Chest
Volume 110, Issue 4, October 1996, Pages 952-957
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Clinical Investigations: Breathing and not Breathing: Articles
Patients with Acute Hyperventilation Presenting to an Inner-City Emergency Department

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We studied 23 consecutive patients with acute hyperventilation presenting to an inner-city emergency department, diagnosed on clinical grounds by the attending physician and confirmed by arterial blood gas values in 5 patients. An organic basis for the presenting complaints was excluded and chest radiograph, serum biochemistry, blood cell count, and thyroid function test results were normal. The male to female ratio was 12:11. Presenting complaints were dyspnea (61%), paresthesia (35%), chest pain or tightness (43%), muscle spasm (9%), dizziness (13%), palpitations (13%), and panic (30%). Similar previous episodes were reported in 74%. Misattribution of the presenting complaints to a cardiac or other life-threatening disorder was reported in 20 patients (87%) and was the main reason for their presentation to the hospital. Although no patients presented with clinical features of asthma, 7 (30%) were known asthmatics receiving treatment and another 10 (44%) had a history and investigation results suggestive of asthma. Only 2 had a history of anxiety or depression, but 17 (78%) patients exceeded the threshold for anxiety or panic on Clinical Interview Schedule (CIS-R) interview (score ≥12). Marihuana or alcohol abuse were involved in 17% with a history of past abuse in 26%. When assessed 2 months after the attack, 13 (57%) had resting or stressor-induced hyperventilation with a significant (p<0.05) association with asthma but not with a positive CIS-R score. These results illustrate the multifactorial basis of acute hyperventilation, the importance of misattribution, and the danger of using the term “hyperventilation syndrome” in the emergency department.

Section snippets

Patients

We studied 23 consecutive patients presenting with an episode of acute hyperventilation over a period of 1 year. The patient register was checked to ensure that no patients had been missed over the study period. Diagnosis of acute hyperventilation was made on clinical grounds by the emergency department physicians on the basis of history, observation, and examination, and in five patients arterial blood gas determinations, taken within the first 2 h of presentation to the hospital. In all

Results

Our patients were almost equally divided between men (12) and women (11). The presenting complaints are listed in Table 1 and were elicited by the emergency department physicians at the time of initial presentation. No patient with an organic cause for their complaints was referred to us, and in all cases, chest radiograph, blood biochemistry, and full blood cell count measured at the time of presentation were normal. No patient presented with any symptoms or signs suggestive of asthma, and

Discussion

Patients with acute hyperventilation are well known to all emergency departments, but to our knowledge, this study is probably the first to attempt to study these difficult patients at and soon after the time of initial presentation. In common with most studies that rely on busy emergency department staff for patient selection, the selection criteria could be criticized in that arterial blood gas data were available only in about one fourth of the patients referred, and this blood was sometimes

Acknowledgments

Dr. J. Costello, Director of the Department of Respiratory Medicine, and Professor R. Murray, head of the Academic Department of Psychological Medicine, provided laboratory facilities.

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  • Cited by (0)

    The Wellcome Trust provided financial support.

    revision accepted May 17.

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