Da Costa's syndrome

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Da Costa's syndrome
Other namesSoldier's heart, irritable heart syndrome, [1] neurocirculatory asthenia, [2] cardiac neurosis, chronic asthenia, effort syndrome, functional cardiovascular disease, primary neurasthenia, subacute asthenia
Specialty Psychiatry, Cardiology
Symptoms fatigue upon exertion, shortness of breath, palpitations, sweating, chest pain
Differential diagnosis chronic fatigue syndrome, postural orthostatic tachycardia syndrome (POTS), mitral valve prolapse syndrome

Da Costa's syndrome, also known as soldier's heart among other names, was a syndrome or a set of symptoms similar to those of heart disease. These include fatigue upon exertion, shortness of breath, palpitations, sweating, chest pain, and sometimes orthostatic intolerance. It was originally thought to be a cardiac condition, and treated with a predecessor to modern cardiac drugs. In modern times, it is believed to represent several unrelated disorders, some of which have a known medical basis.

Contents

Historically, similar forms of this disorder have been noticed in various wars, like the American Civil War and Crimean war, and among British troops who colonized India. The condition was named after Jacob Mendes Da Costa who investigated and described the disorder in 1871. [3] [4]

Signs and symptoms

Symptoms of Da Costa's syndrome include fatigue upon exertion, weakness induced by minor activity, shortness of breath, palpitations, sweating, and chest pain. [4]

Causes

Da Costa's syndrome was originally considered to be heart failure or other cardiac condition, and was later recategorized to be psychiatric. [5] [6] The term is no longer in common use by any medical agencies and has generally been superseded by more specific diagnoses, some of which have a medical basis.

Diagnosis

Although it is listed in the ICD-9 (306.2) and ICD-10 (F45.3) under "somatoform autonomic dysfunction", [5] [7] the term is no longer in common use by any medical agencies and has generally been superseded by more specific diagnoses.

The orthostatic intolerance observed by Da Costa has since also been found in patients diagnosed with chronic fatigue syndrome, postural orthostatic tachycardia syndrome (POTS) [8] and mitral valve prolapse syndrome. [9] In the 21st century, POTS is classified as a neurological condition. Exercise intolerance has since been found in many organic diseases.

Classification

There are many names for the syndrome, which has variously been called soldier's heart, cardiac neurosis, chronic asthenia, effort syndrome, functional cardiovascular disease, neurocirculatory asthenia, primary neurasthenia, and subacute asthenia. [10] [11] [12] [13] Da Costa himself called it irritable heart  [14] and the term soldier's heart was in common use both before and after his paper. Most authors use these terms interchangeably, but some authors draw a distinction between the different manifestations of this condition, preferring to use different labels to highlight the predominance of psychiatric or non-psychiatric complaints. For example, Oglesby Paul writes that "Not all patients with neurocirculatory asthenia have a cardiac neurosis, and not all patients with cardiac neurosis have neurocirculatory asthenia." [13] None of these terms have widespread use.

Treatment

The report of Da Costa shows that patients recovered from the more severe symptoms when removed from the strenuous activity or sustained lifestyle that caused them. A reclined position and forced bed rest were the most beneficial.[ citation needed ]

Other treatments evident from the previous studies were improving physique and posture, appropriate levels of exercise where possible, wearing loose clothing about the waist, and avoiding postural changes such as stooping, or lying on the left or right side, or the back in some cases, which relieved some of the palpitations and chest pains, and standing up slowly can prevent the faintness associated with postural or orthostatic hypotension in some cases.

Pharmacological intervention came in the form of digitalis, a group of glycoside drugs derived from the foxglove ( Digitalis purpurea ), which is now known to act as a sodium-potassium ATPase inhibitor, increasing stroke volume and decreasing heart rate; at the time it was used for the latter effect in patients with palpitations. [15]

History

Da Costa's syndrome is named for the surgeon Jacob Mendes Da Costa, [16] who first observed it in soldiers during the American Civil War. At the time it was proposed, Da Costa's syndrome was seen as a very desirable [17] physiological explanation for "soldier's heart". Use of the term "Da Costa's syndrome" peaked in the early 20th century. Towards the mid-century, the condition was generally re-characterized as a form of neurosis. [18] It was initially classified as "F45.3" (under somatoform disorder of the heart and cardiovascular system) in ICD-10, [19] and is now classified under "somatoform autonomic dysfunction".

