Signs of hyperventilation syndrome: Hyperventilation Syndrome – Pulmonary Disorders
Hyperventilation Syndrome: A Diagnosis Usually Unrecognized
Hyperventilation syndrome is a common disorder that is characterized by repeated episodes of excessive ventilation in response to anxiety or fear. Symptoms are manifold, ranging from sensations of breathlessness, dizziness, paresthesias, chest pains, generalized weakness, syncope, and several others. Although sudden and extreme anxiety usually triggers discrete attacks, a pattern may be chronic, recurrent and subtle. The resultant physical sensations often dominate and obscure the underlying hyperventilation and cause the over breathing to be overlooked. Diagnosis and treatment rely on reproduction of symptoms by voluntary forced rapid breathing in the clinic, producing many of the recognizable symptoms and allowing for understanding and conscious breath control by the patient. Through this means the attacks may usually be ameliorated or eliminated entirely.
Anxiety; Depression; Hyperventilation syndrome; Non-cardiac chest pain; Panic attacks; Psychosomatic disorders; Syncope
Hyperventilation is one of the most commonly overlooked diagnoses in all of clinical medicine [1,2], occurring most often in young or middle aged subjects, and is estimated to constitute approximately 5%-10% of all general medical patients. Moreover, its manifestations may be chronically disabling, for in my personal experience in evaluating applicants for permanent disability status, I have estimated a frequency of as high as 15% or more. Despite its high prevalence, however, this diagnosis regularly eludes family practitioners, internists, and also several specialty groups as well, notably neurologists, cardiologists and psychiatrists. Although associated panic with extreme anxiety is usually obvious during the episodes, the somatic manifestations such as dizziness, weakness, chest pain, dry mouth, numbness and tingling often divert attention from the causative breathing disorder. Obscuring recognition even further, the syndrome can acquire a more subtle chronic and recurring pattern . In most instances, patients describe a feeling of shortness of breath, but they may be totally unaware of such rapid respiration. Once this diagnosis is suspected, simple measures can confirm its presence and allow for control of all the disagreeable bodily sensations, and, at the same time, reduce the underlying anxiety itself.
Cause of hyperventilation and physical effects
For most people, hyperventilation is rare and only occurs as an occasional response to fear or stress. For others, this condition occurs regularly as a typical response to emotional excesses such as fear, anxiety, or anger. When hyperventilation is a frequent occurrence, it is known as hyperventilation syndrome.
How emotional stress induces such a respiratory response is unclear, but it is likely rooted in the evolutionary â€œflight or fightâ€ reaction, wherein, in anticipation of imminent need for increased exertion combined with increased adrenergic drive, rapid respiration results. If such exertion is not required, however, this response becomes disproportionally great, setting in motion the undesirable chain of events noted in this report.
The excessive breathing produces hypocapnia, respiratory alkalosis and a complex sequence of physiologic changes responsible for most of the signs and symptoms; these changes may even produce bronchoconstriction that may actually result in audible wheezing, augmenting the sensation of dyspnea as well as simulating or intensifying preexisting asthma [3,4]. Thus since it can complicate asthma, the clinician should consider both asthma and hyperventilation when encountering features of both conditions.
Certain other physical and chemical disruptions can produce excessive breathing, and these include aspirin overdose, left ventricular failure, pulmonary emboli, pyrexia and others. Exclusion of these various physical conditions is usually rapidly accomplished by careful history and physical examination. Hence this discussion is limited to the most common syndrome that is emotionally rooted.
Symptoms and their cause
Because of rapid mouth breathing, the sensation of dryness of the mouth is a regular feature. The sensation of dizziness, or giddiness, sometimes resembles true vertigo, and may culminate in unconsciousness and resemble seizures, suggesting diseases that cause syncope or vestibular dysfunction. These symptoms probably result from one or two causes: 1) transient alkalosis , which increases the avidity of oxygen binding to hemoglobin such that oxygen becomes less readily available to tissues, including brain cells (the Bohr effect), or 2) hypocapnia causes increased cerebral vascular resistance and decreased cerebral blood flow . Symptoms may also be aggravated by upright posture, suggesting orthostatic hypotension. The somatic sensations of numbness and tingling (paresthesias) also probably originate in the brain, and they are typically perioral in location, but more often they affect the arms, hands, legs, and feet, occasionally dominant or exclusively localized to one side of the body-usually the left , simulating a vascular neurologic disorder. Additional symptoms include hot sensations, sometimes with diaphoresis, and feelings of chilliness. These sensations likely result from adrenergic stimulation combined with peripheral vasomotor changes. Musculoskeletal pains and spasms, sometimes noted primarily in the chest, may also occur in a variety of locations, such as the head and back. The chest pain is often variable in nature, lasting from minutes to hours, often sharp and migratory; but it may occasionally resemble a cardiac origin. Nausea and symptoms consistent with aerophagia and globus hystericus are also commonly associated with the anxiety and rapid breathing. Hyperventilation produces sinus tachycardia and other electrocardiographic changes [8-10], most commonly downward shifts of ST segments with flattening of the T waves in the left precordial leads together with an apparent prolongation of the QT interval, changes resembling those of hypokalemia. Isolated T wave inversions and marked ST depressions are less common. The ST shifts can closely simulate cardiac ischemic changes, but they are usually not induced-or are even lessened-by exercise.
The patient him/herself may overlook the original excessive breathing, having become preoccupied with the associated somatic symptoms, and frequently complain that they often cannot get a â€œdeep enough breath,â€ and they may sigh repeatedly while being interviewed, with predominately thoracic rather than abdominal respiration, often describing themselves as being anxious and depressed .
In many other instances of hyperventilation, bizarre unexplained somatic symptoms in virtually any area may dominate the picture and appear more severe than any demonstrable organic disease. Under these circumstances, the clinician must carefully seek associated signs that can allow for suspicion of the underlying hyperventilation .
Why is hyperventilation so often missed?
Because of tendency by clinicians to fixate on the multiple secondary bodily sensations, the underlying excessive breathing is often overlooked. Since this syndrome does not belong in a category of organic physical disorders, medical textbooks and school curricula seldom devote much attention to this diagnosis per se. While the underlying anxiety and panic are considered psychiatric conditions, the apparent physical manifestations are mistakenly attributed to the anxiety itself, and as a result, little or no attention is devoted to the inextricably associated hyperventilation.
It was not until 1980 that the specific concept of the panic disorder was designated as a psychological diagnosis . According to the latest psychiatric handbook, DSM-5 , diagnostic criteria for a panic attack include a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within minutes: 1) palpitations, and/or accelerated heart rate, 2) sweating, 3) trembling or shaking, 4) sensations of shortness of breath or being smothered, 5) feeling of choking, 6) chest pain or discomfort, 7) nausea or abdominal distress, 8) feeling dizzy, unsteady, lightheaded, or faint, 9) chills or hot flashes, 10) de-realization (feelings of unreality) or depersonalization (being detached from oneself), 11) fear of losing control or going insane, 12) sense of impending death, 13) paresthesias (numbness or tingling sensations), 14) chills or hot flashes.
Even cursory examination of this above list reveals that many of these symptoms attributed to panic likely result purely from hyperventilation. I have observed many of them even in otherwise normal individuals directed to purposely hyperventilate, including accelerated heart rate, trembling, dizziness, paresthesias, and hot or cold sensations. Although not included in the panic criteria, I have also regularly observed dryness of the mouth and generalized weakness and fatigue. When subjecting individuals with suspected panic attacks to voluntary forced breathing, I have encountered the common reproduction of other features of the entire syndrome that include sensations of shortness of breath and increased anxiety. Sometimes, but not always, chest pains typical of attacks can be reproduced.
Anxiety and fear that initiate the hyperventilation spells probably contribute primarily to symptoms such as fear of losing control, smothering sensations, and sweating. These spells often occur in the setting of agoraphobia. In recent years, few authors have considered the possibility that hyperventilation could have caused many-if not all-of the multiple somatic symptoms. Some , however, have recognized that panic attacks are inextricably associated with hyperventilation, in which the excessive breathing per se induces disagreeable somatic symptoms that produce further anxiety, resulting in a vicious cycle of more frequent and severe attacks.
