Hyperventilation syndrome: symptoms and treatment

Hyperventilation syndrome (increased respiration) is one of the most common manifestations of vegetative-vascular dystonia. It arises as a result of dysfunctions in the central nervous system due to various causes. It manifests itself as a whole group of symptoms, including respiratory, vegetative, mental, vascular, painful and muscular manifestations. The result of the changes is abnormal breathing, an increase in pulmonary ventilation. It requires complex treatment, first of all - regulation of processes in the central nervous system. From this article you can learn about the causes, symptoms and ways of treating hyperventilation syndrome.

General information. Statistics

Hyperventilation syndrome may occur under other names: Yes Costa syndrome (named after an American physician who described similar phenomena in soldiers participating in the civil war), stress syndrome, nervous respiratory syndrome, psychophysiological respiratory reactions, respiratory neurosis, unstable respiration, irritable syndrome heart.

Occurs in 6-11% of the world's population. Women often suffer: in the weaker sex this condition is detected 4-5 times more often than in men.

Causes

In most cases, the basis of hyperventilation syndrome is the pathology of the nervous system of a functional, and sometimes organic, nature

Hyperventilation syndrome is a manifestation of a disturbance in the regulation of respiratory function by the autonomic nervous system. Despite its far from neurological manifestations, the reason is precisely this. Different states can lead to disturbance of the regulatory functions of the autonomic nervous system. All factors of hyperventilation syndrome development can be divided into 4 groups:

• psychogenic: neuroses, neurasthenia, hysteria, fears, staying in conditions of chronic stress and anxiety;
• diseases of the nervous system of organic nature: when there is a clear morphological substrate (for example, arachnoiditis with increased intracranial pressure);
• diseases of other organs and systems (for example, diabetes mellitus, rheumatoid arthritis, hypertension);
• intoxication and metabolic disorders (eg, calcium and magnesium deficiency).

There is no doubt that psychogenic factors are leading. This feature of the emergence of hyperventilation syndrome in people with psychological problems from childhood: it often occurs in those people who in childhood had the opportunity to observe a picture of respiratory disorders. For example, an attack of bronchial asthma, suffocation of drowning people and others.

In hyperventilation syndrome, there is an increased excitability of the respiratory center in the brainstem, the alternation of the inspiratory phases and expiration, a disruption of the respiratory program occurs, as a result of which breathing becomes redundant, pulmonary ventilation is intensified inadequately by the existing needs. There is a decrease in the content of carbon dioxide in the blood, increases the pH of the blood due to excess alkali, there is a mineral imbalance. All these changes cause the symptoms of hyperventilation syndrome.

Symptoms

Hyperventilation syndrome often has a crisis course, that is, its symptoms occur quite suddenly, last for a certain period of time (several minutes or hours) and recede. After a while, the attack repeats.

A typical picture of a hyperventilation crisis is as follows. The patient has anxiety and fear for no apparent reason. Simultaneously with this or a little later there is shortness of breath, a feeling of lack of air (swallowing the air, convulsively opening the mouth), the inability to breathe deeply, lump in the throat. Breathing is becoming more frequent. Fear intensifies, it seems to the patient that now death will overtake him. Cardiovascular disorders (chest pain, palpitations, high blood pressure) are associated. The patient is panic-stricken. In addition to respiratory and cardiovascular disorders, other symptoms may appear.

All the symptoms of hyperventilation syndrome can be divided into several groups:

• vegetative (respiratory, cardiovascular, gastrointestinal disorders, urinary disorders);
• changes in consciousness;
• musculo-tonic and motor disorders;
• pain and other disorders of the senses;
• mental disorders.

Let us consider each group of symptoms in more detail.

Breathing disorders

Respiratory disorders can be very diverse. They form the main clinical component of the hyperventilation crisis. These are symptoms such as:

• a feeling of lack of air (oxygen), dissatisfaction with the breath, a sense of its inefficiency. The patient is fixated on his breath, in the fresh air, "breathing hygiene that is, on correction of environmental factors that will provide him with a full breath. Patients complain of an inordinate desire to breathe in full, which is impossible, in their opinion, although they are trying. If they manage to take such a breath, they focus their attention on it, as if to confirm the reality of their violations, although in fact this "deep" breath is no different from the others. Usually the real breathing in these patients is rapid and deep, with a normal rhythm of inspiration and expiration. In stressful situations, the degree of fixation on one's sensations is strengthened;
• loss of automatic breathing. It seems to the patient that if he does not follow his breaths, that is, if they do not reproduce them with willpower, then independent respiratory activity will cease. "I will have a stop in breathing, and I'll suffocate says such a patient about himself;
• the feeling of impossibility to realize a full breath as a result of some obstacle (lump in the throat, squeezing of the chest). In this type of respiratory distress, patients are also fixed on their breathing, but more at its individual stages (and not on environmental factors, as described above), that is, they search for the cause in themselves ("remove the clod "relax the muscles of the pectoral cells "). Objectively, breathing in such patients is frequent, with an irregular rhythm of alternation of inspiration and expiration, involving auxiliary muscles (those that normally do not participate in the act of breathing). Clinically, it looks like an asthma attack, therefore this variant of respiratory disorders is sometimes called atypical asthma, but with auscultation (listening), no respiratory noises, typical of this asthma attack, not is revealed;
• periodic sighs, coughing, yawning, sniffing. Naturally, there is not an occasional yawning or sniffing, single episodes of coughing, but a systematic causeless repetition of these actions. These manifestations of respiratory disorders occur not in the course of the crisis of the hyperventilation syndrome. They are not noticed by the patients themselves, they do not give him any discomfort, usually they pay attention to others. However, such minor changes are sufficient to change the normal gas state of the blood and the violation of pH.

