Myofascial syndrome

Myofascial syndrome

Myofascial syndrome is local pain and tension in certain areas of the skeletal muscles. The predominant age is over 20 years old. The predominant gender is female. Risk factors

    • Excessive exercise
    • Prolonged static stress, monotonous postures
    • Injuries
    • May be associated with diseases of the joints or osteochondrosis of the spine.

Clinical picture

    • Pain on palpation of trigger zones located in the thickness of the muscles, in the places of the muscular-tendon-vein junction, in the region of the sternocostal joints, the xiphoid process
    • Headache due to tension in the neck and trapezius muscles
    • Back pain mediated by irritation of trigger points within the spinal muscles
    • Upper limb pain radiating from subscapularis trigger points
    • Pain syndrome similar to sciatica, caused by irritation of trigger zones in the gluteal muscles
    • Palpation detection of myofascial trigger zones, the occurrence of pain during palpation.


    • Local injections of anesthetics
    • Irrigation of painful areas with chloroethyl, then – muscle stretching exercises
    • Massage
    • Ultrasound on affected areas
    • Therapeutic gymnastics, the exclusion of prolonged static tense postures.

Forecast. The risk of developing fibromyalgia among patients with myofascial syndrome is higher in those who have signs of depression, anxiety, sleep disorders.

Synonym. musculo-fascial syndrome

See also Fibromyalgia, Chronic Fatigue Syndrome

ICD. M79.1 Myalgia


Morgagni-Adams-Stokes syndrome is a syncope caused by a sharp decrease in cardiac output and cerebral ischemia due to acute cardiac arrhythmias (complete AV block, paroxysmal tachycardia, ventricular fibrillation, sinoatrial node weakness syndrome, etc.). Etiology

    • Drug intoxication: calcium channel blockers, B-adrenergic blockers, digoxin, amiodarone, lidocaine, novocainamide
    • Other factors
    • Myocardial ischemia involving the center of automatism of the atrioventricular node
    • Infiltrative, inflammatory, or fibrosing diseases affecting the heart and its conduction system
    • Aging (degeneration of the atrium-ventricular node)
    • Neuromuscular diseases (dystrophic myotonia, Kearns-Sayre syndrome)

Risk factors

    • Diseases of the coronary vessels
    • Dysfunction of the atrioventricular node in history
    • MI (especially as a result of right coronary artery occlusion)
    • Amyloidosis
    • Hemoside-ros
    • Hemochromatosis
    • Chagas disease
    • Loew’s disease
    • Diffuse connective tissue diseases with heart damage (SLE, rheumatoid arthritis, etc.).

Clinical picture

    • Sudden dizziness or loss of consciousness
    • Pallor
    • Arterial hypotension
    • To-nico-clonic convulsions (with ventricular asystole lasting more than 15 s)
    • Severe bradycardia or tachycardia.

ECG – heart rhythm disturbances

    • AV blockade of varying degrees
    • Sinoauricular blockade
    • Xiica bundle branch blocks
    • Ventricular tachycardia
    • Supraventricular tachycardia
    • Wolff-Parkinson-White Syndrome
    • Sinoatrial arrest
    • Weak sinoatrial node syndrome
    • Transition from sinus rhythm to atrial fibrillation and vice versa.

Laboratory studies – the level of digoxin and cardio

cyphic enzymes in blood serum.

Special Studies

    • EKG
    • Cardiomonitoring
    • 24-hour ECG monitoring (according to Holter)
    • Echocardiography
    • Electrophysiological study of atrioventricular conduction in the Hpsa bundle (hysography)
    • Coronary angiography according to indications
    • Myocardial biopsy for suspected inflammatory, infiltrative, or degenerative disease. Differential Diagnosis
    • Stroke
    • Transient cerebrovascular accident
    • epileptic seizure
    • THE BODY
    • Pulmonary hypertension
    • Aortic stenosis
    • orthostatic collapse
    • Vasovagal syncope
    • Meniere’s disease
    • Globular thrombus in the heart
    • Hypoglycemia
    • Hysteria.



    • Hospitalization for observation and examination
    • Further treatment – outpatient
    • Physical activity is normal if the condition is stable. Tactics of conducting
    • ECG monitoring
    • Stimulants of a- and B-Adrenergic receptors in case of heart block (izadrin, orciprenaline sulfate, ephedrine, adrenaline)
    • Glucocorticoids
    • Atropine
    • Treatment of paroxysmal tachyarrhythmias
    • Electropulse therapy – especially indicated for severe arterial hypotension
    • Novocaine mid lidocaine, disopyramide, amiodarone, verapamil
    • Transesophageal or transthoracic pacing in emergency cases
    • Temporary endocardial pacing
    • Implantation of an artificial pacemaker, if the root cause of the syndrome is not eliminated.

Surgical treatment – implantation of an artificial pacemaker according to indications. Drug therapy

    • With bradyarrhythmias
    • Atropine 1 mg IV for high degree of AV block with arterial hypotension
    • Isadrin 2.5 mg under the tongue 3-6 r / day
    • Isadrin 1 mg in 250 ml 0.9% intravenous NaCl starting at 5 mcg/min if severe bradycardia persists with atropine
    • Orciprenaline sulfate 20 mg orally 6-10 r / day
    • Adrenaline 1 mg IV for complete heart block with asystole, may be repeated after 5 min. If necessary, the product is administered intracardiac. With the introduction of adrenaline against the background of bradycardia with normal blood pressure, the development of a hypertensive crisis is likely.
    • Precautions – when using adrenomimetics, tachycardia and ectopic foci of automatism in the myocardium are likely to occur.

case management

    • Patient’s condition
    • Routine observation if a pacemaker is implanted
    • 2-week follow-up after treatment with ECG and Holter monitoring
    • Ban on driving and physical labor until normal functions are restored
    • Prevention
    • withdrawal of foods that can cause complete heart block. Complications
    • Damage to the cerebral cortex, vital centers and death
    • Possible consequences of fainting

driving a car, working at height and operators of moving machines and mechanisms.

The forecast is always serious

    • Possible fatal outcome in the next attack
    • The most unfavorable prognosis was noted in patients with an autosomal dominant hereditary conduction disorder.
    • The average life expectancy of untreated patients with third-degree AV block is 2.5 years. With proper diagnosis and treatment (implantation of a pacemaker according to indications), the prognosis is favorable.


  • Adams-Stdks Syndrome
  • Adams-Moragni-Stokes syndrome
  • Spence syndrome
  • Stokes Syndrome See also Stroke. Sinus bradycardia. Atrioventricular blockade III degree. Myocardial infarction, KSD amyloidosis. 145.9 Conduction disorder, unspecified

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