| Revision as of 06:43, 12 May 2008 editPosturewriter (talk | contribs)260 edits Added history 1864-1916 integrating exertion/cardiac/fatigue aspects← Previous edit |
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== History == |
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== History == |
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Da Costa's Syndrome was first described among soldiers in 1869 by ], who called it neurocirculatory asthenia or cardiovascular neurosis,<ref>''A Dictionary of the History of Medicine'', Anton Sebastian, Informa Health Care, ISBN 1850700214</ref> but acquired its more usual name from the 1871 Da Costa study, which reported the latter's observations made during the American Civil War.<ref name="titleDa Costa's syndrome (www.whonamedit.com)">{{cite web |url=http://www.whonamedit.com/synd.cfm/2882.html |title=Da Costa's syndrome (www.whonamedit.com) |accessdate=2007-12-18 |format= |work=}}</ref> Use of the term "Da Costa's syndrome" peaked in the early 20th century. Towards the mid-century, the condition was generally re-characterized as a form of ].<ref name="isbn1-58901-014-0">{{cite book |author=Edmund D., MD Pellegrino; Caplan, Arthur L.; Mccartney, James Elvins; Dominic A. Sisti |title=Health, Disease, and Illness: Concepts in Medicine |publisher=Georgetown University Press |location=Washington, D.C |year=2004 |pages=165 |isbn=1-58901-014-0 |oclc= |doi=}}</ref> It was initially classified as "F45.30" (under ] of the heart and cardiovascular system) in ], <ref name="isbn92-4-154422-8">{{cite book |author=World Health Organization |title=Icd-10: The Icd-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines |publisher=World Health Organization |location=Geneva |year=1992 |pages=168 |isbn=92-4-154422-8 |oclc= |doi=}}</ref> and is now classified under "somatoform autonomic dysfunction". A 1987 historical overview by Oglesby <ref name="pmid3314950">{{cite journal |author=Paul O |title=Da Costa's syndrome or neurocirculatory asthenia |journal=Br Heart J |volume=58 |issue=4 |pages=306–15 |year=1987 |pmid=3314950 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=3314950}}</ref> described it as having "a long and honourable history in the medical literature", considering it to still exist "as a disorder of unknown origin", "more often identified and labelled in psychiatric terms such as "anxiety state" or "anxiety neurosis" - and affecting 2-4% of the population. |
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This constellations of symptoms acquired the title of Da Costa's syndrome from the 1871 study by Da Costa, which reported observations he made during the American Civil War.<ref name="titleDa Costa's syndrome (www.whonamedit.com)">{{cite web |url=http://www.whonamedit.com/synd.cfm/2882.html |title=Da Costa's syndrome (www.whonamedit.com) |accessdate=2007-12-18 |format= |work=}}</ref> Use of the term "Da Costa's syndrome" peaked in the early 20th century. Towards the mid-century, the condition was generally re-characterized as a form of ].<ref name="isbn1-58901-014-0">{{cite book |author=Edmund D., MD Pellegrino; Caplan, Arthur L.; Mccartney, James Elvins; Dominic A. Sisti |title=Health, Disease, and Illness: Concepts in Medicine |publisher=Georgetown University Press |location=Washington, D.C |year=2004 |pages=165 |isbn=1-58901-014-0 |oclc= |doi=}}</ref> It was initially classified as "F45.30" (under ] of the heart and cardiovascular system) in ], <ref name="isbn92-4-154422-8">{{cite book |author=World Health Organization |title=Icd-10: The Icd-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines |publisher=World Health Organization |location=Geneva |year=1992 |pages=168 |isbn=92-4-154422-8 |oclc= |doi=}}</ref> and is now classified under "somatoform autonomic dysfunction". |
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Da Costa's Syndrome involves a set of symptoms which include left-sided chest pains, ], breathlessness, and fatigue in response to exertion. Earl de Grey who presented four reports on British soldiers with these symptoms between 1864 and 1868, and attributed them to the heavy weight of military equipment being carried in knapsacks which were tightly strapped to the chest in a manner which constricted the action of the heart. Also in 1864, Henry Harthorme observed soldiers in the ] who had similar symptoms which were attributed to “long-continued overexertion, with deficiency of rest and often nourishment”, and indefinite heart complaints were attributed to lack of sleep and bad food. In 1870 Arthur Bowen Myers of the Coldstream Guards also regarded the accoutrements as the cause of the trouble, which he called neurocirculatory asthenia and cardiovascular neurosis.<ref>{{cite book | last = Goetz | first = C.G. | authorlink = | coauthors = Turner C.M. and Aminoff M.J. editors | title = Handbook of Clinical Neurology | publisher = Elsevier Science Publishers | date = 1993 | location = B.V. | pages = 429-447 | url = | doi = | id = | isbn = }}</ref><ref> {{cite journal|title=Discussions On The Soldier's Heart|journal=Proceedings of the Royal Society of Medicine, Therapeutical and Pharmacological Section|date=1916-01-18|first=Sir James |last=Mackenzie|coauthors=R.M.Wilson, PHilip Hamill, Alexander Morrison, O.Leyton, & Florence A.Stoney|volume=9|issue=|pages=27-60|id= |url=|format=|accessdate=2008-05-06 }}</ref> |
