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| In 1950 Edwin Wheeler and his colleagues from the ] and the ] presented their report of a 20 year follow-up study of 173 patients with the Effort Syndrome in J.A.M.A. They found that the condition generally takes a variable course, and also varies from person to person. Most subjects completed quesionairres and of the 60 who attended medical examinations, 11.7% were well, 35% had symptoms, 38.3% had mild disability, and 15% had severe disability, and there are notes where the subjects led quiet or moderate lifestyles, and when changing to more strenuous and sustanined activities their health deteriorated, so they returned to the quiet life and recovered. The periods of recouperation from the severe epidodes varied from several days, and up to six weeks, and in one case for a year. In some cases this occurred two or three times in their life before they recognised the necessity and value of limiting their activities. Co-morbidity and life expectancy were better than average. An abstract attached to the article referred to the typical features of thin physiques, and long, narrow chests, and the vasomotor responsese were below normal with delayed blood pressure and pulse in response to standard exertion, and there was high blood lactate concentration and low oxygen consumption associated with strenuous exercise. | In 1950 Edwin Wheeler and his colleagues from the ] and the ] presented their report of a 20 year follow-up study of 173 patients with the Effort Syndrome in J.A.M.A. They found that the condition generally takes a variable course, and also varies from person to person. Most subjects completed quesionairres and of the 60 who attended medical examinations, 11.7% were well, 35% had symptoms, 38.3% had mild disability, and 15% had severe disability, and there are notes where the subjects led quiet or moderate lifestyles, and when changing to more strenuous and sustanined activities their health deteriorated, so they returned to the quiet life and recovered. The periods of recouperation from the severe epidodes varied from several days, and up to six weeks, and in one case for a year. In some cases this occurred two or three times in their life before they recognised the necessity and value of limiting their activities. Co-morbidity and life expectancy were better than average. An abstract attached to the article referred to the typical features of thin physiques, and long, narrow chests, and the vasomotor responsese were below normal with delayed blood pressure and pulse in response to standard exertion, and there was high blood lactate concentration and low oxygen consumption associated with strenuous exercise. | ||
| In 1980 Soviet researcher V.S.Volkov presented his report on a comparative study of the exertional capacity of 228 patients with three stages of the effort syndrome (which he referred to as neurocirculatory dystony - NCD). For healthy men the average was 1176 kgm/min, and the three stages of NCD were 1161, 940 & 591 respectively, and for healthy women was 834, and the stages of NCD were 854, 621 & 420 kgm/min, indicating that the severity of the condition was related to circulatory efficiency and exertional capacity. 87.2% tolerated levels of 600 kgm/min or more, and 14 of the others had to stop because of overwhealming radiating chest pain, fatigue, and “fear for their hearts”, and another 14 stopped their test prematurely because of changes in their heart rates which reached sub-maximal levels. | |||
| From 1982 -1983, researchers at the South Australian Institute For Fitness Research and Training examined more than 80 volunteers with persistnat fatigue and found similar results, and a training programme was designed on the basis that they would participate if they kept within their own limits and improved at their own rate. Eleven who didn’t train were examined 6 months later with no significant change. Ten completed three months training of 2 hours per night twice per week, and six completed six months or more. Three cases improved but plateaud after three months below 600 kgm/min, and 3 ot those who were initially recorded as below 400 kgm/min showed significant improvement. Twelve months after starting the training programme one of the participants entered a six mile marathon and completed it. Although the results were not published in medical journals the general findings were reported in several Australian newspapers. | |||
| ⚫ | '''Treatment''' The reports of DaCosta, 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 |
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| According to the theory of research co-ordinator, Max Banfield, the four cardiac like symptoms of DaCosta’s syndrome were caused by the postural compression of the ] which was related to abnormal spiinal curvture, chest shape, and leaning forward. | |||
| * (1) The postural compression of the ]s placed strain on the structures between them resulting in occasional brief sharp stabbing pains in the lower left side of the chest. | |||
| * (2) Pressure on the ] impeded it’s upward movement and impaired it’s function and respiratory efficiency to cause an occasional sense of not being able to get a full breath, particularly during exercise, where two to four deep breaths in quick succession may be required every twenty yards or so. | |||
