Many stressed out young people suffer from hyperventilation which can feel like a heart attack but isn’t.

The picture above is of haemoglobin the chemical which carries oxygen from the lungs to the cells of your body that are then used to produce energy (ATP) and sustain life. in the return trip, the waste product carbon dioxide (CO2) is carried from the cells to the lungs for disposal. Hyperventilation is “an increase in the rate and depth of breathing that exceeds the body’s need to remove the waste product CO2″ (Marieb & Hoehn, Human Anatomy and Physiology, 5th ed.) Hyperventilation can be described as breathing too fast or overbreathing. Click button to listen to Hyperventilation and rightclick to download

FAMILY MATTERS: Hope and help for hyperventilaters, Understanding the triggers and overcoming the psychological and physiological symptoms brought on byanxiety by Dr Kraisit Naruekhatpichai

Most of us know and may experience some familiar symptoms caused by stress, such as stomach ache, headache and insomnia. Some people, however, still don’t know that stress can also affect the respiratory system and lead to respiratory disorder. This symptom is called Hyperventilation Syndrome (HVS). Hyperventilation Syndrome involves breathing too deeply and rapidly followed by a tingling sensation in the hands and feet. unlike asthma, a recent study concluded that HVS is most likely a psychologically-based disease. People who are around HVS sufferers need to understand that for patients with this condition it is a consequence of behavioural breathlessness rather than a direct physical sickness. although HVS doesn’t result in actual physical obstruction that prevents proper breathing, patients suffering from this condition still feel that it interferes with how they get on with their daily lives This syndrome (the reason it is called a syndrome is because when HVS occurs it involves a series of symptoms) usually affects young women aged 15-30, especially when they feel uncontrollably frustrated and extremely angry, in which the underlying psycho-mechanism triggers the sufferer to breathe rapidly and deeply. after prolonged, rapid and deep breathing, the lungs release so much carbon dioxide and takes in so much oxygen that eventually it gets to the point where the exchange rate of CO2 and O2 exceeds the metabolic requirements of the body, which can result in haemodynamics and chemical imbalance. also, calcium in the blood will take in more protein and cause low calcium in the blood; low blood calcium can lead to symptoms such as numbness or tingling in the fingers, toes or around the lips. although HVS sounds as though it vitally impacts people’s lives, it is reported to be quite common. Most patients and even their loved ones often think of HVS as a life-threatening occurrence, like lung disease, or that it increases the risk of cardiovascular disease, and thus need emergency care, which is not always the case. Some families spend loads of money and waste so much time trying to get an unnecessary diagnosis. The first occurrence of an episode of hyperventilation is typically the most severe because it gets easier for the syndrome to reoccur thereafter. after a patient has experienced several panic attacks, sometimes just one deep breath could bring on shortness of breath, along with all the other symptoms mentioned above. such patients will feel they need to visit the hospital often, and will usually be diagnosed as having nothing seriously wrong with them. Or worse, they don’t receive a proper explanation on their condition from the doctor. Some patients may become overly concerned about their health, and unfortunately their family members might misunderstand their actions as attention-seeking behaviour. If, however, sufferers strongly feel that their condition does greatly have an impact on their daily lives and the people around them, they should come forward and speak to a psychologist about the best suitable treatment. first aid tips and suggestions for HVS patients are as follows: 1. Do not panic. All the symptoms are largely not at all harmful. try to stay calm and in control of your breathing and try to breathe a bit more slowly. 2. If this does not work, use a paper bag and breath into it slowly. Make sure the paper bag covers your mouth and nose completely – that way, it will bring back the balance of carbon dioxide and calcium in the blood. it will also help get rid of the tingling sensation and numbness in the fingers, toes and area around the lips. 3. have a full understanding of the condition. when it happens, make sure that people around you know that this is not an act or an attempt at seeking attention. Family and friends should be supportive to patients but at the same time must make sure they are not getting more and more out of control with their anxieties or spoiled. 4. be mentally stronger. try to confront the problems of the condition with smart solutions and try to relax. also, regular exercise can help reduce the chance of hyperventilating as it lowers tension and stress levels. 