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===1864-1899=== |
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Da Costa's Syndrome involves a set of symptoms which include left-sided chest pains, palpitations, breathlessness, and fatigue in response to exertion, The condition was first described by Earl de Grey who presented four reports on British soldiers with these symptoms between 1864 and 1868, and attributed them to the heavy weight of military equipment being carried in knapsacks which were tightly strapped to the chest in a manner which constricted the action of the heart. Also in 1864, Henry Harthorme observed soldiers in the ] who had similar symptoms which were attributed to “long-continued overexertion, with deficiency of rest and often nourishment”, and indefinite heart complaints were attributed to lack of sleep and bad food. In 1870 Arthur Bowen Myers of the Coldstream Guards“ also regarded the accoutrements as the cause of the trouble and called it neurocirculatory asthenia and cardiovascular neurosis<ref>{{cite book | last = Goetz | first = C.G. | authorlink = | coauthors = Turner C.M. and Aminoff M.J. editors | title = Handbook of Clinical Neurology | publisher = Elsevier Science Publishers | date = 1993 | location = B.V. | pages = 429-447 | url = | doi = | id = | isbn = }}</ref> <ref> {{cite journal|title=Discussions On The Soldier's Heart|journal=Proceedings of the Royal Society of Medicine, Therapeutical and Pharmacological Section|date=1916-01-18|first=Sir James |last=Mackenzie|coauthors=R.M.Wilson, PHilip Hamill, Alexander Morrison, O.Leyton, & Florence A.Stoney|volume=9|issue=|pages=27-60|id= |url=|format=|accessdate=2008-05-06 }}</ref>. However “the best known contribution to the subject” was J.M.DaCosta’s study of 300 soldiers which reported similar findings and added that the condition often developed and persisted after a bout of fever or diarrhoea. He also noted that the pulse was always greatly and rapidly influenced by position, such as stooping or reclining. A typical case involved a man who was on active duty for several months or more and contracted an annoying bout of diarrhoea or fever, and then, after a short stay in hospital, returned to active service. The soldier soon found that he could not keep up with his comrades in the exertions of a soldier's life as previously, because he would get out of breath, and would get dizzy, and have palpitations and pains in his chest, yet upon examination some time later he looked like a man in sound condition <ref> {{cite journal|title=On Irritable Heart|journal=The American Journal of the Medical Sciences|date=January 1871|first=Jacob Medes|last=Da Costa|coauthors=|volume=|issue=|pages=p.18-52|id= |url=|format=|accessdate=2008-02-13 }}</ref>. In 1876 surgeon Arthur Davy attributed the symptoms to military drill where “over-expanding the chest, caused dilatation of the heart, and so induced irritability”<ref>{{cite book | last = Goetz | first = C.G. | authorlink = | coauthors = Turner C.M. and Aminoff M.J. editors | title = Handbook of Clinical Neurology | publisher = Elsevier Science Publishers | date = 1993 | location = B.V. | pages = 429-447 | url = | doi = | id = | isbn = }}</ref>. |
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J. M. DaCosta’s study of 300 soldiers reported similar findings in 1871 and added that the condition often developed and persisted after a bout of fever or diarrhoea. He also noted that the pulse was always greatly and rapidly influenced by position, such as stooping or reclining. A typical case involved a man who was on active duty for several months or more and contracted an annoying bout of diarrhoea or fever, and then, after a short stay in hospital, returned to active service. The soldier soon found that he could not keep up with his comrades in the exertions of a soldier's life as previously, because he would get out of breath, and would get dizzy, and have palpitations and pains in his chest, yet upon examination some time later he appeared generally healthy.