| * (3) Pressure on the heart pushed it toward the anterior chest wall where changes in pulse were more readily perceived as ]. | |||
| * (4) Pressure on the air and blood vessels in the chest impaired blood flow to the brain resulting in tiredness, and the resistance to blood flow affected the tone of the walls of the abdominal veins which weakened circulation and reduced exertional capacity. | |||
| The factors which contributed to the cause, as evident from the observations of DaCosta, Lewis, Wood, Wheeler. and other sources, included a stooped curvature of the upper spine ] and sideways curvature of the spine ]. Leaning forward or stooping added to the pressure, which would be more pronounced in a chest which was small, long, narrow, flat, or receding, e.g. ]. Other factors included tight belts or corsets, or the enlarging womb of ], especially in the latter stages when it presses up against the diaphragm, heart, and lungs. Hence, another contributing feature may be ]. The mechanism for the affect on circulation is comparable with ], and the chronic effect is evident in ]. | |||
| DaCosta’s Syndrome is a type of ], and posture is one of many other possible causes which have been confusing the link between cause and effect. | |||
| ⚫ | '''Treatment''' The reports of DaCosta, 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 laying 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 orhtostatic hypotension in some cases. | ||
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| * (4) Wood P. (1941) DaCosta's syndrome, The ], May 24th 1941, Vol.1, p.767-772. | * (4) Wood P. (1941) DaCosta's syndrome, The ], May 24th 1941, Vol.1, p.767-772. | ||
| * (5) 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.) | * (5) 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.) | ||
| * (6) 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) | |||
| * (7) Banfield M.A. (1982) SA study matches Russian results. Adelaide “News” Dec. 20th, p.18 as reported by journalist Diane Beer. | |||
Revision as of 05:58, 18 December 2007
Da Costa's Syndrome is a medical condition named after physician J.M. Da Costa who identified a set of symptoms occurring amongst soldier’s during the American Civil War. 200 patients in the study reported chest pains, palpitations, breathlessness, dizziness and fatigue, typically brought on by strenuous exertion, such as hard field service, and long marches, or marching at double-quick pace. He also observed that the symptoms could follow wounds, scurvy, or viral infections, and tended to persist after the fever had passed. The pulse was always greatly and rapidly influenced by position and could be aggravated by stooping, or by laying on the left or right side in some cases, and on the back in others. He reported that the waist belt and the knapsack seemed to have something to do with it, and recommended that the soldiers did not wear restrictive clothing because it was liable to retard or prevent recovery.
In 1919 Sir Thomas Lewis commented “ it is because these symptoms and signs are largely, and sometimes wholly, the exaggerated physiological response to exercise . . . that I term the whole the ‘effort syndrome’.”
In 1941 Paul Wood studied the respiratory function of 150 cases of DaCosta's syndrome, and found that although the cause of the left sided chest pain was elusive it was located in the muscular and fibrous structures in the anterior chest wall, and although "very few patients had pain while these measurements were being made" it was associated with poor upward movement of the diaphragm, and poor expansion of the chest, particularly the lower chest. Similar pains occurred in the right side of the chest, and in other parts of the chest wall, but less commonly. A more severe chest pain could be brought on by cranking a lorry engine, or lifting a heavy weight.
In 1950 Edwin Wheeler and his colleagues from the Massachusetts General Hospital and the Harvard Medical School presented their report of a 20 year follow-up study of 173 patients with the Effort Syndrome in J.A.M.A. They found that the condition generally takes a variable course, and also varies from person to person. Most subjects completed quesionairres and of the 60 who attended medical examinations, 11.7% were well, 35% had symptoms, 38.3% had mild disability, and 15% had severe disability, and there are notes where the subjects led quiet or moderate lifestyles, and when changing to more strenuous and sustanined activities their health deteriorated, so they returned to the quiet life and recovered. The periods of recouperation from the severe epidodes varied from several days, and up to six weeks, and in one case for a year. In some cases this occurred two or three times in their life before they recognised the necessity and value of limiting their activities. Co-morbidity and life expectancy were better than average. An abstract attached to the article referred to the typical features of thin physiques, and long, narrow chests, and the vasomotor responsese were below normal with delayed blood pressure and pulse in response to standard exertion, and there was high blood lactate concentration and low oxygen consumption associated with strenuous exercise.
