Principles of exercise testing & interpretation : including pathophysiology and clinical applications / Karlman Wasserman ... [and others].

Format:

Book

Contributor:

Wasserman, Karlman.

Language:

English

Subjects (All):

Exercise tests.

Heart function tests.

Pulmonary function tests.

Exercise Test.

Exertion--physiology.

Medical Subjects:

Exercise Test.

Exertion--physiology.

Physical Description:

xv, 556 pages : illustrations ; 29 cm

Edition:

Third edition.

Other Title:

Principles of exercise testing and interpretation

Pathophysiology and clinical applications

Place of Publication:

Philadelphia : Lippincott Williams & Wilkins, [1999]

Contents:

1. Exercise Testing and Interpretation: An Overview 1

Why Measure Gas Exchange to Evaluate Cardiovascular Function and Cellular Respiration? 2

Cardiac Stress Test and Pulmonary Stress Test: Nomenclature Fallacies 2

Cell Respiration and Bioenergetics 3

Normal Coupling of External to Cellular Respiration 4

Quantifying State and Time Course of Cellular Respiration from Measurements of External Respiration 4

Patterns of Change in External Respiration (O[subscript 2] Uptake and CO[subscript 2] Output) as Related to Function, Fitness and Disease 6

Factors Limiting Exercise 6

Fatigue 6

Dyspnea 7

Pain 7

Evidence of Systemic Dysfunction Uniquely Revealed by Integrative Cardiopulmonary Exercise Testing 7

2. Physiology of Exercise 10

Skeletal Muscle 11

Mechanical Properties and Fiber Types 11

Energetics 12

Oxygen Cost of Work 17

Work Efficiency 18

Vo[subscript 2] Non-Steady State 19

Lactate Increase 19

Lactate Increase as Related to Work Rate 19

Lactate Increase as Related to Time 19

Lactate Increase in Response to Increasing Work Rate 20

Mechanisms of Lactate Increase 21

Buffering the Exercise-induced Lactic Acidosis 7

The Anaerobic Threshold (AT) Concept 29

Identifying AT by Gas Exchange 30

Altered Physiological Responses to Exercise above the AT 33

Anaerobic, Lactate and Lactic Acidosis Thresholds 39

Metabolic-Cardiovascular-Ventilatory Coupling 40

Cellular Respiration and High Energy Phosphate Regeneration 40

Cardiovascular Coupling to Metabolism: Muscle O[subscript 2] Supply 40

Ventilatory Coupling to Metabolism 42

Effect of Dietary Substrate 46

Control of Breathing 47

Acid-Base Regulation 47

Physical Factors 48

Reflexes Regulating Breathing During Exercise 48

Gas Exchange Kinetics 52

Oxygen Uptake Kinetics 52

CO[subscript 2] Output Kinetics 55

3. Measurements During Integrative Cardiopulmonary Exercise Testing 62

What Is an Integrative Cardiopulmonary Exercise Test? 63

When Should Integrative Cardiopulmonary Exercise Testing Be Used? 64

Measurements 64

Electrocardiogram 64

Maximal Oxygen Uptake (Vo[subscript 2]max) Maximum Oxygen Uptake (Peak Vo[subscript 2]) 65