<ref> {{cite journal|title=On Irritable Heart|journal=The American Journal of the Medical Sciences|date=January 1871|first=Jacob Medes|last=Da Costa|coauthors=|volume=|issue=|pages=p.18-52|id= |url=|format=|accessdate=2008-02-13 }}</ref> In 1876 surgeon Arthur Davy attributed the symptoms to military drill where “over-expanding the chest, caused dilatation of the heart, and so induced irritability".<ref>{{cite book | last = Goetz | first = C.G. | authorlink = | coauthors = Turner C.M. and Aminoff M.J. editors | title = Handbook of Clinical Neurology | publisher = Elsevier Science Publishers | date = 1993 | location = B.V. | pages = 429-447 | url = | doi = | id = | isbn = }}</ref> |
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===1900-1949=== |
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In 1916 the Royal Society of Medicine conducted a series of discussions on cardiac-like ailments in military life in World War 1. According to ] who opened the conference only 10% of cases involved actual heart disease. The remainder were referred to as having Soldier’s Heart, with no known cause. <ref> {{cite journal|title=Discussions On The Soldier's Heart|journal=Proceedings of the Royal Society of Medicine, Therapeutical and Pharmacological Section|date=1916-01-18|first=Sir James |last=Mackenzie|coauthors=R.M.Wilson, PHilip Hamill, Alexander Morrison, O.Leyton, & Florence A.Stoney|volume=9|issue=|pages=27-60|id= |url=|format=|accessdate=2008-05-06 }}</ref> Typically those soldier’s "will say they were in the trenches and felt well and fit, until one day they felt seedy and ill” and sought medical advice “when they were found to have a raised temperature", generally due to ], ], or other infections. After a few days rest they returned to the strenuous life in the trenches and soon collapsed with faintness, breathlessness and pain. They then noticed that they became breathless in response to moderate exertions such as walking quickly, or up a hill, or running upstairs, which sometimes also caused pain over their heart, and their heart rate became unduly rapid, and a sense of giddiness and fatigue was “easily induced”. However, "If they stop, sit, or lie down the sensation speedily disappears”. When these soldiers were medically examined various systolic murmurs were often found and some of the patients had ] of the legs, and were irritable, depressed, or brooding over their health or woes. |
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According to MacKenzie the same ailments occurred in civilian life where "we find identical conditions for instance, in people recovering from an exhausting illness, such as ] fever, or ], or after a severe surgical procedure", or "in people who have suffered a long mental or physical strain, particularly with insufficient sleep, as in a daughter who has for long periods nursed an ailing mother." |
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Mackenzie suggested that treatment should include the removal of the infection or toxins, and improving general health and strength with mild enjoyable exercise such as "bowls or quoits or skittles" in the "fresh air". He also referred to the importance of the judicious use of exercise which should involve the simple principle of exercising "so long as it gives him pleasure and causes no distress or discomfort, but to stop or slow down as soon as he experiences the sense of exhaustion, breathlessness and pain." |
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Regarding the symptom of exhaustion "There is a persistent over-action of vasomotor influences" . . . and sometimes . . . "flushes of heat pass over the body, and warmth may tend to overfilling of the peripheral vessels. This is seen in people who ] when standing in a warm room, or who speedily become exhausted or even faint when exertion is made. In these, the blood tends to accumulate in the peripheral veins of the limbs and in the large abdominal veins”, which results in a reduced blood flow to the brain so that “the sense of exhaustion and ] are provoked". MacKenzie presented this description to show that this type of exhaustion is related to poor blood circulation and was not the same mechanism which produced exhaustion of the heart itself. |
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Since then, a variety of similar or partly similar conditions have been described. Although it is listed in the ] under "somatoform autonomic dysfunction", the term is no longer in common use by any medical agencies and has generally been superseded by more specific diagnoses. |
