Cervical Heart Syndrome

Introduction In recent years, the incidence of cervical spondylosis has increased year by year. It is not uncommon for middle-aged people to suffer from this disease. Cervical spondylosis not only makes patients feel neck discomfort, activity is limited, but also because of bone hyperplasia in the neck can stimulate oppression of the sympathetic nerves, affecting the internal organs, involving the cardiovascular system, resulting in precordial pain, chest tightness, palpitations, electrocardiogram ischemia Myocardial changes, ventricular premature beats or premature atrial contractions can also cause symptoms such as elevated blood pressure. These manifestations are called "cervical angina pectoris", "cervical arrhythmia", and "cervical hypertension", collectively referred to as " Cervical heart syndrome." The incidence rate accounts for more than 40% of people with ECG and blood pressure and abnormal heart rhythm.

Cause

Cervical spondylosis can involve the cardiovascular system, such as pain in the anterior region, similar to coronary heart disease-like angina; can also stimulate or compress the spinal cord and spinal cord blood vessels due to osteophytes, causing sympathetic nerve cell dysfunction in the lateral horn, or due to vertebral-basal artery blood supply Insufficient, the cardiovascular regulation of central medullary ischemia, causing reflex coronary artery spasm, leading to myocardial ischemia, induced arrhythmia.

Cervical heart syndrome includes cervical angina pectoris, arrhythmia and hypertension, and belongs to the category of cervical vertebrae related lesions. It is a symptom similar to angina pectoris, arrhythmia and hypertension caused by cervical degeneration, which is easily misdiagnosed and mistreated. The disease is more common in the elderly, and the symptoms worsen with age. This is because with the increase of age, due to traumatic injury, strain and other cumulative damage, cervical vertebrae and paravertebral soft tissue damage or cervical vertebrae hyperplasia, cervical disc herniation or cervical instability and other degenerative changes lead to aseptic inflammation, oppression, Stimulate or pull the nerve root or sympathetic chain, causing intricate, confusing, seemingly different symptoms from cervical spondylosis. The sympathetic trunk of the neck is located in front of the transverse process of the cervical vertebrae. There are usually 3 to 4 ganglia, ie, the cervical, middle, middle and lower cervical ganglia. The posterior fibers form the heart, the heart and the subcardiac nerve. heart. When the cervical transverse process is degenerative, especially in the second or third cervical vertebrae compression or pulling the sympathetic ganglia in front of it, the cardiac nerves, especially the supraventricular nerves, are excitatory, causing coronary artery contraction, ie Can cause pain in the precordial area, chest tightness, palpitations, shortness of breath and other symptoms similar to coronary heart disease. Cervical angina is typical as sudden pain. The pain is mostly located in the middle or upper part of the sternum. It can also affect most of the precordial area and radiate to the left shoulder and left upper limb. Can be a sense of crush or suffocation, often accompanied by chest tightness, shortness of breath, dizziness, brain ups, insomnia, sweating, irritability, neck soreness and discomfort. The blood lipids may be high or normal, the heart load test is mostly abnormal, and the effect of taking nitroglycerin is not good. Cervical arrhythmia, generally no cardiovascular and other organic lesions, often induced by changes in body position, more recurrent and gradually increasing trend, taking anti-arrhythmia drugs is more difficult to work.

an examination

Related inspection

Cervical CT examination of cerebral blood flow Doppler echocardiography

Cervical hypertension, mostly atherosclerotic trend but no atherosclerotic and other organic lesions, blood pressure fluctuations, mostly caused by posture changes, the effect of taking antihypertensive drugs is not good. Clinically, for unexplained angina, arrhythmia and hypertension, don't forget to check the cervical vertebrae when you have not cured for a long time. Maybe the root of the disease is in the cervical spine. At this time, ECG, echocardiography, etc., may not find organic lesions, but the cerebral blood flow map shows increased vascular tone, blood flow into the brain is asymmetrical, can vary by 20% to 50%. If the X-ray film of the cervical spine, CT or MRI shows degenerative changes such as cervical hyperplasia, it can be initially diagnosed if it is induced after the desk is overdue or turned and the head is turned. Symptoms are relieved or disappeared after treatment with cervical spondylosis, and can be diagnosed.

Differential diagnosis

Middle and old people are also the age of coronary heart disease, so "cervical heart syndrome" is often misdiagnosed as coronary heart disease. However, angina pectoris in cervical heart syndrome is different from angina pectoris in coronary heart disease. It has nothing to do with increased labor load and emotional agitation. It is not relieved to take nitroglycerin and calcium antagonists. The increase of cervical load is often the predisposing factor of such angina, such as high lie position, prolonged over-head and bow. In the body posture, the head and neck turn to one side for a long time, and the back is cold, wet, sprained, and tired. Cervical spondylosis can be confirmed by cervical radiography. However, after the diagnosis of cervical spondylosis, the possibility of cardiovascular disease can not be immediately ruled out. Therefore, the patient should be further monitored by 24-hour ECG: after 2 hours of supine rest, compare with the electrocardiogram before bed rest; take the sitting position and complete 45 degrees or more in 1 minute. Turn the neck to the left and right 30 times, compare the ECG before and after the neck. For example, after the supine position, the ST segment and T wave showed ischemic changes, disappeared after walking; the ST segment and T wave ischemic changes appeared or aggravated after the neck, indicating that the ECG changes were related to the neck load, which can be diagnosed as Cervical heart syndrome." In contrast to coronary heart disease, ST-segment and T-wave ischemic changes are not associated with increased or decreased neck load, but only exacerbated during activity or exercise. Therefore, the lying position test and the neck test are simple, economical and effective methods for distinguishing "neck syndrome" from coronary heart disease.

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