Respiratory symptoms are always present in the picture of hyperventilation syndrome. Manifestations from other organs and systems can fluctuate from absence at all to vivid manifestations.

Cardiovascular disorders

Similar changes often accompany hyperventilation crises. Such violations include:

• pain in the region of the heart of a different nature (stitching, shooting, compressing, aching);
• a feeling of palpitations;
• pain in the chest, a feeling of contraction;
• discomfort in the heart;
• changes in blood pressure;
• heart rhythm disturbances (more often extrasystoles);
• changes are possible on the part of the ECG (rise of the segment S-T);
• headache;
• dizziness, unstable when walking;
• noise in the ears and head, short-term hearing loss;
• cyanotic color of hands and feet;
• increased sweating;
• Raynaud's syndrome (due to spasm of blood vessels).

Gastrointestinal disorders

Manifestations from the gastrointestinal tract almost always accompany the hyperventilation syndrome. It can be:

• change of peristalsis (more often in the direction of strengthening) and, as a consequence, frequent defecation up to diarrhea; much less often - constipation;
• ingestion of air with food and belching with air (aerophagia);
• bloating, flatulence, rumbling in the abdomen;
• nausea, vomiting;
• intolerance of any food products (to which earlier, before the disease, the patient was quite calm);
• stomach ache.

Violations of urination

This type of violation directly accompanies the hyperventilation crisis. The most pronounced changes are toward the end of the crisis. This is a frequent urge to urinate with a lot of light urine.

Changes in consciousness

To this group of violations include such violations of consciousness as:

• fainting;
• pre-memory states: darkening in the eyes, "flies "fog" before the eyes, narrowing of the fields of vision (including a look like in binoculars), blurred vision, transient blindness;
• sensation déjà vu (deja vu) - "already seen." Perhaps also a feeling of "already heard "already experienced "never seen "never heard". That is, there is an obsession that such events have already occurred (or did not occur);
• sense of loss of reality: a person is lost in reality, he presents himself in some parallel world (a tale, a horror film, and so on). This state is called derealization;
• a sense of loss of personality, a transformation into someone else, that is, a situation where the "I" is not "I". The name of this state is depersonalization.

Musculo-tonic and motor disorders

These disorders in 90% of cases accompany hyperventilation crises. They look like this:

• trembling in the hands and feet;
• an internal shiver with a feeling of heat or cold;
• convulsive muscle spasms (contractions): the most common is the so-called carpopedal spasm. This is when the hand becomes a "midwifery hand" and / or the muscles of the foot flexibly contract. "The hand of an obstetrician" - the fingers are brought together (assembled as if you are taking a pinch of something) and slightly bent;
• increased readiness for muscle contractions. Checked by tapping a neurological hammer on the face below the zygomatic arch (a symptom of Khvostek).

Painful and sensitive disorders

These disorders develop in 100% of cases with hyperventilation syndrome. Most often represented by such phenomena:

• feeling of numbness in different parts of the body (mostly face and hands);
• tingling, crawling, burning, twisting;
• "Legs refuse "I can not move" and similar sensations;
• painful component of muscle spasms (that is, all convulsive muscle contractions are accompanied by pain);
• pain in different parts of the body (in the heart, stomach, head and so on).

Mental disorders

Mental disorders in this case do not mean inadequacy in behavior, but only reflect the psychological features of the condition of patients at the time of the crisis:

• anxiety;
• fears;
• anxiety;
• sadness and longing;
• emotionality (violent reaction to what is happening around).

Diagnostics

For the diagnosis of hyperventilation syndrome, the thoroughness of collecting complaints and anamnesis of the disease, careful examination of the patient plays a role. Since the patient usually presents a lot of complaints from various organs and systems (respiratory, cardiovascular, gastrointestinal tract, etc.), this should serve as a criterion in favor of the diagnosis hyperventilation syndrome. Of course, first of all, it is necessary to exclude organic diseases of those systems, on the part of which the patient makes complaints. For this, additional methods of investigation (ultrasound of the heart, ECG, spirography, ultrasound of the abdominal cavity organs and so on) are used.

