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Hyperventilation provocation in patients with chest pain and a negative treadmill exercise test
C Bass1, J B Chambers, W N Gardner
1Barnes Unit, John Radcliffe Hospital, Oxford, U.K.
Journal of Psychosomatic Research
|January 1, 1991
Summary
In patients with chest pain and negative exercise tests, voluntary hyperventilation (VHV) reproduced pain in 39%. These individuals exhibited abnormal breathing patterns and hypocapnia, suggesting a link between respiratory control and non-cardiac chest pain.
Area of Science:
- Cardiology
- Pulmonology
- Psychology
Background:
- Non-cardiac chest pain (NCCP) is a common clinical challenge.
- Exercise treadmill tests (ETT) are used to rule out cardiac ischemia.
- A significant proportion of patients with chest pain have negative ETT results.
Purpose of the Study:
- To investigate the role of voluntary hyperventilation (VHV) in reproducing chest pain in patients with negative ETT.
- To identify physiological and psychological correlates of VHV-positive tests in this cohort.
Main Methods:
- 44 patients with chest pain and negative ETT underwent a 3-minute VHV test at rest.
- Physiological parameters (breath-holding time, end-tidal pCO2, respiratory rate) were measured.
- Psychological variables, including agoraphobia scores, were assessed.
Main Results:
- Chest pain was reproduced in 17 patients (39%) during or after VHV.
- VHV-positive patients showed more hyperventilation symptoms, respiratory complaints, shorter breath-holding times, lower resting end-tidal pCO2, and higher respiratory rates.
- Higher scores for phobic avoidance related to agoraphobia were noted in VHV-positive patients.
Conclusions:
- Chest pain in a significant subset of patients with negative ETT is associated with VHV.
- Abnormalities in breath control and relative hypocapnia are present even without active chest pain.
- Chronic respiratory control abnormalities may interact with psychological factors in NCCP.