Hyperventilation can cause: Hyperventilation | Michigan Medicine

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Hyperventilation | Michigan Medicine

Topic Overview

Hyperventilation is breathing that is deeper and more rapid than normal. It causes a decrease in the amount of a gas in the blood (called carbon dioxide, or CO2). This decrease may make you feel lightheaded, have a rapid heartbeat, and be short of breath. It also can lead to numbness or tingling in your hands or feet, anxiety, fainting, and sore chest muscles.

Some causes of sudden hyperventilation include anxiety, fever, some medicines, intense exercise, and emotional stress. Hyperventilation also can occur because of problems caused by asthma or emphysema or after a head injury. But it occurs most often in people who are nervous or tense, breathe shallowly, and have other medical conditions, such as lung diseases or panic disorder. Women experience hyperventilation more often than men. Most people who have problems with hyperventilation are 15 to 55 years old. Hyperventilation may occur when people travel to elevations over 6000 ft (2000 m). Symptoms can be similar to symptoms that are caused by another, more serious medical problem, such as a lung problem.

Acute (sudden) hyperventilation is usually triggered by acute stress, anxiety, or emotional upset. Chronic (recurring) hyperventilation may be an ongoing problem for people with other diseases, such as asthma, emphysema, or lung cancer.

Many women have problems with hyperventilation during pregnancy, but it usually goes away on its own after delivery.

In many cases, hyperventilation can be controlled by learning proper breathing techniques.

Symptoms of hyperventilation

Symptoms of hyperventilation usually last 20 to 30 minutes and may include:

Feeling anxious, nervous, or tense.
Frequent sighing or yawning.
Feeling that you can’t get enough air (air hunger) or need to sit up to breathe.
A pounding and racing heartbeat.
Problems with balance, lightheadedness, or vertigo.
Numbness or tingling in the hands, feet, or around the mouth.
Chest tightness, fullness, pressure, tenderness, or pain.

Other symptoms may occur less frequently, and you may not realize they are directly related to hyperventilation. These symptoms can include:

Headache.
Gas, bloating, or burping.
Twitching.
Sweating.
Vision changes, such as blurred vision or tunnel vision.
Problems with concentration or memory.
Loss of consciousness (fainting).

Hyperventilation is not a disease, but you may need to be checked by your doctor if you have repeated episodes of hyperventilation symptoms. If you have recurring symptoms, you might be diagnosed with a condition called hyperventilation syndrome (HVS).

Treatment for hyperventilation depends on the cause. Home treatment is usually all that is needed for mild hyperventilation symptoms. Medical treatment may be needed for hyperventilation symptoms that are moderate to severe, that last for long periods of time, that come back, or that interfere with your daily activities. Medical treatment usually includes reassurance, stress reduction measures, breathing lessons, or medicine.

Check Your Symptoms

Do you have problems with hyperventilation?

Hyperventilation is breathing that is faster than normal.

How old are you?

Less than 12 years

12 years or older

Are you male or female?

Why do we ask this question?

If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you noticed irregular heartbeats or heart rate changes even when you are not hyperventilating?

Yes

Arrhythmia or heart rate changes when not hyperventilating

Do you think there could be a breathing problem other than hyperventilation?

Yes

Respiratory problem other than hyperventilation

Do you think you have a breathing problem other than hyperventilation?

Yes

Respiratory problem other than hyperventilation

Did you pass out completely (lose consciousness)?

If you are answering for someone else: Is the person unconscious now?

(If you are answering this question for yourself, say no.)

Are you back to your normal level of alertness?

After passing out, it’s normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.

Yes

Has returned to normal after loss of consciousness

Did the loss of consciousness occur during the past 24 hours?

Yes

Loss of consciousness in past 24 hours

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

Would you describe the problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Can you control your breathing?

Some people can control their hyperventilation by breathing into a paper bag or using different breathing techniques.

Yes

Able to control hyperventilation

Not able to control hyperventilation

Do you feel lightheaded or dizzy, like you are going to faint?

It’s normal for some people to feel a little lightheaded when they first stand up. But anything more than that may be serious.

Are you still hyperventilating after 30 minutes of home treatment?

Yes

Has tried more than 30 minutes of home treatment without improvement

Do you hyperventilate often?

Does the problem interfere with your daily activities?

Yes

Hyperventilation interferes with daily activities

Are you having more frequent or severe problems with hyperventilation?

Yes

Symptoms are becoming more frequent or severe

Have you had problems with hyperventilation for more than a week?

Yes

Hyperventilation problems for more than a week

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Severe trouble breathing means:

You cannot talk at all.
You have to work very hard to breathe.
You feel like you can’t get enough air.
You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It’s hard to talk in full sentences.
It’s hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.
It’s becoming hard to breathe with activity.

Symptoms of a heart attack may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Respiratory Problems, Age 12 and Older

Respiratory Problems, Age 11 and Younger

Change in Heartbeat

Home Treatment

Home treatment may help you control your breathing and stop hyperventilation. First, sit down and concentrate on your breathing.

Breathing techniques

Breathe through pursed lips, as if you are whistling, or pinch one nostril and breathe through your nose. It is harder to hyperventilate when you breathe through your nose or pursed lips, because you can’t move as much air.
Slow your breathing to 1 breath every 5 seconds, or slow enough that symptoms gradually go away.
Try belly-breathing, which fills your lungs fully, slows your breathing rate, and helps you relax.
- Place one hand on your belly just below the ribs. Place the other hand on your chest. You can do this while standing, but it may be more comfortable while you are lying on the floor with your knees bent.
- Take a deep breath through your nose. As you inhale, let your belly push your hand out. Keep your chest still.
- As you exhale through pursed lips, feel your hand go down. Use the hand on your belly to help you push all the air out. Take your time exhaling.
- Repeat these steps 3 to 10 times. Take your time with each breath.

Always try measures to control your breathing or belly-breathe first. If these techniques don’t work and you don’t have other health problems, you might try breathing in and out of a paper bag that covers your nose and mouth.

Using a paper bag

Use a paper bag to control your breathing. Take 6 to 12 easy, natural breaths, with a small paper bag held over your mouth and nose. Then remove the bag from your nose and mouth and take easy, natural breaths.
Next, try belly-breathing (diaphragmatic breathing).
Alternate these techniques until your hyperventilation stops.

If hyperventilation continues for longer than 30 minutes, call your doctor immediately.

Do not use a paper bag if:

Follow these precautions when using the bag method:

Do not use a plastic bag.
Do not breathe continuously into a paper bag. Take 6 to 12 natural breaths, with a paper bag held over your mouth and nose, then remove the bag from your nose and mouth.
Do not hold the bag for the person who is hyperventilating. Allow the person to hold the bag over his or her own mouth and nose.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Symptoms do not improve with home treatment measures.
Symptoms become more severe or frequent.

Prevention

You may be able to avoid hyperventilation:

Breathe through your nose. It is harder to hyperventilate when your mouth is closed, because you can’t move as much air through your nose.
Loosen your clothing. Tight belts and waistbands, girdles, bras, and skintight jeans can all restrict breathing and cause shallow, upper-chest breathing.
Learn belly-breathing (diaphragmatic breathing) techniques, and practice them when you are not hyperventilating so that you can use the techniques when you need them. People who hyperventilate usually take shallow breaths, filling only their upper chest when they inhale.
Try different relaxation techniques and see what works best for you. For more information, see the topic Stress Management.
Talk to friends, family members, or a counselor to help you relieve anxiety. Keep a journal to help you focus on your problems and find workable solutions.
Eat a healthy mix of foods. Watch out for caffeine: drink less coffee, tea, and soda, and do not eat as much chocolate. For more information, see the topic Healthy Eating.
Exercise. Regular aerobic exercise forces you to take full breaths and helps you to reduce anxiety that contributes to hyperventilation. For more information, see the topic Fitness.
Make sure you get a good night’s sleep. Being rested may help reduce daytime anxiety. For more information, see the topic Sleep Problems, Age 12 and Older.
Practice healthy thinking and stop negative thoughts.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

What are your main symptoms? How long have you had your symptoms? What was happening in your life when your symptoms began?
Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated?
What activities make your symptoms better or worse?
Do you think that sports activities or activities related to your job or hobbies caused your symptoms? Have you recently changed jobs, been laid off, or been fired?
Do you have a lot of stress in your life? Have you recently had a change in your family, such as a divorce or death of a loved one?
Has anyone else in your family ever had problems with hyperventilation or been diagnosed with an anxiety disorder or depression?
What home treatment measures have you tried? Did they help?
What nonprescription medicines have you tried? Did they help?
What prescription and nonprescription medicines do you take?
Do you smoke or use other tobacco products?
Are you using alcohol or illegal drugs, such as marijuana or cocaine, to help manage your symptoms?
Do you have any health risks?