With a competent interview, in most cases, you can identify a positive psychogenic anamnesis, that is, the presence of increased emotional stress, anxiety and similar changes.

You can also conduct a fairly simple and not requiring any adaptations: try to ask the patient deeply and often to breathe for 3-5 minutes. Usually this is enough to reproduce all the symptoms of the hyperventilation syndrome. After the onset of symptoms, they can be eliminated by inhalation of air with a carbon dioxide content of 5% or breathing in a plastic bag (since with hyperventilation syndrome, there is a decrease in the content of carbon dioxide in the blood and in the exhaled air, the inhalation of air with an elevated content of carbon dioxide helps to cope with the symptoms).

When electromyography is performed, a positive test is found for the latent muscle spasms. In special blood tests, a shift in the acid-base state of the blood towards alkalization can be detected.

A special questionnaire was developed, which allows correctly diagnosing hyperventilation syndrome in 90% of cases.

It should be noted that a single symptom or data from additional research methods does not at all indicate a hyperventilation syndrome. Respiratory disorders can be a symptom of such formidable diseases as bronchial asthma or heart failure, so only a comprehensive examination and thoughtful attitude of the doctor to the complaints made help to correctly put diagnosis.

Treatment of hyperventilation syndrome

Treatment of hyperventilation syndrome primarily involves the correction of psychogenic disorders and a change in the patient's attitude toward his condition. Many patients with hyperventilation syndrome present their condition extremely difficult. They think that they have a very serious and, most importantly, deadly disease. The first task of the doctor is to demonstrate to the patient the absence of organic changes, help to understand the safety manifestations of the disease for life (it is impossible to die at the time of the hyperventilation crisis), to show the dependence of symptoms on the internal voltage. The patient should defeat his fear. As soon as the patient changes his attitude to the symptoms of the hyperventilation syndrome, one can consider the disease to be half vanquished. And sometimes this is enough for the symptoms to completely recede.

For the treatment use psychotherapeutic techniques (psychoanalysis, suggestion, auto-training, behavioral therapy and many others), which help to look differently at the disease.

A separate aspect in the treatment is breathing exercises, the purpose of which is to teach the patient the "right" breathing. The patient is trained to breathe a diaphragm (abdominal type of breathing), observe the inspiratory-expiratory phases (:), slow breathing. Classes are held daily, last at first for several minutes. Gradually, their duration increases.

Well-proven method of reverse biological communication in the treatment of hyperventilation syndrome. When using it, a person learns to control the functions of the body that are usually beyond his control, in this case breathing.

Recommended normalization of the regime of work and rest (if possible without overtime and night shifts), sufficient sleep. Dosed physical exercise, walking, full-fledged days off with changing of the situation (fishing, hunting, trips for city ​​and so on) - everything that contributes to the normalization of the psychological sphere is shown to patients with hyperventilation syndrome.

Medical treatment of hyperventilation syndrome consists in the use of various means:

• correction of psychological disorders: antidepressants (Coaxil, Prozac, Zoloft, Sirleft, Paxil, Amitriptyline, Lerivon, Simbalta and others), tranquilizers (Adaptol, Afobazol, Buspirone, Gidazepam, Alprazolam, Grandaxin and so on), sedatives (tincture of motherwort, valerian, combined remedies - Dormiplant, Persen, Barbovan, Corvalol), antipsychotics (Eglonil, Ridazine);
• vegetotrophic preparations: Platifillin, Bellaspon, Bellataminal, Belloid, β - adrenoblockers (Anaprilin, Metoprolol);
• drugs that reduce neuromuscular excitability: calcium preparations (calcium gluconate, calcium chloride), magnesium (Magne B6), vitamin D2;
• vitamins of group B (Milgamma, Neurobeks), metabolic substances (Mildronate, Riboxin, Glutamic acid, Actovegin).

Means for correcting psychogenic changes require a course application for at least 2 months (but should be prescribed strictly by the attending physician).

Some drugs are used only at the time of the hyperventilation crisis, to relieve the patient of his condition (for example, Platifillin, Anaprilin).

At the time of the development of the hyperventilation crisis, the patient can breathe in a polyethylene (or paper) package, that is, to inhale and exhale into the package itself without taking his face off him. Increasing the concentration of carbon dioxide in the air so inhaled helps to stop the crisis.

Hyperventilation syndrome is a pathological condition, behind which lie the perennial problems of patients, their endless visits to doctors in search of the correct diagnosis. Symptoms of hyperventilation syndrome "poison" life, literally and figuratively, "do not give a full breath." Despite the variety of clinical symptoms in this condition, a pronounced fear in the development of crises, this disease does not carry a danger. And in this need to convince the patient. And to get rid of the disease forever, you need to get into the hands of a competent neurologist and a psychologist (psychotherapist). Hyperventilation syndrome is successfully treated!

I. Kochetkov, director of the Center for Cognitive Therapy, talks about what the hyperventilation syndrome is: