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Exercise Testing and Interpretation: An Overview |
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1 | (9) |
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Cell Respiration and Bioenergetics |
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2 | (1) |
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What Is Cardiopulmonary Exercise Testing? |
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3 | (1) |
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Why Measure Gas Exchange to Evaluate Cardiovascular Function and Cellular Respiration? |
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3 | (1) |
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Cardiac Stress Test and Pulmonary Stress Test: Nomenclature Fallacies |
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4 | (1) |
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Normal Coupling of External to Cellular Respiration |
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4 | (1) |
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Patterns of Change in External Respiration (Oxygen Uptake and Carbon Dioxide Output) as Related to Function, Fitness, and Disease |
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5 | (1) |
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Factors Limiting Exercise |
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6 | (1) |
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6 | (1) |
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6 | (1) |
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6 | (1) |
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Evidence of Systemic Dysfunction Uniquely Revealed by Integrative Cardiopulmonary Exercise Testing |
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7 | (3) |
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10 | (56) |
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11 | (7) |
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Mechanical Properties and Fiber Types |
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11 | (1) |
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12 | (6) |
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18 | (1) |
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18 | (1) |
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19 | (1) |
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19 | (9) |
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Lactate Increase as Related to Work Rate |
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19 | (1) |
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Lactate Increase as Related to Time |
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20 | (1) |
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Lactate Increase in Response to Increasing Work Rate |
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21 | (1) |
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Mechanisms of Lactate Increase |
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22 | (1) |
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Oxygen Supply, Critical Capillary PO2, and Lactate Increase |
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23 | (5) |
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Buffering the Exercise-Induced Lactic Acidosis |
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28 | (2) |
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The Anaerobic Threshold Concept |
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30 | (12) |
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The Oxygen Flow-Independent and Oxygen Flow-Dependent Work Rate Zones and the Anaerobic Threshold |
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31 | (1) |
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Identifying the Anaerobic Threshold by Gas Exchange |
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32 | (3) |
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Altered Physiological Responses to Exercise Above the Anaerobic Threshold |
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35 | (6) |
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Anaerobic, Lactate, and Lactic Acidosis Thresholds |
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41 | (1) |
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Metabolic-Cardiovascular-Ventilatory Coupling |
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42 | (8) |
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Cellular Respiration and High-Energy Phosphate Regeneration |
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42 | (1) |
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Cardiovascular Coupling to Metabolism: Muscle Oxygen Supply |
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43 | (2) |
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Ventilatory Coupling to Metabolism |
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45 | (3) |
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Effect of Dietary Substrate |
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48 | (2) |
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50 | (5) |
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50 | (1) |
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50 | (1) |
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Reflexes Regulating Breathing During Exercise |
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51 | (4) |
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55 | (4) |
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56 | (2) |
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Carbon Dioxide Output Kinetics |
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58 | (1) |
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59 | (7) |
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Changes in Blood Gases and pH During Exercise |
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66 | (10) |
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Oxygen, Carbon Dioxide, and H+ Ion Transport |
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67 | (2) |
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67 | (1) |
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68 | (1) |
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68 | (1) |
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The Relation Between Cardiac Output and Oxygen Uptake During Exercise |
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69 | (2) |
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Estimating Cardiac Output |
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71 | (1) |
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71 | (3) |
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74 | (2) |
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Measurements During Integrative Cardiopulmonary Exercise Testing |
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76 | (35) |
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What Is an Integrative Cardiopulmonary Exercise Test? |
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77 | (1) |
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When Should Cardiopulmonary Exercise Testing Be Used? |
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77 | (1) |
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78 | (26) |
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78 | (2) |
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Maximal Oxygen Uptake (VO2max) and Maximum Oxygen Uptake (Peak VO2) |
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80 | (1) |
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Oxygen Uptake and Work Rate |
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81 | (1) |
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Pattern of Work Rate Increase and the VO2 Response |
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81 | (3) |
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Cardiac Output and Stroke Volume |
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84 | (2) |
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Anaerobic, Lactate, and Lactic Acidosis Thresholds |
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86 | (4) |
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Heart Rate--Oxygen Uptake Relationship and Heart Rate Reserve |
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90 | (1) |
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Oxygen Pulse and Stroke Volume |
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91 | (1) |