While waiting for your appointment, it may be helpful to keep a diary of your symptoms .

Credits

Current as of:
February 26, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine

Current as of: February 26, 2020

Author:
Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine

Hyperventilation Syndrome: Practice Essentials, Pathophysiology, Etiology

Author

Brian Kern, MD Staff Physician, Department of Emergency Medicine, Detroit Medical Center; Clinical Assistant Professor, Wayne State University School of Medicine

Brian Kern, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Michigan State Medical Society, Michigan College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

John J Oppenheimer, MD Clinical Professor, Department of Medicine, Rutgers New Jersey Medical School; Director of Clinical Research, Pulmonary and Allergy Associates, PA

John J Oppenheimer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, New Jersey Allergy, Asthma and Immunology society

Disclosure: Received research grant from: quintiles, PRA, ICON, Novartis: Adjudication<br/>Received consulting fee from AZ for consulting; Received consulting fee from Glaxo, Myelin, Meda for consulting; Received grant/research funds from Glaxo for independent contractor; Received consulting fee from Merck for consulting; Received honoraria from Annals of Allergy Asthma Immunology for none; Partner received honoraria from ABAI for none. for: Atlantic Health System.

Acknowledgements

Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association

Disclosure: Nothing to disclose.

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

webmd.com”>Disclosure: Nothing to disclose.

Edward J Newton, MD, FACEP, FRCPC Professor of Clinical Emergency Medicine, Chairman, Department of Emergency Medicine, University of Southern California Keck School of Medicine

Edward J Newton, MD, FACEP, FRCPC is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Royal College of Physicians and Surgeons of Canada, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Hyperventilation.

What causes hyperventilation? Information

The term hyperventilation describes excessive ventilation of the lungs, beyond what is required to achieve normal arterial blood gases.

Where hyperventilation occurs chronically or in recurrent episodes and is associated with somatic (respiratory, neurological, intestinal) or psychological (anxiety) symptoms, it is known as hyperventilation syndrome.^[1]

About 5-10% of general medical outpatients are thought to have this syndrome and, because of the range of somatic symptoms, the risk of misdiagnosis is high.

Pathogenesis

Hyperventilation has little effect on arterial pO₂ and almost no effect on oxygen saturation which is nearly 100% under normal circumstances. Its main effect is to lower pCO₂ and produce a respiratory alkalosis. A secondary hypocalcaemia also occurs as calcium dissociation is shifted towards the unionised, bound form.

There are many factors that influence the respiratory drive, including the elasticity of the lungs and the resistance in the airways but the most important factors are arterial pH, pCO_{2 and}pO₂.

Of these, pCO₂ is most important, although some people with chronic obstructive pulmonary disease (COPD) can depend on the hypoxic drive.

Epidemiology

It is quite common but precise prevalence is unknown. A postal survey indicated that 8% of adults without asthma have functional breathing problems (of which symptomatic hyperventilation is the most common).^[2]
Hyperventilation syndrome is more common in people with asthma and also more common in females.^[3]
It is more common in asthmatic patients, occurring in 29% in one survey.^[4]

Aetiology

The most common reason for increasing respiratory rate and depth is exercise, the extent depending upon the level of exercise. However, as this is a normal physiological response, it is inappropriate to call it hyperventilation.

Other causes include:

Metabolic acidosis, which will cause compensatory hyperventilation. This may occur with diabetic ketoacidosis or with acute kidney injury. Carbon dioxide is a very weak acid but the volume exchanged in a day makes it the most important contributor to acid base balance.
Problems of respiratory exchange may exist, including V/Q imbalance due to, for example, pulmonary embolism or poor gas exchange with pulmonary oedema.
Hypoxia, which can be the result of altitude, especially when ascent has been too rapid and acclimatisation has not occurred. Hyperventilation can cause mountain sickness with cerebral oedema. Rapid descent is imperative as the condition can be fatal.
Fever, toxins and drugs – these can all increase the respiratory rate, possibly by a central action on the brain.
Aspirin overdose, which leads first to a primary hyperventilation and respiratory alkalosis by central stimulation and then to a secondary hyperventilation for the metabolic acidosis caused by the acidic nature of the drug.
Iatrogenic hyperventilation by over-ventilating patients with head injuries, which was once a common technique but has fallen from favour, as it has been shown to produce a worse outcome. ^[5]
Hyperventilation in response to anxiety, which is common. It is more common in women and may be associated with panic disorder.
Hyperventilation which may also occur as part of dysfunctional breathing in those with asthma.^[4]

The remainder of this article will concentrate on hyperventilation as it may present in the community.

Presentation

Symptoms

The complaint is usually of a paroxysmal rather than a continuous nature, although chronic hyperventilation can occur.
The patient may complain of shortness of breath when an attack occurs.
Pain or discomfort in the chest is common.
Paraesthesiae usually affects both arms. The complaint is often of numbness or tingling in the fingers and sometimes toes.
Other symptoms include:
- Dizziness.
- Perioral tingling.
- Weakness.
- Tinnitus.
- Palpitations.
- Feeling of choking or suffocation.
- Wheezing.
- Sweating.
- Loss of consciousness (uncommon).

Signs

There are unlikely to be any signs unless the patient is seen during an acute attack when:

The patient will look very anxious and be struggling to breathe.
Speech is difficult and the accessory muscles of ventilation are used.
Note the ratio of the inspiratory duration to the expiratory duration:

In quiet breathing, this is about 1:2.
In asthma, the expiratory phase is prolonged (especially if severe) and the patient may expire through pursed lips.
In hyperventilation, the inspiratory phase may be more energetic and the expiratory phase is not prolonged.

Trousseau’s sign (also called ‘main d’accoucheur’ or carpopedal spasm) is muscle spasm in the hands, with the tips of the fingers and thumb apposed and the fingers straight. It results from hypocalcaemia.
Chvostek’s sign is also due to hypocalcaemia. Flick behind the ear, just in front of the mastoid bone where the facial nerve emerges. The hypersensitive facial nerve makes the muscles of the face twitch.

Chronic hyperventilation

Chronic hyperventilation may be rather more difficult to diagnose. The patient rarely hyperventilates in a clinically apparent manner and may have been through multiple investigations already.

There may be a persistently low arterial pCO₂ with a high renal excretion of bicarbonate so that pH is normal.
Occasional deep, sighing breaths may be noted. These keep the pCO₂ depressed.
They may hyperventilate more obviously when stressed and readily produce symptoms under these conditions.

Differential diagnosis

The diagnosis may be obvious from the history.

Where a patient’s history is confusing, consider hyperventilation syndrome and enquire if breathlessness is:

Occurring at rest while reading or watching TV.
Associated with light-headedness and paraesthesiae.
Poorly related to severity of exertion.
Associated with fear of dying during attacks.

Chronic hyperventilation may mimic many serious organic disorders but features are often atypical. Patients with exercise-induced hyperventilation are more likely to have a psychiatric than a cardiac disorder. Early detection and treatment of these patients may reduce the potential morbidity associated with unnecessary invasive investigations.

Investigation

The diagnosis is essentially a clinical one but it may be necessary to perform various tests to exclude other conditions:

Arterial blood gases in an attack may be helpful but pCO₂ can also be measured in end expiratory air. The latter test is more often used, as it is less invasive, less painful and so less likely to induce hyperventilation.
ECG may exclude coronary heart disease or arrhythmia and D-dimer testing and CXR may be required in case of pulmonary embolism or pneumothorax. It may also reveal a prolonged QT interval due to hypocalcaemia during an acute attack.
Pulmonary function tests and lung gas transfer help to rule out other underlying lung conditions, such as asthma or pulmonary embolism.
Toxicology screen.
Acute hyperventilation syndrome can be clinically misdiagnosed as epileptic seizures. Therefore an electroencephalogram (EEG) may be required.^[8]

Management

Anxiety can cause hyperventilation, producing symptoms that are interpreted as indicating serious physical illness. This causes more hyperventilation, worse symptoms and a vicious circle. Careful explanation of the nature of the condition is needed. Patients may find it difficult to accept the aetiology. Reproducing symptoms with voluntary hyperventilation may be useful.