Various Medical Diseases Simulated by Hyperventilation
The frequent occurrence of light-headed sensations, sometimes followed by syncope, often combined with paresthesias and weakness that can be dominant on one side of the body, suggest the possibility of a neurologic disorder such as cerebral vascular thrombosis or transient ischemic attacks. Various forms of neurogenic seizures are also suggested.
In as much as the hyperventilation syndrome is but one of many causes of chest pain, its importance as a causative factor in populations without cardiac disease is of special interest. For example, Beitman et al.,  in a study of non-anginal chest pain, provided a typical description of coexisting hyperventilation/panic disorder without considering the possibility that hyperventilation could have been an underlying contributor, an association that had been commonly noted previously [17,18].
A number of researchers have also examined functional disability and persistence of symptoms in patients with chest pain and normal coronary arteries, and they have discovered that approximately 40% have panic disorder . In following such patients for up to six years or more, at least 70% continue to have chest pain, which is often debilitating. Approximately half reported being unable to work due to their symptoms and their usual daily activities were limited by chest pain despite the supposedly reassuring finding of normal coronary angiograms. They usually continued to consult repeatedly with their physicians for the same complaints, frustrated that nobody seemed to understand the source of their plight. This is understandable, for in none of these instances was the possibility of hyperventilation sought to explain the mechanism of the chest pain, without which efforts to control this disorder would have been futile.
Finally, cardiac dysrhythmias also may be suspected as an explanation for syncopal episodes.
As noted above, hyperventilation may simulate or intensify asthma. Of importance, asthmatic attacks bear a disproportionally high relationship with both panic attacks and hyperventilation .
Other apparently physical conditions
In many other instances of hyperventilation, bizarre unexplained somatic symptoms in virtually any part of the body may dominate the picture and appear more severe than any demonstrable organic disease. Under these circumstances, the clinician must carefully seek associated signs that can allow for suspicion of the underlying hyperventilation .
Diagnosis and Treatment of Hyperventilation
First, given any of the manifold symptoms and signs noted above, it is incumbent on the clinician to suspect that the problem may be caused by hyperventilation, even if the breathing disorder is denied by the patient. Suspicion is especially important when the diagnosis of panic attacks is considered.
Given a high index of suspicion, the presence of underlying hyperventilation is usually easily confirmed. This is accomplished by reproducing many or all the symptoms after the patient is instructed to breathe rapidly and deeply for at least two or three minutes, or at least until some discomfort such as paresthesias or dizziness is experienced, which can be identified by the patient as being identical to some or all of those experienced during an actual episode. Once recognized, prevention and control of at least this part of the disorder are usually successful through explanation of symptom causation and how the symptoms can be aborted by either breath holding or rebreathing into a paper bag. Before one recommends paper bag rebreathing, however, diagnosis of hyperventilation syndrome must be secure, for adverse events may occur if one overlooks serious underlying conditions of acute Myocardial Infarction (MI), pneumothorax, pulmonary embolism and others. By allowing patients to understand the origin of the overbreathing, the simple maneuvers described above not only relieve the symptoms but help to allay the underlying anxiety that initially triggered the attack. This can be reinforced even further by instructing patients to try purposely hyperventilating at home, bringing on the typical symptoms, and then realizing how quickly they can be reversed by breath holding.
Curiously, the associated chest pains may not be reproduced in such a short time frame, requiring a lengthier period of overbreathing to develop . Alternatively, the chest pains may originate independently in the musculoskeletal system but intensified during an actual episode.
Although laboratory confirmation of this disorder with the use of respiratory testing for reduced blood and alveolar levels of CO2 has been advocated , I consider this unduly complex and expensive, but such testing could be reserved for difficult cases. Similarly, treatment aimed at training of proper breathing techniques rather than this simple explanatory approach detailed above, could be reserved as a secondary measure.
Few systematic studies have sought to demonstrate a causative role for hyperventilation in producing and sustaining panic attacks. One study , however, did demonstrate such a close relationship, providing a basis for treatment of both the breathing disorder and the panic state. In this instance, patients were provided a CO2 sensor and an audio playback device. The patients were directed to perform repeated breathing sessions per day for 28 days in their own homes. This treatment enabled patients to normalize their breathing patterns by controlling their respiratory rate and exhaled CO2, as measured by the sensor. The results were striking, for after 12 months, 68% of patients were panic-attack free, 96% of patients had reported a significant reduction in their panic symptoms, and all patients experienced long-lasting reductions in panic attack frequency and severity, anxiety symptoms, and avoidance behaviors, all of which were coupled with improvements in mood and quality of life. If confirmed by similar studies, this could provide a major step toward diagnosis and management of many-if not all-panic syndromes. This observation accords well with the likelihood that the panic and hyperventilation are often inextricably associated, providing a vicious cycle between the two, i.e., panic initiates hyperventilation, and symptoms from the latter then trigger more panic. As a practical matter, simple measures, as described above, may suffice to prevent and control the entire sequence of symptoms associated with panic in the vast majority of afflicted patients.
Treatment of the underlying anxiety can benefit this disorder through a pharmacologic approach with benzodiazepines, antidepressants and cognitive behavioral therapy. Interestingly, however, those recommending such treatments generally ignore the presence and potential benefit of the simplified breathing measures already presented .
Hyperventilation is one of the most commonly overlooked diagnoses in all of clinical medicine, baffling family practitioners, internists, and also several specialty groups as well, notably neurologists, cardiologists and psychiatrists. Although associated panic with extreme anxiety is usually obvious during the episodes, apparent somatic manifestations such as dizziness, weakness, chest pain, dry mouth, numbness and tingling often divert attention from the underlying breathing disorder. Patients often describe a feeling of shortness of breath, but may be totally unaware of such rapid respiration. Once suspected, simple measures of diagnosis and treatment usually suffice to prevent and control the disagreeable bodily sensations as well as the underlying anxiety itself. Such measures, if employed early in evaluation, can allow for the avoidance of costly and complex additional tests such as brain imaging, stress testing, interventional cardiovascular procedures and many others.
Hyperventilation: Symptoms, Causes, Treatment, Emergencies
You breathe without thinking because your body does it for you automatically. But things can change your breathing pattern and make you feel short of breath, anxious, or ready to faint. When this happens, it’s called hyperventilation, or overbreathing.
That’s when you inhale much deeper and take much faster breaths than normal. This deep, quick breathing can change what’s in your blood. Normally, you breathe in oxygen and breathe out carbon dioxide. But when you hyperventilate, the carbon dioxide levels in your bloodstream drop too low. You’ll notice it right away because you’ll start to feel sick.
Hyperventilation happens most often to people 15 to 55 years old. It can come about when you feel nervous, anxious, or stressed. If you hyperventilate often, your doctor may tell you that you have hyperventilation syndrome.
Women hyperventilate more often than men do. It may happen more often when a woman is pregnant, but the problem usually goes away on its own after the baby is born.
Many conditions and situations can bring on hyperventilation, including:
You may not always be aware that you’re overbreathing. But signs may include:
- Shortness of breath, or feeling that you can’t get enough air
- A faster than normal heartbeat
- Feeling faint, dizzy, or lightheaded
- Pain or tightness in your chest
- Frequent yawn or sighs
- A numb, tingly feeling in your hands or feet
You may be able to stop yourself from hyperventilating if you focus on taking controlled breaths.
These steps may not feel natural, but don’t let that stop you. Controlled breathing may help you begin breathing normally once again. If it works, you should feel better again within half an hour.
You can do it a couple of ways:
Purse your lips. Put your lips into the same position that you’d use to blow out birthday candles. Breathe in slowly through your nose, not your mouth. Then, breathe out slowly through the small opening between your lips. Take your time to exhale, and don’t blow the air out with force. Repeat these steps until you feel normal.
Limit your airflow. Keep your mouth closed, and press one nostril closed with your finger. Breathe in and out through the open nostril. Don’t inhale or exhale too quickly, and don’t exhale too hard. Repeat several times. You can switch nostrils if you like. Just do all your breathing through your nose, not your mouth.
