| Hyperventilation syndrome is an acute or chronic condition in which an individual breathes excessively and at a more rapid rate than necessary for the body's needs, which changes blood chemistry, affects the function of nerves and muscles, and also decreases blood flow to the brain. Individuals with this disorder usually seek medical attention and fear that something is happening to their body. The symptoms often reinforce the individual's belief there is imminent danger of bodily harm, further increasing the level of anxiety.
Hyperventilation syndrome is usually generated by intense fear or anxiety. Although there is considerable overlap in symptoms between hyperventilation syndrome and panic disorder, these conditions are separate. Approximately 50% of individuals with panic disorder have hyperventilation symptoms, and 25% of individuals with hyperventilation syndrome have panic disorder.
Individuals are often not aware they have altered their breathing. Symptoms can be seen during prolonged crying either from normal grieving or a depressive disorder. Acute hyperventilation syndrome is easier to diagnose than chronic hyperventilation syndrome, in which individuals may present with respiratory, heart, neurologic, or gastrointestinal symptoms without apparent overbreathing.
The underlying mechanism is unknown, but certain triggers may provoke an exaggerated respiratory response in susceptible individuals. Triggers may include emotional distress and lactic acid levels that build up in response to exercise, caffeine, carbon dioxide, certain medications such as isoproterenol, and some hormones such as cholecystokinin. Individuals with hyperventilation syndrome tend to breathe using the upper chest muscles rather than the diaphragm, so that their lungs are chronically overinflated. When stress induces the need to take a deep breath, the individual feels short of breath, which creates more anxiety and begins a vicious cycle.Risk: Although no clear genetic factors have been found, close relatives of individuals with hyperventilation syndrome are more likely to have the disorder. The female-to-male ratio may approach 7 to 1. Cases have been reported in all age groups except infants, with the peak age of incidence from 15 to 55 years (Newton). Incidence and Prevalence: Up to 10% of individuals in a general internal medicine practice in the US had a primary diagnosis of hyperventilation syndrome; acute hyperventilation syndrome accounts for only 1% of cases (Newton). |
Source: Medical Disability Advisor
| History: Individuals may have a history of recurrent episodes of feeling short of breath or being unable to fill the lungs. They may present with feelings of pins-and-needles (paresthesias) in the fingers and toes and around the mouth, spasms in muscles of the hands and/or feet (carpopedal spasm), and feelings of lightheadedness, faintness, dry mouth, or distorted reality such as visual hallucinations. There are often concerns of a heart attack, stroke, suffocation, or other bodily harm. Feeling that the heartbeat is heavy and rapid (palpitations) is common. Attention and concentration are limited because of fear or panic. Each episode is experienced as intensely as the first.
Individuals with acute hyperventilation syndrome may present with great agitation and anxiety. History more often includes sudden onset of chest pain, shortness of breath, or neurologic symptoms such as dizziness, weakness, fainting, or paresthesias after a stressful event. Swallowing of air during overbreathing may lead to gastrointestinal symptoms including bloating, belching, excess gas, and a pressure sensation over the upper abdomen. Physical exam: The individual may be asked to hyperventilate. If this reproduces the symptoms, the diagnosis is confirmed. In acute hyperventilation syndrome, it may be obvious that the individual is breathing rapidly and deeply. The upper chest wall may be tender from muscle fatigue. Chemical changes associated with decreased carbon dioxide levels may cause carpopedal spasm, wheezing, or decreased blood calcium levels associated with characteristic abnormalities in muscular contraction (Chvostek's or Trousseau's signs). Physical signs of anxiety may include shaking (tremor), dilated pupils (mydriasis), pale skin (pallor) and rapid heartbeat (tachycardia). In chronic hyperventilation syndrome, rapid or deep breathing is usually not apparent, but the individual may sigh deeply 2 to 3 times a minute. Tests: Tests may establish a medical diagnosis to account for the hyperventilation. Electrocardiogram (ECG) may reveal characteristic changes. Blood gases can show characteristic abnormalities associated with overbreathing. Chest x-ray is indicated when disease of the heart or lungs is suspected. |
Source: Medical Disability Advisor
| If presumed acute hyperventilation syndrome is not yet diagnosed, transport to the hospital for further evaluation may be indicated. Individuals should be made more aware of their breathing and trained to use the diaphragm and abdomen rather than the upper chest. The individual may be instructed to breathe through the nose and not the mouth during an attack as a way to limit the overbreathing. Although individuals can breathe into a paper bag to avoid the blood chemistry changes and other symptoms of hyperventilation, rebreathing from a paper bag may be dangerous in individuals with undiagnosed lung or heart disease and is thus not recommended.
