Chest
Volume 112, Issue 4, October 1997, Pages 1091-1101
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Diagnosing Cardiovascular and Lung Pathophysiology From Exercise Gas Exchange

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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 ( V˙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 V˙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

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