If you’re with someone who’s hyperventilating, encourage them try these moves. Make sure that they inhale and exhale slowly, and coach them to repeat as long as needed, since you won’t see an instant change.
When to See a Doctor
If you aren’t able to get your breathing under control within a few minutes, or if you’re trying to change your breathing patterns and it isn’t working, see a doctor or go to the emergency room right away, especially if you have any pain. Do the same for anyone else who’s hyperventilating.
If this isn’t your first time hyperventilating and the problem gets in the way of your normal activities, you may have hyperventilation syndrome or an anxiety problem. Your doctor or therapist can find a diagnosis and help you manage the problem. Medication may help some people.
Hyperventilation | Johns Hopkins Medicine
What is hyperventilation?
Hyperventilation is rapid or deep breathing, usually caused by anxiety or panic. This overbreathing, as it is sometimes called, may actually leave you feeling breathless.
When you breathe, you inhale oxygen and exhale carbon dioxide. Excessive breathing may lead to low levels of carbon dioxide in your blood, which causes many of the symptoms that you may feel if you hyperventilate.
Symptoms and Diagnosis
Associated symptoms include:
Dizziness or lightheadedness
Shortness of breath
Belching, bloating, dry mouth
Numbness and tingling in your arms or around your mouth
Muscle spasms in hands and feet, chest pain and palpitations
The goal in treating hyperventilation is to raise the carbon dioxide level in the blood. There are several ways to do this:
Reassurance from a friend or family member can help relax your breathing. Words like “you are doing fine,” “you are not having a heart attack” and “you are not going to die” are very helpful. It is extremely important that the person helping you remain calm and deliver these messages with a soft, relaxed tone.
To increase your carbon dioxide, you need to take in less oxygen. To accomplish this, you can breathe through pursed lips (as if you are blowing out a candle) or you can cover your mouth and one nostril, breathing through the other nostril.
If anxiety or panic has been diagnosed, see a psychologist or psychiatrist to help you understand and treat your condition.
Learn breathing exercises that help you relax and breathe from your diaphragm and abdomen, rather than your chest wall.
Practice relaxation techniques regularly, such as progressive muscle relaxation or meditation.
Symptoms of Hyperventilation Syndrome
Hyperventilation syndrome is a nonmedical cause of shortness of breath. It is very scary but not life-threatening. It can be hard to tell hyperventilation syndrome apart from other causes of shortness of breath. If there is any doubt about the cause of difficulty breathing, call 911 immediately.
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Causes of Hyperventilation Syndrome
The term hyperventilation syndrome is a shortened version of the more descriptive “psychogenic hyperventilation syndrome,” which indicates a psychosomatic cause for breathing too deep and/or too fast. Basically, that means there is some sort of behavioral or emotional reason for the hyperventilation. In most cases, hyperventilation goes hand-in-hand with anxiety or panic disorders. Many of the symptoms of hyperventilation syndrome appear during what is commonly called a panic attack.
There are other, more serious medical conditions that may lead to hyperventilation. The most serious is related to an increase of pressure inside the skull (intracranial pressure), which can happen from a traumatic brain injury or from a stroke. The increased pressure pushes the brain through the foramen magnum, the opening in the base of the skull where the spinal cord exits. This is called herniation of the brain and leads to neurogenic hyperventilation syndrome, an involuntary reaction of the respiratory centers in the brain to increases in pressure.
For the purposes of this article, the term hyperventilation syndrome refers to conditions stemming from behavioral causes.
Recognizing Hyperventilation Syndrome
If a patient with rapid, shallow breathing has the ability to become calmer and slow his or her breathing, it may be hyperventilation syndrome. A behavioral cause of hyperventilation can be overcome, a medical cause of rapid breathing probably cannot. Working with the patient to slow his breathing often distinguishes the condition from other causes of shortness of breath as well as treats it.
Never assume a patient is suffering from hyperventilation syndrome. Always look for other causes of shortness of breath first. It’s important to note that hyperventilation patients must be conscious and able to communicate. Unconscious or unresponsive victims are likely not suffering from hyperventilation syndrome.
The Nijmegen Questionnaire to Identify Hyperventilation Syndrome
Developed to screen patients complaining of shortness of breath for possible hyperventilation syndrome, the Nijmegen questionnaire identifies several signs and symptoms of hyperventilation syndrome. Correctly using this screening tool requires a clinical background, especially since many of the screening questions could be symptoms of much more serious medical conditions.
Of the hyperventilation syndrome symptoms and signs listed in the Nijmegen questionnaire, there are several that are distinctly related to hyperventilation syndrome. These signs and symptoms are strong indicators of hyperventilation syndrome, especially if the patient has several of them:
- Tense feeling
- Fast or deep breathing
- Tingling in fingers and hands
- Stiffness or cramps in fingers and hands
- Tightness around the mouth
- Cold hands or feet
- Palpitations in the chest
Despite their relationship to hyperventilation syndrome, each of these signs and symptoms could also be related to other medical conditions. Always assume the worst possible scenario first, then proceed to less serious conditions, in order to identify the cause of shortness of breath.
Hyperventilation – Symptoms, Causes, Treatments
Hyperventilation, or overbreathing, is a condition in which you breathe too quickly or deeply. Usually, hyperventilation occurs with anxiety. Overbreathing can cause imbalances in the levels of oxygen and carbon dioxide in your blood. These imbalances can make you feel breathless, dizzy, light-headed, confused or weak.
Along with rapid breathing, other symptoms of hyperventilation may include abdominal bloating, chest pain, difficulty sleeping, dry mouth, muscle spasms, numbness, or tingling.
Hyperventilation is most often caused by stress, anxiety or panic. It may also result from medical conditions, such as asthma, bleeding, a pulmonary (lung) condition, a cardiac (heart) condition, diabetic ketoacidosis (life-threatening complication of diabetes), or an infection. The side effects of certain drugs or medications can also trigger hyperventilation. Along with rapid breathing, other symptoms of hyperventilation may include abdominal bloating, chest pain, difficulty sleeping, dry mouth, muscle spasms, numbness, or tingling.
Hyperventilation can happen to anyone. Usually, adults breathe at eight to 16 breaths per minute. A breathing rate exceeding 16 breaths per minute is characteristic of either hyperventilation or tachypnea (rapid shallow breathing). While tachypnea and hyperventilation are sometimes considered to be the same, hyperventilation is usually related to stress or anxiety.
Treatment for hyperventilation is aimed at increasing carbon dioxide levels in the blood, usually by adjusting your breathing rate. Seeking reassurance from nearby people or reducing stress may help you cope with anxiety or panic. You can also increase carbon dioxide levels and decrease your oxygen levels by pursing your lips or breathing through a single nostril. Long-term care for hyperventilation includes psychiatric help, breathing exercises, relaxation techniques, and physical exercise. In serious cases, medication may be prescribed to treat hyperventilation.
Seek immediate medical care (call 911) if this is your first experience of hyperventilation, or if you have a fever, bleeding, severe pain, chest pain, or shortness of breath with hyperventilation.
Seek prompt medical care if you have hyperventilation that is persistent or causes you concern.
Hyperventilation Syndrome – AFP 50 Years Ago
Am Fam Physician. 2000 Dec 1;62(11):2409-2412.
This feature is part of a year-long series of excerpts and special commentaries celebrating AFP’s 50th year of publication. Excerpts from the two 1950 volumes of GP, AFP’s predecessor, appear along with highlights of 50 years of family medicine.
This feature, titled “Hyperventilation Syndrome,” and written by O. Brandon Hull, M.D., Lubbock, Texas, is reproduced from the September 1950 issue of GP. The commentary is provided by Sumi Makkar, M.D., editorial fellow for AFP.
Hyperventilation syndrome is produced when a patient has some stimulus leading to overbreathing with a resultant loss of carbon dioxide from the lungs. Although the physician sees such a case practically every day and the symptoms follow a fairly definite pattern, too often it is incorrectly diagnosed.
