In recent years, the incidence of cervical spondylosis has been increasing year by year. It is not uncommon for middle-aged people to suffer from this disease. Cervical spondylosis not only makes patients feel discomfort in the neck and restrict their activities, but also stimulates the sympathetic nerve and affects the internal organs due to the osteophytes in the neck, involving the cardiovascular system, resulting in anterior heart pain, chest tightness, palpitations, ischemic myocardial changes in the electrocardiogram, premature ventricular beats or premature atrial beats, and can also cause symptoms such as increased blood pressure, which are called “cervical angina These manifestations are called “cervical angina”, “cervical arrhythmia”, and “cervical hypertension”, which are collectively called “cervical heart syndrome”. The incidence of the syndrome accounts for more than 40% of the population with abnormal electrocardiogram, blood pressure and heart rhythm.
Pathology and clinical manifestations of cervical heart syndrome
Cervical spondylosis can involve the cardiovascular system, such as pain in the precordial region, similar to coronary angina; it can also cause sympathetic nerve cell dysfunction in the lateral horn due to stimulation or compression of the spinal cord and spinal blood vessels by the bony bulge, or cause ischemia in the cardiovascular regulation center in the medulla oblongata due to insufficient blood supply to the vertebrobasilar artery, resulting in reflex coronary artery spasm contraction, leading to myocardial ischemia and inducing arrhythmia. These are the cardiovascular damages caused by cervical spondylosis.
Cervical heart syndrome, which includes cervical angina, arrhythmia and hypertension, belongs to the category of cervical spine-related lesions. It is a symptom similar to angina pectoris, arrhythmia and hypertension caused by degenerative changes of the cervical spine, and is easily misdiagnosed and mistreated. The disease is more common in middle-aged and elderly people, and the symptoms worsen with age. This is because as we age, accumulative injuries such as trauma and strain injury cause damage to the cervical spine and paravertebral soft tissues or degenerative changes such as cervical spine osteophytes, cervical disc herniation or cervical spine instability, leading to sterile inflammation, which compresses, stimulates or pulls on the nerve roots or sympathetic nerve chain, causing intricate, confusing symptoms that seem different from those of cervical spondylosis. The sympathetic nerve trunk in the neck is located in front of the transverse processes of the cervical spine and generally has three to four ganglia, namely the superior, middle, middle and inferior cervical ganglia, whose postganglionic fibers form the superior, middle and inferior cardiac nerves distributed to the heart, respectively. When the cervical transverse process degenerates, especially the 2nd and 3rd cervical vertebrae compress or pull the sympathetic ganglion in front of them, which increases the excitability of the cardiac nerves, especially the supracardiac nerve, and causes the obstruction of coronary artery contraction, it can lead to the symptoms similar to coronary heart disease such as pain in the precordial region, chest tightness, palpitation and shortness of breath.
The typical onset of cervical angina is sudden pain, which is mostly located behind the middle or upper part of the sternum, and can also spread to most of the precordial region, radiating to the left shoulder and left upper limb. The pain may be a feeling of pressure or suffocation, often accompanied by chest tightness, tightness of breath, dizziness, insomnia, excessive sweating, agitation, neck pain and discomfort. The blood lipids may be high or normal, the cardiac stress test is not abnormal, and nitroglycerin is not effective. Cervical arrhythmias, generally without cardiovascular or other organic lesions, are often triggered by changes in body position, with recurrent episodes and a tendency of gradual aggravation, and it is difficult to take anti-arrhythmic drugs.
In cervical hypertension, there is a tendency of atherosclerosis but no organic lesion such as arteriosclerosis, and the blood pressure fluctuates greatly, mostly triggered by postural changes, and the effect of antihypertensive drugs is not good. In clinical practice, for unexplained angina pectoris, arrhythmia and hypertension, don’t forget to check the cervical spine when it is not cured for a long time, maybe the root of the disease is in the cervical spine. At this time, electrocardiogram, echocardiogram, etc., may not find organic lesions, but cerebral hemogram can see increased vascular tension, blood flow to the brain left and right asymmetry, can be a difference of 20% to 50%. If the cervical spine X-ray, CT or MRI (magnetic resonance imaging) shows degenerative changes such as cervical spine osteophytes, which are mostly induced after prolonged ambulation or head twisting or head shaking, the initial diagnosis can be confirmed. The diagnosis can be confirmed when the symptoms are relieved or disappear after treatment of cervical spondylosis.
