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Da Costa's syndrome
Specialty	Psychiatry

Da Costa's Syndrome produces symptoms similar to heart disease, such as fatigue upon exertion, shortness of breath, palpitations, sweating, and chest pain. However, upon examination, nothing is found to be physically wrong with the patient.

The World Health Organization classifies this condition as a somatoform autonomic dysfunction (a type of psychosomatic disorder) in their ICD-10 coding system. In their ICD-9 system, it was classified under non-psychotic mental disorders. It is generally considered a physical manifestation of an anxiety disorder. The syndrome is also frequently interpreted as one of a number of imprecisely characterized "postwar syndromes".

Da Costa's syndrome is named for the surgeon Jacob Mendes Da Costa, who first observed it in soldiers during the American Civil War. At the time it was proposed, Da Costa's Syndrome was seen as a very desirable physiological explanation for soldier's heart.

There are many names for this syndrome, which has variously been called cardiac neurosis, chronic asthenia, effort syndrome, functional cardiovascular disease, neurocirculatory asthenia, primary neurasthenia, and subacute asthenia. Da Costa himself called it irritable heart and the term soldier's heart was in common use both before and after his paper. Most authors use these terms interchangeably, but some authors draw a distinction between the different manifestations of this condition, preferring to use different labels to highlight the predominance of psychiatric or non-psychiatric complaints. For example, Paul writes that "Not all patients with neurocirculatory asthenia have a cardiac neurosis, and not all patients with cardiac neurosis have neurocirculatory asthenia." None of these terms are used very often in modern texts.

History

This constellation 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 "F45.3" (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. Da Costa’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 orthostatic intolerance observed by Da Costa has since also been found in patients diagnosed with chronic fatigue syndrome and mitral valve prolapse syndrome. In the 21st century, this intolerance is classified as a neurological condition. Exercise intolerance has since been found in many organic diseases.

Treatment

The report of Da Costa shows 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, a coping skill now known as pacing. 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.

References

1. Selian Neuhoff, "Clinical Cardiology", MacMillan NY 1917 Chapter XX, p.255), cited "vlib.us". Retrieved 2007-12-18.
2. ^ "2008 ICD-9-CM Diagnosis 306.* - Physiological malfunction arising from mental factors". 2008 ICD-9-CM Volume 1 Diagnosis Codes. Retrieved 2008-05-26. "Neurocirculatory asthenia is most typically seen as a form of anxiety disorder."
3. "Dorlands Medical Dictionary:Da Costa syndrome". Retrieved 2008-05-26.
4. Engel CC (2004). "Post-war syndromes: illustrating the impact of the social psyche on notions of risk, responsibility, reason, and remedy". J Am Acad Psychoanal Dyn Psychiatry. 32 (2): 321–34, discussion 335–43. PMID 15274499.
5. Clark MR, Treisman GL (eds.) (2004). Pain And Depression: An Interdisciplinary Patient-centered Approach (Series: Advances in Psychosomatic Medicine, vol. 25). Basel: Karger. p. 176. ISBN 3-8055-7742-7. {{cite book}}: |author= has generic name (help)
6. National Research Council; Committee on Veterans' Compensation for Posttraumatic Stress Disorder (2007). PTSD Compensation and Military Service: Progress and Promise. Washington, D.C: National Academies Press. p. 35. ISBN 0-309-10552-8. Retrieved 2008-05-26. Being able to attribute soldier's heart to a physical cause provided an "honorable solution" to all vested parties, as it left the self-respect of the soldier intact and it kept military authorities from having to explain the "psychological breakdowns in previously brave soldiers" or to account for "such troublesome issues as cowardice, low unit morale, poor leadership, or the meaning of the war effort itself" (Van der Kolk et al., as cited in Lasiuk, 2006).{{cite book}}: CS1 maint: multiple names: authors list (link)
7. "Neurasthenia". Rare Disease Database. National Organization for Rare Disorders, Inc. 2005. Retrieved 2008-05-28.
8. Paul Wood, MD, PhD (1941-05-24). "Da Costa's Syndrome (or Effort Syndrome). Lecture I". Lectures to the Royal College of Physicians of London. British Medical Journal. pp. 1(4194): 767–772. Retrieved 2008-05-28.{{cite web}}: CS1 maint: multiple names: authors list (link)
9. Cohen ME, White PD (1951). "Life situations, emotions, and neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome)". Psychosom Med. 13 (6): 335–57. PMID 14892184. Retrieved 2008-05-28.
10. ^ Paul O (1987). "Da Costa's syndrome or neurocirculatory asthenia". Br Heart J. 58 (4): 306–15. PMID 3314950. Cite error: The named reference "pmid3314950" was defined multiple times with different content (see the help page).
11. ^ Da Costa, Jacob Medes (January 1871). "On irritable heart; a clinical study of a form of functional cardiac disorder and its consequences". The American Journal of the Medical Sciences (61): p.18–52. {{cite journal}}: |access-date= requires |url= (help); |pages= has extra text (help)
12. "Da Costa's syndrome (www.whonamedit.com)". Retrieved 2007-12-18.
13. Edmund D., MD Pellegrino; Caplan, Arthur L.; Mccartney, James Elvins; Dominic A. Sisti (2004). Health, Disease, and Illness: Concepts in Medicine. Washington, D.C: Georgetown University Press. p. 165. ISBN 1-58901-014-0.{{cite book}}: CS1 maint: multiple names: authors list (link)
14. World Health Organization (1992). Icd-10: The Icd-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization. p. 168. ISBN 92-4-154422-8.
15. Goetz, C.G. (1993). Handbook of Clinical Neurology. B.V.: Elsevier Science Publishers. pp. 429–447. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
16. Mackenzie, Sir James (1916-01-18). "Discussions On The Soldier's Heart". Proceedings of the Royal Society of Medicine, Therapeutical and Pharmacological Section. 9: 27–60. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
17. Goetz, C.G. (1993). Handbook of Clinical Neurology. B.V.: Elsevier Science Publishers. pp. 429–447. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
18. Online Mendelian Inheritance in Man (OMIM): Orthostatic Intolerance - 604715
19. Goudsmit EM, Howes S, "Pacing: A strategy to improve energy management in chronic fatigue syndrome", Health Psychology Update (BPS), 2008, 17, 1, 46-52

• Somatoform disorders
• Anxiety disorders