Da Costa's syndrome involves a set of symptoms that include left-sided chest pains, palpitations, breathlessness, and fatigue in response to exertion. Earl de Grey who presented four reports on British soldiers with these symptoms between 1864 and 1868, and attributed them to the heavy weight of military equipment being carried in knapsacks that were tightly strapped to the chest in a manner that constricted the action of the heart. Also in 1864, Henry Harthorme observed soldiers in the American Civil War who had similar symptoms that were attributed to "long-continued overexertion, with deficiency of rest and often nourishment", and indefinite heart complaints were attributed to lack of sleep and bad food. In 1870 Arthur Bowen Myers of the Coldstream Guards also regarded the accoutrements as the cause of the trouble, which he called neurocirculatory asthenia and cardiovascular neurosis. [20] [21]

Soldiers carry an exhausted troop off the battlefield In this undated file photo, U.S. Army Capt. Emil Kapaun, right, a chaplain with the 3rd Battalion, 8th Cavalry Regiment, 1st Cavalry Division, helps a Soldier carry an exhausted troop off the battlefield 130311-A-CP123-001.jpg
Soldiers carry an exhausted troop off the battlefield

J. M. Da Costa's study of 300 soldiers reported similar findings in 1871 and added that the condition often developed and persisted after a bout of fever or diarrhoea. He also noted that the pulse was always greatly and rapidly influenced by position, such as stooping or reclining. A typical case involved a man who was on active duty for several months or more and contracted an annoying bout of diarrhoea or fever, and then, after a short stay in hospital, returned to active service. The soldier soon found that he could not keep up with his comrades in the exertions of a soldier's life as previously, because he would get out of breath, and would get dizzy, and have palpitations and pains in his chest, yet upon examination some time later he appeared generally healthy. [14] In 1876 surgeon Arthur Davy attributed the symptoms to military foot drill where "over-expanding the chest, caused dilatation of the heart, and so induced irritability". [20]

During World War I, Sir Thomas Lewis (who had been a member of staff of the Medical Research Committee) studied many soldiers who had been referred to the Military Heart Hospitals in Hampstead and Colchester with 'disordered action of the heart' or 'valvular disease of the heart'. In 1918 he published a monograph summarizing his findings, which showed that the vast majority did not have structural heart disease, as evidenced by the diagnostic methods available at the time. [22] In it, he reviewed the difference in symptoms between 'effort syndrome' and structural heart disease, examined possible causes of 'effort syndrome', the diagnosis of structural heart disease in soldiers, its outlook and treatment, and lessons learned by the Army.

Since then, a variety of similar or partly similar conditions named above have been described.

See also

Related Research Articles

Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person's blood pressure drops when they are standing up (orthostasis) or sitting down. Primary orthostatic hypotension is also often referred to as neurogenic orthostatic hypotension. The drop in blood pressure may be sudden, within 3 minutes or gradual. It is defined as a fall in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg after 3 minutes of standing. It occurs predominantly by delayed constriction of the lower body blood vessels, which is normally required to maintain adequate blood pressure when changing the position to standing. As a result, blood pools in the blood vessels of the legs for a longer period, and less is returned to the heart, thereby leading to a reduced cardiac output and inadequate blood flow to the brain.

<span class="mw-page-title-main">Tachycardia</span> Heart rate exceeding normal resting rate

Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal or abnormal.

<span class="mw-page-title-main">Premature ventricular contraction</span> Skipped beat with ventricular origin

A premature ventricular contraction (PVC) is a common event where the heartbeat is initiated by Purkinje fibers in the ventricles rather than by the sinoatrial node. PVCs may cause no symptoms or may be perceived as a "skipped beat" or felt as palpitations in the chest. PVCs do not usually pose any danger.

<span class="mw-page-title-main">Dysautonomia</span> Any disease or malfunction of the autonomic nervous system

Dysautonomia, autonomic failure, or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels. Dysautonomia has many causes, not all of which may be classified as neuropathic. A number of conditions can feature dysautonomia, such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, Ehlers–Danlos syndromes, autoimmune autonomic ganglionopathy and autonomic neuropathy, HIV/AIDS, mitochondrial cytopathy, pure autonomic failure, autism, and postural orthostatic tachycardia syndrome.

<span class="mw-page-title-main">Palpitations</span> Perceived cardiac abnormality in which ones heartbeat can be felt

Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart.

<span class="mw-page-title-main">Chest pain</span> Discomfort or pain in the chest as a medical symptom

Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or the elderly may have less clear symptoms.

Neurasthenia is a term that was first used as early as 1829 for a mechanical weakness of the nerves. It became a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologist George Miller Beard reintroduced the concept in 1869.

