Da Costa Syndrome

• Initially described as occurring in soldiers in wartime, the disorder is seen with similar prevalence in the general population
• Physical examination is normal
• Aetiology is unknown but patients usually have a normal life span
• Also referred to as “Effort Syndrome” as symptoms resemble those of fatigue following effort in healthy individuals

History of Da Costa syndrome

1864 – First recorded by the British in the Crimea, when termed ‘palpitation’, and later the constellation of symptoms was referred to by Hartshorne as “cardiac muscular exhaustion“

1864 – Maclean WC (Professor of military medicine at the Army Medical School, Netley) initially felt army discharges secondary to ‘diseases of the circulatory system’ (8% of the those discharged between 1863-1866 of the 5500 case reviewed) were thought to be the effect of exertion on a soldier’s chest constricted by tight webbing and equipment/li>

The pack-straps press on important muscles, arteries, veins and nerves to a degree which only those who have carried the loaded pack can appreciate… You can well imagine how impossible it must be to make severe exertion under so many disadvantages without suffering

Maclean 1864

1870 – A.B.R. Myers reviewed extensively, in his ‘Alexander’ Prize Essay the writings of Maclean, E.J. Parkes and Aitken on the matter of the ‘irritable heart’ of combat soldiers. He concluded that three major factors accounted for this difference: rheumatic fever, Bright’s disease and violent manual labour. He also pointed to the soldier’s equipment

His waist-belt adds to the constriction below the chest, and his tunic collar above it… and then, to complete the artificial chest case, the knapsack straps supply all that is requisite, whilst the pouch-belt adds its share to the general compression. The chest, thus fixed as it were in a vice, has little or no power of expansion, and the circulation through the heart, lungs and great vessels is proportionately impeded

Myers 1870

1871 – Da Costa defined as “irritable heart syndrome,” in cases from the American Civil War. He found the disorder, was not confined to the infantry but affected the cavalry and artillery so the packs were unlikely to be to blame. Although this was widely regarded as a disorder suffered by soldiers in wartime, Da Costa made the important observation that the same cluster of symptoms could also be seen in civilians.

The ‘syndrome’ has undergone many name changes with the evolution of more advancements in physiological and anatomical testing. From ‘cardiac neurosis,’ ‘disordered action of the heart,’ ‘soldier’s heart,’ and ‘neurocirculatory asthenia’; to ‘vasoregulatory asthenia,’ (Holmgren) ‘hyperkinetic heart syndrome,’ (Gorlin) or ‘hyperdynamic β-adrenergic circulatory state.(Frohlich).

Associated Persons

• Jacob Mendez Da Costa (1833-1900)
• Sir John Parkinson (1885-1976)
• Sir Thomas Lewis (1881-1945)

Alternative names

• Da Costa’s disease
• Soldiers heart, cardiac neurosis, neurocirculatory asthenia and effort syndrome

Eponymic chest pain syndromes

• Bornholm disease
• Tietze syndrome
• Syndrôme de Huchard or Texidor Twinge
• Da Costa syndrome
  

References

Original articles

• Hartshorne H. On heart disease in the army. American Journal of the Medical Sciences. 1864; 48: 89-92.
• Maclean WC. The influence of the present knapsack and accoutrements on the health of the infantry soldier. Journal of the Royal United Service Institution. 1864; 8: 105-115.
• Maclean WC. A Lecture on Diseases of the Heart in the British Army: The Cause and the Remedy. Br Med J. 1867; 1(320): 161–164.
• Myers ABR. On the etiology and prevalence of diseases of the heart among soldiers. London, J. Churchill, 1870.
• Da Costa JM. On Irritable Heart; A Clinical Study of a Form of Functional Cardiac Disorder and Its Consequences. American Journal of the Medical Sciences 1871, 61: 17–52.

Review articles

• Wilson RM. The Irritable heart of soldiers. Br Med J. 1916 Jan 22; 1(2873): 119–120.
• Lewis T. The soldier’s heart and the effort syndrome. London, Shaw. 1918
• Vaisrub S. Da Costa Syndrome Revisited. JAMA. 1975 Apr 14;232(2):164
• Paul O. Da Costa’s syndrome or neurocirculatory asthenia. Br Heart J. 1987; 58(4): 306–315
• Jones E. Historical approaches to post-combat disorders. Philos Trans R Soc Lond B Biol Sci. 2006; 361(1468): 533–542