In 1980 Soviet researcher V.S.Volkov presented his report on a comparative study of the exertional capacity of 228 patients with three stages of the effort syndrome (which he referred to as neurocirculatory dystony - NCD). For healthy men the average was 1176 kgm/min, and the three stages of NCD were 1161, 940 & 591 respectively, and for healthy women was 834, and the stages of NCD were 854, 621 & 420 kgm/min, indicating that the severity of the condition was related to circulatory efficiency and exertional capacity. 87.2% tolerated levels of 600 kgm/min or more, and 14 of the others had to stop because of overwhealming radiating chest pain, fatigue, and “fear for their hearts”, and another 14 stopped their test prematurely because of changes in their heart rates which reached sub-maximal levels.
From 1982 -1983, researchers at the South Australian Institute For Fitness Research and Training examined more than 80 volunteers with persistnat fatigue and found similar results, and a training programme was designed on the basis that they would participate if they kept within their own limits and improved at their own rate. Eleven who didn’t train were examined 6 months later with no significant change. Ten completed three months training of 2 hours per night twice per week, and six completed six months or more. Three cases improved but plateaud after three months below 600 kgm/min, and 3 ot those who were initially recorded as below 400 kgm/min showed significant improvement. Twelve months after starting the training programme one of the participants entered a six mile marathon and completed it. Although the results were not published in medical journals the general findings were reported in several Australian newspapers. According to the theory of research co-ordinator, Max Banfield, the four cardiac like symptoms of DaCosta’s syndrome were caused by the postural compression of the chest which was related to abnormal spiinal curvture, chest shape, and leaning forward.
- (1) The postural compression of the ribs placed strain on the structures between them resulting in occasional brief sharp stabbing pains in the lower left side of the chest.
- (2) Pressure on the diaphragm impeded it’s upward movement and impaired it’s function and respiratory efficiency to cause an occasional sense of not being able to get a full breath, particularly during exercise, where two to four deep breaths in quick succession may be required every twenty yards or so.
- (3) Pressure on the heart pushed it toward the anterior chest wall where changes in pulse were more readily perceived as palpitations.
- (4) Pressure on the air and blood vessels in the chest impaired blood flow to the brain resulting in tiredness, and the resistance to blood flow affected the tone of the walls of the abdominal veins which weakened circulation and reduced exertional capacity.
The factors which contributed to the cause, as evident from the observations of DaCosta, Lewis, Wood, Wheeler. and other sources, included a stooped curvature of the upper spine [[kyphosis[[, a forward curve in the lower spine lordosis and sideways curvature of the spine scoliosis. Leaning forward or stooping added to the pressure, which would be more pronounced in a chest which was small, long, narrow, flat, or receding, e.g. pectus excavatum. Other factors included tight belts or corsets, or the enlarging womb of pregnancy, especially in the latter stages when it presses up against the diaphragm, heart, and lungs. Hence, another contributing feature may be visceroptosis. The mechanism for the affect on circulation is comparable with Valsalva Maneuver, and the chronic effect is evident in tilt table test.
DaCosta’s Syndrome is a type of chronic fatigue, and posture is one of many other possible causes which have been confusing the link between cause and effect.
Treatment The reports of DaCosta, 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 laying 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 orhtostatic hypotension in some cases.
References
- (1) Da Costa J.M. (1871) On Irritable Heart, The American Journal of Medical Sciences January 1871, p.18-52 and p.28-29.
- (2) Lewis T. (1919) The soldier’s heart and the effort syndrome, Paul B. Hoeber, New York.
- (3) Lewis T. (1933) Diseases of the heart, The MacMillan Co., New York p.158-164.
- (4) Wood P. (1941) DaCosta's syndrome, The British Medical Journal, May 24th 1941, Vol.1, p.767-772.
- (5) Wheeler E.O. (1950), Neurocirculatory Asthenia et.al. - A Twenty Year Follow-Up Study of One Hundred and Seventy-Three Patients., Journal of the American Medical Association, 25th March 1950, p.870-889 (Contributors to the study: Edwin O.Wheeler, M.D., Paul Dudley White, M.D., Eleanor W.Reed, and Mandel E.Cohen, M.D.)
- (6) 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)
- (7) Banfield M.A. (1982) SA study matches Russian results. Adelaide “News” Dec. 20th, p.18 as reported by journalist Diane Beer.
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