What is the appropriate management and treatment for a young to middle-aged adult diagnosed with neurocirculatory asthenia?

Neurocirculatory Asthenia: Management and Treatment

Neurocirculatory asthenia is a functional cardiovascular disorder requiring reassurance, psychiatric evaluation to exclude anxiety disorders, and non-pharmacological interventions focused on improving physical fitness and autonomic nervous system balance.

Understanding the Condition

Neurocirculatory asthenia (also called Da Costa's syndrome or effort syndrome) is a chronic functional disorder characterized by respiratory complaints, palpitations, chest discomfort, dizziness, and fatigue, with a normal physical examination 1. This condition most commonly presents as a familial disorder unrelated to specific triggers, though infections and psychological stresses may aggravate symptoms 1.

Critical Diagnostic Distinction

The most important clinical step is determining whether this is primary or secondary neurocirculatory asthenia, as this fundamentally changes prognosis and treatment approach:

• Secondary neurocirculatory asthenia (59% of cases): A psychiatric diagnosis (mainly anxiety disorder) precedes the cardiorespiratory symptoms, which are actually manifestations of the underlying mental disorder 2
• Primary neurocirculatory asthenia (41% of cases): Cardiorespiratory symptoms occur without preceding psychiatric illness 2

Patients with secondary neurocirculatory asthenia demonstrate significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior, and impaired quality of life compared to those with primary disease 2. At 1-year follow-up, primary neurocirculatory asthenia has a much better prognosis 2.

Treatment Algorithm

Step 1: Psychiatric Evaluation and Treatment (if indicated)

Conduct a structured psychiatric diagnostic interview to identify anxiety disorders, depression, or other mental illness 2. If psychiatric illness is identified:

• For anxiety-predominant presentations: Consider anxiolytic therapy such as Adaptol 1500 mg daily for 8 weeks, which showed 74% improvement rates in patients with neurocirculatory asthenia 3
• Address elevated state and trait anxiety, which correlates with physiological manifestations including hypertensive reactions 3

Step 2: Non-Pharmacological Interventions (Primary Treatment)

Reassurance is the cornerstone of management 1. Explain that:

• Physical examination is normal 1
• Patients typically have a normal life span 1
• Symptoms do not indicate serious cardiac pathology 1

Physical fitness improvement measures are essential 1:

• Interval hypoxic training combined with "dry" carbonic baths: This combination therapy demonstrated significant improvement in autonomic nervous system function, cardiovascular parameters, and psychological status 4
• This approach reduced severe meteopathic reactions from 14% to 3% and moderate reactions from 31% to 14% in meteosensitive patients 4
• Treatment improved microcirculatory function and reduced anxiety levels 4

Step 3: Adjunctive Therapies for Specific Presentations

For patients with enhanced meteosensitivity (62% of neurocirculatory asthenia patients):

• Non-pharmacological modalities including interval hypoxic training are pathogenetically justified for both treatment and prevention of weather-dependent symptom exacerbations 4
• These interventions address the underlying autonomic nervous system imbalance that makes patients vulnerable to biotropic weather factors 4

For patients with hypertensive syndrome:

• Low-frequency bioresonance intracranial electrostimulation may provide relief of headache, improved sleep and performance, and enhanced exercise tolerance 5
• This approach is particularly useful for minimizing medication requirements 5

Common Pitfalls to Avoid

• Do not dismiss symptoms as purely psychological without formal psychiatric evaluation 2. The distinction between primary and secondary disease requires structured assessment.
• Do not overlook the familial nature of primary neurocirculatory asthenia 1. Family history is relevant for prognosis and patient education.
• Avoid attributing all cases to recent infections or stressors 1. While these may aggravate symptoms, most cases represent an underlying familial tendency.
• Do not use terms like "effort syndrome" or "neurocirculatory asthenia" when only one-quarter of patients actually experience decreased energy and fatigue by specified criteria 2. Consider more precise diagnostic terminology based on the predominant symptom pattern.

Expected Outcomes

Patients with primary neurocirculatory asthenia who receive appropriate reassurance and physical fitness interventions generally have excellent long-term outcomes with normal life expectancy 1. Those with secondary disease require treatment of the underlying psychiatric condition for optimal results 2.