Rebreathing into a paper bag can be used to help build up the pCO₂ but this should only be used where the diagnosis is certain, as it may be dangerous if there is physical disease.
Relaxation techniques may be helpful.
Breathing exercises are frequently used to treat dysfunctional breathing and hyperventilation syndrome. However, there is currently no strong evidence of benefit either in children or adults.^{[9, 10]}
Treating asthmatics with dysfunctional breathing, using a brief physiotherapy intervention (teaching breathing retraining exercises), improves quality of life but this is only maintained in a quarter of patients six months on.^[11]

Pharmacological

The basis of treatment should be behavioural therapy rather than medication but there may be a place for drugs.

Benzodiazepines can be used in the acute situation if severe. Use only occasionally, as there is the potential for sedation and dependence.
Propranolol may be of value if asthma has been excluded.
Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may also be of value.

Associated diseases

Treat any associated contributory conditions:

Approximately 50% of patients with panic disorder and 60% of patients with agoraphobia hyperventilate as part of their disorder but only 25% of patients with hyperventilation syndrome also have panic disorder.
Other psychiatric disorders – eg, obsessive-compulsive disorders; however, not all patients have demonstrable psychological pathology.

Complications

Mortality attributable to hyperventilation syndrome is extremely rare but has been reported.^[12]
Hyperventilation syndrome can, however, have a severely adverse effect on quality of life.^[13]
There is significant psychiatric morbidity associated with the syndrome.
Individuals are at risk of iatrogenic complications from investigation or treatment of wrong diagnosis.

Prognosis

Prognosis is generally good but will depend on the underlying cause and comorbidity.^[12]
Management of associated disorders (such as agoraphobia) will alter the course of the hyperventilation.
Patients treated with breathing retraining, stress reduction interventions and certain drug treatment (eg, SSRIs) appear to experience significant reductions in the frequency and the severity of exacerbations.

Hyperventilation: cause or effect? | Emergency Medicine Journal

Doctors in accident and emergency (A&E) medicine are confronted with a large number of patients that have the label of a “panic attack”. Typically these are young patients who are hyperventilating. Not all hyperventilation in the A&E department is “cause”; some of it is “effect”. The difficulty is spotting the one when hyperventilation is effect and not cause. It is important for emergency physicians, who are often junior doctors to consider any history of shortness of breath as a major symptom. Such patients require detailed assessment to exclude a serious cause. The following case discussion highlights the factors that differentiate hyperventilation “cause” from “effect”.

Case report

A 26 year old woman presented to the A&E department of a district general hospital at 1402 with a history of sudden onset “shortness of breath, fast heart beat and intermittent dizzy spells to the point of near collapse” lasting 30 minutes. Her symptoms had almost resolved at the time of arrival in the A&E department. She had a similar attack in the past and was admitted to a medical ward of the same hospital eight months previously, from where she took her own discharge against medical advice within 24 hours of admission. She had undergone outpatient investigations including a 24 hour cardiac tape recording, which was reportedly normal. Past medical history revealed that she had undergone surgery for varicose veins at age 16 years. She was taking oral contraceptives and smoked 10 cigarettes per day. On examination, she had a pulse rate of 125 beats/min and a blood pressure of 140/90 mm Hg. Notably her oxygen saturation on air was recorded as 88% in the ambulance before arrival, but subsequently was normal on 10 l/min of oxygen and remained normal even after the oxygen was discontinued. Examination of the respiratory and cardiovascular system was unremarkable. An electrocardiogram (ECG) was performed, but not commented upon. It was subsequently reported as showing a right ventricular strain pattern with S1Q3T3 and was considered to be abnormal (fig 1). Arterial blood gas analysis and chest radiography were not performed. After observing the patient for 30 minutes, a reassessment of her condition revealed a pulse rate of 90 beats/min, blood pressure of 140/90 mm Hg and no hypoxia on air. She was discharged with a presumptive diagnosis of “anxiety related hyperventilation” and asked to see her general practitioner if her symptoms recurred. Two days later she was admitted to hospital after another episode of acute shortness of breath. On this occasion she was unwell, tachycardic, hypotensive and hypoxic. ECG was unchanged. Arterial blood gas analysis showed a Po₂ of 8.0 kPa on 40% oxygen. A Krypton ventilation perfusion lung scan revealed multiple defects on the perfusion scan (fig 2) with a high probability of pulmonary embolus. She was given heparin and responded well. She was discharged after nine days and prescribed warfarin.

Figure 1

ECG showing right ventricular strain with S1Q3T3.

Figure 2

V/Q scan showing multiple perfusion defects.

Discussion

A young woman presenting with shortness of breath, fast pulse and respiratory rate and dizziness is quite common in emergency medicine. In many cases anxiety and panic are the cause of this shortness of breath, but sometimes it may be a symptom of a more serious underlying condition like pulmonary embolus. It is important for emergency physicians to exclude such pathology before labelling shortness of breath as anxiety related. This can be done by close attention to history and examination, pre-existing risk factors and the use of some basic investigations attainable in the A&E department.

Regarding the clinical history, too little was made of her having shortness of breath to the point of near collapse. A detailed history would have highlighted this.

Examination revealed a tachycardia, tachypnoea and a documented period of hypoxia. This should have indicated the likelihood of a serious underlying cause. No reassurance should have been gained by the fact that her physiology was seen to normalise.

Risk factors for thromboembolic disease include major abdominal/pelvic surgery, immobilisation, recent lower limb trauma, pregnancy or post-partum, major medical illness and previous proven deep vein thrombosis or pulmonary embolus. Her risk factors for thromboembolism were minor, but did include smoking, oral contraceptives and previous lower limb varicose vein surgery (10 years ago).

Any abnormality in ECG and chest radiograph will suggest a serious underlying cause for “hyperventilation”. Such patients should be referred for urgent investigations to exclude pulmonary embolism. Her ECG was abnormal and that in itself should have dictated a referral.

The main discriminating factors in this case were dizziness to the point of near collapse, shortness of breath, respiratory rate > 20 breaths/min, hypoxia recorded by pulse oximetry in the ambulance and an abnormal ECG.

A district general hospital with a catchment population of 200 000 may expect to diagnose 50 cases of pulmonary embolism annually.¹ As some of these only become apparent at necropsy, the true incidence of pulmonary embolism is probably much higher at 1% of all admissions.² The incidence in A&E attendances is unknown, but is likely to be only a small proportion of young patients presenting with hyperventilation. Risk factors are important and 80–90% of patients with pulmonary embolus have predisposing factors. The clinical patterns of pulmonary embolus include sudden collapse (faintness and/or hypotension), pulmonary haemorrhage syndrome (pleuritic chest pain and/or hemoptysis) and isolated dyspnoea. This last category of patients presenting with shortness of breath without chest pain contributes up to 25% of all those diagnosed with pulmonary embolus.³ Most patients (>97%) with pulmonary embolus are short of breath with a respiratory rate > 20 breaths/min. ECG, arterial blood gas analysis and chest radiography are the basic investigations for diagnosing pulmonary embolus. d-dimer assays can be used to exclude the presence of thromboembolic disease.⁴ Newer d-dimer assays show promise as a tool for use in the A&E department. The diagnosis of pulmonary embolus can be confirmed by lung imaging using ventilation/perfusion isotope scanning, pulmonary angiography or spiral computed tomography. The guidelines for initial assessment and action are outlined by the British Thoracic Society, Standards of Care Committee Report.³ (At present the British Thoracic Society guidelines do not mention the use of d-dimer assays).

The lesson that should be learnt from our case is that pulmonary embolism can present without chest pain and consequently a symptom of shortness of breath should always be taken seriously, particularly if the features previously mentioned are present.

Acknowledgments

Contributors

Tapan Mehta contributed in data collection, literature search, illustrations and writing of the paper. John Sutherland contributed in literature search and writing of the paper. David Hodgkinson edited the paper and is also the guarantor.

References

↵
Anderson FA, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. Archives of Intensive Medicine1991;15:933–8.
↵
Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest1995;108:978–81.
↵
British Thoracic Society Working Party. Suspected acute pulmonary embolism: a practical approach. Thorax1997;52:S1–24.
↵
Miller A. A fresh look at D-dimer in suspected pulmonary embolism. Thorax1998;53:821–2.

Hyperventilation

What is hyperventilation? Hyperventilation occurs when people breathe too rapidly. Most people take at least a couple of seconds to breathe in and

What is hyperventilation?

