DA COSTA'S syndrome, or neurocirculatory asthenia.

Abstract

SUMMARYThesyndrome variously called Da Costa's syndrome, effort syndrome, neurocirculatory asthenia, etchasbeenstudied formorethan100years bymanydistinguished physicians. Originally identified inmeninwartime, ithasbeenwidely recognised asacommonchronic condition inbothsexes incivilian life. Although thesymptoms mayseemtoappear after infections andvarious physical andpsychological stresses, neurocirculatory asthenia ismostoften encountered asafamilial disorder that isunrelated tothese factors, although theymayaggravate anexisting tendency. Respiratory complaints (including breathlessness, withandwithout effort, andsmothering sensations) arealmost universal, andpalpitation, chest discomfort, dizziness and faintness, andfatigue arecommon.Thephysical examination isnormal. Theaetiology isobscure butpatients usually haveanormal life span. Reassurance andmeasures toimprove physical fitness arehelpful. DaCosta's syndrome orneurocirculatory asthenia hasalongandhonourable history inthemedical literature andinclinical medicine. Yetitisinfrequently mentioned today. Itisunlikely tohavedisappeared; itprobably exists muchasbefore butis moreoften identified andlabelled inpsychiatric termssuchasanxiety state oranxiety neurosis. Thereisnoharminthis shift indiagnostic labels as long astheessential importance ofthesyndrome, its prognosis, andtreatment areproperly appreciated. Suchisnotalways thecaseand, asinother medical issues, itiseducational toreview andsummarise the past. Whathasbeenforgotten should notnecessarily remain forgotten. Forthepurposes ofthisdiscussion, a broad definition ofDaCosta's syndrome that isapplicable tomilitary andcivilian patients is:adisorder of unknown origin, often familial, characterised bythe presence ofoneor more symptomsincluding breathlessness withandwithout effort, palpitation, nervousness, chest discomfort nottypical ofangina pectoris causedby ischaemic heartdisease, fatigability, andfaintness; tending to occurin attacks whichmayrecuroveryears andforwhich there isnospecific treatment.