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92 | (1) |
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92 | (1) |
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92 | (1) |
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93 | (5) |
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Arterial Bicarbonate and Acid--Base Response |
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98 | (1) |
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Tidal Volume/Inspiratory Capacity Ratio |
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99 | (1) |
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Measurements Unique to Constant Work Rate Exercise Testing |
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99 | (5) |
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Data Display and Interpretation |
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104 | (2) |
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Evaluation of Systemic Function from the Nine-Panel Graphical Array |
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104 | (2) |
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Factors Confounding Interpretation of Cardiopulmonary Exercise Testing |
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106 | (1) |
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106 | (5) |
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Pathophysiology of Disorders Limiting Exercise |
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111 | (22) |
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112 | (2) |
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Peripheral Arterial Diseases |
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114 | (1) |
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114 | (4) |
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115 | (1) |
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116 | (1) |
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117 | (1) |
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118 | (1) |
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Pulmonary Vascular Diseases |
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118 | (2) |
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Causes of Increased Ventilation |
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118 | (1) |
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Causes of Exercise Arterial Hypoxemia |
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119 | (1) |
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Effect on Systemic Hemodynamics |
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119 | (1) |
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120 | (6) |
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Obstructive Lung Diseases |
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120 | (4) |
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Restrictive Lung Diseases |
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124 | (1) |
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Chest Wall (Respiratory Pump) Disorders |
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125 | (1) |
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Defects in Hemoglobin Content and Quality |
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126 | (1) |
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126 | (1) |
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Left-shifted Oxyhemoglobin Dissociation Curve |
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127 | (1) |
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Carboxyhemoglobinemia and Cigarette Smoking |
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127 | (1) |
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Chronic Metabolic Acidosis |
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127 | (1) |
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Muscle Disorders and Endocrine Abnormalities |
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128 | (1) |
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Psychogenic Causes of Exercise Limitation and Dyspnea |
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128 | (1) |
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128 | (1) |
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Poor Effort and Manipulated Exercise Performance |
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129 | (1) |
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129 | (1) |
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129 | (4) |
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Clinical Exercise Testing |
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133 | (27) |
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Exercise Laboratory and Equipment |
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134 | (10) |
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General Laboratory Environment |
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134 | (1) |
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134 | (1) |
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Measurement of Volume, Flow Rate, or Ventilation |
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135 | (1) |
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Breathing Valves, Mouthpieces, and Masks |
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136 | (1) |
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136 | (1) |
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Ergometers: Treadmills and Cycles |
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137 | (2) |
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Electrocardiogram and Systemic Blood Pressure |
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139 | (1) |
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Oximetry, Blood Sampling, and Arterial Catheters |
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140 | (2) |
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Data Sampling and Computation |
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142 | (1) |
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Quality Control, Validation, and Maintenance |
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142 | (2) |
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Preparing for the Exercise Test |
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144 | (2) |
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Requesting the Test and Notifying the Patient |
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144 | (1) |
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The Patient in the Exercise Laboratory |
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144 | (2) |
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Performing the Exercise Test |
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146 | (10) |
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Incremental Exercise Test to Symptom-Limited Maximum |
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146 | (4) |
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Constant Work Rate Exercise Tests |
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150 | (2) |
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Treadmill Test for Detecting Myocardial Ischemia |
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152 | (1) |
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153 | (1) |
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Other Tests Suitable for Fitness or Serial Evaluations |
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154 | (2) |
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156 | (1) |
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156 | (4) |
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160 | (23) |
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161 | (7) |
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161 | (1) |
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161 | (1) |
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Adults of Normal (Predicted) Body Weight |
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161 | (2) |
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163 | (3) |
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166 | (1) |
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166 | (1) |
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166 | (1) |
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167 | (1) |
