Abstract
For more than a century, we have encountered a condition—now called the “hyperventilation syndrome”—characterized primarily by breathlessness, lightheadedness or dizziness, weakness, numbness and tingling (paresthesias) and chest pain 1 ,2 . Rarely have organic diseases been found to account for the symptoms in such cases, and in the absence of effective recognition, symptoms usually persist. Contributing to the confusion, the hyperventilation syndrome has been given many names that include irritable heart, soldier's heart, Da Costa's syndrome effort syndrome, neurocirculatory asthenia and, more recently, panic disorder (panic attacks). These episodes occur in many persons under the stresses of daily living, but in those not overtly stressed, anxious or depressed, they may also appear in those who appear outwardly calm as they "bottle up" their feelings, possibly because of undeveloped or lack of acceptable emotional outlets. These episodes are surprisingly common, occurring with an estimated prevalence in the range of 10% of all general medical patients 2 . I have personally encountered them as an explanation or contributor to approximately 15% of patients applying for long-term disability. Most medical caregivers readily recognize acute hyperventilation attacks occurring under acute stress. However, chronic or recurrent hyperventilation problems often are unrecognized probably for a variety of reasons, including the frequent lack of obvious over-breathing, a tendency to focus on one or two complaints that alone are not particularly suggestive of hyperventilation, compounded by absence of discussion of the topic in healthcare schools and cursory coverage in medical textbooks.