Supportive psychotherapy can reassure the individual that he or she is getting enough oxygen during an attack. Any underlying psychological disorder should be treated if the individual is able to change his or her focus from physical to psychological matters. Antianxiety medications, sedatives, beta-blockers, and tricyclic antidepressants may be useful in selected individuals but should not be given for prolonged periods. |
Source: Medical Disability Advisor
| Most individuals can be taught to manage this syndrome themselves. Some will remain fixated on their physical symptoms however, even with the most skillful psychotherapist, and continue to experience episodes of hyperventilation.
Death is extremely rare but may result from heart attack (myocardial ischemia) in individuals with pre-existing coronary artery disease. Complications may occur from unneeded tests such as angiography or from certain treatments (e.g., blood thinners). |
Source: Medical Disability Advisor
| The individual may faint because the amount of carbon dioxide decreases with overbreathing, causing decreased blood flow to the brain. Individuals who fall during fainting may experience injury. If forced to remain standing, individual may have a seizure or further decrease in blood flow to the brain. Changes in blood chemistry associated with overbreathing may include decreased calcium that causes muscle twitching or spasm, decreased potassium that causes generalized weakness, or decreased phosphate that may cause pins-and-needles (paresthesias) and weakness.
Heart rhythm disturbances can result from hyperventilation. Hyperventilation syndrome can develop into such a concern about heart disease (cardiac neurosis) that individuals impose limits on their activities. In older individuals with coronary artery disease, decreased carbon dioxide levels associated with overbreathing may further narrow vessels supplying the heart and cause damage to the heart muscle. |
Source: Medical Disability Advisor
| Accommodations may include modifying identifiable work situations that provoke the hyperventilation, such as having to wear protective gear on the face or being in a crowded, noisy workplace. The individual should be introduced to stressful situations gradually under appropriate supervision and support. Other accommodations may include providing a flexible work schedule for medical or psychiatric appointments and allowing break time, rather than a fixed schedule, according to individual's needs. Highly stressful activities such as operating machinery should be temporarily adjusted. The workspace can also be modified to reduce noise or visual distractions. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have intense fear, anxiety, or emotional distress?
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Is individual taking isoproterenol or cholecystokinin?
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Does individual have recurrent episodes of feeling short of breath or being unable to fill the lungs?
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Does individual have paresthesias in the fingers and toes and around the mouth? Does individual have carpopedal spasm?
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Does individual express concerns of a heart attack, stroke, or suffocation?
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Does individual complain of palpitations?
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Did individual present with great agitation and anxiety?
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Did individual have a sudden onset of chest pain, shortness of breath, or neurologic symptoms such as dizziness, weakness, fainting, or paresthesias after a stressful event? Has individual swallowed air?
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Does individual complain of symptoms including bloating, belching, excess gas, and a pressure sensation over the upper abdomen?
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Has individual had tests to establish a medical diagnosis to account for the hyperventilation, such as ECG, blood gases or a chest x-ray?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Has the underlying cause of hyperventilation been diagnosed? Is it being treated?
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Has individual been made more aware of the pattern of breathing?
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Has individual been trained to use the diaphragm and abdomen rather than the upper chest for breathing?
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Is individual participating in psychotherapy?
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Have anti-anxiety medications, sedatives, beta-blockers, or tricyclic antidepressants been tried?
Regarding prognosis:
- Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any conditions that may affect the ability to recover?
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Does individual have any complications such as fainting, injuries from falling, changes in blood chemistry, paresthesias, weakness, or heart rhythm disturbances?
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Has individual developed a cardiac neurosis?
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Source: Medical Disability Advisor
| Newton, Edward. "Hyperventilation Syndrome." eMedicine. Eds. Robin R. Hemphill, et al. 17 Jun. 2004. Medscape. 7 Nov. 2004 <http://emedicine.com/emerg/topic270.htm>. |
Source: Medical Disability Advisor
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