Hyperventilation syndrome is a symptom complex seen practically every day of a physician’s practice. It has been estimated by Kerr (1937) to account for 25 to 33⅓ percent of the general practitioner’s cases. Too often this type of case goes unrecognized and undiagnosed, the patient being considered by the attending physician as a “neurotic” in order to account for the multiplicity of complaints. Or, all too frequently, the patient is diagnosed as having a serious illness, generally heart disease. It is the purpose of this paper to stress the common occurrence of this syndrome in the everyday practice of the general practitioner, the internist, and every other specialist. Because of its bizarre manifestations and its basic etiology, it is seen by everyone regardless of the limitation of one’s practice.
Too many of us have been lulled into a sense of false security by medical school teachings. We were taught to diagnose all organic diseases and have been exposed to those stressing psychosomatic complaints. Most of us find, however, that we fall short when it comes to dealing with cases having many vague complaints, for all too often a supposed complete history, physical, and laboratory work-up fail to reveal actual pathology. Hyperventilation syndrome is in this category. We have heard of it in medical school, maybe read an occasional article. There is no question in our own mind but what we could easily diagnose a case of tetany without assistance. But do we recognize the mild symptoms seen in most of these cases? The usual teachings fail to associate these common experiences in daily practice, and since one has to draw upon his own experience and ingenuity to explain them, he frequently remains confused or makes an erroneous diagnosis. Unless a case shows definite signs of tetany, we may miss the chronic or mild forms with early signs and symptoms.
Let’s discuss briefly the physiologic mechanism producing hyperventilation syndrome, the common complaints, and then present case histories of the type encountered in every practice.
Although much work has been done on the physiology and biochemistry of this subject, it is not completely understood. The scope of this paper does not include the experimental side of the problem but rather calls to your attention the practical significance of the studies of Haldane (1908) and others through Goldman (1922) to Kerr, Kerr having introduced the term hyperventilation syndrome in 1937. Suffice to say, hyperventilation syndrome is produced when a patient has some stimulus which produces overbreathing and overventilation with the resultant loss of carbon dioxide from the lungs. This produces a change in the blood pH, and alkalosis results. There is some argument that this is the complete story, but one gets lost in the observations of the biochemist and physiologist. The basic change is essentially as described, and for further study as to whether alkalosis is the sole cause for the actions the adrenals play and many other factors, one is referred to the literature on the subject.
Hyperventilation syndrome produces a multiplicity of sensations to the patient and a multitude of symptoms and complaints for the physician to understand. They follow a fairly definite pattern: more commonly, headache, lightheadedness, dizziness, constriction around the chest, dyspnea, palpitation, numbness and tingling of the extremities, drawing of the hands, even sharp chest pain, and a sensation of suffocation. And to quote some of the patients, “I hurt all over,” “My hands tingle,” “I can’t breathe,” “I can’t get any air,” and the list may go on, depending on the description of various people. These have been produced experimentally by Fraser (1938) and Sargant (1940), Hinshaw and Boothby (1941). Soley (1948) and Shock (1938) have explained the “effort syndrome” on a hyperventilation basis.
The important thing to recognize is that the hyperventilation syndrome varies in degrees from patient to patient. The stimulus may be so different as to completely baffle the physician. A student nurse ordinarily in excellent health starts having menstrual cramps and hyperventilates producing all the symptoms listed above, even to the point of tetany. A politician gets excited listening to the election returns and develops a supposed heart attack, or it may be a young man with a chill at the onset of pneumonia, a patient with ulcer pain, or a truck driver after a minor traffic entanglement.
One must rely solely on a very careful history and elicit time of onset and place to get a possible lead if it is a patient complaining of having had “fainting spells,” “heart attack,” “dizzy spells,” or any symptoms as listed above. A patient who sighs frequently or “Can’t breathe below here,” pointing toward the sternum, and stating “I can breathe but the air doesn’t do me any good,” is one to be observed closely and to be given a hyperventilation test in an effort to reproduce the symptoms. If one sees the patient in an attack, usually as an emergency, one has an advantage because then he understands the situation and can obtain a more reliable history, especially if one observes the environment and surroundings….
Treatment of hyperventilation cases reduces to a few basic facts.
A complete, careful, detailed history including the time, place, and circumstances preceding the attack or attacks.
Complete physical examination and any laboratory work deemed necessary.
Hyperventilation test by having the patient breathe rapidly 15 to 30 times a minute through the mouth with a full expansion of the chest will reproduce many of the symptoms that occurred with the attack. Maybe not all because of the different type of stimulus. Breathing into a paper bag restores it normally within one to three minutes. One takes a small paper bag, holding it over the nose and mouth so that the patient may rebreathe for one to three minutes, and, in rebreathing the carbon dioxide, the symptoms subside gradually, usually within three minutes. When this is done, it gives the physician the opening he needs to convince the patient that hyperventilation is the cause of his complaints.
Many physicians have shown little interest, have spent too little time to thoroughly recognize the significance of such a variety of complaints in the so-called “neurotic.” The patient who is reassured without adequate explanation or told “it’s all in your head” or “you are just imagining your symptoms” remains unsatisfied and all too frequently seeks a cultist who will spend time on the patient. Any organic lesion must be described and treated, but to prevent hyperventilation syndrome the patient must have an explanation in terms he can understand and must be taught to control it. The general practitioner and internist must then decide how much can be accomplished by treating the organic lesion and preventing the initial stimuli from producing hyperventilation. If it is purely on an anxiety state and too fixed for the physician, then a psychiatric consultation should be advised. Medication such as phenobarbital or ammonium chloride may help temporarily in mild anxiety states and get temporary results, but the cause must be found and eliminated in all cases if satisfactory results are to be obtained.—O. BRANDON HULL, M.D.
Dr. Hull describes an important phenomenon that is likely underappreciated and underdiagnosed. In a review of the literature from the past four years, few articles were found that were entirely devoted to hyperventilation syndrome. One review article in Chest acknowledges the complexity of the syndrome and the scarcity of information written on the subject.1 The term has been applied in multiple contexts, including psychiatry and physiology, and its usefulness as a single entity for any discipline has been questioned. A study of 23 patients who presented to the emergency department with hyperventilation further emphasizes the uncertainty surrounding the nature of the syndrome.2 The authors of this study suggest that the etiology of the syndrome is multi-factorial, including anxiety and, possibly, asthma. 3 Despite the lack of information about the cause of hyperventilation syndrome, the physiologic changes induced by hypocapnia are very real to the patient.
Curiously, I have for the most part used the term “hyperventilation” to describe patients in the setting of intensive care or patients with acidosis and secondary respiratory alkalosis. Neither in teaching rounds nor in formal lectures has it been emphasized that the constellation of symptoms including dyspnea, lightheadedness, and numbness and tingling of extremities can be attributed to hyperventilation syndrome.4 Instead, I suspect we have all been taught to first and foremost consider diagnoses like myocardial infarction, pulmonary embolus, arrhythmias and stroke. In this medicolegal era, fear of the consequences of missing serious conditions leads us to disregard diagnoses that are not lifethreatening.
Retrospectively, I can recall several patients who anxiously presented in an outpatient setting with atypical chest pain, shortness of breath or dizziness. After a review of their cardiovascular risk factors, a preliminary examination and often electrocardiography, I generally reassured the patients and sent them home. Although I attributed their symptoms to anxiety, some patients were not relieved with that explanation. Perhaps if I had asked them to hyperventilate in the office and triggered their symptoms (hyperventilation provocation test), I could have revealed a more believable cause for their symptoms. Even though the diagnostic value of the hyperventilation provocation test has been questioned, it is certainly a handy tool that can ease a patient’s distress.5,6
While “25 to 33⅓ percent of the general practitioner’s cases” seems a gross overestimation of hyperventilation syndrome, it is likely more prevalent than we think. Maybe today’s generation of doctors is more excited about diagnosing conditions like chronic fatigue syndrome, irritable bowel syndrome or fibromyalgia. Nonetheless, hyperventilation syndrome is a common source of distress among patients now, just as it was 50 years ago. In the face of rising health care costs, it is prudent to consider this syndrome in our differential diagnoses.—sumi makkar, m.d.