Orthostatic intolerance (OI) is the development of symptoms when standing upright that are relieved when reclining. There are many types of orthostatic intolerance. OI can be a subcategory of dysautonomia, a disorder of the autonomic nervous system occurring when an individual stands up. Some animal species with orthostatic hypotension have evolved to cope with orthostatic disturbances.

<span class="mw-page-title-main">Postural orthostatic tachycardia syndrome</span> Abnormally high heart rate after a postural change

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, numbness or tingling in the extremities, chest pain, and shortness of breath. Other conditions associated with POTS include myalgic encephalomyelitis/chronic fatigue syndrome, migraine headaches, Ehlers–Danlos syndrome, asthma, autoimmune disease, vasovagal syncope, and mast cell activation syndrome. POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, gentle and slow postural changes, avoiding prolonged bedrest, medication, and physical therapy.

<span class="mw-page-title-main">Exercise intolerance</span> Inability to perform physical exercise at normal levels

Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the normally expected level or duration for people of that age, size, sex, and muscle mass. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but can result from various disorders.

<span class="mw-page-title-main">Sinus tachycardia</span> Sinus rhythm with a rate that is higher than normal

Sinus tachycardia is a sinus rhythm of the heart, with an increased rate of electrical discharge from the sinoatrial node, resulting in a tachycardia, a heart rate that is higher than the upper limit of normal.

<span class="mw-page-title-main">Inappropriate sinus tachycardia</span> Syndrome where the sinus heart rate is inexplicably faster than expected

Inappropriate sinus tachycardia (IST) is defined as sinus tachycardia that is not caused by identifiable medical ailments, a physiological reaction, or pharmaceuticals (a diagnosis of exclusion) and is accompanied by symptoms, frequently invalidating and affecting quality of life. IST symptoms include palpitations, chest discomfort, exhaustion, shortness of breath, presyncope, and syncope.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

<span class="mw-page-title-main">Jacob Mendes Da Costa</span> American physician

Jacob Mendes Da Costa, or Jacob Mendez Da Costa was an American physician.

<span class="mw-page-title-main">Syncope (medicine)</span> Transient loss of consciousness and postural tone

Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. Psychiatric causes can also be determined when a patient experiences fear, anxiety, or panic; particularly before a stressful event, usually medical in nature. When consciousness and muscle strength are not completely lost, it is called presyncope. It is recommended that presyncope be treated the same as syncope.

Roemheld syndrome (RS), or gastrocardiac syndrome, or gastric cardiac syndrome or Roemheld–Techlenburg–Ceconi syndrome or gastric-cardia, was a medical syndrome first coined by Ludwig von Roemheld (1871–1938) describing a cluster of cardiovascular symptoms stimulated by gastrointestinal changes. Although it is currently considered an obsolete medical diagnosis, recent studies have described similar clinical presentations and highlighted potential underlying mechanisms.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform. The status of ME/CFS as a functional somatic syndrome is contested. Although the aetiology remains unclear, there are consistent findings of biological abnormalities, and major health bodies such as the NAM, WHO, and NIH, classify it as an organic disease.

Idiopathic chronic fatigue (ICF) or chronic idiopathic fatigue or insufficient/idiopathic fatigue is a term used for cases of unexplained fatigue that have lasted at least six consecutive months and which do not meet the criteria for myalgic encephalomyelitis/chronic fatigue syndrome. Such fatigue is widely understood to have a profound effect on the lives of patients who experience it.

