HYPERVENTILATION

Dr. Abdul Baseer (PT)

Introduction

• It is a physiological response to abnormally increased respiratory “drive”

which can be caused by a wide range of organic psychiatric and physiological
disorders or a combination of these

• It is a state of breathing in excess of metabolic requirements resulting in a

lowering of the alveolar partial pressure of Carbon Dioxide and arterial partial
pressure of carbon dioxide.

• Synonymous with “hypercapnia”

Continued…
• Acute Hyperventilation is a normal physiological response to stress and
may result in self regulating panaesthesia, dizziness and palpitations.
• Disorder of chronic hyperventilation or the spontaneous occurrence of
prolonged hyperventilation with multiple and alarming symptoms, was
described as the Hyperventilation syndrome in 1937.
• Hyperventilation in its chronic recurrent forms generally tends to go
unrecognized and the diverse symptoms are labelled as functional.
• Hyperventilation is more likely to be recognized in association with panic
disorders or phobic states because of its causal, consequential or
perpetuating relationships.
Signs and Symptoms
• Some patients present with a constant level of hypocapnia which
drops further as a result of trigger mechanisms.
• Others present with resting levels of carbon dioxide within the normal
range but with episodic lowering of the PaCO2 to a level that
precipitates symptoms.
• HYPOCAPNIA induces vascular constriction resulting in decreased
blood flow and as a response to the Bohr effect there is inhibition of
transfer of oxygen from hemoglobin in the circulating blood to the
tissue cells. Most of the cerebral, peripheral and cardiac symptoms
occur as a consequence
• System Signs and Symptoms
1. CVS Palpitation, Chest Pain (pseudo-angina) and PVC
2. GIT Dysphagia, Dyspnea, Epigastric pain, Diarrhoea
3. GeneralExhaustion, Lethargy, Weakness, Headache, Sleep
disturbance, Excessive Sweating
4. MSK  Muscle pain, Tremors, Involuntary contractions, Cramps
5. NEURO Paraesthesia, Lack of coordination, dizziness syncope
6. RESP Breathlessness, Excessive sighing, chest pain, Bronchospasm
7. Psych  Anxiety, Panic attacks, Phobic states, Depersonalization
Causes of hyperventilation..
• Necessary to recognize any specific organic, physiological or psychological causes.

• Drugs ingested( causing acidosis or Resp. distress) alcohol, caffeine and nicotine

• Organic Disorder Anaemia, Asthma, Chronic Severe pain, CNS disorders, DM,
Pneumonia, Pulmonary Embolus and LVF(Pul. Edema)

• Physiological Pyrexia, Pregnancy, Leutal phase of menstrual cycle

• Psychological Panic disorders, Anxiety, and Phobic States

Checking for causes..

• Personality altered breathing patterns?

• Diagnostic tests HVPT(Voluntary hyperventilation provocation tests)

, Nijmegen Questionnaire, The Think Test, Ambulatory monitoring of
transcutaneous PaCo2 and breath holding time.
Breathing Patterns..
• Normally there is an Active Inspiratory phase and a passive expiratory
phase at approx. 8-14 breaths per minute.
• Breathing patterns related to Chronic Hyperventilation syndromes
vary widely from gross upper Thoracic movements with SCM
activation at a rate of 50 breaths/min to a near normal rate and
volume and minimal upper thoracic movement.
• RR and Volume may be irregular
Treatment..
• Re education
• Start by Assessment History, S/S Personality and Physical
Examination
• History Family history and Childhood History
• S/S Rated on a Disability scale and Distress scale
• Personality Posture, facial expressions, general demeanor of body
and hands, manner in which History is given and emotional
responses.
• PE shape of chest, findings from auscultation and etc..
Treatment Plan
• Agreed upon after discussion of symptoms and findings.
• Goal is short term and Long term.
• SHORT TERM control symptoms
• LONG TERM Spontaneously maintain a corrected breathing pattern
Breathing education
Home Programme
Exercise and fitness program..