1. Gardner WN.
The pathophysiology of hyperventilation disorders. Chest.
2. Saisch SG,
Patients with acute hyperventilation presenting to an inner-city emergency department. Chest.
3. Singer EF.
Acute hyperventilation in the emergency department. Chest.
4. Rosen P, ed. Emergency medicine: concepts and clinical practice. 4th ed. St. Louis: Mosby Year Book, 1998:1466.
5. Hornsveld H,
The low specificity of the Hyperventilation Provocation Test. J Psychosom Res.
6. Vansteenkiste J,
Diagnostic tests of hyperventilation syndrome. Eur Respir J.
Hyperventilation | Health Navigator NZ
Hyperventilation is a breathing pattern disorder. It can be defined as moving more air through your chest than your body can deal with.
Key points about hyperventilation
- Hyperventilation syndrome is a common breathing disorder.
- It affects between 10–30% of otherwise healthy people.
- Symptoms include shortness of breath, rapid breathing and heart rate.
- Symptoms such as chest pain or dizziness should be checked by a doctor.
- Hyperventilation may be a response to emotional or environmental factors.
- The condition can cause changes to bodily systems, tension and headaches.
- Treatment involves breathing retraining and medication in some cases.
What is hyperventilation?
Hyperventilation syndrome (HVS) is defined simply as moving more air through your chest than your body can deal with. It may be caused by breathing faster than normal (more than 15 breaths a minute), mouth breathing, sighing or yawning frequently. Most people have experienced short episodes of acute over-breathing during stressful or frightening events, and that is very easy to spot. But chronic hyperventilation, characterised by a wide array of symptoms, mimics serious disease and is baffling to both sufferer and doctor alike.
The balance between the oxygen-rich air you breathe in and the carbon-dioxide rich air breathed out is controlled by your lungs. In chronic ‘over breathers’, too much carbon dioxide is flushed out of your system, producing unpleasant changes. Even slight falls in carbon dioxide levels directly affect nerve cells, as well as blood flow to your heart and brain, producing a wide variety of symptoms in any organ or system in your body.
Natural anxiety over symptoms leads to further over-breathing, creating a vicious circle. This new breathing pattern becomes a major stress all by itself. The normal pattern of breathing often changes from abdominal breathing to upper chest breathing, often through your mouth, leading to changes in upper chest and neck muscles, which in turn causes pain, tension and headaches.
What causes hyperventilation?
Hyperventilation syndrome is your body’s way of signalling distress. There are many triggers, involving physical, emotional and environmental factors.
- Especially at risk are people who push themselves too hard at work, study or sport. or simply burn the candle at both ends.
- For some, hyperventilation syndrome is an occupational hazard if their jobs involve a lot of speaking (eg, actors, lawyers, telephonists).
- Dusty or noisy workplaces.
- Chronic mouth-breathers are particularly prone, as are people with asthma.
- Anaemia (not enough red oxygen carrying cells in your blood) stimulates breathing rates.
- Hormonal triggers. CO2 levels drop by up to 25% post-ovulation, during pregnancy and menopause.
- Poor posture or ergonomics at work and resulting occupational overuse syndrome are common triggers.
- After surgery, illness or prolonged social or physical stress
What are the symptoms of hyperventilation?
Acute attack – agitation, rapid upper chest breathing and heart-rate, chest pain, shortness of breath, nausea, tingling, dizziness, clammy hands, dilated pupils, perhaps fainting and general weakness.
Chronic or long-standing – general tiredness, lack of concentration and sleep disturbances, tingling, dizziness, chest pain and palpitations, irritable cough and breathing discomfort with frequent sighs and yawns, erratic blood pressure, upset gut, bloated feelings, nausea, sexual problems, achy muscles, twitching and cramps, tension and panicky feelings, depression and anxiety.
Chronic hyperventilation is increasingly recognised as a significant cause of ill-health, although it remains widely under-diagnosed. If undiagnosed and untreated, the chronic hyperventilator lives in fear of symptoms and self-confidence can take a nose-dive. Life can become a misery for the over-breather.
Caution: Known as the great mimic, some hyperventilation syndrome symptoms such as chest pain, dizziness and shortness of breath need checking by your doctor to rule out serious events.
How is hyperventilation diagnosed?
You need an accurate diagnosis so do go and see your doctor. They may refer you to a specialist physiotherapist for further assessment and to help identify possible triggers.
How is hyperventilation treated?
Half of the cure is knowledge of the disorder and its triggers. Half is hard work – undertaking and committing to breathing pattern retraining and learning effective specific relaxation methods.
A structured treatment plan often includes:
- breathing retraining
- upper respiratory health assessment
- postural and upper chest musculoskeletal balancing
- stress recognition
- physical coping strategies
- sleep hygiene
- a graduated fitness regimen/lifestyle appraisal
- counselling for anxiety and depression if required
- medicine such as anti-anxiolytics/muscle relaxants if indicated.
It takes up to 6–8 weeks to change an established pattern from dysfunctional breathing back to normal. For some, it may take longer. Regular and effective practice is essential with regular checks with your specialist physiotherapist and liaison with your GP and/or counsellor.
What are some common concerns with hyperventilation?
Am I going mad? Have I got a serious disease? Why me? Will I ever get over it? These are all common expressions of disbelief at being diagnosed with HVS. The good news is HVS/breathing pattern disorders are just that – a disorder not a disease. The bad news is that it takes time, patience and practice, practice, practice. There is no instant cure.
As you learn to normalise your breathing and so restore balanced carbon dioxide and oxygen levels, the unpleasant symptoms associated with over-breathing will subside. You can enjoy life again!
Breathing Works Breathing pattern disorders clinic and resource centre, Auckland
90,000 Hyperventilation syndrome – symptoms and treatment
Author: doctor, scientific director of JSC Vidal Rus, Zhuchkova T. V., [email protected]
Hyperventilation is a phenomenon that occurs with frequent shallow breathing when inhalation is taken from the upper chest. This causes the level of carbon dioxide in the blood to decrease.It is the decrease in the carbon dioxide content that leads to the fact that hemoglobin does not give up oxygen and the body suffers from hypoxia. The arteries contract, which reduces the amount of blood that is transported through the body. In this case, our brain and body experience a lack of oxygen.
Causes of hyperventilation
A similar condition can occur with very strong anxiety, fear, or unreasonable outbursts of emotions. Many other conditions can also trigger hyperventilation syndrome – panic disorder, stress, hysteria, heart disease such as congestive heart failure or heart attacks, acute pain, drugs that cause bleeding (such as acetylsalicylic acid overdose), pregnancy ketoacidosis, and similar medical conditions , the use of stimulants, lung diseases (asthma, chronic obstructive pulmonary disease or pulmonary embolism / blood clots in the vessels of the lungs /), infectious diseases (for example, pneumonia or sepsis).
Symptoms of hyperventilation
If you experience these symptoms, you should immediately see a doctor: rapid breathing, shortness of breath, tight feeling, tightness, chest pain, anxiety, dry mouth, blurred vision, tingling in the fingers and toes, pain and cramps in the hands and fingers , loss of consciousness.
What Can You Do
During an attack it is necessary to slow down the respiratory rate. Take 1 breath every 10 seconds. Don’t breathe into a paper bag.This is dangerous because you may not have enough oxygen.
You may need the help of others to cope with the stress and anxiety that causes hyperventilation. Seek help from family, friends, a spiritual mentor, doctor, or mental health professional. You should definitely see your doctor.
What a doctor can do
Your doctor will perform a thorough physical examination.
During your visit, your doctor will be able to assess how often you breathe. If your breathing rate is not too high, your doctor may specifically induce hyperventilation by showing you how to breathe.
When you are hyperventilating, your doctor will be able to see how you are feeling and observe your breathing by determining which muscles in your chest and surrounding areas are working as you breathe.
Among other things, the doctor may conduct the following tests: ECG / chest x-ray, blood test for oxygen, carbon dioxide, computed tomography of the chest, study of ventilation / blood supply to the lungs.