5. If all else fails, seeing a psychologist might be the best solution. and get the right prescription drug if necessary Dr Krisit Narukatpichai is CEO and a psychologist at Manarom Hospital. (Source: Bangkok Post, FAMILYMATTERS, Hope and help for hyperventilaters, Understanding the triggers and overcoming the psychological and physiological symptoms brought on by anxiety, 1/06/2011, Dr Kraisit Naruekhatpichai, link) Health Vocabulary respiratory – relating to the process of breathing air in and out ???????????????? respiratory disorder – a disease in the lungs (or affecting the process of breathing air in and out) (See Wikipedia)lungs – the organs in your chest that fill with air when you breathe ??? carbon dioxide – CO2, the chemical waste product created by the body’s cells and sent by the blood to the lungs for breathing out (expiration) into the air thus disposing them (See Wikipedia) haemoglobin – the protein composed that “gives red blood cells their characteristic color; function primarily to transport oxygen from the lungs to the body tissues” also carries 10% of the carbon dioxide from the cells to the lungs as waste disposal (See Wikipedia) hyperventilation - an increase in the rate and depth of breathing that exceeds the body’s need to remove the waste product CO2, breathing too  fast or overbreathing, to the person suffering from hyperventilation it seems like they are not getting enough oxygen, but actually fast breathing reduces the carbon dioxide (CO2) concentration of the blood to below its normal level because one is expiring more CO2 than is being produced in the body, thereby raising the blood’s pH value (making it more alkaline), initiating constriction of the blood vessels which supply the brain and preventing the transport of oxygen and other molecules necessary for the function of the nervous system, can result from a psychological state such as a panic attack or from a physiological condition such as metabolic acidosis, can cause symptoms such as numbness or tingling in the hands, feet and lips, lightheadedness, dizziness, headache, chest pain, slurred speech, nervous laughter, and sometimes fainting (See Wikipedia) Hyperventilation Syndrome (HVS) – “a respiratory disorder, psychologically or physiologically based, involving breathing too deeply or too rapidly (hyperventilation). HVS may present with chest pain and a tingling sensation in the fingertips and around the mouth (paresthesia) and may accompany a panic attack. People with HVS may feel that they cannot get enough air. in reality, they have about the same oxygenation in the arterial blood (normal values are about 98% for hemoglobin saturation) and too little carbon dioxide in their blood and other tissues. While oxygen is abundant in the bloodstream, HVS reduces effective delivery of that oxygen to vital organs due to low-CO2-induced vasoconstriction and the suppressed Bohr effect. The hyperventilation is self-promulgating as rapid breathing causes carbon dioxide levels to fall below healthy levels, and respiratory alkalosis (high blood pH) develops. This makes the symptoms worse, which causes the person to try breathing even faster, which further exacerbates the problem” (See Wikipedia) panic – a sudden strong feeling of fear and confusion, which makes you act without thinking carefully ???????????? (See glossary) panic attack – a sudden and short period of intense fear, usually begin abruptly and reaching a peak within 10 minutes and then decreasing over the next several hours; many who experience a panic attack fear they are having a heart attack or a nervous breakdown, symptoms include “increased heart rate (tachycardia), rapid breathing (hyperventilation) which may be perceived as shortness of breath (dyspnea), and sweating (which increases grip and aids heat loss). because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH (respiratory alkalosis or hypocapnia), which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, burning and lightheadedness. Moreover, the release of adrenaline during a panic attack causes vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and lightheadedness. a panic attack can cause blood sugar to be drawn away from the brain and towards the major muscles. it is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood” (See Wikipedia) release – to allow a substance to flow out from somewhere ????? metabolism (noun) – the chemical processes in the body that use food to make energy (ATP)and build new cells (See Wikipedia) metabolic (adjective)   anxiety – a feeling of nervousness or worry stress – a feeling of worry and tension from difficulties in life; when you worry and think too much about problems insomnia – not being able to sleep  syndrome – “the association of several clinically recognizable features, signs (observed by a physician), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others” (See Wikipedia) condition – same as “medical condition” medical condition – a broader tterm than disease and can include injuries to the