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Peak Heart Rate and Heart Rate Reserve |
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168 | (1) |
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Relationship of Oxygen Uptake and Heart Rate: The Peak Oxygen Pulse |
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168 | (2) |
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Brachial Artery Blood Pressure |
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170 | (1) |
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171 | (1) |
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Oxygen Uptake--Work Rate Relationship |
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172 | (1) |
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Breathing Reserve, Tidal Volume, and Breathing Frequency at Maximum Exercise |
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172 | (2) |
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Exercise Ventilation and Breathing Reserve |
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172 | (1) |
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Tidal Volume and Breathing Frequency |
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173 | (1) |
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174 | (1) |
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174 | (1) |
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Physiological Dead Space--Tidal Volume Ratio |
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175 | (1) |
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Arterial and End-Tidal Carbon Dioxide Tensions |
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176 | (1) |
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Arterial, Alveolar, and End-Tidal Oxygen Tensions and Arterial Oxyhemoglobin Saturation |
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177 | (1) |
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Femoral and Mixed Venous Values and Estimation of Cardiac Output |
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178 | (1) |
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179 | (1) |
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180 | (3) |
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Principles of Interpretation: A Flowchart Approach |
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183 | (15) |
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Introduction to Flowcharts |
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184 | (1) |
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Establishing the Pathophysiological Basis of Exercise Intolerance |
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184 | (1) |
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Maximum Exercise Capacity and Anaerobic Threshold (Flowchart 1) |
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184 | (2) |
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Exercise Intolerance with Normal Peak Oxygen Uptake (Flowchart 2) |
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186 | (4) |
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Low Peak Oxygen Uptake with Normal Anaerobic Threshold (Flowchart 3) |
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190 | (1) |
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Low Peak Oxygen Uptake with Low Anaerobic Threshold (Flowchart 4) |
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191 | (4) |
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Low Peak Oxygen Uptake with Anaerobic Threshold Not Determined (Flowchart 5) |
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195 | (1) |
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196 | (2) |
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Clinical Applications of Cardiopulmonary Exercise Testing |
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198 | (44) |
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Differential Diagnosis of Disorders Causing Exercise Intolerance |
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199 | (1) |
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Pathophysiological Responses in Common Disorders |
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200 | (10) |
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Oxygen Uptake and Carbon Dioxide Output as Related to Work Rate |
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200 | (2) |
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Heart Rate and Carbon Dioxide Output as a Function of Oxygen Uptake |
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202 | (1) |
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Heart Rate and Oxygen Pulse as a Function of Work Rate |
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202 | (1) |
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Tidal Volume as a Function of Exercise Minute Ventilation |
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202 | (4) |
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Exercise Minute Ventilation as a Function of Carbon Dioxide Output |
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206 | (1) |
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Ventilatory Equivalents for Oxygen and Carbon Dioxide |
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206 | (1) |
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End-Tidal Oxygen and Carbon Dioxide |
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206 | (4) |
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Diagnoses Uniquely Made by Cardiopulmonary Exercise Testing |
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210 | (4) |
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Development of Myocardial Dyskinesis with Myocardial Ischemia During Exercise |
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210 | (1) |
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Chronic Heart Failure Due to Diastolic Dysfunction |
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210 | (1) |
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Pulmonary Vascular Occlusive Disease Without Pulmonary Hypertension (Pulmonary Vasculopathy) |
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211 | (1) |
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Patent Foramen Ovale with Development of a Right-to-Left Shunt During Exercise |
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211 | (1) |
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Pulmonary Vascular Disease Limiting Exercise in Chronic Obstructive Pulmonary Disease |
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212 | (2) |
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Impaired Muscle Bioenergetic Function |
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214 | (1) |
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Psychogenic Dyspnea and Behavioral Causes of Exercise Intolerance |
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214 | (1) |
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Grading Severity of Heart Disease |
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214 | (1) |
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Estimating Peak Cardiac Output During Exercise from Oxygen Uptake at Peak Work Rate |
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215 | (3) |
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Cardiac Output Estimated from Oxygen Uptake Applying the Fick Principle |
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215 | (1) |
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Behavior of Changing Arterial--Venous Oxygen Difference During Exercise |
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216 | (1) |
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Estimating Arterial--Venous Oxygen Difference |
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216 | (1) |
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Shortcut Estimate of Stroke Volume from Oxygen Pulse |
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217 | (1) |
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Cardiopulmonary Exercise Testing for Prognostic Evaluation |
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218 | (4) |
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Prognosis in Heart Failure and Prioritizing Patients for Heart Transplantation |
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218 | (2) |
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Prognosis in Primary Pulmonary Hypertension and Prioritizing Patients for Lung Transplantation |
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220 | (1) |