Middle-aged and elderly people are also the age when coronary heart disease is more common, so “cervical heart syndrome” is often misdiagnosed as coronary heart disease. However, there is a difference between angina pectoris in cervical heart syndrome and angina pectoris in coronary heart disease. It has nothing to do with increased exertional load and emotional excitement, and cannot be relieved by taking nitroglycerin and calcium antagonists; however, increased load on the cervical spine is often a precipitating factor for this type of angina, such as high pillow position, prolonged maintenance of excessive head tilting and head lowering posture, prolonged head and neck turning to one side, cold, dampness, sprain and strain on the spine. It can be confirmed by cervical spine radiographs whether it is cervical spondylosis. However, after the diagnosis of cervical spondylosis is confirmed, the possibility of cardiovascular disease cannot be ruled out immediately, so the patient should be further monitored by 24-hour ECG: compare the ECG after 2 hours of lying down rest with the ECG before lying down; take a sitting position, complete 30 times each of 45 degrees or more of left and right neck turning within 1 minute, and compare the ECG before and after neck turning. If the ST segment and T wave are ischemic after lying down and disappear after walking, and if the ST segment and T wave are ischemic after turning the neck, it means that the ECG changes are related to the neck load and the diagnosis of “cervical heart syndrome” can be confirmed. Unlike coronary artery disease, the ischemic changes in ST segment and T wave are not related to the increase or decrease of neck load, but are only aggravated during activity or exercise. Therefore, the prone test and neck turn test are easy, economical and effective methods to distinguish “cervical heart syndrome” from coronary artery disease.
The root cause of “cervical heart syndrome” is cervical spondylosis, so the main treatment is cervical spondylosis. Such as correcting the high pillow position, using the appropriate height of the pillow (about 1 fist high); avoiding excessive head tilting, low head or long time head turned to one side; paying attention to the neck warmth, avoiding the neck, spine and back cold; local physical therapy, hot compress; appropriate neck gymnastics to move the neck, can alleviate or reduce the various symptoms of “cervical heart syndrome”.
Treatment of cervicocardiac syndrome
I. Stellate ganglion block with manipulation
Patients with stellate ganglion block are placed in a supine position with a thin pillow under the pillow, and the neck is slightly flexed and the jaw is closed, so that the anterior cervical muscles are relaxed. Needle entry method: routine skin disinfection, left hand middle finger tip immediately above the sternoclavicular joint about two horizontal fingers (cricoid cartilage plane equivalent to the 6th cervical transverse process) along the tracheal wall gently gouge, the sternocleidomastoid muscle and its deep surface of the common carotid artery sheath to the lateral, fingertip downward pressure, may be to the 6th cervical transverse process of the node, finger fixed. The right hand holds a No. 7 needle perpendicular to the skin along the edge of the middle fingernail of the left hand and rapidly enters the needle, encountering the bone that is the 6th cervical transverse process. Slightly into the needle 2mm, so that the tip of the needle away from the long cervical muscle, back to draw no blood, no cerebrospinal fluid, no gas after the slow injection of 1% lidocaine 10ml, remove the needle after compression for 4-6 minutes, observe 1 hour no adverse reactions, before leaving the hospital. All patients were treated with alternating left and right stellate ganglion block method. 3 days once, 7 times as a course of treatment.
Manual treatment
1.Pressing and rubbing method: The patient is in prone position. The whole body is relaxed, and the doctor pushes the back of the shoulder and the shoulder to the upper limb with both palms, and slowly kneads the scapular area and the inner edge of the shoulder for 10 minutes. Then the patient is placed in a lateral position and the doctor slowly and deeply presses the sternocleidomastoid muscle, trapezius muscle and scapularis muscle with the thumb from top to bottom for 4-5 times, and adds the plucking and pressing tendon technique at the posterior edge of the trapezius muscle, scapularis muscle and the collar ligament for 8 minutes.
2.Fix the wrong suture method: The patient sits upright. The doctor’s thumb of one hand to find and hold the affected vertebra, the doctor’s chest against the patient’s head, the other hand forearm placed under the patient’s jaw, cervical spine positioning rotation trigger method, often can be heard to reset the sound of the bullet. Finally, the thoracic spine confrontation reset method to rectify the small joints of the thoracic spine. Once a day, 7 times for a course of treatment.
II. Small needle knife treatment
Long’s traction technique
Four, warming technology
V. Psychological adjustment
VI. Rehabilitation training (shoulder and back muscles mainly)
Care and management
I. Health education.
Blood pressure is measured once or twice a day and recorded.
ECG check once a week.
IV. Daily supervision and supervision of training must be adhered to the principle of exercising from less to more, gradually and with discomfort.
V. Psychological guidance.
Six, the discontinuation of antihypertensive drugs need to slowly reduce the dose, not suddenly reduce the dose (with the exception of those whose blood pressure quickly returns to normal after treatment).
Seven, guide the patient’s emotional stability to reduce fluctuations, in order to cooperate with treatment.