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Sir Thomas Lewis re-named this collection of symptoms ''effort syndrome'' in '''1919''' because he observed that in some cases the symptoms occurred exclusively in response to physical exertion.<ref>Lewis T. (1919) The soldier’s heart and the effort syndrome, Paul B. Hoeber, New York.</ref> During this time, several other synonyms were used to describe collections of symptoms which are related to Da Costa's syndrome, including soldier's heart, neurocirculatory asthenia, and anxiety neurosis. |
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In '''1939''' J.L. Caugney Jnr. from the Department of Medicine, Columbia University in New York City, reviewed the literature of internal medicine on the subject of cardiovascular neurosis which referred to cases that involved symptoms similar to those of heart disease occurring where there was no apparent disease of the heart or blood vessels.<ref> {{cite journal|title=Cardiovascular Neurosis; A Review|journal=Psychosomatic Medicine|date=April 1939|first=J.L. Jnr.|last=Caugney|coauthors=|volume=1|issue=3|pages=311-324|id= |url=|format=|accessdate=2008-04-26 }}</ref> He mentioned earlier terms such as effort syndrome, and presented a description of a typical civilian patients' past and present physique, health, and personal history. The patient was generally aged 30, and previously did clerical work but was currently unemployed, and had a thin build and long chest, was never robust, had frequent sore throats and colds as a child, had his tonsils and appendix out, and was "unable to sit and lie quietly". He generally had a weak stomach, and had his kidneys damaged by ], and there were frequent fluctuations in the color and volume of his urine. His blood pressure was unstable, and his peripheral circulation was poor, with pale fingers and toes in cold weather, and he had a poor memory, and difficulty with concentrating and thinking clearly. “He had always been nervous and easily fatigued", and he "was never allowed" to take part in competitive sports and had felt physically inferior to others of his own age. In a typical case he had a respiratory infection three years earlier but never recovered properly, and since then has had gradually increasing pain in his heart, shortness of breath, dizziness, faintness and weakness. All of his symptoms were “made worse by exertion or nervous strain”. Caugney states that the breathlessness "is not true air hunger, but literally a 'shortness of breath' a feeling that deep breath cannot be achieved. The patient usually localizes this sensation in the chest wall itself, and describes a constant dissatisfaction similar to the transient annoyance which a normal person has after attempting to sigh but not quite attaining the complete expansion desired”. Caugney also noted previous exercise tests which indicated "a physiological abnormality in the patient as compared to the normal person”, but he interpreted that response to exercise as "no more dependent on the amount of exertion than it is on the emotional reaction he has, the fear he has that the test will injure seriously his already weakened heart." In describing the lack of stamina for exertion he suggested that there were two groups of patients, the first who never developed the ability to persevere against the challenges and adversities of life, and those who tried but gave up. |
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Several limited studies of these conditions were undertaken during the '''mid-20th century'''], May 24th 1941, Vol.1, p.767-772.</ref><ref> {{cite journal|title=Low oxygen consumption and low ventilatory efficiency during exhausting work in patients with neurocirculatory asthenia, effort syndrome, anxiety neurosis|journal=Journal of Clinical Investigation|date=1946 Nov.|first=Mandel E.|last=Cohen|coauthors=R.E. Johnson, F.C. Consolazio, P.D. White|volume=25|issue=6|pages=920|id= |url=|format=|accessdate=2008-01-20 }}</ref> and in '''1947''' S.Wolf studied the "respiratory distress characterized by inability to get a full breath” and found that the thoracic diaphragm function was abnormal, and when the diaphragms contractile state during inspiration was such that adequate inspiration was no longer possible, breathlessness occurred with a feeling of inability to take a full breath. The spasm of the diaphragm was often accompanied by pains in the chest and shoulder, occlusion of the lower end of the esophagus, and difficulty swallowing. <ref> {{cite journal|title=Sustained Contraction of the Diaphragm, the Mechanism or a Common Type of Dyspnoea and Precordial Pain|journal=Journal of Clinical Investigation|date=1947 November|first=S.