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Prognosis in Chronic Obstructive Pulmonary Disease and Prioritizing Emphysema Patients for Lung Reduction Surgery |
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221 | (1) |
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Preoperative Evaluation of Surgical Risk |
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222 | (1) |
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222 | (1) |
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223 | (1) |
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Who Should Undergo Cardiopulmonary Exercise Testing Preoperatively? |
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223 | (1) |
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Measuring Impairment for Disability Evaluation |
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223 | (3) |
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Impairment and Disability |
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224 | (1) |
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Problems in Assessing Impairment from Only Resting Measures |
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224 | (1) |
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Exercise Testing and Impairment Evaluation |
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225 | (1) |
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226 | (1) |
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226 | (6) |
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Physiological Basis of Exercise Rehabilitation |
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226 | (2) |
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Exercise Rehabilitation in Heart Disease |
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228 | (2) |
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Exercise Rehabilitation in Chronic Obstructive Pulmonary Disease |
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230 | (2) |
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Assessing the Effectiveness of Treatment |
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232 | (3) |
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Screening for Development of Disease in High-Risk Patients |
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235 | (1) |
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Graded Exercise Testing and the Athlete |
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235 | (1) |
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235 | (7) |
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242 | (329) |
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245 | (3) |
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248 | (3) |
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Case 3 Normal Man: Air and Oxygen Breathing Studies |
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251 | (5) |
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Case 4 Normal Woman: Air and Oxygen Breathing Studies |
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256 | (5) |
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261 | (3) |
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264 | (3) |
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267 | (3) |
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Case 8 Normal Man with Ventilatory Chemoreflex Insensitivity |
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270 | (3) |
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Case 9 Exceptionally Fit Man with Mild Lung Disease |
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273 | (3) |
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Case 10 Normal Subject: Cycle and Treadmill Studies |
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276 | (4) |
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Case 11 Normal Subject: Before and After β-Adrenergic Blockade |
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280 | (5) |
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Case 12 Normal Subject: Immediate Effects of Cigarette Smoking |
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285 | (5) |
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Case 13 Cardiologic Misdiagnoses in a Man at Ages 65 and 72 |
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290 | (7) |
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Case 14 Obesity, Hypertension, and Cigarette Smoking |
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297 | (3) |
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300 | (3) |
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Case 16 Coronary Artery Disease |
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303 | (3) |
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Case 17 Coronary Artery Disease |
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306 | (3) |
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Case 18 Small Vessel Coronary Artery Disease |
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309 | (3) |
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Case 19 Coronary Artery Disease Developed Over a Three-Year Interval |
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312 | (5) |
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Case 20 Myocardial Ischemia with Mild Interstitial and Obstructive Airway Disease |
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317 | (3) |
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Case 21 Silent Myocardial Ischemia, Systemic Hypertension, and Mild Interstitial Lung Disease |
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320 | (3) |
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Case 22 Ischemic Cardiomyopathy |
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323 | (3) |
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326 | (3) |
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Case 24 Cardiomyopathy, Hypertrophic Type |
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329 | (4) |
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Case 25 Chronic Heart Failure: Before and After Therapy |
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333 | (5) |
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Case 26 Cardiomyopathy with Oscillatory Function |
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338 | (4) |
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Case 27 Mitral Insufficiency |
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342 | (3) |
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Case 28 Mitral Stenosis: Before and After β-Adrenergic Blockade |
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345 | (4) |
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Case 29 Congenital Heart Disease |
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349 | (5) |
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Case 30 Peripheral Arterial Disease |
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354 | (3) |
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Case 31 Peripheral Arterial Disease with Pulmonary Vascular and Obstructive Airway Disease |
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357 | (3) |
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Case 32 Heart Failure--Dominant Mixed Cardiovascular Disease in an Anemic Smoker |
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360 | (3) |
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Case 33 Hypertensive Cardiovascular Disease and Carboxyhemoglobinemia |
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363 | (3) |
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Case 34 Patent Ductus Arteriosus |
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366 | (3) |
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Case 35 Vasoregulatory Asthenia |
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369 | (3) |
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Case 36 Mild Chronic Bronchitis with Normal Exercise Performance |
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372 | (3) |
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Case 37 Chronic Bronchitis and Obesity |
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375 | (3) |
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Case 38 Chronic Bronchitis, Cigarette Smoking, and Obesity |
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378 | (3) |
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Case 39 Emphysema with Mild Airway Obstruction |
