WordNet

a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
an increased depth and rate of breathing greater than demanded by the body needs; can cause dizziness and tingling of the fingers and toes and chest pain if continued

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/17 18:48:56」(JST)

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Hyperventilation syndrome (HVS; also chronic hyperventilation syndrome or CHVS) is a respiratory disorder, psychologically or physiologically based, involving breathing too deeply or too rapidly (hyperventilation). HVS may present with chest pain and a tingling sensation in the fingertips and around the mouth (paresthesia) and may accompany a panic attack.

People with HVS may feel that they cannot get enough air. In reality, they have about the same oxygenation in the arterial blood (normal values are about 98% for hemoglobin saturation) and too little carbon dioxide in their blood and other tissues. While oxygen is abundant in the bloodstream, HVS reduces effective delivery of that oxygen to vital organs due to low-CO₂-induced vasoconstriction and the suppressed Bohr effect.

The hyperventilation is self-promulgating as rapid breathing causes carbon dioxide levels to fall below healthy levels, and respiratory alkalosis (high blood pH) develops. This makes the symptoms worse, which causes the person to try breathing even faster, which further exacerbates the problem.

The respiratory alkalosis leads to changes in the way the nervous system fires and leads to the paresthesia, dizziness, and perceptual changes that often accompany this condition. Other mechanisms may also be at work, and some people are physiologically more susceptible to this phenomenon than others.^[1]

Causes [edit]

Hyperventilation syndrome is believed to be caused by psychological factors and by definition has no organic cause.^[2] It is one cause of hyperventilation with others including infection, blood loss, heart attack,^[3] hypercapnia or alkalosis due to chemical imbalances, decreased cerebral blood flow, and increased nerve sensitivity may also underlie this symptom.^[4]

In one study, one third of patients with HVS had "subtle but definite lung disease" that prompted them to breathe too frequently or too deeply.^[5]

Many people with panic disorder or agoraphobia will experience HVS. However, most people with HVS do not have these disorders.^[1]

Diagnosis [edit]

Hyperventilation syndrome is a remarkably common cause of dizziness complaints. About 25% of patients who complain about dizziness are diagnosed with HVS.^[4]

A diagnostic Nijmegen Questionnaire provides an accurate diagnosis of Hyperventilation without triggering symptoms. It has been used extensively in many scientific studies^{[citation needed]}.

The standard diagnostic technique is to have the patient breathe rapidly for two minutes. This will trigger the symptoms and convince the patient that overbreathing is responsible for the symptoms. This test can only be performed at a time when the patient is not already experiencing symptoms.

Treatment [edit]

While traditional intervention for an acute episode has been to have the patient breathe into a paper bag, causing rebreathing and restoration of CO₂ levels, this is not advised or taught.^[6] When patients hyperventilate, they change their blood chemistry toward alkalosis. In alkalosis, hemoglobin binds more securely to the oxygen ('alkalotic O₂ clamping', also called the 'Bohr effect'), so the patient's cells become relatively hypoxic. Restricting inspired oxygen worsens this hypoxia and is detrimental to the patient. If attempting to calm the patient does not work within a few minutes, and the patient's condition is deteriorating, the hyperventilation may be caused by a medical condition (some of which are life threatening such as head injuries or drug overdose).

The same benefits can be obtained more safely from deliberately slowing down the breathing rate by counting or looking at the second hand on a watch. This is sometimes referred to as "7-11 breathing", because a gentle inhalation is stretched out to take 7 seconds (or counts), and the exhalation is slowed to take 11 seconds. This in-/exhalation ratio can be safely decreased to 4-12 or even 4-20 and more, as the O₂ content of the blood will easily sustain normal cell function for several minutes) at rest when normal blood acidity has been restored.

Most patients benefit from carefully, deliberately slowing down their breathing twice a day for five minutes at a time.^[4] The goal is to reduce breathing to no more than five breaths per minute. This helps retrain their habits and convince them that faster breathing is unnecessary.