body (See Wikipedia) X brought on by Y – disease or medical condition X caused by conditions or event Y X triggers Y (verb) – conditions or event X causes disease or medical condition Y trigger (noun) -a cause of a disease or medical condition psychology (noun) – the scientific study of the human mind and the reasons for human behaviour psychologist (noun) – a person who works in the area of psychology (practices psychology) mental –  ??????????????, ???????????????? mental disorder – a condition that has a negative effect on a person’s beahviour or emotions during daily life (See Wikipedia and Google Definitions)psychological (adjective) psychologically (adverb)   psychologically-based disease – same as “mental disorder”mental sickness – same as “mental disorder” physiology (noun) – the study of how bodies function (See Wikipedia)physiological (adjective)  physical sickness – involving the body (not just the mind)  symptom – a sign that someone has an illness ????? series of symptoms – one symptom happening, then another symptom, and another, and so on … diagnosis – when a doctor makes a judgement about what disease a patient has tingling – a strange feeling under the skin (like stinging) ?????????????????????????????? sensation – feeling a tingling feeling – having a strange stinging-like feeling under your skin numb (adjective) – having no feeling in part of your body numbness (noun)  asthma – a long-term condition in which the lungs become inflammed and breathing difficult ????????? (See Wikipedia) physical obstruction – an object that prevents another object from passing through a passageway (example: a piece of food in the throat became a “physical obstruction” that prevented breathing) suffering – having physical or mental pain or problems ?????????????? underlying – underneath, supporting, forming a foundation or basis for something prolonged – continuing for a long time ???????????? rapid – happening quickly ???????????? life-threatening – it might kill you risk – the possibility that something dangerous or unpleasant might happen ?????????? cardiovascular – related to the heart and blood vessels the heart and blood vessels (veins, arteries) in the body and the way that they operate to support life, “an organ system that passes nutrients (such as amino acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body to help fight diseases and help stabilize body temperature and pH to maintain homeostasis” (See Wikipedia) cardiovascular disease – a disease that affects the heart or blood vessels (See Wikipedia) emergency – an unexpected situation involving danger in which immediate action is necessary ??????????? emergency care – (See Wikipedia on emergency medical services and emergency medicine) occurrence – something that happens ?????????, ????????????????????, ??????????????? episode – a short period in which someone suffers from an illness badly  severe – very serious and worrying ????????? ?????????????? severe episode – suffering from an illness very badly patient – someone who is receiving medical treatment ??????, ????? treatment – the process of providing medical care ???????? aid – help; assistance ????????????? First Aid – medical help given to a sick or injured person before full medical treatment from a doctor is available (See Wikipedia) calm – peaceful and quiet; without anxiety ??????,???????????, ??? stay calm – continue being quiet and peaceful (without worrying) tension – the feeling of being so nervous or worried that you can’t relax ????????????? prescription – medicine that a doctor prescribes to cure an illness General Vocabulary X concluded that Y – after studying the situation, explanation Y was given X a consequence of Y – X happened because Y happened actual – real; existing in fact ???? reason – an explanation ??????  frustrated – want something but cannot get it, feeling annoyed and impatient because you are prevented from achieving something ???????,???????????, ??????????eventually – at the end of a period of time or at the end of a process ???????? X sounds as though Y – X seems to have the meaning Y, if X then Y it seems vital – very important impact – effect vitally impacts people’s lives – has a big effect on life (big change in life) quite common – happens often, seen oftentypically – usually; normally ???????????????? concerned – worried about something ??????????? attention-seeking – when people do things to make other people pay attention to them (look at them, spend time with them) pay attention to – watch, listen or take notice of someone or something impact – an effect or influence ??????? come forward – doing or saying something (after not doing or saying anything, perhaps because you are shy or think your problem is not important) suitable – right for a situation or person ??????? supportive – helping spoiled – when a child is given every they want (so that they always expect this, which ruins their personality eventually) confront – try to deal with and solve a difficult problem ??????????????????????????? chance – possibility

