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CARDIOPULMONARY EXERCISE TESTING Historical Perspective, Principles & Applications

CARDIOPULMONARY EXERCISE TESTING Historical Perspective, Principles & Applications. JOSEPH PRIESTLY (1733-1804) Discovers Oxygen. LAVOISIER’S EXPERIMENTS ON OXYGEN IN THE ATMOSPHERE. ANTOINE & MADAME LAVOISIER. ADOLPH FICK (1829-1901) AND CARDIAC OUTPUT.

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CARDIOPULMONARY EXERCISE TESTING Historical Perspective, Principles & Applications

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  1. CARDIOPULMONARY EXERCISE TESTING Historical Perspective, Principles & Applications

  2. JOSEPH PRIESTLY (1733-1804) Discovers Oxygen

  3. LAVOISIER’S EXPERIMENTS ON OXYGEN IN THE ATMOSPHERE

  4. ANTOINE & MADAME LAVOISIER

  5. ADOLPH FICK (1829-1901) AND CARDIAC OUTPUT

  6. NATHAN ZUNTZ (1847-1920) COLLECTING EXPIRED AIR

  7. CARDIOPULMONARY EXERCISE LAB AT THE UNIVERSITY OF PENNSYLVANIA Collecting Expired Air

  8. DICKINSON RICHARDS AND THE CARDIOPULMONARY UNIT “The foundation upon which the work of Dr. Cournand and myself chiefly rests is that of Laurence J. Henderson…he was a general physiologist in the broadest sense. It was from Henderson that we derived the simple but essential concept that lungs, heart, and circulation should be thought of as one single apparatus for the transfer of respiratory gases between outside atmosphere and working tissues.”

  9. THE GAS TRANSPORT SYSTEM

  10. CARDIO-PULMONARY EXERCISE TESTING Breath-by-Breath Respiratory Gas Exchange Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986

  11. CARDIO-PULMONARY EXERCISE (CPX) Modified Naughton Protocol for Incremental Treadmill Exercise Patterson JA, et al. Am J Cardiol 1972;30:757

  12. THE PRINCIPLE OF ADOLPH FICK O2 Uptake (VO2) Arterio-Venous O2 difference = Cardiac Output VO2 = cardiac output • A−VO2 difference

  13. OXYGEN UPTAKE AND INCREMENTAL MUSCULAR WORK Maximal O2 Uptake

  14. MAXIMAL O2 UPTAKE Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986

  15. CLASSIFICATION OF FUNCTIONAL IMPAIRMENT FOR PATIENTS WITH CARDIAC OR CIRCULATORY FAILURE Weber KT, et al. N Engl J Med 1980;303:242

  16. RESPONSE IN ARTERIO-VENOUS O2 DIFFERENCE TO UPRIGHT ISOTONIC EXERCISE Weber KT & Janicki JS. Am J Cardol 1985;55:22A

  17. CARDIAC OUTPUT RESPONSE TO UPRIGHT ISOTONIC EXERCISE Weber KT & Janicki JS. Am J Cardol 1985;55:22A

  18. RELATIONSHIP BETWEEN CARDIAC OUTPUT AND LEFT VENTRICULAR FILLING PRESSURE DURING UPRIGHT ISOTONIC EXERCISE Weber KT & Janicki JS. Am J Cardol 1985;55:22A

  19. RESPONSE IN MIXED VENOUS LACTATE TO UPRIGHT ISOTONIC EXERCISE Weber KT & Janicki JS. Am J Cardol 1985;55:22A

  20. CARDIO-PULMONARY EXERCISE Anaerobic Threshold Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986

  21. CARDIO-PULMONARY EXERCISE Gas Exchange, VE and HR

  22. CPX AND GRADING THE SEVERITY OF IMPAIRED AEROBIC CAPACITY Weber KT, et al. Clin Chest Med 1984;5:173

  23. AEROBIC CAPACITY AND SYMPTOMATIC STATUS • Patients with cardiac disease begin to experience limiting symptoms when VO2 is <22 mL/kg/min • They consider themselves severely limited with VO2 <16 mL/kg/min Patterson JA, et al. Am J Cardiol 1972;30:757

  24. NORMAL VENTILATORY RESPONSE TO INCREMENTAL ISOTONIC EXERCISE Pardy RL, et al. Clin Chest Med 1984;5:35

  25. CARDIO-PULMONARY EXERCISE Predicting Cardiac Index and VE Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986

  26. THE PROPORTION OF THE MAXIMUM VOLUNTARY VENTILATION (VENTILATORY RESERVE) USED DURING INCREMENTAL ISOTONIC EXERCISE BY PATIENTS WITH CHRONIC CARDIAC FAILURE Class A 43% Class B 52% Class C 34% Class D 37% VE max MVV MVV=FEV1×35 Weber KT, et al. Circulation 1982;65:1213

  27. EXERCISE VE AND VENTILATORY RESERVE (MVV) Cardiac vs. Ventilatory Limitation

  28. ARTERIAL O2 IN EMPHYSEMA AND BRONCHITIS Jones NL. Clin Sci 1966;31:39

  29. CRITERIA USED TO IDENTIFY CARDIAC FROM VENTILATORY CAUSE OF EXERTIONAL DYSPNEA Cardiac • Achieve anaerobic threshold and VO2max • Exercise VE is <50% of MVV • Do not develop arterial O2 desaturation Ventilatory • Do not achieve anaerobic threshold or VO2max • Exercise VE is >50% of MVV • Propensity to develop arterial O2 desaturation Weber KT. In: Fishman’s Pulmonary Diseases and Disorders. New York: McGraw-Hill. 1998

  30. INDICATIONS FOR CPX TESTING IN THE EVALUATION AND MANAGEMENT OF CARDIOPULMONARY DISEASE • Identify the nature of the disease • Identify the severity of the disease • Monitor the natural course of the disease • Select therapy • Monitor response to therapy

  31. ASSESSING THE SEVERITY OF CHRONIC CARDIAC FAILURE By CXR

  32. ASSESSING THE SEVERITY OF CHRONIC CARDIAC FAILURE By CXR, Hemodynamic Data, and Ejection Fraction Resting Resting CI (L/min/M2) 1.80 1.85 PCW (mmHg) 28 27 EF (%) 24 26

  33. ASSESSING THE SEVERITY OF CHRONIC CARDIAC FAILURE By Response to Exercise Resting Exercise Resting Exercise CI (L/min/M2) 1.80 3.43 1.85 6.00 PCW (mmHg) 28 42 27 40 EF (%) 24 -- 26 -- Exerc. capac. (sec) -- 492 -- 924

  34. SIX- AND 12-MONTH SURVIVAL Chronic Cardiac Failure Likoff MJ, et al. Am J Cardiol 1987;59:634

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