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1156 pages added, reviewed or updated during the last month (last updated: 28/1/2021)

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effort syndrome or neurocirculatory asthenia

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The syndrome variously called Da Costa's syndrome, effort syndrome, neurocirculatory asthenia, etc has been studied for more than 100 years (1).

Da Costa's syndrome is a psychiatric disorder in which the patient experiences chest pain which may mimic angina.

It is found commonly, but not exclusively, in women in association with other symptoms of anxiety. Respiratory complaints (including breathlessness, with and without effort, and smothering sensations) are almost universal, and palpitation, chest discomfort, dizziness and faintness, and fatigue are common (1). The physical examination is normal (1).

Classically, Da Costa's syndrome develops in two situations:

  • in the relative or friend of an individual who has recently been diagnosed as suffering from a cardiac condition
  • in the period following a myocardial infarction

Da Costa's syndrome may be differentiated from angina on the basis of the history and cardiac investigation (e.g. ECG). If angiography is performed, the coronary arteries are found to be normal.


  • Da Costa's original description of this syndrome was based on observations of soldiers during the American Civil War


  1. Paul O. Da Costa's syndrome or neurocirculatory asthenia. Br Heart J. 1987 Oct;58(4):306-15.

Last reviewed 01/2018