90,000 Hyperventilation syndrome: symptoms, treatment
Initial appointment with a neurologist: 1850 rub.
Symptoms of hyperventilation syndrome can be as follows:
- rapid breathing,
- frequent sighs,
- dry cough,
- poor tolerance of stuffy rooms,
- sometimes convergence of fingers and toes,
Hyperventilation syndrome ( GVS ) is a disorder of the human autonomic system, in which the usual respiratory control program is disrupted. This is a pathology that has a paroxysmal course. This phenomenon leads to the fact that the degree of saturation of the body with carbon dioxide decreases, the acidity of the blood changes. Hypoxia (oxygen starvation) occurs. Among the causes of DHW are unreasonable outbursts of emotions, heart failure, neurological and mental disorders.However, the disease is usually psychogenic in nature.
What are the symptoms of hyperventilation syndrome? Most often, doctors hear from patients the following complaints: “ I can not breathe deeply “, “my heart hurts.” These are the usual hyperventilation syndrome symptoms. treatment of this disease should be carried out by a professional neurologist. Only a specialist can determine the presence of a disease, correctly interpret the shift in the pH of the blood towards alkalosis.A qualified physician will not confuse bronchial asthma and hyperventilation syndrome. He will prescribe adequate and effective treatment.
Pulse Medical Center will help you recover! We will relieve you of hyperventilation syndrome. The best doctors, the latest equipment, proven drugs and effective therapeutic diets – all this at the Pulse MC!
The Pulse Medical Center employs highly qualified neuropathologists who specialize in disorders of the human autonomic system.They will conduct a high-quality examination and make an accurate diagnosis in a short time. Hyperventilation syndrome (symptoms) – treatment of this disorder will be of high quality in the “Pulse” MC!
We are pleased to offer you individual comprehensive programs that guarantee a quick recovery. Our healing methods include more than pharmacotherapy. Professionals at the Pulse Medical Center practice treatment with massage, SPA procedures, audio-video sensor regulation. After undergoing therapy, the words “ cannot breathe deeply ” will cease to be a part of your life!
Neuropathologists at the Pulse Center do not just diagnose hyperventilation syndrome .Treatment will include work with psychologists. We will eliminate the very cause of the disease. The Pulse Medical Center will bring you back to a healthy and happy life!
Call us or sign up for an online consultation right now!
Hyperventilation syndrome – causes of development and treatment
Hyperventilation syndrome involves rapid breathing only in the upper part of the lungs, due to which the level of blood saturation with carbon dioxide is insufficient.Against this background, hypoxia develops, the arteries gradually narrow, and the volume of blood in the circulatory system decreases. The bottom line is that the body’s cells receive less oxygen than they need.
What causes hyperventilation
This syndrome often manifests itself in those who constantly experience panic attacks , stress, fear, hysteria, psychological disorders, deep depression. But infectious diseases, as well as pneumonia and heart failure, can cause a similar effect.
How to detect hyperventilation syndrome
Please note that this condition is potentially hazardous to human health and life. If you find the first signs, you should consult a doctor.
Signs of hyperventilation:
– Rapid breathing and a feeling of constant lack of oxygen;
– Pressing feeling in the chest area;
– Dry mouth;
– Tingling in the fingers, decreased temperature of the extremities;
– Tightness in the chest area.
What to do during seizures
The described syndrome can develop slowly, or it can come with an attack. In the second case, it may seem to a person that he cannot breathe and that he is having a heart attack (chest discomfort due to hyperventilation syndrome is often confused with a heart attack). When the syndrome occurs, you must call an ambulance or contact your doctor directly. At a critical moment, it is necessary to slow down breathing and not breathe very often, in small breaths.Because of this, the volume of absorbed carbon dioxide will only increase.
The main task is to cope with anxiety and anxiety attacks. It will seem to a person that he is about to suffocate. It is advisable at such a moment to call someone for help for moral support.
How to treat hyperventilation syndrome
First of all, the doctor should conduct a comprehensive medical examination and look at a snapshot of the lungs. After understanding the situation, medications are prescribed, as well as exercises for proper breathing.It is difficult to completely get rid of the problem, but there are various methods (including medicinal ones) that improve blood circulation and increase the oxygen saturation of the blood.
Learn more about diseases with the letter “D”:
Soft tissue hematoma,
Herminoma of the brain
Hypertensive cerebral crisis
Description and causes of development
Hyperventilation syndrome (HVS) has a mental and neurological nature, affecting the development of an abnormal breathing rhythm, which leads to excessive ventilation of the lungs.The disease proceeds against the background of vegetative, mental, respiratory disorders, as well as malfunctions of the muscle tone. For the first time in the medical literature, the phenomenon was described in the 70s of the 19th century by the American doctor Da Costa. In reference books, you can find other names for the disease, but the original term has firmly taken root in medical practice.
The main factor in the development of hot water supply is irregular breathing formed over a long period of time. Anomalies are susceptible to such categories of people as people involved in dynamic sports, playing wind instruments, experiencing a prolonged state of stress, observing the process of strangulation of other people (drowning, suffocating during an asthmatic attack, etc.).etc.). In addition, physiological deviations that affect the formation of the respiratory rhythm play an important role. All possible causes of the phenomenon are divided into three groups:
- Psychogenic. This group accounts for more than half of all cases of morbidity. Against the background of experienced anxiety, depressive periods, panic attacks, neurasthenia, hysteria, there is a large proportion of the likelihood of developing hyperventilation syndrome. If a patient in childhood witnessed another person suffocating, an emotional transfer of this situation to oneself may occur.
- Organic. This group includes physiological factors: dysfunction of the central nervous system, malfunctions of internal organs, hypertension, systematic bronchitis, diabetes. The incidence of HVS against the background of anatomical lesions is about 5% of the total.
- Mixed. The group includes 35% of cases. It is characterized by the fact that the catalyst for the onset of the disorder is the psychological factor in the existing physiological pathology.In addition, there are cases when the syndrome was formed as a result of prolonged use of certain types of medications with a hormonal composition.
Unlike many other internal systems, a person can partially control the respiratory function – hold his breath, take a deep breath, increase and decrease the frequency of inhalation and exhalation. Therefore, the emotional and mental status of the patient directly affects the respiratory rhythm. During anxiety and stress, there is a change in the biochemical balance in the body, a long-term violation of which affects the exchange of calcium and magnesium.Respiratory enzymes are produced in a different amount, which provokes increased ventilation of the lungs. Not only an increased amount of oxygen enters the blood, but also carbon dioxide is intensively removed from it. This leads to a change in the acid-base balance of the blood solution to the alkaline side. The next stage is a change in consciousness, disorder of autonomic functions, increased anxiety and fear. And increased anxiety again provokes respiratory dysfunction. It becomes difficult for a person to “break out” of this status on his own, even if the initial provoking factor has already exhausted itself.
Signs of pathology
Symptoms of pathology are multifaceted and can manifest in each individual case in different ways. But in almost all patients, three main signs are recorded: a failure in the frequency of respiration upward, emotional disorder and a change in the tone of the muscular apparatus.
Respiratory dysfunction is manifested by symptoms such as:
- feeling short of breath;
- Spasm in the throat, feeling of difficulty getting air into the respiratory tract;
- Violation of the automation of movements during inhalation, “stopping” breathing, forcing the patient to apply control efforts;
- Constant desire to yawn, cough, take a deep breath, sniff during sleep and while awake.
The DHW phenomenon against the background of anxiety causes the following complaints:
- chronic nervous tension;
- unreasonable disturbance;
- people lose the ability to relax;
- a feeling of fear when being in an open space with a large number of people around.
An increase in muscle tone is associated with a change in the chemical composition of the blood solution, which affects the increase in nervous excitability. The patient complains of constant tingling in the extremities, numbness, loss of sensitivity, spasm of certain parts of the body, convulsions.Accompanying general symptoms are systematic headaches, soreness in the abdomen, increased gas production, unstable stools, tension in the heart area, heart palpitations, and clouding of consciousness.
In acute cases, attacks occur – crises, when a person thinks that he is about to suffocate. The condition is akin to a panic attack. At this moment, the patient is convinced that he is in a place where no one can provide him with medical assistance. There is nausea, dizziness, heartbeat in the head, fear of death, suffocation, hot flashes or, conversely, cold, pulling pain in the heart.With the described status, respiration in a plastic or paper bag helps well. The patient inhales the air that he himself had exhaled before. It contains an increased concentration of carbon dioxide, which stops the imbalance in the blood and reduces symptoms to naught.
How is the disease diagnosed?
Respiratory ailments and a large number of symptoms often lead specialists to assume the presence of organic disorders of the pulmonary and cardiovascular system. Initially, an examination is carried out by a therapist, cardiologist and pulmonologist.Survey measures do not reveal serious physiological disorders. In this case, the therapist pays increased attention to the emotionality and general mental state of the patient, redirects him to a neurologist.
The specialist carefully collects a psychogenic anamnesis, asks about the traumatic situations experienced, fears originating in childhood, neuroses, depressive states. Next, a neurological examination, electromyography is performed, which allows detecting increased excitability of nerve and muscle fibers.
Of great importance is the follow-up examination by a psychologist, who will not only determine the structure of the personality, but also carry out testing using a special questionnaire drawn up by Dutch scientists. This survey reveals the presence of the syndrome in 90% of cases. A hyperventilation test is performed: the patient is asked to breathe deeply for a while. If deep breaths lead to vegetative changes, emotional anxiety, this indicates a positive test result.
A laboratory study of the blood composition is carried out, a drop in the pressure of carbon dioxide in the composition is detected, as well as a decrease in the amount of calcium and magnesium elements.In parallel, an examination of the internal organs takes place using instrumental methods. This is necessary to exclude or identify physiological pathologies leading to DHW.
How to deal with hyperventilation syndrome?
Reconstructive manipulations include both drug therapy and psychoemotional correction. It is important to explain to a person that his disease is not associated with organic damage, that it is formed against the background of mental imbalance and unreasonable anxiety.The treatment is based on work with a psychologist who conducts a course of psychoanalysis of children’s fears and experienced stressful moments. The patient must be taught respiratory gymnastics and persuaded to exercise regularly. An additional technique is teaching ways to relax the body. Acute crisis is relieved by using the package. An instrumental method for controlling the frequency and depth of respiration is biofeedback therapy. Receiving data from special equipment, they help the patient learn how to correct movements during inhalation and exhalation.
Drug treatment includes a course of antidepressants, mild sedatives and antipsychotics, vegetotropes. To normalize the blood composition, drugs with an increased content of calcium and magnesium are prescribed, which reduce the body’s need to breathe deeply and have a calming effect, reduce muscle and nervous excitability. Recovery takes a long period – about six months. When a positive effect is achieved, the person continues to be periodically observed by a specialist – a neurologist.
Prediction of the course of the disease and preventive measures
DHW does not pose a significant threat to life, however, it greatly reduces its quality. If you do not seek professional help in time, the symptomatology progresses, the person loses the ability for subsequent social activity, nervous upset and fears are aggravated. The effectiveness of the treatment has a high level, the patient has every chance of a full recovery. It is important to systematically form a positive outlook on life, to change the attitude towards stressful situations.This will avoid recurrence of the pathology in the future. If necessary, it is important to seek psychological help in a timely manner.
Hyperventilation syndrome – signs, causes, symptoms, treatment and prevention
The diagnostics are based on a number of methods. Among them:
- Analysis of complaints of the disease, anamnesis.
- General examination, listening to the lungs with a phonendoscope.
- Spirometry – allows you to assess air permeability, the ability of the lungs to expand.
- Capnography – study the content of carbon dioxide gas in the exhaled air.
Voluntary hyperventilation test – used for typical symptoms.
Study of the gas composition of the blood – the voltage in the blood of carbon dioxide, oxygen is determined, the saturation of the blood with oxygen is estimated.
Also, the doctor offers to fill out a special questionnaire, in which you need to assess the severity and quantification of symptoms. Depending on the amount of points, it is roughly judged whether the patient has pathology.In some cases, it is necessary to consult a psychotherapist.
Treatment is based on changing the patient’s attitude to his illness, breathing exercises, medications to eliminate internal tension. It is possible to influence the neurophysiological and neurochemical foundations by prescribing psychotropic, vegetotropic agents and drugs that reduce neuromuscular excitability. Thus, ergocalciferol (vit. D2) at a dose of 20,000-40,000 IU per day enterally for one month, as well as calcium gluconate, calcium chloride, magnesium lactate, potassium and magnesium asparaginate, will be effective.
It is possible to prevent the development of hyperventilation syndrome by adhering to a healthy lifestyle, refraining from playing computer games, observing the regime of work and rest.
Literature and sources
Video on the topic:
Hyperventilation syndrome – symptoms, treatment, prevention, causes, first signs
It is a decrease in carbon dioxide content that leads to the fact that hemoglobin does not give up oxygen and the body suffers from hypoxia. The arteries contract, which reduces the amount of blood that is transported through the body. In this case, our brain and body lack oxygen.
Causes of hyperventilation
A similar condition can occur with very strong anxiety, fear or unreasonable outbursts of emotions. Many other conditions can also trigger hyperventilation syndrome – panic disorder, stress, hysteria, heart disease such as congestive heart failure or heart attacks, acute pain, drugs that cause bleeding (such as acetylsalicylic acid overdose), pregnancy ketoacidosis, and similar medical conditions , the use of stimulants, lung diseases (asthma, chronic obstructive pulmonary disease or pulmonary embolism / blood clots in the vessels of the lungs /), infectious diseases (for example, pneumonia or sepsis).
Symptoms of hyperventilation
If you experience these symptoms, see a doctor immediately: rapid breathing, shortness of breath, tightness, tightness, chest pain, anxiety, dry mouth, blurred vision, tingling in the fingers and toes, pain and cramps in hands and fingers, loss of consciousness.
What You Can Do
During an attack, slow your breathing rate. Take 1 breath every 10 seconds.Don’t breathe into a paper bag. This is dangerous because you may not have enough oxygen.
You may need the help of others to cope with the stress and anxiety that causes hyperventilation. Seek help from family, friends, a spiritual mentor, doctor, or mental health professional. You should definitely see your doctor.
What a doctor can do
Your doctor will do a thorough physical examination.
During your visit, your doctor will be able to assess how often you breathe. If your breathing rate is not too high, your doctor may specifically induce hyperventilation by showing you how to breathe.
When you are hyperventilating, your doctor can find out how you are feeling and observe your breathing by determining which muscles in your chest and surrounding areas are working as you breathe.
Among other things, the doctor may conduct the following tests: ECG / chest x-ray, blood test for oxygen, carbon dioxide, computed tomography of the chest, ventilation / blood supply to the lungs.
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Hyperventilation syndrome – causes, symptoms, diagnosis and treatment
Hyperventilation syndrome – a neuropsychiatric pathology leading to the formation of a pathological respiratory rhythm that increases pulmonary ventilation with the development of alkalosis. It is accompanied by variable vegetative, algic, muscular-tonic, respiratory, mental disorders. It is diagnosed by testing, hyperventilation test, study of CBS and blood electrolytes.Treatment consists of a combination of non-drug (psychotherapy, relaxation techniques, breathing exercises, biofeedback therapy) and drug (psychotropic drugs, magnesium, calcium) methods.
The term “hyperventilation syndrome” was coined by the American physician Da Costa in 1871. Subsequently, variable synonymous names of the disease were proposed: “respiratory neurosis”, “neurorespiratory syndrome”, “respiratory dystonia”, however, the most widespread was preserved for the original term.Hyperventilation syndrome (HVS) occurs in 6-11% of patients seeking medical attention. The disease affects people of various age categories, including the elderly and children. The peak incidence is between 30 and 40 years of age. Women get sick 4-5 times more often than men. GVS has a predominantly chronic course; among the sick, acute cases account for only 2%.