Hyperventilation occurs when people breathe too rapidly. Most people take at least a couple of seconds to breathe in and out. If a person sounds as though he’s run a mile and is breathing heavily, that’s a sign of hyperventilation.

What causes hyperventilation?

Rapid or labored breathing can result from extreme anxiety or panic. It is also associated with fever, head injuries, and asthma. Certain medications can cause hyperventilation as well. Rapid breathing is a common sign of illness in infants, children, and seniors. Hyperventilation alone isn’t dangerous, but it can cause carbon dioxide levels in the blood to fall below normal levels. Once that happens, a person may experience the following symptoms:

Tightness in the throat
Difficulty getting a deep, “satisfying” breath
Chest pains
Dizziness
Faintness
Trembling hands
Cramps, numbness, or tingling in the hands and feet
Numbness or tingling around the mouth
Convulsions

What to watch out for

If a hyperventilating person is also coughing and wheezing when she exhales, she may be having an asthma attack. Help her take any appropriate prescribed medications. If this is her first asthma attack, if it’s more severe than previous attacks, or if she experiences intense chest pain spreading to one or both arms, call 911 or go to an emergency room immediately. It could be that a heart attack or another problem is to blame.

What to do when someone is hyperventilating

Make sure the person is in a comfortable position — preferably sitting down. This will make breathing easier. Speak calmly and reassuringly as you encourage him or her to breathe more slowly. Sometimes it helps for people to hold their breath for a count of three after each inhalation. If this technique doesn’t work, try having the person breathe into a paper bag. This helps increase carbon dioxide levels in the blood and encourages slower breathing.

It’s important to reassure someone who is having trouble breathing. A person may become even more anxious when he feels as if he can’t catch his breath — and anxiety only increases breathing difficulties. Calmly tell the person that he will be all right. If he is able to carry on a conversation, it sometimes helps to encourage him to talk about what he is feeling.

Once breathing has returned to normal, the symptoms of hyperventilation usually go away without further treatment. If they do not, or if you suspect that the cause is a medical condition rather than anxiety, seek medical attention immediately.

References

Handbook of First Aid and Emergency Care. American Medical Association.

American College of Emergency Physicians. First Aid Manual.

MedlinePlus. U.S. National Library of Medicine and National Institutes of Health. Rapid deep breathing (hyperventilation). http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm

Everything you need to know about hyperventilation

What is hyperventilation?

Hyperventilation (hyper – too much, ventilation – breathing) is a condition in which a person experiences abnormal, increased rate and depth of breathing, for a prolonged period. When they begin to breathe too fast and too deeply, they blow off carbon dioxide from the lungs and blood which results in chemical changes which cause a variety of symptoms but most distressing the feeling of acute anxiety.

Symptoms

Hyperventilation is accompanied by various symptoms including dizziness/light headedness, anxiety, feeling of suffocation, numbness or tingling in the toes or fingers, feeling of being detached from the body, heart palpitations, chest pains, dry mouth, clammy hands, difficulty swallowing, tremors, sweating, weakness and fatigue. People may also less commonly experience blurring of vision, headaches and sometimes become unconscious.

An attack of hyperventilation may last between 20 and 30 minutes during which time the patient normally seeks help from the nearest doctor or emergency department. Although scary, hyperventilation due to anxiety is seldom dangerous.

Causes

Hyperventilation is usually caused by anxiety or a panic attack, but can be experienced in association with other illnesses for example, severe stomach pains, heart failure, collapsed lung, severe bleeding, a central nervous system disorder, a diabetic emergency and poisons.

Prevention

Hyperventilation can be prevented by avoiding situations that lead to anxiety. Avoiding stimulants like caffeine and cigarette smoke can also reduce the occurrence of hyperventilation. Regular exercise to relieve stress may also be helpful.

Diagnosis

The important thing to recognize is that not all hyperventilation is anxiety related and therefore taking a good history is essential. If the patient has a history of anxiety or anxiety related hyperventilation the diagnosis is easier.

Hyperventilation can be pathological and associated with serious illness so a history of past systemic illness is important.

Management

If you suspect the patient has a cause for hyperventilation other than anxiety, ensure that they get to the nearest Emergency Centre.

The treatment of anxiety related hyperventilation is fairly simple and usually very effective.

Coaching the patient gradually back to breathing normally is effective management once you have established their trust and confidence. Establish a rhythm of breathing by counting out loud and slowly reduce the rate. Once they realise that they are not seriously ill, that realisation will in itself mitigate the anxiety and relax them.

Hyperventilation causes a lower than normal carbon dioxide level in the blood and so “re-breathing” of air can help to restore the balance and improve symptoms. Breathing in and out of a brown paper bag (a bag) four or five times creates rebreathing and the desired effect. Allow the patient to rebreathe air only for short periods until symptoms improve.

Hyperventilation — causes, symptoms, treatment and prevention

Feel like you run out of breath at the slightest sign of stress? You might be hyperventilating. Here are the reasons and treatment options for this condition.

Written by Mita Majumdar | Updated : September 25, 2014 4:29 PM IST

Hyperventilation is a condition when you breathe deeper and more rapid than normal. It is more common in women than men and in people between 15 to 55 years of age. It is also most commonly associated with panic attacks.

We breathe in oxygen and breathe out carbon dioxide. During hyperventilation, we tend to breathe excessively, that is, we over-breathe and this leaves us breathless. This increases the removal of carbon dioxide from the blood, so the carbon dioxide pressure inside the blood decreases causing a condition called respiratory alkalosis where the blood becomes more alkaline. Alkalosis further causes the blood vessels supplying blood to the brain to constrict. And reduced blood supply to the brain causes symptoms such as

Lightheadedness and dizziness
Numbness and tingling in the fingertips, arms and around the mouth
Chest pain
Confusion, palpitation and shortness of breath
Shortness of breath
Bloating and belching
Weakness

These are thus the symptoms of hyperventilation. Severe hyperventilation can even cause loss of consciousness.

So why do we get hyperventilated in the first place? Scientists believe hyperventilation is more of a consequence rather than a cause of certain diseases or conditions. And treatment will depend on what’s causing your hyperventilation. Let’s take a look at some of them.

Anxiety or panic disorder

Anxiety and panic disorder which is a severe form of anxiety, is probably the most common cause of hyperventilation. This type of hyperventilation is called acute or sudden hyperventilation. The two almost form a vicious cycle, in the sense, anxiety can lead to hyperventilation, and this rapid breathing can make you panic. Anxiety is also accompanied by faster heart rate, sweating, trembling and dizziness. You may also feel the need to pee frequently or you may have a problem with swallowing. Dry mouth and loose stools are also common symptoms of anxiety and panic.

Treatment:

Psychotherapy
Cognitive-behavioural therapy where you are guided to identify and challenge the negative thinking patterns causing anxiousness and panic.
Exposure therapy where you confront your fears in a controlled environment.
Medication such as benzodiazepines and anti-depressants combined with self help therapies and behavioural therapies.

Heart failure and heart attack

Heart failure, a chronic condition in which your heart is no longer able to pump out oxygen-rich blood, can cause you to hyperventilate. But this type of hyperventilation is called chronic hyperventilation. You can have heart failure if your high blood pressure is not well controlled or if you have coronary artery disease wherein the blood vessels supplying blood to the heart become narrow.

When the fluid builds up in the lungs, liver, gastrointestinal tract and extremities because of the heart failure, the condition is called congestive heart failure. Heart attack, arrhythmias, and certain infections involving the heart muscles can also cause heart failure.

Symptoms include hyperventilation, shortness of breath, cough, fatigue, palpitations, loss of appetite, enlarged liver or abdomen, swollen hands and feet, and sometimes weight gain.

Treatment:

Medicines that treat the symptoms and prevent the heart failure from getting worse, for example, drugs to reduce cholesterol, keep your blood from clotting, reduce arrhythmias, open up clogged blood vessels, and other symptoms. Caution Ibuprofen and naproxen may worsen heart failure.
Devices such as pacemaker and defibrillator.
Coronary bypass surgery or angioplasty with or without stenting. Heart valve surgery may also be suggested by surgeons.
Intra-aortic balloon pump (IABP) and left ventricular assist device (LVAD) are two treatments in case of end stage heart failure when no other treatment work and you are waiting for a heart transplant.

Lung disease

Lung disease such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary embolism are some of the common lung diseases that cause chronic hyperventilation.

