Hyperventilation syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Farman Khan, MD, MRCP [2]

In acute HVS, obvious tachypnea and hyperpnea are present. In chronic hyperventilation syndrome, rapid or deep breathing is usually not apparent, but the individual may sigh deeply 2 to 3 times a minute. Frequent, sighing respirations and frequent yawning are noted. Characteristically, patients have multiple complaints without much supporting physical evidence of disease.

The upper chest wall may be tender from muscle fatigue. However, this is not a helpful finding, because chest wall tenderness is also found in costochondritis and in a wide variety of other serious and benign thoracoabdominal diseases.

Manifestations of anxiety such as tremor, mydriasis, pallor, tachycardia can occur. Evidence of depersonalization or hallucination may be noted.

Signs due to electrolyte abnormalities:

• Carpopedal spasm: Occurs when Chemical changes associated with decreased carbon dioxide levels may cause involuntary contraction of the hands called carpopedal spasm.

• Chvostek or Trousseau signs: May be positive because of low calcium levels.

• Wheezing: May be heard because of bronchospasm from hypocarbia.

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