Oxygen Uptake and Work Rate 67

Pattern of Work Rate Increase and the VO[subscript 2] Response 67

Upward Displacement of VO[subscript 2] as A Function of Work Rate 68

Cardiac Output and Stroke Volume 71

Anaerobic (Lactate, Lactic Acidosis) Threshold (AT, LT, LAT) 73

Heart Rate-Oxygen Uptake Relationship and Heart Rate Reserve 76

Oxygen Pulse (VO[subscript 2]/HR) and Stroke Volume 77

Arterial Blood Pressure 78

Breathing Reserve 79

Expiratory Flow Pattern 79

Tests of Uneven VA/Q 79

Arterial Bicarbonate and Acid-Base Response 83

Tidal Volume/Inspiratory Capacity Ratio (VT/IC) 84

Measurements Unique to Constant Work Rate Exercise Testing 84

Data Display and Interpretation 87

4. Pathophysiology of Disorders Limiting Exercise 95

Obesity 96

Peripheral Arterial Diseases 98

Heart Diseases 98

Coronary Artery Disease 99

Myopathic Heart Disease 100

Valvular Heart Disease 101

Congenital Heart Disease 101

Pulmonary Vascular Diseases 102

Causes of Increased Ventilation 102

Causes of Exercise Arterial Hypoxemia 102

Effect on Systemic Hemodynamics 103

Ventilatory Disorders 104

Obstructive Lung Diseases 104

Restrictive Lung Diseases 107

Chest Wall (Respiratory Pump) Disorders 109

Defects in Hemoglobin Content and Quality 109

Anemia 110

Left-shifted Oxyhemoglobin Dissociation Curve 110

Carboxyhemoglobinemia and Cigarette Smoking 110

Chronic Metabolic Acidosis 110

Muscle Disorders and Endocrine Abnormalities 111

Psychogenic Causes of Exercise Limitation and Dyspnea 112

Anxiety 112

Poor Effort and Manipulated Exercise Performance 112

Combinations of Defects 112

5. Clinical Exercise Testing 115

Exercise Laboratory and Equipment 116

General (Laboratory) Environment 116

Measuring Gas Exchange 116

Measurement of Volume, Flow Rate, or Ventilation 117

Breathing Valves, Mouthpieces, and Masks 119

Gas Analyzers 119

Ergometers: Treadmills and Cycle 121

Electrocardiogram and Systemic Blood Pressure 123

Oximetry, Blood Sampling, and Arterial Catheters 124

Data Sampling and Computation 126

Validation and Maintenance 126

Preparing for the Exercise Test 127

Requesting the Test and Notifying the Patient 127

The Patient in the Exercise Laboratory 128

Performing the Exercise Test 129

Incremental Exercise Test to Symptom-Limit Maximum 130

Constant Work Rate Exercise Tests 133

Treadmill Test for Detecting Myocardial Ischemia 135

Arm Ergometry 137

Other Tests Suitable for Fitness or Serial Evaluations 137

Preparing the Report 138

6. Normal Values 143

Peak Oxygen Uptake 144

Age and Gender 144

Activity Level 144

Adults of Normal (Predicted) Body Weight 144

Overweight Patients 146

Underweight Patients 148

Children 148

Exercise Mode 148

Maximum Heart Rate and Heart Rate Reserve 150

Relationship of VO[subscript 2] and Heart Rate: The Maximum Oxygen Pulse 151

Brachial Artery Blood Pressure 152

Anaerobic (Lactate, Lactic Acidosis) Threshold 153

Oxygen Uptake-Work Rate Relationship 154

Breathing Reserve, Tidal Volume, and Breathing Frequency at Maximum Exercise 155

Maximum Exercise Ventilation and Breathing Reserve 155

Tidal Volume and Breathing Frequency 156

Ventilatory Measures at the Anaerobic Threshold: VE/VCO[subscript 2], VE/VO[subscript 2], and the Breathing Reserve Index 156

Physiologic Dead Space/Tidal Volume Ratio 157

Arterial and End-Tidal CO[subscript 2] Tensions 159

Arterial, Alveolar, and End-Tidal Oxygen Tensions and Arterial Oxyhemoglobin Saturation 160

Femoral and Mixed Venous Values and Estimation of Cardiac Output 161

Acid-Base Balance 162

7. Principles of Interpretation: A Flow Chart Approach 165

Introduction to Flow Charts 166

Establishing the Pathophysiologic Basis of Exercise Intolerance 166

Maximum Exercise Capacity and Anaerobic Threshold (Flow Chart 1) 166

Exercise Intolerance with Normal Peak VO[subscript 2] (Flow Chart 2) 167

Low Peak VO[subscript 2] with Normal AT (Flow Chart 3) 169

Low Peak VO[subscript 2] with Low AT (Flow Chart 4) 171

Low Peak VO[subscript 2] with AT Not Determined (Flow Chart 5) 175

8. Clinical Applications of Cardiopulmonary Exercise Testing 178

Differential Diagnosis of Disorders Causing Exercise Intolerance 179

Pathophysiological Responses in Common Disorders 179

O[subscript 2] Uptake and CO[subscript 2] Output as Related to Work-Rate 179

Heart Rate and VCO[subscript 2] as a Function of VO[subscript 2] 180

Heart Rate and O[subscript 2] Pulse as a Function of Work Rate 185

VT as a Function of VE 185

VE as a Function of VCO[subscript 2] 185

Ventilatory Equivalents for O[subscript 2] and CO[subscript 2] 185

Diagnoses Uniquely Made by Cardiopulmonary Exercise Testing 188

Development of Myocardial Ischemia with Myocardial Dyskinesis during Exercise 188

Chronic Heart Failure Due to Diastolic Dysfunction 188

Pulmonary Vascular Occlusive Disease without Pulmonary Hypertension 189

Patent Foramen Ovale with Development of a Right to Left Shunt during Exercise 189

Pulmonary Vascular Disease Limiting Exercise in COPD 191

Impaired Muscle Bioenergetic Function 191

Psychogenic Dyspnea and Behavioral (Anxiety or Malingering) Causes of Exercise Intolerance 191

Grading Severity of Heart Disease 192

Estimating Peak Cardiac Output During Exercise from O[subscript 2] Uptake at Peak VO[subscript 2] 192

Cardiac Output Estimated by the Direct Fick Method 192

Behavior of Changing Arterial-Venous O[subscript 2] Difference during Exercise 193

Initial and Final Estimate of C(a - v)O[subscript 2] 193

Examples of Estimating C(a - v)O[subscript 2] 194

Short-Cut Estimate of Stroke Volume from O[subscript 2] Pulse 194

Prioritizing Patients for Heart Transplantation 194

Preoperative

Evaluation of Surgical Risk 196

Thoracotomy 197

Abdominal Surgery 197

Analysis 198

Measuring Impairment for Disability Evaluation 198

Impairment and Disability 198

Problems in Assessing Impairment from Resting Measures Only 198

Exercise Testing and Impairment Evaluation 199

O[subscript 2] Cost of Work 200

Analysis 201

Exercise Rehabilitation 201

Physiological Basis of Exercise Rehabilitation 201

Exercise Rehabilitation in Heart Disease 204

Exercise Rehabilitation in Chronic Obstructive Pulmonary Disease 204

Assessing Effectiveness of Treatment 205

Screening for Development of Disease in High Risk Patients 208

Graded Exercise Testing and the Athlete 209

D. Placement of a Brachial Artery Catheter 541.

Notes:

Includes bibliographical references and index.

ISBN:

0683306464

OCLC:

39811649