Asthma This disease is caused by inflammation in the airways in which the airways of the lungs swell and narrow. Symptoms include cough, wheezing, hyperventilation, shortness of breath, tightness in the chest, difficulty breathing, anxiety, and sweating.

Treatment:

Inhalers with steroids or long acting beta-agonists as maintenance or controller medicines.
Quick relief medicines such as short-acting inhaled bronchodilators or oral corticosteroids.
Hospital stay in case of severe asthma where you will be given breathing assistance and intravenous medications.

Chronic obstructive pulmonary disease (COPD) This is a disease where you have long-term cough with mucus (chronic bronchitis) mostly in combination with emphysema which gradually destroys your lungs. Smoking, second hand smoke and pollution are the leading cause of COPD.

Symptoms include hyperventilation that involves shortness of breath even with mild activity and difficulty catching your breath, wheezing, cough, and respiratory infections.

There is no cure for COPD. You need to control it with proper diet, avoiding cold air and reducing pollution. To relieve symptoms you may have to go in for medications.

Treatment:

Bronchodilators to open the airways.
Steroids administered orally, intravenously, or through inhalers.
Antibiotics in case of respiratory infections.

Pulmonary embolus Any embolus is a blockage of artery because of blood clot, tumor cells or fat. When the blockage is in the artery leading to the lungs it is called pulmonary embolus.

Symptoms are chest pain, sudden cough where you may cough out blood, and hyperventilation in the form of rapid breathing, fast heart rate, and sudden onset of shortness of breath. Anxiety, sweating, and wheezing are other symptoms that you could experience.

Treatment: Pulmonary embolus is an emergency situation that needs hospitalization. You will be given clot dissolving medication and then blood thinners to prevent formation of new clots.

Pneumonia

Pneumonia is an infection of the lung by the Streptococcus pneumoniae bacteria. COPD, smoking, brain disorders, immune system problems, or sometimes even a surgery can increase the chances of being infected by pneumonia.

Symptoms:

cough with green, yellow, or bloody mucus
mild or high fever
shaking chills
hyperventilation (shortness of breath)

Treatment:

fluids
antibiotics
oxygen therapy

Ketoacidosis

Ketoacidosis is a condition in which your body cannot use sugar as fuel (energy source) because of insufficient or no insulin. During such cases, the body fat break down to supply the required fuel. This results in build-up of waste products called ketones. Ketoacidosis normally occurs in diabetics and is considered to be a life threatening condition.

Symptoms:

hyperventilation
decreased alertness
fruity breath
dry skin and mouth
headache and muscle stiffness
nausea, vomiting, stomach pain

Treatment: The treatment requires hospitalization where the doctor will correct the high blood sugar level and/ or treat the infection causing ketoacidosis.

Other causes of hyperventilation

However, these diseases / conditions are not always the cause of hyperventilation. In most cases, hyperventilation is caused by

stress, anxiety, depression, anger
bleeding
severe pain
drug overdose, for example, aspirin overdose
pregnancy

Home treatment for hyperventilation

If you are over-breathing due to stress, panic, anger or depression, (and this is the most common cause) try the following breathing techniques to control hyperventilation.

Try breathing once every 5 seconds or slow enough till gradually your over-breathing stops.
Purse your lips as if you are whistling and breathe.
Pinch one nostril and breathe through your nose.
Place one hand on your belly and the other on your chest. Take a deep breath as if you are filling your belly and let your belly push your hand out. Exhale slowly pushing the air out of your belly with your hands. Repeat these steps 5 to 10 times.

The purpose of these breathing techniques is to get more carbon dioxide circulating in your blood. If hyperventilation continues for 30 minutes, get medical help. Also get medical attention if you are hyperventilating for the first time, or if you have fever, bleeding or pain.

Russian scientists suggested a number of methods to treat hyperventilation. Among them are psychotherapy, pharmacotherapy, remedial gymnastics, and correction of respiratory disorders. The correction of respiratory disorders are done through biofeedback mechanism, recurrent respiration, or carbon dioxide inhalation.

Read more about causes, symptoms, diagnosis and treatment of stress.

Reference:

http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000158.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000145.htm
http://www.webmd.com/a-to-z-guides/hyperventilation-home-treatment
http://www. ncbi.nlm.nih.gov/pubmed/2114670

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90,000 Breathe – don’t breathe. What Happens to the Brain When We Hold Our Breath

The idea of the study, published in the European Journal of Applied Physiology , was born out of the practical work of Irina, a freediving coach – free scuba diving. Freediving athletes dive in the pool or in the sea. At competitions, holding their breath, they lie quietly, swim as far as possible or dive as deep as possible.

“The world records are fantastic – holding your breath for more than 11 minutes at rest, 200 meters long in the pool and 217 meters deep.But what happens in the body at this time is not yet fully understood, the long-term effects are also unclear, ”said Irina.

Stefan Mifsud sets the world record for holding his breath: 11 minutes 35 seconds

The longer the breath holding lasts, the more carbon dioxide accumulates in the blood, and the oxygen content decreases. The researchers suggested that in such conditions, the work of the brain may change: the speed of reactions and thought processes will decrease, and attention will deteriorate.

How long can you not breathe

The study compared the results of two groups of subjects: 13 professional freedivers and nine people without special training. One of the professional freedrivers held his breath for the longest time – for 5 minutes 45 seconds.

It is believed that an ordinary person can not breathe for about a minute, but during the research it turned out that this is not the case. If you explain to the participant in advance what awaits him and what sensations he will experience, then the time for holding the breath can be increased by removing the psychological barrier.Thanks to this, in the control group, the best result was 4 minutes 23 seconds.

Freediver training in the pool. Photo: Elina Manninen / Shutterstock

“If you know what happens to the body during breath holding, what to fear and what not, you can calmly perceive the unpleasant sensations and increase the breath holding up to 2-3 minutes. Until involuntary contractions of the diaphragm begin – reflex urge to inhale, there is nothing to fear, ”said Patricia Ratmanova.

What happens with prolonged breath holding

In order to assess the brain and body condition during breath holding, the researchers recorded an electroencephalogram, cardiogram, blood pressure, oxygen levels in the blood and brain tissues and other indicators. Immediately after holding their breath, the subjects were given a test for attention and hand-eye coordination – a proofreading test. Volunteers received a sheet with rows of letters printed in random order. Their task was to look through the letters and look for those that were named by the researchers. They had to underline one of the given letters, and cross out the other.

“We expected that brain function would deteriorate, but everything turned out to be completely wrong. Brain activity did not change, attention did not decrease – we did not find any negative changes, even with prolonged breath holdings, ”said Patricia.

Scientists have suggested that in humans, like in marine mammals (whales, dolphins, seals), the so-called “diving reflex” is triggered. It aims to protect the brain and heart from lack of oxygen.

A test subject from the control group during a study in the laboratory of physiology of muscle activity of the Institute of Biomedical Problems of the Russian Academy of Sciences. Photo courtesy of Patricia Ratmanova

During the “diving reflex” at the periphery of the body, the vessels constrict, which reduces blood flow to muscles and oxygen consumption, increases blood pressure and slows the heart rate.As a result, blood mainly flows to the heart and brain. In the brain, blood vessels, on the contrary, expand, blood flow and oxygen supply to brain cells increase. As a result, the work of the brain does not suffer when holding the breath.

Meditation and Holotropic Breathwork

Nevertheless, breathing exercises can affect the functioning of the brain, sometimes this effect is positive, sometimes it is dangerous.

“The techniques used in meditation are usually associated with slowing down the breathing rhythm or holding the breath for a short time.Their main task is to help a person concentrate on the sensations of his own body, to distract himself from external stimuli. There is no harm from such breathing exercises, ”explained Patricia.

Hyperventilation, which, for example, underlies holotropic breathing, can be dangerous.

“When we breathe deeply and rhythmically, carbon dioxide is washed out of our blood. The body reacts to this by reflex vasoconstriction. As a result, despite deep breathing, the so-called cerebral hypoxia occurs – a lack of oxygen in the brain, ”said the researcher.

In some people, this can trigger an epileptic seizure. “There are those who are predisposed to epilepsy and do not even know about it. Such people can live their whole lives without a single attack, if not provoked by hyperventilation. And after the epilepsy manifests itself for the first time, the seizures may recur, ”the scientist warned.

Ekaterina Borovikova

How to get vaccinated against pneumonia and why is hyperventilation of the lungs dangerous? Pulmonology doctors answer questions

Lung diseases are among the most common in the world.Most of these are caused by smoking, infections and heredity. How to Avoid Lung Disease? How not to miss pneumonia? Is it always necessary to treat a cough? When does a cough turn into bronchitis? Can your lungs be restored if you quit smoking? The online conference “Lung Diseases in Adults and Children” was held on the information portals “Healthy People” (24health.by) and TUT.BY.

Answers to questions:

Elena Ignatievna Davidovskaya, Chief Freelance Pulmonologist of the Ministry of Health, Candidate of Medical Sciences, Head of the Department of Pulmonology and Surgical Treatment of Respiratory Diseases, Republican Scientific and Practical Center for Pulmonology and Phthisiology;
Vladimir Ivanovich Bobrovnichy, chief freelance pediatric pulmonologist of the Ministry of Health, candidate of medical sciences, dean of the pediatric faculty of the Belarusian State Medical University.

– How effective is the pneumonia vaccine for adults? If so, when do you recommend booster vaccinations for adults?

Elena Davidovskaya : A very important question. Vaccination against pneumonia, or rather against pneumococcal infection (one of the varieties of which is pneumonia caused by this microorganism), is a highly effective specific method of protection. It should be understood that other pathogens can also be the cause of pneumonia, but the most common and significant of them in all age groups is precisely a special type of streptococcus – pneumococcus.

This microorganism can cause sinusitis, otitis media, exacerbation of chronic respiratory diseases. For adults, the risk of contracting pneumococcal pneumonia increases if a person has chronic diseases – cardiovascular, bronchopulmonary, oncological, liver, kidney, blood, diabetes mellitus and immunodeficiency states. In addition, due to physiological changes, people over 65 are especially at risk. By being vaccinated with a pneumococcal vaccine, we reliably protect ourselves from this type of infection, including pneumococcal infection number 1 – pneumonia.

Today there are several types of pneumococcal vaccines, including those registered and used in our country. If you have already been vaccinated before, revaccination is carried out no earlier than three years later. In addition, for revaccination, you can call another type of pneumococcal vaccine – conjugate, after which revaccination will not be required in the future. You can get detailed information on the types of pneumococcal vaccine and the vaccination / revaccination schedule in each institution where it is given.

– I am 33 years old, I do not smoke, I had pneumonia three times (in childhood, in 2014 and in 2017). What preventive measures would you recommend? Should I get the pneumococcal vaccine?

Elena Davidovskaya, Vladimir Bobrovnichy: Pneumonia is an acute infectious disease that usually ends in full recovery. If you have not had any other pneumococcal infections, vaccinations are not necessary at this time.To prevent respiratory infections in the future, we advise you to lead a healthy lifestyle. Take care of yourself, get a flu shot every year and be healthy!

– I would like to know if the blue lips during training are related to the lungs? A year ago, I was wearing heaviness and my lips turned blue. Now every workout (I do Taoist practices that do not involve heavy loads) my lips turn blue. I completely checked my heart: an ultrasound scan, took readings when I was spinning my bike, a consultation with a cardiologist – everything was normal.Blood for biochemistry – everything is also normal, cholesterol is slightly elevated. I was told that it could be hyperventilation of the lungs, as exercises for breathing and energy. Tell me if I need to see a pulmonologist? I did fluorography, no pathologies were revealed.

Elena Davidovskaya: Not an ordinary question. Blue lips, including during exercise, can be a symptom of a number of diseases. Therefore, a detailed examination is necessary. You have already completed some of the research.If no significant cardiovascular pathology, anemia, radiological signs of lung disease are found, blue lips may be associated with hyperventilation. Hyperventilation is excessive breathing in frequency and depth, which does not correspond to the physiological need at the moment (lack of intense physical activity). To understand the situation and choose in the future the optimal type of physical exercise, you can additionally contact a pulmonologist for diagnostic functional tests, as well as a neurologist.

– How and where is pulmonary hypertension treated in Belarus?

Elena Davidovskaya, Vladimir Bobrovnichy: The concept of “pulmonary hypertension” includes both an independent disease – primary pulmonary hypertension (PAH), and occurs in a number of other pathological conditions – secondary pulmonary hypertension with heart defects, impaired development and growth of the lungs, lung diseases, systemic diseases of the connective tissue, pulmonary embolism, as well as taking certain medications.In this regard, it is important to understand the causes of pulmonary hypertension; for this, a comprehensive examination is carried out.

In secondary pulmonary hypertension, the treatment of the underlying disease forms the basis of therapy. Primary pulmonary hypertension requires PAH-specific therapy. Despite the name, “pulmonary” disease is more related to the vessels of the lungs, therefore, examination, treatment and observation is carried out mainly by a cardiologist. Several PAH-specific drugs are registered in Belarus.The specialist chooses treatment based on the level (severity) of pulmonary hypertension, as well as the development, severity and signs of chronic heart failure. Treatment is carried out in specialized departments of healthcare institutions of the country. For example, in the Minsk region, qualified assistance in the treatment of pulmonary hypertension can be obtained at the Republican Scientific and Practical Center “Cardiology” and the Minsk Regional Hospital.

My name is Eugene, 31 years old. I don’t smoke, drink in moderation on holidays, play basketball and go to the pool – in general, I would call my lifestyle healthy.After pneumonia, periodical nighttime temperature rises with chills persist for three months, an increased level of CRP (C-reactive protein – Approx. TUT.BY) in the analyzes, back muscles hurt. Is this a normal state for the body after suffering pneumonia? How long can it take? What tests, examinations, procedures can you recommend for a speedy recovery and elimination of the virus from the body?

Elena Davidovskaya: Your condition may have various reasons.In this regard, with all the documents, you need to get the advice of a specialist at the Republican Scientific and Practical Center for Pulmonology and Phthisiology.

– In January of this year, I did a fluorography due to the fact that I coughed very badly. On fluorography there were blackouts, and I was sent for an X-ray of the lungs. X-rays showed the presence of two spots in the right lung. The therapist prescribed me a course of antibiotics, sent me for tests and told me to come after the end of the course of taking medications (she did not give me a sick leave).The re-shot showed the blackouts again. As a result, the therapist referred me to a phthisiatrician, who prescribed me another course of antibiotics. As a result, in two weeks I did one fluorography, 4 X-rays, drank two courses of antibiotic and suffered a pulmonary disease on my legs. I am interested in the question: should I at least have been offered a sick leave? Are complications possible after a disease on the legs? How can I recover, who and how to prosecute in case of complications?

Elena Davidovskaya, Vladimir Bobrovnichy: The decision to issue a sick leave is made taking into account the clinical condition at the time of the request.Currently, based on the information you provided, it is not possible to assess the possibility of issuing a certificate of incapacity for work. The examination carried out by you with a therapist and phthisiatrician allows you to exclude the presence of complications at the moment. Positive X-ray dynamics indicates the effectiveness of the therapy, and the number of studies performed corresponds to the course of the disease. This situation does not require any specific recovery measures. It is important to follow general recommendations: a healthy lifestyle, good nutrition, a rational regime of work and rest, and maintaining physical activity.In the future, do not forget about the annual influenza vaccination.

The child was 7 years old, had 2 pneumonia. The first one – at the age of 3 years (2015), the second – at the age of 5 years (two years later, in 2017). At the same time, the child was often sick up to 5-6 years by himself. The first time, in 2015, they were treated in a hospital, after 2 years, pneumonia was treated simply with an antibiotic (as prescribed by a doctor). After that, the child as a whole suffered from ARVI only once. Could these both cases be somehow connected and somehow affect the child’s health in the future? What prophylaxis can you recommend?

Vladimir Bobrovnichy: The probability that these cases are related is not high.Disease prevention includes a set of specific and non-specific measures. Specific prophylaxis – vaccination according to the National Vaccination Schedule, as well as against influenza. Non-specific include good nutrition, physical education, hardening, healthy microclimate, including psychological.

– Is it always necessary to go to the hospital for pneumonia? Is outpatient treatment of this disease possible and what symptoms are indications for compulsory hospitalization?

Elena Davidovskaya, Vladimir Bobrovnichy: Mild pneumonia can be successfully treated on an outpatient basis.The indications for hospitalization are clearly defined by the current clinical protocols in the country and are assessed by the doctor on a case-by-case basis.
Read in full: https://news.tut.by/society/669965.html

Photo: Vitaliy Gil
TUT.BY, portal “Healthy people”, January 24, 2020

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dyspnea

Shortness of breath is simply defined as “the feeling that you are not breathing,” and most of us are familiar with this feeling when we once ran around the neighborhood as children or in later years, climbing hills or hurrying to the bus. In this context, of course, this is an absolutely normal reaction to stress, and we like it because we can control it.

However, when we feel the breath and do not strain, it is a completely different matter. We no longer feel in control and one of the results is that our alarm level goes up.As soon as we start to worry, the feeling can turn into panic, which will only worsen the situation, as this in itself can cause shortness of breath. It is much easier to breathe if we keep as calm as possible.

Shortness of breath may occur suddenly (like an acute attack) or gradually. It can persist for a long time and become a chronic disease. To avoid undue anxiety, it is important that those affected (patients and caregivers) take control of the situation again, and that is what your doctor will do.Therefore, it is important to inform your doctor about any unexpected episodes of shortness of breath. (NB) Your doctor calls dyspnea dyspnea ).

reasons

Acute attack

A sudden attack will require a quick visit to a doctor, as it often requires immediate treatment. People who have asthma , chronic obstructive pulmonary disease (COPD) or heart failure are usually well prepared by their doctors, with a plan of action that includes starting treatment before the doctor arrives.If this is new to you, seek immediate medical attention.

Asthma, COPD and infection ( pneumonia and bronchitis) are common in the group of people with aspergillosis. British Lung Foundation List the following common reasons:

Asthma outbreak: You may feel like your chest is tight, or you may feel like wheezing rather than choking.
Flash HOPD: You may experience more odor and fatigue than usual, and your usual ways to control your breathing don’t work as well.
A n Elbow embolism .This is when you have clots in your pulmonary arteries that have traveled from other parts of your body, usually your legs or arms. These clots can be very small and cause severe shortness of breath. The more clots can be released over a long period of time, the worse your feeling of shortness of breath will be, and ultimately you may have daily prolonged shortness of breath.
Pulmonary infections such as pneumonia and bronchitis .
Pneumothorax (also called collapsed lung)
Pulmonary edema or fluid or fluid in the lungs . This may be due to your heart’s inability to pump fluid efficiently, or to liver disease, cancer, or infection. It can also cause prolonged shortness of breath, but this can be reversed once the cause is known.
Heart attack (also called coronary thrombosis)
Heart arrhythmia , This is an abnormal heart rhythm.You may feel like your heart is skipping a beat, or you may experience a rapid heartbeat.
Hyperventilation or panic attack .

Long-term (chronic) dyspnea

Chronic dyspnea is usually a symptom of an underlying chronic disease such as asthma, allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), obesity, and more. British Lung Foundation List the following common reasons:

Chronic obstructive pulmonary disease (COPD)
Heart failure . It may be due to problems with the rhythm, valves, or heart muscles of your heart.
Interstitial Lung Disease (ILD) including Idiopathic Pulmonary Fibrosis (IPF) These are conditions where inflammation or scar tissue builds up in your lungs.
Allergic alveolitis , which is an allergic reaction of the lungs to certain types of dust that you breathe into.
Industrial or occupational lung diseases such as asbestosis , which is caused by exposure to asbestos.
bronchiectasis . This is when your bronchial tubes are scarred and distorted, leading to a build-up of phlegm and chronic coughing.
Muscular dystrophy or myasthenia gravis causing muscle weakness.
Anemia and kidney disease .
Being obese, out of shape, and feeling anxious or depressed can also make you short of breath. You can often have these problems along with other conditions.Treating them is an important part of treating your shortness of breath.

Diagnosis of shortness of breath

Your doctor will want to find out what is causing your shortness of breath, and as you can see above, there are many possibilities, so it may take some time to diagnose. In the group of people with aspergillosis, the list is much shorter, but your doctor should still be sure that he has found the correct cause. There are some useful tips on BLF for people who are going to the doctor for the first time with shortness of breath, including recording your breathless activities over the phone with a camera and showing the recordings to the doctor.

NOTE: If you have chronic shortness of breath, you are sometimes asked to rate your level of shortness of breath from 1 to 5 using this scale:

Class	Activity-related dyspnea
1	Does not worry about shortness of breath, except for exercise
2	Shortness of breath on hurrying on a level or climbing a small hill
3	Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes of walking at his own pace
4	Stops to breathe after walking about 100 yards or after a few minutes on level ground
5	Too breathless to leave the house, or breathless while undressing

Breathing control

Once the cause of your shortness of breath has been identified, you and your doctor can work together to control your breathing.Things you can do include ( from BLF website ):

If you smoke, get help to quit . There is very good evidence that visiting someone who is trained to help people quit smoking and regularly using nicotine replacement and / or anti-vomiting drugs increases your chances of becoming a long-term non-smoker.
Get flu jab every year.
Attempt some breathing techniques .There are various methods you can use to help you control your breathing. If you practice them and use them every day, they will help you when you are active and get breathless breathing. They will also help you manage if you suddenly feel short of breath. Some examples are:
– Blow as you walk: exhale when you make great efforts such as standing, stretching, or bending.
– Lip Breathing: Exhale as if you were whistling with your lips.
Be more physically active . Exercise can include walking, gardening, dog walking, housework or swimming, or going to the gym. Read our guide to exercising in bed or in a chair.
If you have a lung condition, you may be referred to the Pulmonary Rehabilitation (PR) program by your doctor, and if you have heart problems, there are also cardiac rehabilitation services available.These activities can help you control your shortness of breath, make you more prepared, and make you more enjoyable.
If you are short of breath due to a loss of fitness, ask your therapist or nurse practitioner about local referral schemes that support people wanting to be more active.
Drink and eat healthy and manage your weight . Your doctor can help you figure out what your healthy weight should be. If you are overweight, it will take more effort to breathe and move, and it will be more difficult to control your shortness of breath.
If you have diabetes, ask about educational activities that can help you manage your weight and eat a more balanced diet. Your PCP or Nurse Practitioner can help you find healthy eating support services.
Get treatment if you feel stressed or anxious . If there is no specialist dyspnea clinic in your area that can provide this kind of help, ask your GP to refer you to a counselor or clinical psychologist who can help you.Medication can sometimes help, too, so talk to your GP about it.
Use the right medication correctly Some dyspnea is treated with inhalers. If you have an inhaler, make sure someone checks it regularly as you know how to use it correctly. Don’t be afraid to ask to try different types if you can’t get along with what you have. Use them as directed. Ask your doctor or nurse for a written description of how you can manage your lung condition.
If you are taking a pill, capsule, or liquid for breathing control, make sure you know why you are taking it and ask your healthcare professional or pharmacist if you do not. If your shortness of breath is caused by heart failure, you may need to adjust your treatment according to your weight and the degree of swelling in your ankles. Make sure you have a written plan that you understand.
If you have COPD, you may have a rescue bag so you can start early treatment if you have an outbreak.This should always be accompanied by a written action plan that you understand and agree to.

Can oxygen help?

Evidence suggests that oxygen will not help your breathing if the oxygen level in your blood is normal. But if you have a condition that means your blood oxygen levels are low, oxygen treatment can make you feel better and live longer.

Your PCP can refer you for advice and tests.You should see a professional to assess your needs and make sure you are using oxygen safely. They will monitor oxygen use and change the recipe as needed. Never use oxygen without professional advice.

Further information:

90,000 Epileptic seizure provocateurs | Children’s Clinical Diagnostic Center in Domodedovo

Seizure provocateurs are events that precede the onset of an epileptic seizure and are considered by the patient and physician as a possible explanation of why the seizure occurred after the events occurred, and not earlier or later.

Most Reported Seizure Provocateurs:

1. Emotional stress is the most frequent provocateur of seizures (from 30% to 66% according to different authors). Relaxation (relaxation exercises) is often used to prevent or reduce the severity of attacks.

2. Deprivation (deprivation) of sleep – the second most frequent provocateur of attacks. It often accompanies hyperactivity, stress, alcohol and stimulants. Sudden awakening is the main provocateur of seizures in juvenile myoclonic epilepsy, and violent awakening is more “dangerous” than spontaneous.

3. Physical activity and fatigue . A decrease in blood pH (metabolic acidosis) during and after exercise is associated with the appearance of epileptiform activity on the EEG. Exercise-induced seizures usually occur after they have stopped. The risk of an attack after prolonged physical activity is significantly higher than after individual physical exercises interrupted by rest. Prolonged hypoxia or hypoglycemia after prolonged physical exertion is also likely to contribute to the onset of seizures.

4. Alcohol . Drinking alcohol is often associated with missed medication and sleep deprivation. Attacks usually occur during a sharp drop in blood alcohol concentration, especially when excessive alcohol consumption is accompanied by a lack of sleep.

5. Skipping the preparation . Skipping one or two doses of the drug rarely causes seizures. At the same time, if patients decide that they are cured and stop taking the drug, the risk of seizures becomes very high.Seizures caused by drug withdrawal are especially characteristic of abrupt withdrawal of barbiturates and benzodiazepines, and can also be observed in persons without epilepsy (“withdrawal syndrome”).

6. Drugs that lower the seizure threshold . Many classes of drugs prescribed in therapeutic doses can lower the threshold for seizures: antidepressants, antipsychotics, CNS stimulants, hypoglycemic agents, antibiotics, aminophylline, antihistamines, ephedrine, steroid hormones, and many others.

7. Metabolic disorders may result from diarrhea, constipation, acute infectious diseases, hepatic and renal failure and diuretic use. Hyper- or hyponatremia, hypokalemia, and hypoglycemia can provoke seizures in patients with or without epilepsy. In patients with diabetes mellitus, seizures often occur due to an overdose of insulin or sulfa drugs, as well as against the background of hypoglycemia due to ingestion of large amounts of food.

8. Hyperventilation . Excessive breathing, unrelated to exercise, can trigger seizures in some patients. Unintentional hyperventilation in daily life can be caused by anxiety, crying, or sexual activity.

9. Fever . An acute infection accompanied by an increase in body temperature can cause seizures in patients of any age.

10. Hormonal changes .From 10% to 70% of women note the relationship of attacks with the menstrual cycle. Pregnancy itself has little effect on the frequency of seizures. The main reason for the increased frequency of seizures during this period is a violation of the regimen of taking medications.

Authors: Dr. med. Kotov A.S .; doctor Eliseev Yu.V.

What are the different causes of hyperventilation?

Hyperventilation occurs when breathing becomes faster and heavier than usual. Anything from stress to intense exercise and medication are common causes of hyperventilation.Fast breathing can also indicate signs of certain medical conditions, from common problems like asthma to more rare conditions. Treatment for hyperventilation depends on the cause of the problem, but usually includes home care. If hyperventilation occurs, you should always consult your doctor to determine the cause.

Improper breathing technique in general can sometimes cause hyperventilation. Usually, a person inhales oxygen and exhales carbon dioxide. In contrast, excessive breathing causes a decrease in blood carbon dioxide levels, causing some of the symptoms of hyperventilation.

Often stress or anxiety causes hyperventilation. Stress from work or other life situations can lead to feelings of nervousness, which in turn can lead to symptoms such as rapid breathing with palpitations, lightheadedness, and dizziness and confusion. In addition to feelings of anxiety, the causes of hyperventilation can be based on fear of something that triggers panic attacks and rapid breathing, such as growth, crowds, or certain animals.

Physical activity or environmental factors can sometimes cause hyperventilation. Altitude changes have been reported to cause rapid breathing. High-intensity exercise can cause heart palpitations and shortness of breath or hyperventilation, especially if the person overdoes it.

Various reasons, if this medical problem may indicate symptoms of a different illness compared to everyday stress. An example of excessive breathing due to illness includes asthma, which inflames and constricts the bronchi.A blood clot that develops into deep vein thrombosis (DVT) can enter the lungs and cause breathing problems, even death, if left untreated. The disease that causes this symptom is chronic obstructive pulmonary disease (COPD), which restricts the air in the lungs. Medical experts also point out that other problems such as heart disease, stroke or pneumonia, as well as kidney and liver disease, chronic fatigue and heart rhythm disturbances are factors that can cause hyperventilation.

Drugs and other medications can cause hyperventilation as a side effect. For example, signs of side effects of aspirin or overdose may include hyperventilation or heart palpitations. Prescription medications such as asthma medications can also be adjusted by your doctor as they sometimes cause rapid breathing and heart palpitations. The causes of hyperventilation are also associated with overdose of methamphetamines, amphetamines and cocaine.

Treatment for these reasons ranges from self-care to medical options.Breathing exercises and relaxation techniques work if stress or anxiety leads to rapid breathing, while light to moderate exercise has been reported to reduce stress and, in turn, reduce the risk of hyperventilation. Beta blockers can help keep breathing in check if home care doesn’t fix the problem. If there are more serious underlying problems, treatment from a healthcare professional is always recommended.

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90,000 breath-hold diving Publications and reviews training in Kharkov

Snorkeling is not only swimming on the surface of the water, but also diving under water with holding the breath.One of the types of snorkeling is skin diving (from the English skindiving: “skin” – skin, “diving” – diving) or freediving (from the English freediving: “free” – free). This type of swimming involves taking a deep breath, then holding your breath and diving under water in order to see the underwater life from a closer distance than while viewing from the surface of the water. Skin diving takes practice and a lot of energy, so skin diving is a great way to keep your body in good physical shape.

Nine rules of breath-hold diving

1. Take a deep breath and hold your breath.
2. Bend your body so that your head is down and your upper body is in an upright position – you will immediately begin to dive.
3. Use your feet to submerge. Do not bend your knees and try not to row with your hands.
4. The mask will begin to press closer to the face as the water pressure increases at depth.
5. Blow out a little air through the nose to relieve the mask pressure.
6. Equalize the pressure in your ears as you dive (below is a technique).
7. Drive slowly and carefully while underwater to maintain air supply.
8. As you rise to the surface, exhale a small amount of air to empty the tube of water, and then take another sharp exhalation at the surface.
9. When lifting, keep an extended arm above your head to avoid hitting anything on the surface of the water.

Learning to Avoid Trouble!

Ear pressure equalization

As you dive deeper, the water pressure increases and affects the ears.It is necessary to equalize the pressure to avoid pain and discomfort. At the beginning of the dive, pinch your nose with your hand through the soft shell of the mask. Then try to exhale through the pinched nose. The air will go to the ears and the pressure will stabilize. You will immediately feel the difference. Blowing over your ears too hard, however, can cause injury, so do it carefully and do not continue diving if the pressure in your ears cannot be equalized. Practice ear blowing on land before diving.

We use loads correctly!

You may find it difficult to dive because of the positive buoyancy associated with the very salty water of the Red Sea. A wetsuit complicates this task, or even makes it impossible without the use of weights. Place the weights on your belt evenly while maintaining balance. You will become heavier and lower in the water, you will immediately feel that diving and staying underwater will become much easier. However, do not carry too many weights. It is best to seek advice from a dive instructor or guide.

Lung hyperventilation

There is a technique that allows you to stay under water longer – this is the so-called technique of hyperventilation of the lungs, which consists in releasing carbon dioxide from the lungs, which is responsible for reflex inhalation. At the same time, excessive hyperventilation is very dangerous and can cause loss of consciousness at a shallow depth. Therefore, never dive alone while using the hyperventilation technique.
The essence of hyperventilation is as follows: take two or a maximum of three deep and quick breaths; hold your breath on the last breath; dive and feel that you can stay underwater longer before the need for breathing arises.
Do not take more than 2-3 sudden breaths during hyperventilation. Excessive hyperventilation drastically reduces the volume of carbon dioxide, and oxygen will be used up before you even feel the need for a new breath.

Hyperventilation can cause: Hyperventilation | Michigan Medicine

Hyperventilation | Michigan Medicine

Topic Overview

Symptoms of hyperventilation

Check Your Symptoms

Try Home Treatment

Make an Appointment

Call 911 Now

Seek Care Today

Seek Care Now

Call 911 Now

Home Treatment

Breathing techniques

Using a paper bag

Symptoms to watch for during home treatment

Prevention

Preparing For Your Appointment

Credits

Hyperventilation Syndrome: Practice Essentials, Pathophysiology, Etiology

Hyperventilation.

Pathogenesis

Epidemiology

Aetiology

Presentation

Symptoms

Signs

Chronic hyperventilation

Differential diagnosis

Investigation

Management

Pharmacological

Associated diseases

Complications

Prognosis

Hyperventilation: cause or effect? | Emergency Medicine Journal

Case report

Discussion

Acknowledgments

References

Hyperventilation

Everything you need to know about hyperventilation

Hyperventilation — causes, symptoms, treatment and prevention

Feel like you run out of breath at the slightest sign of stress? You might be hyperventilating. Here are the reasons and treatment options for this condition.

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How to get vaccinated against pneumonia and why is hyperventilation of the lungs dangerous? Pulmonology doctors answer questions

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