Hyperventilation syndrome following mild COVID-19 in a health care worker

Abstract

Hyperventilation syndrome (HVS) is a frequently overlooked complication in the aftermath of SARS-CoV-2 infection. We describe the case of a 53-year-old female dental surgeon who, several weeks after recovering from COVID-19, developed severe exertional dyspnea (mMRC grade 4), palpitations, and marked anxiety (HADS score 14/9). Despite normal findings on pulmonary function tests, chest CT, and echocardiography, clinical suspicion was raised for HVS based on a high Nijmegen score (49/64) and the presence of hypocapnia (26.9 mmHg) on post-exercise arterial blood gas following a six-minute walk test (6MWT), which also revealed reduced exercise capacity (67% of predicted distance). A multidisciplinary management plan including respiratory physiotherapy, psychotherapy, and pharmacologic anxiolysis was implemented. Follow-up demonstrated significant symptom improvement and functional recovery, enabling a return to professional activity. This case underscores the relevance of considering HVS in the differential diagnosis of post-COVID dyspnea and illustrates the utility of simple tools such as the 6MWT and Nijmegen questionnaire in both diagnosis and therapeutic monitoring.