Пульсация сосудов шеи бывает артериальной или венозной, наблюдается при некоторых кардиальных пороках и разновидностях аритмии, артериальной гипертензии, тампонаде сердца, ТЭЛА, перикардите, ряде легочных патологий, поражении щитовидной железы. Причину возникновения симптома определяют на основании данных опроса, физикального обследования, лабораторных и аппаратных диагностических методов. Лечение включает немедикаментозные методики, бета-адреноблокаторы, гиполипидемические средства, гипотензивные препараты, антибиотики, хирургические вмешательства.
The symptom is caused by jerky contractions of the walls of the carotid arteries or veins of the neck. Arterial pulsation develops due to increased cardiac output and increased pulse pressure. It is stable in any position of the body, it is well felt when palpated. Sometimes combined with contractions of the temporal and brachial arteries, less often - small peripheral vessels. The patient's head sways in time with the pulse.
The pulsation of the veins is provoked by stagnation of blood with an increase in pressure in the ERW system. A distinctive feature is the lower force of contractions and the absence of a pulse wave sensation during palpation. The veins of the neck are visually dilated, increase on inspiration, with pressure on the area of the right hypochondrium. Complemented by pulsation in the epigastric zone.
The following options for pulsation of the vessels of the neck are distinguished:
Pulsation of the arteries can normally be noticeable in thin adults. In children, it is determined during strong crying. The pulse on the veins is visible during excitement, intense stress. Sometimes seen in the supine position with the upper half of the body elevated. In the latter case, unlike pathological conditions, it is visualized not on the entire or a significant part of the neck, but on a limited area - on the side about 4 cm above the sternum.
"Dance of the carotid" is a characteristic sign of aortic insufficiency. The cause of congenital malformation are diseases accompanied by connective tissue dysplasia. During life, the pathology develops against the background of rheumatism, SLE, atherosclerosis, endocarditis. The feeling of pulsation in the vessels of the neck disturbs already at the initial stage, complemented by a rapid heartbeat. With progression, cephalgia, dizziness, fainting, shortness of breath, extrasystoles, angina pectoris, and excessive sweating are observed.
The etiological factor of congenital aortic aneurysm, as in the previous case, is connective tissue dysplasia. The acquired variant is formed with aortitis, atherosclerosis, mechanical damage (trauma, surgery). Patients complain of retrosternal pain, tachycardia, shortness of breath, dizziness. Aneurysms of significant size compress large veins, which entails the addition of a venous pulsation. Possible dysphagia, frequent pneumonia against the background of stagnation in the lungs.
In patients with essential arterial hypertension, the pulsation of the vessels of the neck is combined with headaches, cardialgia, palpitations, shortness of breath during physical exertion. In secondary hypertension, symptoms characteristic of damage to various organs and anatomical structures are added. A sign can be detected with hypertension against the background of the following diseases:
Visible pulse waves on the arteries of the neck in thyrotoxicosis are associated with an increase in systolic pressure, an increase in cardiac output. The clinical picture includes excitability, nervousness, imbalance, insomnia. Characteristic features are exophthalmos, weight loss, general hyperthermia, increased sweating, constant thirst, polyuria. Dyspepsia, myopathy, osteoporosis are observed.
Pulsation of the vessels of the neck
Cardiac tamponade is caused by the accumulation of fluid in the pericardial cavity. More often it is formed acutely, provoked by injuries with the development of hemopericardium, surgical operations and manipulations, dissection of an aortic aneurysm. The patient is agitated, complains of heaviness in the chest, fear of death, increasing shortness of breath. Blue skin. Tachycardia, tachypnea, arterial hypertension, deafness of heart tones are determined. In a chronic course, all symptoms progress gradually.
Exudative pericarditis occurs against the background of infections, purulent processes, rheumatic diseases, uremia, and other conditions. Pulsation is combined with swelling of the veins of the neck on inspiration. There are aching pains in the chest, cough, shortness of breath. Constrictive pericarditis becomes the outcome of exudative, develops after injuries, operations. The pulsation of the vessels is supplemented by cyanosis, pastosity of the face and neck, fatigue, dyspepsia. Subsequently, ascites, severe asthenia occur.
Congenital tricuspid insufficiency, like other congenital heart defects, is more often provoked by connective tissue dysplasia. The most common cause of the acquired form is rheumatism. There are complaints of shortness of breath, cardialgia, hemoptysis, dyspepsia. The venous vessels of the neck are dilated and pulsate. With the aggravation of the condition, edema, liver enlargement, ascites, hydrothorax are observed.
The symptom is also found in the late stages of chronic cor pulmonale, accompanied by the development of right ventricular heart failure. Pathology is formed in chronic lung diseases (for example, emphysema and pneumosclerosis), chest deformities of various origins, tumors, atherosclerosis of the pulmonary artery. The main symptom is shortness of breath. Cyanosis of the skin, cardialgia, swelling and pulsation of the jugular veins, hepatomegaly, persistent peripheral edema are revealed.
Pulsation of vessels in the neck accompanies the following types of arrhythmia:
With pulmonary embolism, an acute cor pulmonale is formed. Tachycardia or bradycardia, collapse, cardialgia, arrhythmias, pulsation of the neck veins, dizziness, neurological disorders are detected. Shortness of breath, hemoptysis develop, pneumonia, the appearance of pleural effusion are possible. There are intestinal paresis, pain in the right hypochondrium, fever.
Superior vena cava syndrome is associated with a violation of blood flow in the system of this vessel and, as a result, a deterioration in the outflow of blood from the upper body. It is manifested by cyanosis, swelling and varicose veins on the neck, face, arms and upper torso. Cough, shortness of breath, dysphagia are observed. Signs increase when moving to a supine position, so patients sleep half-sitting.
Diagnostic measures are carried out by a cardiologist. When the respiratory system is involved, a pulmonologist is involved in the examination. Patients with thyrotoxicosis are referred for a consultation with an endocrinologist. When collecting an anamnesis, attention is paid to the presence of diseases of the heart and lungs, which can provoke secondary pathologies, accompanied by a pulsation of the cervical vessels.
As part of the survey, complaints of shortness of breath, increased fatigue, rhythm disturbances and other changes indicating the nature of the disease are established. During the examination, the type of vascular pulsation (arterial or venous) is determined, swelling of the neck, expansion of superficial veins, increased blood pressure, peripheral edema and other manifestations are detected. Perform percussion and auscultation of the heart and lungs. The additional examination program provides for the following procedures:
Ultrasound of the vessels of the neck
Treatment tactics are chosen taking into account the cause of vascular pulsation:
The following operations can be performed: