weakness, tiredness, difficulty concentrating, drowsiness, headache and neck pain.

In addition, the importance of orthostatic hypotension for cardiac health and mobility of those affected has long been underestimated. A long-term observational study over 23 years in more than 12,000 people with orthostatic hypotension showed that this circulatory regulation disorder is a general risk of falling. Heart complaints also seem to be more common in people with orthostatic hypotension.

Vasovagal syncope

A vasovagal syncope is a reflexively occurring faint. It is the most common form of circulatory collapse, a sudden fainting. Around a third of all people are fainted or threatened with fainting at least once in their life. The most common cause is the reflex-like circulatory collapse, i.e. syncope. This mostly occurs but not exclusively while standing. Classic signs of impending faint are dizziness and black vision, a feeling of heaviness in the legs, nausea and sweating. Occasionally, however, these omens of impending impotence fail to appear.

The spectrum of possible triggers for reflexively occurring fainting (used synonymously: reflex syncope, vasovagal syncope) is broad. These include: standing for a long time, going to the toilet, pain, seeing blood, drawing blood, emotions such as fear or excitement. Rare triggers are pressure on the neck or neck arteries from tight-fitting collars or rapid turning of the head. Although the triggers vary widely from person to person, the reflex that leads to fainting is always the same. This vasovagal reflex temporarily causes a prompt drop in blood pressure and often a slowing of the heartbeat.

At first glance, a reflex that leads to fainting may seem absolutely superfluous. However, the vasovagal reflex may have an evolutionary role and protect us from major blood loss after injury. Against this background, fainting in the context of vasovagal syncope would be the necessary evil of an originally life-saving reflex. Even if the fainting states seem unpredictable to you, you can prevent them. We have put together some practical tips for everyday life that have proven to be helpful for patients with their complaints.

To differentiate, for example, between fainting in the event of circulatory collapse and loss of consciousness in epilepsy, it can be very helpful if the event can be described by an observer. We find again and again that including all observations enables a first differentiation between different forms of powerlessness, i.e. for example circulatory collapse and epilepsy.

Postural tachycardia syndrome (POTS)

Postural tachycardia, i.e. the acceleration of the pulse while standing or during low physical exertion, is an often overlooked circulatory disorder - especially since postural tachycardia syndrome rarely leads to fainting. More common are unspecific complaints that change over the course of the day, such as headache, dizziness, weakness, but also anxiety or fear. Those affected often notice a fast pulse or a palpable palpitations while standing or with comparatively little physical exertion. The symptoms typically occur in an upright position. Those affected feel better when lying down.

The causes of the circulatory disorders mentioned cannot always be proven. Most of the time, however, these disorders are temporary and regress after weeks or months. Possible causes of a postural tachycardia syndrome are, for example, fluid loss and / or salt loss such as in kidney failure, thyroid disease, infections, childbirth, major operations, congenital connective tissue weakness and occasionally also anxiety disorders. This form of circulatory disorder is easily treatable and requires a careful history and examination in order to find the right, individually very different, long-term successful treatment in each case.

Typically, the diagnosis of postural tachycardia syndrome is made late. In order to reduce the uncertainty that the symptoms mentioned can cause, we are carefully informed about the postural tachycardia syndrome after a comprehensive diagnosis. For this it is important to find out which complaints to watch out for and which forms of stress lead to circulatory disorders. As part of the ANS Clinic, we provide you with suitable examination methods and support you in everyday life with an electronic diary as well as recommendations for the prevention of circulatory disorders and an individual treatment concept.

The standardized tests of circulatory regulation at the ANS Clinic also include the investigation of heart rate variability using various test conditions such as deepened breathing, Valsalva maneuvers and passive straightening using a tilting table.

In order to recognize a circulatory disorder but also to find triggers for fainting, it is important to train those affected and their relatives. This is the only way to recognize and avoid triggers in vasovagal syncope, i.e. reflexively occurring states of fainting, for example. The ANS Clinic offers information and technical support for this. Targeted countermeasures take effect very quickly. The cardiovascular training and tips for everyday life help to prevent. Medicines are rarely required for this.

The careful search for the cause and the understanding of all influencing factors make a decisive contribution to the success of the treatment. The ANS Clinic concept is based on close collaboration with colleagues from other medical disciplines such as cardiology, gastroenterology, diabetology, pulmonology and sleep medicine.