- Richard M Schwartzstein, MD
Richard M Schwartzstein, MD
- Professor of Medicine
- Harvard Medical School
- Jeremy Richards, MD, MA
Jeremy Richards, MD, MA
- Assistant Professor of Medicine
- Medical University of South Carolina
The hyperventilation syndrome describes a condition in which an inappropriate increase in minute ventilation beyond metabolic needs (ie, a respiratory alkalosis) is associated with a wide range of symptoms without a clear organic precipitant. As with other medical “syndromes,” there is controversy about the etiology, diagnosis, and treatment of this condition. While it is generally accepted that hyperventilation episodes (or “attacks”) are frequently related to or caused by concomitant panic disorder, other precipitants may also be important.
Many questions have been raised about the term “hyperventilation syndrome” . Some authors suggest that the term should be avoided, as it implies that hyperventilation is the primary cause of and trigger for a patient’s symptoms . Others cite that “hyperventilation syndrome” may at best describe multiple pathophysiologic processes rather than a unique, discrete clinical entity . Nonetheless, “hyperventilation syndrome” is a term in wide use clinically and is descriptive of a common objective finding.
Hyperventilation syndrome is a disorder with no widely-accepted diagnostic criteria . The challenge to the clinician is to be aware of the possibility of hyperventilation syndrome, recognize the benefits and limitations of available diagnostic tools, and be cognizant of the resources and treatments available to help patients with this complex and sometimes debilitating condition.
This topic will discuss the pathophysiology, clinical presentation, diagnosis, and treatment of patients presenting with hyperventilation syndrome. Detailed discussions of associated disorders are presented separately. (See "Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for panic disorder in adults" and "Psychotherapy for panic disorder in adults" and "Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis".)
PREVALENCE AND EPIDEMIOLOGY
The prevalence of hyperventilation syndrome is difficult to assess accurately given estimates based upon small sample sizes, varying diagnostic criteria, and its association with psychological symptoms. There is substantial overlap between hyperventilation syndrome and panic disorder and panic attacks . The prevalence of hyperventilation syndrome has been reported to range from 25 to 83 percent in patients with an anxiety disorder [1,5-7] and up to 11 percent in patients with nonpsychiatric medical comorbidities .
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- PREVALENCE AND EPIDEMIOLOGY
- CLINICAL PRESENTATION
- Somatic signs and symptoms
- Psychological symptoms
- DIFFERENTIAL DIAGNOSIS
- Regulatory systems
- Neurological symptoms
- Pulmonary symptoms
- Initial evaluation
- Further evaluation
- - Ancillary diagnostic testing
- Specialist referral
- Acute management
- Treatment to prevent recurrent episodes
- SUMMARY AND RECOMMENDATIONS