The original traditional treatment of breathing into a paper bag to control psychologically based hyperventilation syndrome (which is now almost universally known and often shown in movies and TV dramas) was invented by New York City physician (later radiologist), Alexander Winter, M.D. [1908-1978], based on his experiences in the U.S. Army Medical Corps during World War II and published in the Journal of the American Medical Association in 1951.^[7]

References [edit]

^ ^a ^b "eMedicine - Hyperventilation Syndrome: Article by Edward Newton, MD". Retrieved 2007-12-21.
^ Shu, BC; Chang, YY, Lee, FY, Tzeng, DS, Lin, HY, Lung, FW (2007-10-31). "Parental attachment, premorbid personality, and mental health in young males with hyperventilation syndrome.". Psychiatry Research 153 (2): 163–70. doi:10.1016/j.psychres.2006.05.006. PMID 17659783.
^ "Hyperventilation". Retrieved 2007-12-20.
^ ^a ^b ^c "Neurology - Hyperventilation Syndrome | Brad McKechnie, DC, DACAN". Retrieved 2007-12-20.
^ Natelson, Benjamin H. (1998). Facing and fighting fatigue: a practical approach. New Haven, Conn: Yale University Press. p. 40. ISBN 0-300-07401-8.
^ Bergeron, J. David; Le Baudour, Chris (2009). "Chapter 9: Caring for Medical Emergencies". First Responder (8 ed.). New Jersey: Pearson Prentice Hall. p. 262. ISBN 978-0-13-614059-7. "Do not use a paper bag in an attempt to treat hyperventilation. These patients can often be cared for with low-flow oxygen and lots of reassurance" |accessdate= requires |url= (help)
^ Winter, A (1951). "A Rapid Emergency Treatment for Hyperventilation Syndrome.". J Am Med Assoc 147 (10): 990. doi:10.1001/jama.1951.03670270080028.

UpToDate Contents

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1. 過換気症候群 hyperventilation syndrome
2. 呼吸困難患者へのアプローチ approach to the patient with dyspnea
3. 総血清カルシウムとイオン化血清カルシウム濃度の相関 relation between total and ionized serum calcium concentration
4. 頻脈を有する小児に対するアプローチ approach to the child with tachycardia
5. 職業性喘息：臨床的特徴および診断 occupational asthma clinical features and diagnosis

English Journal

Dizziness impairs health-related quality of life.

Ten Voorde M, van der Zaag-Loonen HJ, van Leeuwen RB.SourceDepartment of Neurology, Gelre ziekenhuizen, Albert Sweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation.Qual Life Res.2011 Sep 1. [Epub ahead of print]
PURPOSE: Relatively little is known about the level of impairment in patients with dizziness.RESEARCH QUESTION: How much does dizziness impair the quality of life of patients referred to a multidisciplinary dizziness unit PATIENTS AND METHODS: All 2,252 patients completed the Dutch version of the Di
PMID 21881925

Exertional dyspnea in mitochondrial myopathy: clinical features and physiological mechanisms.

Heinicke K, Taivassalo T, Wyrick P, Wood H, Babb TG, Haller RG.Source1Texas Health Presbyterian Hospital Dallas.
American journal of physiology. Regulatory, integrative and comparative physiology.Am J Physiol Regul Integr Comp Physiol.2011 Aug 3. [Epub ahead of print]
Exertional dyspnea limits exercise in some mitochondrial myopathy (MM) patients, but the clinical features of this syndrome are poorly defined and its underlying mechanism is unknown. We evaluated ventilation and arterial blood gases during cycle exercise and recovery in five MM patients with exerti
PMID 21813873

Japanese Journal

過呼吸症候群の精神病理

花澤寿,ハナザワヒサシ,Hanazawa Hisashi
千葉大学教育学部研究紀要 59, 229-234, 2011-03
過呼吸症候群の精神病理を,パニック障害,心身症,転換性障害という3つの病態との関連から検討した。パニック障害は脳の機能性障害に起因する病態とされており,過呼吸症候群が心因性に生じるという前提に立つならばパニック障害と混同すべきではないことを指摘した。また,ヒトの呼吸のもつ自律神経系と随意神経系による二重支配という特徴に注目し,主に前者を通じて症状が生じる心身症としての過呼吸と,後者を通じて症状が生 …
NAID 120003017750