Chest
ReviewsDiagnosing Cardiovascular and Lung Pathophysiology From Exercise Gas Exchange
Section snippets
Which Ergometer?
To stress the cardiorespiratory gas transport system, exercise testing should involve large muscle groups. Practical laboratory ergometers involving large muscle groups are the treadmill and cycle. Although normal untrained subjects can achieve a maximum oxygen consumption ( O2max) on the treadmill that is about 10% higher than they can achieve on the cycle, the cycle ergometer has the major advantage that the work output performed by the patient is known. (The merits of each ergometer
Data Display for the Medical Record
CPET studies in recent years have taught us that different defects in the coupling of external (airway) to cellular (mitochondrial) respiration will affect gas exchange in different ways. Thus, the pattern of gas exchange at the airway can be used to diagnose pathophysiology and used to support or refute the correctness of a clinical diagnosis. With an appropriate display of the data, it is possible to determine, noninvasively, the functional status of the cardiovascular system, the ventilatory
Diagnosis of Exercise Pathophysiology
Exercise requires an increase in gas transport between the airway and mitochondria. Figure 1 illustrates the physiologic mechanisms that must be coupled to achieve this gas exchange. Exercise limitation is caused by any disease state that disrupts the normal gas exchange coupling.
Our approach to diagnosis of exercise pathophysiology has been to use the nine-panel graphic array exemplified by Figure 2. We start with panel 3 because it quantifies the peak O2. We also start with this panel
Conclusion
Evidence has been presented showing how CPET can be used, as a single method, to discriminate among nonanginal myocardial ischemia, CM, and PAD as the major pathophysiology limiting exercise in patients with cardiovascular disease. Similarly, CPET is the only method that can discern if a given pulmonary function impairment limits exercise; it would also seem to be the best noninvasive method to determine if a patient is likely to benefit from an exercise training program which can be expected
References (15)
- et al.
Pathophysiology of activity limitation in patients with interstitial lung disease
Chest
(1996) - et al.
Prognostic value of cardiopulmonary exercise testing using percent achieved of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy
J Am Coll Cardiol
(1996) - et al.
Protocols for exercise testing. Principles of exercise testing and interpretation
(1994) - et al.
Normal values. Principles of exercise testing and interpretation
(1994) - et al.
Principles of interpretation
Principles of exercise testing and interpretation
(1994) - et al.
Case presentations
Principles of exercise testing and interpretation
(1994) - et al.
Cardiopulmonary exercise testing: physiologic principles and clinical applications
(1986)
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2020, Clinics in Chest MedicineCitation Excerpt :Through such data collection, not only can conventional measurements in performance athletics such as the ventilatory threshold and maximal (or peak) oxygen consumption be obtained, but additional critical respiratory limitations to exercise characteristics of COPD can be identified and quantified. In patients with COPD there are unique limitations, including ventilatory inefficiency and ventilation-perfusion mismatch, expiratory flow limitation and dynamic hyperinflation, a disproportionate work of breathing due to airway resistive and elastic abnormalities, and oxygen desaturation and hypercapnea.19,22 Through incremental testing, the timing of these events in relation to peak workload, oxygen consumption, and Borg scores can help individualize the aerobic goals and limits for the exercise prescription.22
Instantaneous VO2 from a wearable device
2018, Medical Engineering and PhysicsCitation Excerpt :There have been a number of studies showing that the level of physical activity undertaken by a person is linked inversely with their risk of developing a range of chronic medical illnesses [2–4].