References

  1. ↑ Vilarinho, Yuri C. (2014). "Irritable heart syndrome in Anglo-American medical thought at the end of the nineteenth century". Historia, Ciencias, Saude--Manguinhos. 21 (4): 1151–1177. doi: 10.1590/S0104-59702014000400005 . ISSN   1678-4758. PMID   25606722.
  2. ↑ Paul, O (October 1987). "Da Costa's syndrome or neurocirculatory asthenia". British Heart Journal. 58 (4): 306–315. doi:10.1136/hrt.58.4.306. ISSN   0007-0769. PMC   1277260 . PMID   3314950.
  3. ↑ Wooley, C F (1976-05-01). "Where are the diseases of yesteryear? DaCosta's syndrome, soldiers heart, the effort syndrome, neurocirculatory asthenia--and the mitral valve prolapse syndrome". Circulation. 53 (5): 749–751. doi: 10.1161/01.CIR.53.5.749 . PMID   770030. S2CID   5070867.
  4. 1 2 Halstead, Megan (2018-01-01). "Postural orthostatic tachycardia syndrome: An analysis of cross-cultural research, historical research, and patient narratives of the diagnostic experience". Senior Honors Theses & Projects.
  5. 1 2 "2008 ICD-9-CM Diagnosis 306.* - Physiological malfunction arising from mental factors". 2008 ICD-9-CM Volume 1 Diagnosis Codes. Retrieved 2008-05-26. Neurocirculatory asthenia is most typically seen as a form of anxiety disorder.
  6. ↑ "Dorlands Medical Dictionary: Da Costa syndrome". Merck. Archived from the original on 20 Aug 2009. Retrieved 2008-05-26.
  7. ↑ "ICD-10 Version:2010". icd.who.int. Retrieved 2023-03-14.
  8. ↑ Low, Phillip A.; Sandroni, Paola; Joyner, Michael; Shen, Win-Kuang (March 2009). "Postural tachycardia syndrome (POTS)". Journal of Cardiovascular Electrophysiology. 20 (3): 352–358. doi:10.1111/j.1540-8167.2008.01407.x. ISSN   1540-8167. PMC   3904426 . PMID   19207771.
  9. ↑ Online Mendelian Inheritance in Man (OMIM): Orthostatic Intolerance - 604715
  10. ↑ "Neurasthenia". Rare Disease Database. National Organization for Rare Disorders, Inc. 2005. Retrieved 2008-05-28.
  11. ↑ Paul Wood, MD (1941-05-24). "Da Costa's Syndrome (or Effort Syndrome). Lecture I". Lectures to the Royal College of Physicians of London. 1 (4194). British Medical Journal: 1(4194): 767–772. doi:10.1136/bmj.1.4194.767. PMC   2161922 . PMID   20783672 . Retrieved 2008-05-28.
  12. ↑ Cohen ME, White PD (November 1, 1951). "Life situations, emotions, and neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome)". Psychosomatic Medicine . 13 (6): 335–57. doi:10.1097/00006842-195111000-00001. PMID   14892184. S2CID   7139766 . Retrieved 2008-05-28.
  13. 1 2 Paul O (1987). "Da Costa's syndrome or neurocirculatory asthenia". British Heart Journal. 58 (4): 306–15. doi:10.1136/hrt.58.4.306. PMC   1277260 . PMID   3314950.
  14. 1 2 Da Costa, Jacob Medes (January 1871). "On irritable heart; a clinical study of a form of functional cardiac disorder and its consequences". The American Journal of the Medical Sciences (61): 18–52.
  15. ↑ Paul, Oglesby (1987). "DaCosta's syndrome or neurocirculatory astheniaBrHeartJ1987;58:306-15" (PDF). Br Heart J. 58 (4): 306–315. doi:10.1136/hrt.58.4.306. PMC   1277260 . PMID   3314950 . Retrieved 13 August 2020.
  16. ↑ "Da Costa's syndrome". www.whonamedit.com. Retrieved 2007-12-18.
  17. ↑ National Research Council; Committee on Veterans' Compensation for Posttraumatic Stress Disorder (2007). PTSD Compensation and Military Service: Progress and Promise. Washington, D.C.: National Academies Press. p. 35. doi:10.17226/11870. ISBN   978-0-309-10552-1 . Retrieved 2008-05-26. Being able to attribute soldier's heart to a physical cause provided an "honorable solution" to all vested parties, as it left the self-respect of the soldier intact and it kept military authorities from having to explain the "psychological breakdowns in previously brave soldiers" or to account for "such troublesome issues as cowardice, low unit morale, poor leadership, or the meaning of the war effort itself" (Van der Kolk et al., as cited in Lasiuk, 2006).{{cite book}}: CS1 maint: multiple names: authors list (link)
  18. ↑ Edmund D., MD Pellegrino; Caplan, Arthur L.; Mccartney, James Elvins; Dominic A. Sisti (2004). Health, Disease, and Illness: Concepts in Medicine. Washington, D.C.: Georgetown University Press. p. 165. ISBN   978-1-58901-014-7.
  19. ↑ World Health Organization (1992). Icd-10: The Icd-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization. p. 168. ISBN   978-92-4-154422-1.
  20. 1 2 Goetz, C.G. (1993). Turner C.M.; Aminoff M.J. (eds.). Handbook of Clinical Neurology. B.V.: Elsevier Science Publishers. pp. 429–447.
  21. ↑ Mackenzie, Sir James; R. M. Wilson; Philip Hamill; Alexander Morrison; O. Leyton; Florence A. Stoney (1916-01-18). "Discussions On The Soldier's Heart". Proceedings of the Royal Society of Medicine, Therapeutical and Pharmacological Section. 9: 27–60.
  22. ↑ Lewis, Thomas (1918). The Soldier's Heart and the Effort Syndrome (1st ed.). London: Shaw & Sons. p. 2.
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