|last=Wolf|coauthors=|volume=26|issue=|pages=1201|id= |url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=439463&pageindex=29|format=|accessdate=2008-03-23 }}</ref> Also in '''1947''' a report by Cohen and White noted that the complete mechanism of Da Costa syndrome symptoms was unknown but when respiration was investigated objective abnormalities were found, just as when the other symptoms of N.C.A. were investigated with objective methods, which demonstrates that the abnormalities are not all in the subjective sphere". The respiratory abnormalities at rest were few but during exercise the abnormalities became more pronounced and the deviations from the normal became greater as the rate and amount of exercise increased.<ref>{{cite journal|title=Studies of Breathing, Pulmonary Ventilation and Subjective Awareneess of Shortness of Breath (Dyspnea) in Neurocirculatory Asthenia, Effort Syndrome, Anxiety Neurosis|journal=The Journal of Clinical Investigation|date=May 1947|first=Mandel |last=Cohen|coauthors=Paul D. White|volume=26|issue=3|pages=520-529|id= |url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?tool=pmcentrez&artid=439184&blogtype=pdf|format=|accessdate=2008-02-04 }}</ref> |
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===After 1950=== |
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In '''1950''' Edmund Wheeler presented the findings of a 20-year longitudinal study of 173 patients with "effort syndrome" which concluded that the condition involved varying degrees of disability but all patients tended to improve with a low-stress lifestyle.<ref>Wheeler E.O. (1950), Neurocirculatory Asthenia et.al. - A Twenty Year Follow-Up Study of One Hundred and Seventy-Three Patients., ], 25th March 1950, p.870-889 (Contributors to the study: Edwin O.Wheeler, M.D., ], M.D., Eleanor W.Reed, and Mandel E.Cohen, M.D.)</ref> |
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In '''1951''' the fourth edition of ]’s book “Heart Disease” contained a chapter on “Neurocirculatory Asthenia”, because, as he explains, the symptoms are similar to heart disease, but are not the same, and he adds, that they are also similar to, but can occur in the absence of anxiety, and therefore need to be discussed separately. |
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He gives the definition of N.C.A. as the typical group of symptoms of breathlessness, often with sighing, palpitations, precordial aches and pains, exhaustion, and related symptoms such as dizziness and faintness, which are precipitated by excitement or effort, and “it constitutes a kind of fatigue syndrome” . . . and in some cases . . . “it is more or less a chronic condition“ . . . and . . . “That such a state of ill health exists there can be no doubt, no matter what its pathogenesis or exciting factors.” and “the symptoms are not exactly like those produced by effort in a normal healthy person. In some patients the neurocirculatory symptoms are prominent but in others it is gastrointestinal or cerebral symptoms, but the reason for those differences “has not been explained”. The general causes of the condition appear to include such strains as worry over business, social, or family matters, emotional conflicts, physical or nervous fatigue, and exhaustion from acute infections or illnesses. The organic basis is not known although it may involve a disorder of the autonomic nervous system. Other possibilities which have been considered in the past 25 years, include thyrotoxicosis, low-grade infection, adrenal hyperactivity, ], and lack of salt, but none have been confirmed, However many of the patients have thin physiques with an “unusually vertical position of the heart”, and “Another interesting finding is abnormality of shape of the capillary loops at the base of the nail”. . . “It is common to find that close relatives have had similar problems, and “Recent studies have suggested that neurocirculatory asthenia belongs to the Mendelian dominant group of inherited disorders.” It was common in World War 1, occurred in civilians as well as soldier’s, and it is generally seen in young adults, but can occur at any age, and is more common in women than men. The symptom of frequent sighing distinguishes the condition from heart disease, and the fatigue sometimes produces more incapacity than heart disease, and in some cases results in complete disability. “It is a real and not an imaginary incapacity, even though at first glance it may have appeared imaginary in World War 1 (1914-1918) when it was sometimes labelled ‘malingering,’ and even though in civilian practice it has frequently been diagnosed as ‘mere nervouseness’.” It is milder in civilian life than in war and it is so commonly associated with psycho-neurosis of the anxiety type “that the two conditions have sometimes been confused one for the other or considered to be synonymous, the term anxiety neurosis having come to mean for many the same collection of symptoms which identify neurocirculatory asthenia.” |
