Hyperventilation syndrome

Hyperventilation syndrome (HVS), is a respiratory disorder, psychologically or physiologically based, involving breathing too deeply or too rapidly.

HVS is believed to be caused by psychological factors and by definition has no organic cause.

Estimated to occur as a primary or major contributing diagnosis in as many is 10% of all general medical patients and up to 25% of all patients complaining primarily of dizziness or fainting

HVS may present with chest pain and a tingling sensation in the fingertips and around the mouth.

 HVS may accompany a panic attack.

HVS and panic attack with feelings of smothering, choking, chest pain, dizziness, unsteadiness, lightheadedness, faint, chills or hot flashes,  paresthesias, palpitations, and or accelerated heart rate are shared symptoms.

With HVS people may feel that they cannot get enough air, but 

have about the same oxygenation in the arterial blood and too little carbon dioxide in their blood and other tissues. 

Emotional stress can induce an excessive respiratory response, the anticipation of immediate need for increased exertion and is combined with increased adrenergic drive resulting in rapid respirations.

 If increased exertion is not required the excessive and inappropriate breathing produces hypocapnia, respiratory alkalosis and physiologic changes that include widespread vasoconstriction, and neurogenic excitability, which are likely responsible for most of the signs and symptoms of hyperventilation syndrome.

These changes may produce broncoconstriction and result in wheezing, augmenting this sensation of dyspnea and simulating asthma.

While most frequently manifested in the form of acute attacks, HVS may occur more chronically and insidiously with symptoms that may include: atypical chest pain, fatigue, mild dyspnea, or exercise intolerance.

Air hunger is coming with HVS.

Oxygen is abundant in the bloodstream, it HVS reduces effective delivery of that oxygen to vital organs due to low-CO2-induced vasoconstriction and the suppressed Bohr effect.

Hypocapnea and respiratory alkalosis with a high blood pH develops, making the symptoms worse, causing faster breathing , which then, further exacerbates the problem.

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. 

Some individuals  are physiologically more susceptible to this phenomenon than others.

Hyperventilation causing paresthesias, lightheadedness, and fainting is related to the increased blood pH seen in respiratory alkalosis: causes a decrease in free ionized calcium which causes paresthesia and symptoms related to hypocalcaemia.

It is one cause of hyperventilation with others including infection, blood loss, heart attack,[8] hypocapnia or alkalosis due to chemical imbalances, decreased cerebral blood flow, and increased nerve sensitivity.[9]

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.[10]

A study, found that 77% of patients with empty nose syndrome have hyperventilation syndrome.[11] Empty nose syndrome can appear in people having done nose surgery like cauterization, turbinectomy, turbinoplasty, etc.[12]

Many people with panic disorder or agoraphobia will experience HVS. However, most people with HVS do not have these disorders.[6]


Hyperventilation syndrome is a remarkably common cause of dizziness complaints. About 25% of patients who complain about dizziness are diagnosed with HVS.[9]

Having a patient deep breath for 2 to 3 minutes until discomfort appears with at least numbness and tingling or sensation of dizziness, and if these sensations are similar to the ones the patient is experiencing then the diagnosis is highly suspected.


Insufficient evidence exits for or against breathing exercises.

The traditional intervention for an acute episode of breathing into a paper bag, causing rebreathing and restoration of CO₂ levels is not advised.

Benefits can be obtained by deliberately slowing down the breathing rate by counting or monitoring with the second hand on a watch. 

7-11 breathing: stretching inhalation out to take 7 seconds and the exhalation is slowed to take 11 seconds. 

Subsequently the  in-/exhalation ratio can be safely decreased to 4-12 or even 4-20 and more, when normal blood acidity has been restored.

Benzodiazepines reduce stress that provokes hyperventilation syndrome, and selective serotonin reuptake inhibitors can reduce the severity and frequency of hyperventilation episodes.

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