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Hyperventilation syndrom

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Definition

Hyperventilation

Breathing at increased rate (tachypnoea) or more deeply (hyperpnoea).
Hyperventilation can be precipitated by physiological conditions, such as exercise, pain or fever.
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Hyperventilation syndrom

HVS is a condition in which minute ventilation exceeds metabolic demands, resulting in hemodynamic and chemical changes that produce characteristic symptoms. This reaction is mainly psychogenic and has been proposed to be designated as panic disorder (Speich et Büchi 2001).

see: www.emedicine.com

Pathophysiology

During hyperventilation, increased amount of CO2 will be exspired.
This causes and increase of blood pH-value (respiratory alcalosis) with secondary reduction of serum Calcium concentration.
This results in neuro-muscular hyperexcitability.

Symptoms

Dyspnoea is not induced by exercise


Primary
  • Agitation, anxiety, palpitation
  • Hyperventilation
  • Upper thoracal breathing (without using the diaphragm)
  • Dyspnoea
  • Paraesthesias („tingling“) periorally, in lips and hands
Cramp phase
painful, tonic muscle spasms:
  • Lips
    Contraction of the upper lip („carp mouth“)
  • Hands („obstetrician hand“; carpo-pedal spasm)
  • Arms
    Flexed elbows in front of the body (“paws position”)

Treatment

  • Bring patient in upright sitting position
  • Reassure, speak to patient
  • Ask patient to breath calmly, slowly
  • Ask patient to re-breath from a plastic bag or from cupped hands
    (Caution: Danger of oxygen deficiency!)
Subsequently, patient should visit family physician, to exclude organ-related causes.


sources

  • Herrmann JM, Radvila A (1999)   Funktionelle Atemstörungen   Dt Ärztebl 96: A-694–697
  • Speich R, Büchi S (2001)   Hyperventilationssyndrom Adieu   Schweiz Med Forum 25