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Treatment involves rest for days or months or as long as required, and elaborate psychotherapy is generally not needed. “In fact, since this condition is neither heart disease nor mental disorder, both cardiologist and psychiatrist are well kept away after the diagnosis has been established, so that the patient may not develop unnecessary fears about either heart or mental state.” |
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“The condition must be discussed seriously, not lightly as if it was of no importance”, and it is equally wrong to dismiss it as negligible or imaginary, as it is to to regard it as dangerous or serious and a threat to life which demands bed rest. Careless disregard will alienate patients and have them seeking advice from charlatans. “The plan of life for the patient needs to be worked out with care” where usually normal but quiet work and play are required, with the avoidance long working hours or new and burdensome tasks. “Often the patient himself is aware of this necessity, but he has perhaps disliked to humor his symptoms or to fall behind his fellows in strenuous living in the business, professional, or social world. With clear medical advice, however, he realizes the wisdom of doing so, and gradually he adjusts himself to suit his symptoms, and is surprised at recapturing a feeling of well being.”<ref>{{cite book | last = White | first = Paul Dudley | authorlink = | coauthors = | title = Heart Disease | publisher = MacMillan | date = 1951 | location = New York, New York | pages = 578-591 | url = | doi = | id = | isbn = }}</ref> |
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In '''1956''' Paul Wood’s 2nd edition of Diseases of the Heart and Circulation included a chapter on the effort syndrome . He described how "The syndrome is characterised by a group of symptoms which unduly limit the subject's capacity for effort" and recorded that " The cardinal symptoms" of effort syndrome, neurocirculatory asthenia, irritable heart, soldier's heart, disordered action of the heart (D.A.H.), etc. are "breathlessness (93%), palpitations (89%), fatigue (88%), left inframammary pain (78%), and dizziness (78%), or syncope (fainting) (35%)". He also suggested a variety of methods for diagnosing the difference between the symptoms and those of heart disease. For example (the) “Left inframammary pain (in the lower rib area) is commonly described as aching or as sharp and stabbing in quality” and “It may be initiated” “by fatigue or strain of respiratory muscles” caused by such things as “incessant minimum trauma from” “faulty posture" . . . and with regard to the breathlessness "It is not only a question of breathlessness on effort, but patients will say they are not able to obtain a satisfying breath, and |
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may take "frequent deep sighs". This can sometimes occur at night when it "may be confused with bronchial asthma or paroxysmal cardiac dyspnea". and "A simple and illuminating test" for the symptom involves forced hyperventilation where "The patient is asked to breath deeply and rapidly for one minute." When a healthy person is asked to stop he feels breathless for about 20 seconds, but a patient with Da Costa's syndrome "continues forced breathing, explaining later that he felt breathless." i.e. there is "] instead of ] after forced breathing", and "Normal subjects have no difficulty holding the breath for at least 30 seconds, but patients |
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with Da Costa's syndrome usually give up very quickly, 30 per cent of them in less than 10 seconds; moreover, in contrast to controls, they show little distress when the reach the breaking-point." . . . With regard to the fatigue the patients often do not feel refreshed when they wake up in the morning, as if their sleep has been of no value, and they may "feel tired and listless during the day, and are unduly fatigued by effort. " . . . and . . . Orthostatic dizziness is related to orthostatic hypotension and "The effort-tolerance test (for effort-intolerance) consists of stepping on and off a chair ten times, and counting the pulse rate before, immediately after, and subsequently at minute intervals until the resting speed is regained. The deceleration time is abnormal (over 2 minutes) in 33% of these patients." and "Physical signs of autonomic dysfunction are helpful in” “assessing the severity of the case." The photo of a painting of a typical round shouldered, thin chested, kyphotic patient is included on page 941. |