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By Rick Nauert PhD Senior News EditorReviewed by John M. Grohol, Psy.D. on December 21, 2010

A new treatment program helps individuals who suffer from panic disorder, using breathing techniques to reduce anxiety and other symptoms.

The method has proved better than traditional cognitive therapy at reducing both symptoms of panic and hyperventilation, according to a new study.

The biological-behavioral treatment program is called Capnometry-Assisted Respiratory Training, or CART, said psychologist and panic disorder expert Dr. Alicia E. Meuret at Southern Methodist University in Dallas.

CART helps patients learn to breathe in such a way as to reverse hyperventilation, a highly uncomfortable state where the blood stream operates with abnormally low levels of carbon dioxide, said Meuret, one of the researchers conducting the study.

Hyperventilation, a state of excessive breathing, results from deep or rapid breathing and is common in patients with panic disorders.

“we found that with CART it’s the therapeutic change in carbon dioxide that changes the panic symptoms — and not vice versa,” Meuret said.

During the treatment, patients undergo simple breathing exercises twice a day. a portable capnometer device supplies feedback during the exercises on a patient’s CO2 levels. The goal of these exercises is to reduce chronic and acute hyperventilation and associated physical symptoms.

This is achieved by breathing slower but most importantly more shallowly. Contrary to lay belief, taking deep breaths actually worsens hyperventilation and symptoms.“Most panic-disorder patients report they are terrified of physical symptoms such as shortness of breath or dizziness,” Meuret said.

“In our study, cognitive therapy didn’t change respiratory physiology, but CART did effectively reduce hyperventilation. CART was proved an effective and powerful treatment that reduces the panic by means of normalizing respiratory physiology.”

The study pitted CART against a conventional cognitive therapy treatment, or CT. Traditional CT teaches patients techniques aimed at helping them change and reverse catastrophic thoughts in order to reduce fear and panic.

In the CART-CT study, 41 patients were assigned to complete either a CART or CT treatment program for panic disorder and agoraphobia, a fear of being trapped with no means of escape or help.

Both treatment programs were equally effective in reducing symptoms, said Meuret. But CART was the only treatment to physiologically alter panic symptoms by actively reversing hyperventilation in the patients. Cognitive therapy didn’t change the respiratory physiology, said Meuret.

The study is the second randomized control trial to measure CART’s effectiveness. By reversing hyperventilation, patients reported a new ability to reduce panic symptoms by means of changing their respiration.

With CT, Meuret said, if a patient reports shortness of breath, the therapist challenges the assumption by asking how often the person actually has suffocated during a panic attack, then hopes that will reverse the patient’s thinking.

“I found that process very challenging for some of my patients because it acknowledges the symptom but says it’s not a problem,” Meuret said.

“CART, however, tells us a patient’s CO2 is very low and is causing many of the symptoms feared, but it can also show how to change these symptoms through correct breathing. There has been an assumption that if people worry less about symptoms it will also normalize their physiology, but this study shows that this is not the case,” she said.

“Hyperventilation remains unchanged, which could be a risk factor for relapse down the road. apart from hyperventilation being a symptom generator, it is an unhealthy biological state associated with negative health outcomes.”

The researchers plan to branch out with their studies on CART by taking the program into the community, particularly to ethnic minorities. they believe CART is a more universally understood treatment due to its physical exercises — as opposed to cognitive therapy’s more intellectual methods — and therefore more accessible to a broader range of people with varying levels of education and different cultural backgrounds.

Ongoing studies will test the efficacy of CART in patients with asthma and fear of blood.

The findings appeared in the Journal of Consulting and Clinical Psychology.

Source: Southern Methodist University

August 11, 2010, 8:51 pm

Life-giving blood is an essential and integral component of the human body. Human blood consists of cellular components known commonly as red cells, white cells and platelets together with a fluid component known as plasma. the red cells contain haemoglobin which is the principal carrier of oxygen and carbon dioxide in the body. there is a highly refined mechanism by which the red cell haemoglobin is empowered to carry out these functions. Red cells are mainly formed within the bone marrow and several different materials are necessary for their formation. These include proper nourishment, particularly proteins, iron, folic acid and several other vitamins. some hormones are also needed for proper production of blood. the integrity and normal functioning of bone marrow which is the soft, spongy tissue inside bones that makes new blood cells, is essential for the production of normal red cells. An adequate and normal amount of blood, both in quantity and adequacy of its essential components, is a mandatory requirement for good health.

