HYPERVENTILATION: ANALYSIS OF CLINICAL SYMPTOMATOLOGY
Authors: G L ENGEL, E B FERRIS, M LOGAN
Journal: Annals of Internal Medicine (1947)

Article1 November 1947HYPERVENTILATION: ANALYSIS OF CLINICAL SYMPTOMATOLOGYGEORGE L. ENGEL, M.D., EUGENE B. FERRIS, M.D., F.A.C.P., MYRTLE LOGAN, M.D.GEORGE L. ENGEL, M.D., EUGENE B. FERRIS, M.D., F.A.C.P., MYRTLE LOGAN, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-27-5-683 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHyperventilation is a common enough occurrence in clinical practice to justify further study of this phenomenon. Although the symptoms of hyperventilation are well known they are often overlooked because patients seldom complain of overbreathing, per se, and seldom exhibit tetany, the best known, but least common manifestation. Most often hyperventilation is psychogenic in origin. Thus, it may occur as a more or less non-specific reaction to the experience of terror, extreme anger, severe pain, or other intense emotions in essentially healthy individuals or it may be a symptom of neurosis. It occurs quite frequently during real anxiety and in the...Bibliography1a. RYDERSHAVERFERRIS HWMEB: Salicylism accompanied by respiratory alkalosis and toxic encephalopathy, New Eng. Jr. Med., 1945, ccxxxii, 617. b. RAPOPORT, S., and GUEST, G. M.: Effect of salicylates on the electrolyte structure of the blood plasma. I. Respiratory alkalosis in monkeys and dogs after sodium and methyl salicylate: the influence of hypnotic drugs and sodium bicarbonate on salicylate poisoning, Jr. Clin. Invest., 1945, xxiv, 757. CrossrefGoogle Scholar2. ENGELROMANOFERRISWEBBSTEVENS GLJEBJPCD: A simple method of determining frequency spectrums in the electroencephalogram. Observations of effects of physiologic variation in dextrose, oxygen, posture, and acid-base balance on the normal E.E.G., Arch. Neurol. and Psychiat., 1944, li, 134. CrossrefGoogle Scholar3. ENGELWEBBFERRIS GLJPEB: Quantitative electroencephalographic studies of anoxia in humans: comparison with acute alcoholic intoxication and hypoglycemia, Jr. Clin. Invest., 1945, xxiv, 697. Google Scholar4. ENGELFERRISRAPOPORTSTEVENSLOGAN GLEBSCDM: Hyperventilation. II. The relation between changes in electroencephalographic mean frequency and arterial and jugular blood; simultaneous study of venous blood of varying cranial origins. To be published. Google Scholar5. FERRISSTEVENSWEBBENGEL EBCDJPGL: Voluntary breathholding. III. The relation of the maximum time of breathholding to the oxygen and carbon dioxide tensions of arterial blood, Jr. Clin. Invest., 1946, xxv, 734. CrossrefGoogle Scholar6. DAVISDAVIS HP: The electrical activity of the brain: its relation to physiological states and to states of impaired consciousness, Assoc. Res. Nerv. and Mental Dis. Proc., 1939, xix, 50. Google Scholar7a. ROMANOENGEL JGL: Delirium: I. E.E.G. data, Arch. Neurol. and Psychiat., 1944, li, 356. b. ENGEL, G. L., and ROMANO J.: Delirium: II. Reversibility of the E.E.G. with experimental procedures, Arch. Neurol. and Psychiat., 1944, li, 378. c. ENGEL, G., L., and ROSENBAUM, M.: Delirium: III. E.E.G. changes associated with acute alcoholic intoxication, Arch. Neurol. and Psychiat., 1945, liii, 44. CrossrefGoogle Scholar8. GIBBSGIBBSLENNOX FAELWG: Electroencephalographic response to overventilation and its relation to age, Jr. Pediat., 1943, xxiii, 497. CrossrefGoogle Scholar9a. ENGELMARGOLIN GLS: Clinical correlation of the electroencephalogram with carbohydrate metabolism, Arch. Neurol. and Psychiat., 1941, xlv, 890. b. DAVIS, H., and WALLACE W. MCL.: Factors affecting changes produced in electroencephalogram by standardized hyperventilation, Arch. Neurol. and Psychiat., 1942, xlvii, 606. c. RUBIN, M. A., and TURNER, E.: Blood sugar level and influence of hyperventilation on slow activity in E.E.G., Proc. Soc. Exper. Biol. and Med., 1942, l, 270. d. ENGEL, G. L., ROMANO, J., FERRIS, E. B., WEBB, J. P., STEVENS, C. D.: (see reference 2). e. BRAZIER, M. A. B., FINESINGER, J. E., and SCHWAB, R. S.: Characteristics of the normal E.E.G. III. The effect of varying blood sugar levels on the occipital cortical potentials in adults during hyperventilation, Jr. Clin. Invest., 1944, xxiii, 319. f. HEPPENSTALL, M.: The relation between the effects of the blood sugar level and hyperventilation on the electroencephalogram, Jr. Neurol., Neurosurg. and