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Revision as of 00:59, 15 December 2007 by Posturewriter (talk | contribs) (minor edit plus added links ~~~posturewriter)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)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.
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 two studies were improving physique, 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.
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.)
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