Etiological triggers provoking the formation of DHW are polymorphic and are implemented against the background of habitually incorrect breathing, which arose due to cultural characteristics, lived experience, individual sports (running, swimming), playing wind musical instruments …Etiofactors are subdivided into:
- Psychogenic . They are found in 60% of cases of hot water supply. The leading role belongs to mental disorders: anxiety disorder, depression, neurasthenia, phobic disorders, less often – hysterical neurosis. Acute and chronic stressful situations can provoke hyperventilation syndrome. In a number of cases, the background for the development of the disease is psychogenic childhood – childhood situations in which the patient witnessed an episode of asphyxia, an attack of bronchial asthma, suffocation of a drowning person.
- Organic . Includes lesions of the central nervous system (hydrocephalus, arachnoiditis, discirculatory encephalopathy) and diseases of the internal organs (hypertension, recurrent bronchitis, diabetes mellitus). The action of purely organic etiofactors is observed in 5% of patients with HVS.
- Mixed . The action of a psychogenic trigger is realized against the background of organic pathology. Make up 35% of the total number of cases.
Hyperventilation syndrome can be provoked by drugs of the following groups: beta-adrenomimetics, salicylates, methyl xanthine derivatives, progesterone preparations.
The functioning of the respiratory system is not as autonomous as the work of other systems and organs. A person is able to regulate the depth of inhalation and exhalation, to arbitrarily hold his breath, to intensify it. This feature determines a close relationship between the respiratory function and the psychoemotional state. Psychogenic triggers, especially anxiety, provoke biochemical shifts that lead to an imbalance in calcium-magnesium balance. There are changes in the work of respiratory enzymes, potentiating the development of hyperventilation.Excessive release of carbon dioxide leads to a drop in its concentration in the blood – hypocapnia, a shift in blood pH to the alkaline side with the development of respiratory alkalosis. These changes cause clinical symptoms: disturbances of consciousness, autonomic, sensory, algic disorders, manifestations of tetany. The result is an increase in anxiety that maintains hyperventilation. A vicious circle is formed that continues to exist even after the cessation of the action of the provoking etiofactor.
Hyperventilation syndrome is characterized by the multiplicity and polymorphism of the arising symptoms. Among the variety of symptoms, a typical triad can be traced: respiratory dysfunction, disturbances in the emotional sphere, muscle-tonic phenomena. Respiratory disorders are presented in four forms. The first is a subjective feeling of lack of air (“empty breath”), forcing the patient to take deeper and / or more frequent breaths. The second is shortness of breath, characterized by patients as “tightness when inhaling”, “lump in the throat”, “the flow of air into the lungs, requiring effort.”Arrhythmic increased breathing is noted with the participation of the auxiliary respiratory muscles. The third option is a disorder of respiratory automatism, which is accompanied by a feeling of respiratory arrest, prompting the patient to constantly monitor the respiratory process and consciously “correct” it. The fourth form includes a hyperventilating equivalent, which is yawning, deep sighing, puffing, and coughing.
Psycho-emotional disorders are of the nature of anxiety, fear.Typically generalized anxiety disorder. Patients note constant nervous tension, increased anxiety, loss of the ability to relax. The fear of open spaces (agoraphobia) and public places (social phobia) is reinforced by the aggravation of respiratory distress in them. Muscular-tonic syndrome is caused by changes in the electrolyte composition of the blood, causing an increase in neuromuscular excitability. It includes paresthesias (sensory disorders felt as “creeping creeps”, numbness, burning, tingling in certain parts of the body), tetanic phenomena (tonic convulsions of the distal extremities, muscle spasms).Carpopedal spasm is possible.
The classic symptomatology of the disease is combined with algic symptoms: headaches, cardialgia, abdominal pain. Complaints from the cardiovascular system include discomfort in the heart, palpitations, from the gastrointestinal tract – dyspepsia, unstable stools, flatulence. Disorders of consciousness are typical: confusion, fogging, syncope.
Hyperventilation crisis is an acute condition with a pronounced disorder of the respiratory rhythm.Fear of suffocation is noted. Hyperventilation crisis refers to panic attacks, accompanied by symptoms typical for them: hyperhidrosis, chills, dizziness, nausea, palpitations, fear of death, a feeling of suffocation, hot flashes and / or cold, discomfort in the cardiac region. The condition is associated with psychological discomfort. It occurs in places where, according to the patient’s conviction, he will not be able to provide adequate assistance. A specific feature of the crisis is its relief when breathing in a cellophane (paper) bag.The patient inhales the air that he exhaled into the bag. The air contains an increased concentration of CO2, which allows you to quickly reduce respiratory alkalosis and stop the symptoms caused by it.
Polymorphism of manifestations, dominance of respiratory disorders leads to the initial erroneous assumption about the presence of pathology of the respiratory or cardiovascular system. Patients are examined by a therapist, pulmonologist, cardiologist without revealing any serious organic pathology.The reason for consulting a neurologist or psychiatrist is the emotional coloring of the complaints, the expressed anxiety of the patient. Diagnosis of hyperventilation syndrome allows:
- Psychogenic history. Indications of a traumatic situation, childhood fears, neurosis, neurasthenia, depressive syndrome are important.
- Neurological examination. Reveals distal hyperhidrosis, positive tests for latent tetany: symptoms of Chvostek, Weiss, Schlesinger, Trousseau’s test.Additionally, electromyography is performed to confirm neuromuscular hyperexcitability and tetany.
- Psychological examination . Includes research of personality structure, psychological testing. The Naymigen questionnaire developed in the Netherlands is used, which in 90% of cases allows detecting hot water supply.
- Hyperventilation test . It is performed by voluntary hyperventilation performed by the patient. A positive result (the occurrence of typical vegetative, psychoemotional, tetanic changes) allows confirming the diagnosis of HVS.
- CBS blood . The acid-base state is shifted towards alkalosis. The drop in the partial pressure of CO2 indicates the respiratory nature of the changes in CBS.
- Blood electrolytes . There is a drop in the concentration of calcium and magnesium in the blood.
- Examination of internal organs . It is necessary to exclude organic pathology. Characterized by tachycardia, lability of the pulse and blood pressure, possibly extrasystole, fluctuation of the ST segment on the electrocardiogram.Radiography of the lungs, the study of FVD remain normal. Examination of the gastrointestinal tract reveals functional abnormalities in the form of various types of dyskinesia.
Hyperventilation syndrome must be differentiated from diseases of the respiratory organs, hypoparathyroidism. The main difference between DHW is labored inhalation, while COPD is labored exhalation. Hypoparathyroidism is accompanied by osteosclerosis, calcium deposition in internal organs, and a decrease in the level of parathyroid hormone.
The therapy is carried out in a complex way by combining pharmacotherapy and non-drug methods.An important role is played by conducting explanatory conversations explaining the nature of the disorders, showing the connection of somatic symptoms with an emotional state, convincing in the absence of an organic disease. The treatment includes:
- Psychotherapy . Cognitive-behavioral and psychoanalytic techniques are being successfully applied. The presence of childhood psychogeny is an indication for psychoanalysis sessions.
- Formation of correct breathing .It is carried out through regular breathing exercises. An auxiliary technique is teaching relaxation techniques. The hyperventilation crisis is stopped by breathing in a bag.
- BFB therapy . With the help of the equipment, the patient receives objective information about the state of breathing, learns to regulate the respiratory function taking into account the received feedback.
- Medication correction of the mental sphere . The most effective are antidepressants with a pronounced anxiolytic effect (fluvoxamine, amitriptyline).Perhaps the appointment of sedatives, antipsychotics, tranquilizers. In a crisis, benzodiazepines (diazepam) are used. A pronounced vegetative component is an indication for the use of vegetotropic drugs.
- Elimination of electrolyte disturbances . It is achieved by taking calcium and magnesium preparations. Calcium reduces the tendency to tetany, magnesium has a sedative, anticonvulsant effect.
The duration of therapy is usually 4-6 months.Patient follow-up is necessary to prevent relapse.
Forecast and prevention
Hyperventilation syndrome does not pose a threat to life, but significantly reduces its quality.