Psychiat., 1944, i, 112. Google Scholar10. HILLFLACK LM: The influence of oxygen inhalation on muscular work, Jr. Physiol., 1910, xl, 347. CrossrefGoogle Scholar11. DARROWPATHMAN CSJH: Relation of heart rate to slow waves in the electroencephalogram during hyperventilation, Am. Jr. Physiol., 1944, cxl, 583. CrossrefGoogle Scholar12. SCHWAB RS, in discussion of paper by DAVIS, H., and WALLACE W. MCL.: Factors affecting changes produced in electroencephalogram by standardized hyperventilation, Arch. Neurol. and Psychiat., 1942, xlvii, 606. Google Scholar13a. ARINGRYDERROSEMANROSENBAUMFERRIS CDHWEMEB: Effect of nicotinic acid and related substances on the intracranial blood flow of man, Arch. Neurol. and Psychiat., 1941, xlvi, 649. b. GIBBS, F. A., GIBBS, E. L., and LENNOX, W. G.: The cerebral blood flow in man as influenced by adrenalin, caffeine, amyl nitrite, and histamine, Am. Heart Jr., 1935, x, 916. CrossrefGoogle Scholar14a. DONOVAN DH: The hyperventilation syndrome, Irish Med. Jr., 1943, 519. b. SCHULTZER, P., and LEBEL, H.: Spontaneous hyperventilation tetany, Acta med. Scandinav., 1939, ci, 303. c. FRASER, R., and SARGENT, W.: Hyperventilation attacks, Brit. Med. Jr., 1938, i, 378. Google Scholar15a. ENGELROMANOMCLIN GLJTR: Vasodepressor and carotid sinus syncope. Clinical, electroencephalographic and electrocardiographic observations, Arch. Int. Med., 1944, lxxiv, 100. b. ENGEL, G. L.: Mechanisms of fainting, Jr. Mt. Sinai Hosp., 1945, xii, 170. CrossrefGoogle Scholar16. ROMANOENGEL JGL: Studies of syncope. III. Differentiation between vasodepressor and hysterical fainting, Psychosom. Med., 1945, vii, 3. CrossrefGoogle Scholar17. HARVEYLILIENTHAL AMJL: Observations on the nature of tetany; the effect of adrenaline, Bull. Johns Hopkins Hosp., 1942, lxxi, 163. Google Scholar18. ROMANOROSENBAUM JM: Unpublished observations. Google Scholar19. FENNRAHNOTISCHADWICKEPSTEINHODGHUNTERHOLMES WOHABLEMAMSWIL 1945. Personal communication. Google Scholar20. OTISRAHNEPSTEINFENN AHMWO: Performance as related to composition of alveolar air, Fed. Proc., 1946, v, 77. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication March 24, 1947.From the Departments of Internal Medicine and Psychiatry, College of Medicine, University of Cincinnati.The work described in this paper was done under a contract, recommended by the Committee on Medical Research, between the Office of Scientific Research and Development and the University of Cincinnati.†Now at Strong Memorial Hospital, Rochester, N. Y. 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KILBURN, M.D.Correlation of Clinical and Physiologic Manifestations of Sustained HyperventilationHyperventilation: An Activating Procedure In ElectroencephalographyEffects of hyperventilation on systemic and coronary hemodynamicsChronic Hyperventilation Syndrome. Clinical Results, Electrocardiographic Findings With ChlordiazepoxideSyncopeIMMUNOLOGICAL ASPECTS OF INFERTILITYTHE HYPERVENTILATION SYNDROMEHYPERVENTILATION FROM ORGANIC DISEASE*PHILIP R. ARONSON, M.D.Anxiety and the anxiety statesKlinische ElektrencephalographieThe Role of the Emotions in Respiratory DiseaseHyperventilation Syndromes; Clinical and Physiologic ObservationsThe effect of hyperventilation and pro-banthine on isolated RS-T segment and T-wave abnormalitiesRespiratory Alkalosis with Especial Reference to Chest PainThe Hyperventilation SyndromeFUNCTIONAL HYPOGLYCEMIA AND THE HYPERVENTILATION SYNDROME: A CLINICAL STUDY*†W. L. JACK EDWARDS, M.D., WILLIAM F. LUMMUS, M.D.The Mechanism of Syncope Associated with Chronic Auricular Fibrillation without Evidence of Organic Heart DiseaseThe electroencephalogram during hypoxia and hyperventilationTHE HYPERVENTILATION SYNDROME*BERNARD I. LEWIS, M.D., F.R.C.P.(C)., F.A.C.P.Experimentelle Untersuchungen über die kleinste Zeiteinheit (Moment) der optischen WahrnehmungFAINTINGBEHAVIOUR UNDER STRESSFaintingHeadache, Syncope and VertigoSymptom patterns of the hyperventilation syndromeHyperventilationThe electroencephalogram during hyperventilation followed by apnoeaA brief review of methods used to elicit or accentuate abnormalities in the electroencephalogram 1 November 1947Volume 27, Issue 5Page: 683-704KeywordsAnxietyEmotions Issue Published: 1 November 1947 Copyright & PermissionsCopyright, 1947, by The American College of PhysiciansPDF downloadLoading ...