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In '''1980''' Soviet researcher V.S.Volkov studied the physical fitness levels of patients with angina heart disease, and compared them to those with neurocirculatory dystony (Da Costa’s syndrome). He divided heart disease patients into three groups with heart pain at rest, heart pain every day, and heart pain occasionally. He also divided NCD patients into three stages of mild, moderate, and severe. 80% of Da Costa’s syndrome patients were fitter than heart disease patients, but 20% were not, and had to stop the exercise because of changes in their heart rate, or overwhelming and radiating chest pain, general fatigue, and fear for their hearts.<ref>Volkov V.S. (1980) Psychosomatic Interrelations and their clinical importance in patients with cardiac type NCD, Soviet Medicine (11) p.9-15 English Abstract (and a translation)</ref> |
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In '''1990''' S.D. Rosen and his colleagues from the Department of Cardiology in the Charing Cross Hospital, London conducted a study of patients who had been diagnosed with the chronic fatigue syndrome, myalgic encephalomyelitis, and postviral syndrome, which they referred to as the modern terms for the effort syndrome. Their objective was to determine the role of emotional factors and chronic habitual hyperventilation in producing the symptoms by testing the levels of CO2 in the lungs during, and after 3 minutes of deliberate rapid and deep breathing, and then again while the patients were thinking about prior personal experiences which involved anger or fear. The results showed that 93 of the 100 patients had evidence characteristic of chronic habitual hyperventilation. Rosen and his colleagues also noted "It has long been recognized that hyperventilation-related illness can appear after or be aggravated by injury or infection”, so they studied that aspect and found evidence of chronic hyperventilation symptoms before the viral infection, and suggested that the infective illness simply made the fatigue worse. Their final paragraph mentioned the opinions of three authors who regarded normal health as being maintained by leading a moderate lifestyle and staying within reasonable boundaries, and that leading an excessively demanding lifestyle beyond those limits may be the cause of the effort syndrome.<ref> {{cite journal|title=Is chronic fatigue syndrome synonymous with effort syndrome?|journal=Journal of the Royal Society of Medicine|date=December 1990|first=S.D. |last=Rosen|coauthors=J.C. King, J.B. Wilkinson, & P.G.F. Nixon|volume=83|issue=|pages=761-764|id= |url=|format=|accessdate=2008-03-22 }}</ref> In '''1994''' S.G, Saish and his colleagues from The College of Thoracic Medicine, Kings College School of Medicine and Dentistry, London, U.K. studied 31 patients with chronic fatigue and found that 71% “had no evidence of hyperventilation during any aspect of the test” and that “There is only a weak association between hyperventilation and chronic fatigue syndrome”.<ref> {{cite journal|title=Hyperventilation and chronic fatigue syndrome|journal=The Quarterly Journal of Medicine|date=June 1994|first=S.G.|last=Saish|coauthors=A. Deale, W.N. Gardner, & S. Wessely|volume=87|issue=6|pages=373-374|id= |url=http://www.ncbi.nlm.nih.gov/pubmed/8140219?ordinalpos=1&itool=EntresSystem2.PEntrez.PUbmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1|format=|accessdate=2008-03-22 }}</ref> In '''1997''' E. Bazelmans and his research colleagues from the Department of Medical Psychology of the University Hospital, Nijmegen, The Netherlands shed doubt on the role of hyperventilation in causing the chronic fatigue syndrome with their evidence that it is not related to the number or severity of symptoms and is probably a consequence rather than a cause of the condition<ref>. {{cite journal|title=The chronic fatigue syndrome and hyperventilation|journal=Journal of Psychosomatic Research|date=1997|first=E.|last=Bazelmans|coauthors=|volume=43|issue=4|pages=371-377|id= |url=http://www.ncbi.nlm.nih.gov/pubmed/9330236?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA|format=|accessdate=2008-03-20 }}</ref> |
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==Related conditions== |
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==Related conditions== |
Other somatoform autonomic dysfunctions include effort syndrome and neurocirculatory asthenia. These may all be the same condition, or may represent slight variations.