When either the number of red cells are reduced or the haemoglobin content of the red cells go down, a state of anaemia is said to be present. Anaemia is one of the more common blood disorders and it can lead to many health problems. Anemia can be caused by several different basic mechanisms. These can be very broadly classified into three separate groups. These are :-

1. Acute or chronic blood loss

2. Inadequate production of red blood cells and / or of haemoglobin

3. Excessive destruction of red blood cells

From another angle, among many other causes, anaemia can also result from inherited disorders, nutritional problems such as an iron or vitamin deficiency, infections, some kinds of cancer or exposure to certain drugs or toxins.

Blood loss can cause anaemia. Blood may be lost acutely due to excessive bleeding secondary to injury, surgery or a problem with the clotting ability of blood which leads to unusual and sustained bleeding from many sites. Slower, long-term blood loss, such as due to intestinal bleeding from hook worm infestations, peptic ulcers or from inflammatory bowel diseases is also known to cause anaemia. it could also be caused by heavy menstrual losses in adolescent girls. A secondary effect of any form of blood loss is an increase in the body’s need for iron, folic acid and other ingredients which are needed to make new red blood cells. If the intake of these nutrients is sub-optimal, then the anaemia due to loss of blood will be potentiated and made worse by the inability of the body to make good the losses and replenish the required amounts of red cells.

Anaemia caused by inadequate production of the required amounts of blood is primarily due to a failure of the bone marrow to function normally. Bone marrow functional disturbances could be produced by certain viral infections, exposure to several toxic chemicals, radiation or medications and in rare cases to a congenital disturbance of the bone marrow. some childhood cancers can also lead to bone marrow problems. In these situations, the marrow is not able to respond to the need to produce more red cells.

Anaemia also occurs when the body is not able to produce enough healthy red cells because of a deficiency of an essential component that is required for the process to be carried out normally. one such important cause is iron deficiency. Iron is essential for haemoglobin production. Poor dietary iron intake or excessive losses of iron from the body can lead to iron deficiency anaemia, which is perhaps the most common cause of anaemia in children. Iron deficiency anaemia can affect children of any age but is most common in those younger than 2 years old. Girls going through puberty also have a particularly high risk for iron deficiency anaemia because of the onset of menstruation, the monthly blood losses increasing the amount of iron they need to consume in their diets.

Anaemia is also known to occur when red blood cells are being destroyed prematurely. These anaemias are collectively referred to as haemolytic anaemia. the normal lifespan of a red blood cell is around 120 days. once they are beyond their useful life, they are destroyed within the body and fresh red cells are produced to replenish the destroyed ones. In all forms of haemolytic anaemias, this life span is shortened, sometimes quite drastically. when such premature destruction occurs, the bone marrow is overwhelmed by the demand to make new red cells and it cannot keep up with the body’s demand for excessive production of red cells. there are several different types of such haemolytic anaemias and the much discussed thalassaemia too falls into this group. Thalassaemia major is a severe form of anaemia in which the red blood cells are rapidly destroyed and iron liberated from this process is deposited in the skin and vital organs. such abnormal depositions of iron are intensely toxic to the tissues in which it is deposited and this leads to damage to many organs of the body. Thalassaemia minor involves only mild anaemia and minimal red blood cell changes. there are other types of anaemias due to shortening of the lifespan of the red cells such as sickle cell anaemia, hereditary spherocytosis and some enzyme deficiencies in the red blood cells. In one particular type of haemolytic anaemia, due to the production of certain types of antibodies, the immune system mistakes red blood cells for foreign invaders and begins destroying them. this can occur acutely and the process can be triggered by many provoking factors. some of these forms of all these haemolytic anaemia could be quite severe with the haemoglobin levels falling to very low levels at regular intervals. the only way to keep the haemoglobin at satisfactory levels is to administer regular blood transfusions.

In certain chronic diseases such as in some forms of chronic arthritis, tuberculosis and other long standing diseases, anaemia may occur as a complication. In many of these cases there is more than one basic cause for the anaemia. Several different mechanisms such as increase in the rate of destruction, poor replenishment of the red cells and a concomitant deficiency of certain nutritional components may all play a part. In such cases, the anaemia is a symptomatic manifestation of the underlying disease and has a multi-faceted origin.

In acute situations where there has been obvious blood loss, symptoms of a sudden reduction in the circulating blood volume may cause shock and collapse. However, if a child has anaemia which has developed over a period of time, depending on the severity, the symptoms may not be all that florid. the first symptoms might be mild skin paleness and decreased pinkness of the lips and nailbeds. These changes may happen gradually and as such they can be difficult to notice. other common signs include irritability, fatigue, dizziness, lightheadedness, and a rapid heartbeat. If the anaemia is caused by excessive destruction of red cells symptoms may include jaundice which is yellowing of the whites of the eyes, an enlarged spleen, and dark plain tea coloured urine. If the haemoglobin falls to very low levels there may be certain features of heart failure as well. In infants and preschoolers, iron deficiency anaemia can result in developmental delays and behavioural disturbances such as decreased motor activity together with problems of social interaction and attention to tasks. Research indicates that such developmental problems may last into and beyond school age if the iron deficiency is not properly treated.

Clinical assessment of anaemia is not all that accurate unless the anaemia is at least moderately severe. However, in very severe anaemias, the heart is called upon to do extra work to get as much of the reduced amounts of blood to the tissues of the body and this may ultimately result in heart failure. In many cases it is often necessary to run quite a few blood tests to ascertain and assess anaemia. These tests are also helpful in categorising the exact type of anaemia. A complete blood count (CBC) provides a number of parameters that could be used to diagnose the type and severity of anaemia. other diagnostic tests may include:

* Blood smear examination: Blood is smeared on a glass slide for microscopic examination of red cells. this can provide certain types of information regarding the size and shape of red cells.

* Iron tests: These include total serum iron and ferritin tests which can help to determine whether anemia is due to iron deficiency.

* Hemoglobin electrophoresis: this test is used to identify various abnormal haemoglobin types in the blood and to diagnose sickle cell anaemia, the thalassaemias, and other inherited forms of anaemia.

* Bone marrow aspiration and biopsy: this test can help determine whether cell production is happening normally in the bone marrow. it is the only way to diagnose certain types of anaemia where the primary problem is in the bone marrow.

* Reticulocyte count: A measure of young red blood cells which helps to determine if the red cell production is at normal levels.

Treatment for anaemia depends on its cause. it is extremely important not to assume various causes and a definitive diagnosis must first be made before starting treatment. the different laboratory tests help to categorise the nature and severity of anaemia. as it often happens, one may have to progressively increase the tests that are being done, depending on the results of the initial basic investigations. more sophisticated tests are necessary in certain cases as the cause may be quite a complicated one or there may be more than one reason for the anaemia.

Depending on the severity of the anaemia, sometimes urgent treatment may be necessary. If the haemoglobin level is very low and into the range that threatens life, an urgent blood transfusion may be necessary. In certain cases, heart failure complicating severe anaemia needs additional treatment. all types of deficiency anaemias would need appropriate treatment with specific substances that are in short supply in the body and are the root cause of the problem. such replenishment therapy may need drugs to be given for a prolonged period of time, possibly for a few months.

Although children often tolerate anaemia much better than adults, they too need special care when they are anaemic. In general, a child with significant anaemia may tire more easily than other kids and therefore need to limit activity levels. it is important for the child’s teachers and other caregivers are aware of the condition. With appropriate treatment, several types of anaemic could be cured but inherited diseases such as thalassaemia do not have a true "cure". whether anaemia can be prevented depends on its cause. currently, there is no way to prevent anaemia due to genetic defects affecting the production of red blood cells or haemoglobin. all types of deficiency anaemias, especially those due to mineral deficiencies can be very effectively prevented by attention to detail about the dietary constituents and by providing a well balanced mixed diet.

The writer would appreciate feedback from the readers. please e-mail him at