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An out-of-hospital perspective on hyperventilation syndrome

02 June 2019
Volume 9 · Issue 2


Hyperventilation and tachypnoea both involve breathing at an increased rate. There are a variety of causes of hyperventilation and conditions associated with it, including acute and chronic hyperventilation syndrome (HVS). The characteristics of HVS are not well defined. It results from a reduction in carbon dioxide and altered pH in the body from overbreathing. Symptoms vary between individuals but usually include altered sensations in the extremities, nausea and headache. Diagnosing patients with this condition can be difficult; diagnostic tools include the hyperventilation provocation test, voluntary overbreathing, the Nijmegen questionnaire and the exclusion of physiological causes in the acute situation. There are various prehospital patient presentations and differentiating between potential underlying causes is vital to appropriate treatment and patient safety. Treatments vary in nature, depending on the desired effect and the clinician's scope of practice. Some aim to reduce the frequency and intensity of attacks while others combat the attack when it strikes. This review briefly discusses some treatments available to a clinician with a basic skill level. There is a lack of evidence in this area, and research with a focus on the out-of-hospital environment is recommended. Because of controversy over existing research regarding the definition of HVS, a review of all sources was conducted to produce a definition. This suggests that HVS is a collection of physical and biochemical reactions from an unnecessarily increased respiratory rate that occurs because of an unknown or benign aetiology which can be triggered by anxiety in the absence of other external factors.

Respiration can vary in numerous ways as a result of different underlying pathologies. Examples include tachypnoea and hyperventilation. Tachypnoea is defined as the respiratory rate of an individual exceeding the expected value for their age group while hyperventilation is overbreathing above the required rate for carbon dioxide elimination resulting in respiratory alkalosis (Whited and Graham, 2019).

Hyperventilation syndrome (HVS) is one of many conditions that present with an increased respiratory rate among other symptoms. The symptoms of HVS were first recognised during the American Civil War when DaCosta (1951) described Union Army soldiers as having an ‘irritable heart’ (Evans, 2005). Kerr et al (1938) were the first to use the term HVS and related it to the presentation of hyperventilation associated with anxiety or panic. Because the characteristics of HVS are poorly defined, the term has been misused, and is often used interchangeably with panic or anxiety disorders.

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