At the time it was proposed, Da Costa's Syndrome was seen as a physiological explanation for "soldier's heart," or signs and symptoms shown by some veterans such as an elevated startle reflex or irritability. These would now be understood as both physiological and psychological, and called PTSD.
This constellations of symptoms acquired the title of Da Costa's syndrome from the 1871 study by Da Costa, which reported observations he made during the American Civil War. Use of the term "Da Costa's syndrome" peaked in the early 20th century. Towards the mid-century, the condition was generally re-characterized as a form of neurosis. It was initially classified as "F45.30" (under somatoform disorder of the heart and cardiovascular system) in ICD-10, and is now classified under "somatoform autonomic dysfunction".
Da Costa's Syndrome involves a set of symptoms which include left-sided chest pains, palpitations, breathlessness, and fatigue in response to exertion. Earl de Grey who presented four reports on British soldiers with these symptoms between 1864 and 1868, and attributed them to the heavy weight of military equipment being carried in knapsacks which were tightly strapped to the chest in a manner which constricted the action of the heart. Also in 1864, Henry Harthorme observed soldiers in the American Civil War who had similar symptoms which were attributed to “long-continued overexertion, with deficiency of rest and often nourishment”, and indefinite heart complaints were attributed to lack of sleep and bad food. In 1870 Arthur Bowen Myers of the Coldstream Guards also regarded the accoutrements as the cause of the trouble, which he called neurocirculatory asthenia and cardiovascular neurosis.
J. M. DaCosta’s study of 300 soldiers reported similar findings in 1871 and added that the condition often developed and persisted after a bout of fever or diarrhoea. He also noted that the pulse was always greatly and rapidly influenced by position, such as stooping or reclining. A typical case involved a man who was on active duty for several months or more and contracted an annoying bout of diarrhoea or fever, and then, after a short stay in hospital, returned to active service. The soldier soon found that he could not keep up with his comrades in the exertions of a soldier's life as previously, because he would get out of breath, and would get dizzy, and have palpitations and pains in his chest, yet upon examination some time later he appeared generally healthy. In 1876 surgeon Arthur Davy attributed the symptoms to military drill where “over-expanding the chest, caused dilatation of the heart, and so induced irritability".
Since then, a variety of similar or partly similar conditions have been described. Although it is listed in the ICD-10 under "somatoform autonomic dysfunction", the term is no longer in common use by any medical agencies and has generally been superseded by more specific diagnoses.
The reports of Da Costa, and Wheeler show that patients recovered from the more severe symptoms when removed from the strenuous activity or sustained lifestyle that caused them. In many cases relapses were prevented by determining the limits of exertion and lifestyle and keeping within them. The limits were related to abnormalities in respiration and circulation. Other treatments evident from the previous studies were improving physique and posture, appropriate levels of exercise where possible, wearing loose clothing about the waist, and avoiding postural changes such as stooping, or lying on the left or right side, or the back in some cases, which relieved some of the palpitations and chest pains, and standing up slowly can prevent the faintness associated with postural or orthostatic hypotension in some cases.