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381 | (3) |
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384 | (3) |
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Case 41 Emphysema with Pulmonary Vascular Disease |
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387 | (3) |
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Case 42 Severe Emphysema and Bronchitis: Air and Oxygen Breathing Studies |
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390 | (5) |
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Case 43 Lung Cancer and Chronic Bronchitis: Preoperative Evaluation |
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395 | (3) |
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Case 44 Bullous Emphysema: Before and After Bullectomy |
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398 | (5) |
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Case 45 Obstructive Airway Disease: Before and After Rehabilitation |
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403 | (5) |
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Case 46 Early Asbestosis and Chronic Bronchitis |
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408 | (3) |
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411 | (3) |
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Case 48 Restrictive Lung Disease (Asbestosis) |
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414 | (3) |
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Case 49 Idiopathic Interstitial Lung Disease |
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417 | (3) |
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Case 50 Mixed Connective Tissue Disease with Interstitial and Pulmonary Vascular Disease |
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420 | (3) |
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Case 51 Interstitial Lung Disease |
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423 | (3) |
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426 | (3) |
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Case 53 Severe Sarcoidosis: Air and Oxygen Breathing Studies |
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429 | (4) |
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Case 54 Interstitial Pneumonitis: Before and After Corticosteroid Therapy |
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433 | (5) |
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Case 55 Interstitial Pulmonary Fibrosis: Air and Oxygen Breathing Studies |
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438 | (5) |
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Case 56 Pulmonary Alveolar Proteinosis: Air and Oxygen Breathing Studies |
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443 | (4) |
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Case 57 Alveolar Proteinosis: Before and After Whole-Lung Lavage |
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447 | (5) |
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Case 58 Pulmonary Microlithiasis: Air and Oxygen Breathing Studies |
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452 | (4) |
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Case 59 Thromboembolic Pulmonary Vascular Disease |
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456 | (3) |
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Case 60 Pulmonary Vasculitis: Air and Oxygen Breathing Studies |
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459 | (5) |
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Case 61 Pulmonary Hypertension with Patent Foramen Ovale |
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464 | (4) |
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Case 62 Left Ventricular Failure with Accompanying Lung Function Changes |
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468 | (3) |
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Case 63 Pulmonary Vascular Disease Secondary to Interstitial and Obstructive Lung Disease |
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471 | (3) |
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Case 64 Pulmonary Arteriovenous Fistulae |
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474 | (3) |
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477 | (3) |
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480 | (3) |
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Case 67 Acute Hyperventilation and Anxiety in a Moderately Obese Man |
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483 | (3) |
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Case 68 Skeletal Disease Limiting Exercise |
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486 | (3) |
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Case 69 Ankylosing Spondylitis |
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489 | (3) |
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Case 70 Myasthenia Gravis |
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492 | (3) |
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Case 71 Aortic and Mitral Stenosis and Obstructive Airway Disease |
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495 | (3) |
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Case 72 Left Ventricular Failure and Mild Obstructive Airway Disease: Cycle and Treadmill Studies |
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498 | (4) |
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Case 73 β-Adrenergic Blockade, Systemic Hypertension, Pulmonary Vascular Disease, and Mild Chronic Bronchitis |
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502 | (3) |
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Case 74 β-Adrenergic Blockade, Obesity, and Asbestosis |
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505 | (3) |
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Case 75 Pulmonary Vascular Disease, Chronic Bronchitis, Asbestosis, and Myocardial Ischemia |
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508 | (3) |
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Case 76 ``CHF,'' ``COPD,'' Obesity, and Anemia |
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511 | (3) |
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Case 77 Mild Obstructive Airway Disease Complicated by Systemic Hypertension and Pulmonary Vascular Disease |
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514 | (3) |
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Case 78 Pulmonary Vascular Disease, Obstructive Airway Disease, and Talc Pneumoconiosis |
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517 | (3) |
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Case 79 Systemic Sclerosis and Primary Lung Cancer: Preoperative Evaluation |
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520 | (3) |
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Case 80 Primary Pulmonary Hypertension Before and After Treatment |
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523 | (5) |
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Case 81 Cardiomyopathy Due to Diastolic Dysfunction |
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528 | (4) |
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Case 82 Transition from Normal to Left Ventricular Failure |
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532 | (5) |
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Case 83 Psychogenic Dyspnea |
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537 | (3) |
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Case 84 Hypertension Treated with β-Adrenergic Blockade |
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540 | (5) |
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Case 85 Ischemic Cardiomyopathy, Restrictive Lung Disease, and β-Adrenergic Blockade |
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545 | (3) |
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A. Symbols and Abbreviations |
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548 | (2) |
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550 | (6) |
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C. Calculations, Formulas, and Examples |
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556 | (10) |
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D. Placement of a Brachial Artery Catheter |
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566 | (2) |
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568 | (3) |
| Index |
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571 | |
Other versions by this Author
