What is the initial approach to managing neurocirculatory asthenia?

Initial Management of Neurocirculatory Asthenia

The initial approach to managing neurocirculatory asthenia centers on reassurance, psychiatric evaluation to distinguish primary from secondary forms, and implementation of a structured exercise program to improve physical fitness, as this functional cardiovascular disorder has a benign prognosis with normal life expectancy. 1

Diagnostic Clarification and Psychiatric Assessment

The first critical step is determining whether the neurocirculatory asthenia is primary or secondary to an underlying psychiatric disorder, as this distinction fundamentally alters prognosis and treatment strategy. 2

• Conduct a structured psychiatric diagnostic interview to identify whether anxiety disorders, depression, or other mental illness preceded the onset of cardiorespiratory symptoms. 2
• In 59% of cases, a psychiatric diagnosis (predominantly anxiety disorders) antedates the neurocirculatory asthenia, defining it as secondary. 2
• Secondary neurocirculatory asthenia patients demonstrate significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior, and impaired quality of life compared to primary cases. 2
• Primary neurocirculatory asthenia (41% of cases) has a substantially better prognosis at 1-year follow-up and patients do not significantly differ from healthy controls in most psychological variables except depression. 2

Core Clinical Presentation to Confirm

Verify the characteristic symptom pattern before proceeding with management:

• Respiratory complaints are nearly universal, including breathlessness (with and without exertion) and smothering sensations. 1
• Palpitations, chest discomfort, dizziness, faintness, and fatigue are common accompanying symptoms. 1
• Physical examination must be normal to confirm the diagnosis. 1
• The condition often presents as a familial disorder unrelated to infections or physical stresses, though these factors may aggravate existing tendencies. 1

Initial Therapeutic Interventions

Reassurance and Education

• Provide explicit reassurance about the benign nature of the condition and normal life expectancy, as this is a cornerstone of management. 1
• Explain that symptoms, while distressing, do not indicate structural heart disease or life-threatening pathology. 1

Physical Fitness Program

• Implement measures to improve physical fitness through structured exercise, as this is the primary non-pharmacological intervention with demonstrated benefit. 1
• Consider interval hypoxic training combined with "dry" carbonic baths for patients with enhanced meteosensitivity, which has shown effectiveness in reducing subjective autonomic manifestations and improving cardiovascular and autonomic nervous system function. 3
• This combined non-medicamentous approach reduced severe meteopathic reactions from 14% to 3% and moderate reactions from 31% to 14% in meteosensitive patients. 3

Pharmacological Considerations for Secondary Cases

For patients with secondary neurocirculatory asthenia where anxiety is prominent:

• Adaptol (mebicar) at 1500 mg daily for 8 weeks demonstrated high efficacy with improvement in 74% of cases in patients with neurocirculatory asthenia and arterial hypertension syndrome, confirmed by clinical and psychological studies. 4
• The psycho-emotional sphere plays a leading role in the formation of hypertensive reactions, with increased state and trait anxiety correlating with physiological traits. 4

Addressing Stressful Life Events

• Evaluate for recent stressful life events in the year before symptom onset, as patients with neurocirculatory asthenia report significantly more stressful events than controls, particularly exits, undesirable events, uncontrolled events, and those with objective negative impact. 5
• Recognition of these stressors supports a multifactorial pathogenesis model and may guide supportive interventions. 5

Critical Pitfalls to Avoid

• Do not dismiss symptoms as purely psychological without proper psychiatric evaluation, as this misses the primary/secondary distinction that determines prognosis and treatment approach. 2
• Avoid extensive cardiac workup beyond what is necessary to exclude organic disease, as this reinforces illness behavior and anxiety. 1
• Do not overlook the familial nature of the condition, which may help with diagnosis and patient understanding. 1
• Failing to address enhanced meteosensitivity (present in 62% of cases) can reduce treatment effectiveness, particularly in regions with biotropic weather factors. 3
• The terms "neurocirculatory asthenia" and "effort syndrome" may be misleading since only about one-quarter of patients meet criteria for decreased energy and fatigue. 2