Abstract

Neurocirculatory dystonia (NCD) is a functional autonomic nervous system disorder characterized by cardiovascular symptoms without structural heart disease. It is commonly seen in adolescents and young adults and may be triggered or exacerbated by stress, anxiety, or physical fatigue. Symptoms include palpitations, chest discomfort, dizziness, and fatigue. Though benign in terms of organic pathology, it can significantly affect quality of life. This report explores the epidemiology, clinical features, diagnostic approach, management strategies, and psychological implications of NCD.

Introduction

Neurocirculatory dystonia (NCD), also known as functional cardiovascular disorder, cardioneurosis, or vasoneurosis, is a condition characterized by a range of cardiovascular symptoms without detectable structural heart disease. It is considered a type of somatoform autonomic dysfunction, wherein the autonomic nervous system—particularly the sympathetic branch—is dysregulated, leading to symptoms that mimic organic heart problems.

Typically seen in adolescents and young adults, especially females, NCD presents with symptoms such as palpitations, chest discomfort, shortness of breath, dizziness, fatigue, and episodes of fainting. These symptoms are often exacerbated by stress, physical overexertion, or emotional disturbances, and may significantly impact a person's quality of life, despite the absence of life-threatening pathology.

The historical roots of NCD trace back to early descriptions of "soldier’s heart" or "Da Costa’s syndrome" during World War I, where soldiers exhibited symptoms of heart disease in the absence of cardiac abnormalities. Today, it is better understood as a psychosomatic or functional condition involving both cardiovascular and neuropsychological components.

Methods

The diagnosis and evaluation of Neurocirculatory Dystonia (NCD) involve a multi-dimensional approach, combining clinical observation, cardiovascular testing, psychological assessment, and the exclusion of organic heart disease. Because NCD mimics cardiac conditions, it is crucial to distinguish it from structural cardiovascular disorders.

1. Clinical Assessment

Detailed Medical History:

•Focus on symptoms such as palpitations, chest pain,

fatigue, dizziness, shortness of breath, and anxiety.

•Identify emotional or physical stressors, lifestyle factors, or psychiatric history.

Physical Examination:

Typically, normal findings, though patients may show signs of sympathetic overactivity (e.g., rapid pulse, cold extremities).

2. Cardiovascular Testing

Electrocardiogram (ECG):

•Usually normal, though may show sinus tachycardia or nonspecific changes.

•Helps rule out arrhythmias or myocardial ischemia.

24-Hour Holter Monitoring:

Detects transient tachycardia or rhythm disturbances.

Useful to correlate symptoms with heart rate.

Echocardiography:

•Used to rule out structural heart disease.

•Typically normal in NCD patients.

Tilt-Table Test:

•Assesses autonomic function and helps diagnose neurocardiogenic (vasovagal) syncope.

•May reveal excessive heart rate increase upon standing (orthostatic intolerance or POTS).

Exercise Stress Test:

•Evaluates cardiovascular response to exertion.

•Often shows exaggerated heart rate response but normal oxygen consumption and no ischemia.

3. Autonomic Function Testing

Heart Rate Variability (HRV):

•Measures autonomic balance.

•NCD patients often show increased sympathetic tone and •reduced parasympathetic activity.

Valsalva Maneuver / Deep Breathing Test:

•Evaluates baroreflex and vagal response.

Results

Based on clinical observations and literature review, the following key findings summarize the results typically associated with Neurocirculatory Dystonia (NCD):

1. Demographics and Prevalence

Age Group: Most commonly affects adolescents and young adults (15–35 years).

Gender Distribution: Higher incidence in females, with a female-to-male ratio of approximately 2:1.

Prevalence: Estimated 10–30% in young populations, especially during periods of emotional or physical stress.

2. Clinical Manifestations

Common Symptoms:

•Palpitations or rapid heartbeat (reported in over 70% of cases)

•Fatigue and exercise intolerance

•Chest discomfort or tightness

•Shortness of breath unrelated to physical exertion

•Dizziness or lightheadedness, especially when standing

•Cold extremities and excessive sweating (hyperhidrosis)

•Emotional instability, anxiety, and sleep disturbances

Symptom Triggers:

•Emotional stress

•Physical overexertion

•Menstrual cycle changes (in women)

•Environmental changes (heat, noise)

3. Cardiovascular and Autonomic Test Findings

ECG: Usually normal; some may show sinus tachycardia or minor arrhythmias.

Holter Monitoring: Intermittent tachycardia, with no serious arrhythmias.

Tilt-Table Test:

•Orthostatic intolerance or exaggerated heart rate response (seen in up to 50% of NCD patients).

•Heart Rate Variability (HRV):

•Shows reduced parasympathetic tone and increased sympathetic activity.

4. Echocardiographic and Imaging Results

Echocardiography: Normal cardiac structure and function.

Stress Tests: No evidence of ischemia or structural heart disease, but exaggerated cardiovascular response to stress may be observed.

Discussion 

Neurocirculatory dystonia (NCD) is a classic example of a functional somatoform disorder, where the autonomic nervous system exhibits abnormal regulation without any underlying structural pathology. While the symptoms often mimic those of organic cardiovascular diseases, clinical investigations typically yield normal results, underscoring the non-organic nature of this condition.

Pathophysiologically, NCD is believed to be caused by a dysregulation of the balance between the sympathetic and parasympathetic branches of the autonomic nervous system. Most patients show signs of sympathetic overactivity, such as increased resting heart rate, sweating, palpitations, and emotional reactivity. Chronic stress, emotional trauma, or anxiety disorders are common contributing factors, often acting as both triggers and perpetuating mechanisms.

Despite being benign in terms of mortality and physical damage, the impact of NCD on quality of life can be profound. Patients frequently report severe fatigue, exercise intolerance, and social or occupational dysfunction. The constant fear of having a heart disease often leads to repeated medical consultations and investigations, increasing healthcare costs and patient anxiety.

One of the greatest challenges in managing NCD is differentiation from true cardiac pathology. Because symptoms like chest pain and palpitations overlap with conditions like arrhythmias, ischemic heart disease, or heart failure, clinicians must carefully exclude organic causes through appropriate testing. This diagnostic uncertainty can cause significant psychological distress for patients.

Conclusion

Neurocirculatory dystonia (NCD) represents a complex interplay between the autonomic nervous system and psychological well-being. Although it lacks structural cardiac pathology, its symptoms closely resemble serious heart conditions, making it a diagnostic and therapeutic challenge for healthcare providers. It is most commonly observed in adolescents and young adults, particularly females, and is often triggered or worsened by emotional stress, physical fatigue, or psychological disorders such as anxiety and depression.

The key to effective management lies in early recognition, thorough exclusion of organic disease, and the application of a biopsychosocial approach. Patients benefit greatly from clear communication, reassurance, and lifestyle modifications including exercise, stress management, and sleep hygiene. In more persistent or severe cases, psychological counseling (especially cognitive behavioral therapy) and pharmacological treatment (e.g., beta-blockers or anxiolytics) can be effective in relieving symptoms and restoring normal daily function.

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