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Cardiopulmonary exercise testing in the assessment of exertional dyspnea.

Datta D, Normandin E, ZuWallack R - Ann Thorac Med (2015 Apr-Jun)

Bottom Line: It is usually investigated by resting tests such as pulmonary function tests and echocardiogram, which may at times can be non-diagnostic.Cardiopulmonary exercise testing (CPET) measures physiologic parameters during exercise which can enable accurate identification of the cause of dyspnea.Though CPET has been around for decades and provides valuable and pertinent physiologic information on the integrated cardiopulmonary responses to exercise, it remains underutilized.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Pulmonary-Critical Care Medicine, University of CT Health Center, Farmington, CT 06030, USA.

ABSTRACT
Dyspnea on exertion is a commonly encountered problem in clinical practice. It is usually investigated by resting tests such as pulmonary function tests and echocardiogram, which may at times can be non-diagnostic. Cardiopulmonary exercise testing (CPET) measures physiologic parameters during exercise which can enable accurate identification of the cause of dyspnea. Though CPET has been around for decades and provides valuable and pertinent physiologic information on the integrated cardiopulmonary responses to exercise, it remains underutilized. The objective of this review is to provide a comprehensible overview of the underlying principles of exercise physiology, indications and contraindications of CPET, methodology and interpretative strategies involved and thereby increase the understanding of the insights that can be gained from the use of CPET.

No MeSH data available.


Related in: MedlinePlus

Changes in physiological parameters with exercise (From Weisman: Clinics in Chest Medicine 2001, with permission.)
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Figure 3: Changes in physiological parameters with exercise (From Weisman: Clinics in Chest Medicine 2001, with permission.)

Mentions: The effects of increasing exercise intensity on ventilatory and gas exchange parameters are depicted in Figure 3. As work rate increases, VO2, VCO2 and minute ventilation (VE) increases linearly till anaerobic metabolism causes lactic acidosis.[7] Once lactic acidosis develops, HCO3 buffers lactate and more CO2 is generated (H+ + HCO3- = H2 CO3 = H2 O + CO2). Consequently, rise in VCO2 is higher than rise in VO2 as more CO2 is produced from HCO3 buffering of lactic acid. VE rises at the same rate and in proportion to rise in VCO2. Hence, VE/VCO2 and PETCO2 remain unchanged while PETO2 and VE/VO2 increases. With continued exercise, with worsening lactic acidosis, ventilation increases markedly to compensate for exercise-induced metabolic acidosis. The rise in VE is more than the rise in VCO2. So VE/VCO2 increases while PETCO2 falls.


Cardiopulmonary exercise testing in the assessment of exertional dyspnea.

Datta D, Normandin E, ZuWallack R - Ann Thorac Med (2015 Apr-Jun)

Changes in physiological parameters with exercise (From Weisman: Clinics in Chest Medicine 2001, with permission.)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4375746&req=5

Figure 3: Changes in physiological parameters with exercise (From Weisman: Clinics in Chest Medicine 2001, with permission.)
Mentions: The effects of increasing exercise intensity on ventilatory and gas exchange parameters are depicted in Figure 3. As work rate increases, VO2, VCO2 and minute ventilation (VE) increases linearly till anaerobic metabolism causes lactic acidosis.[7] Once lactic acidosis develops, HCO3 buffers lactate and more CO2 is generated (H+ + HCO3- = H2 CO3 = H2 O + CO2). Consequently, rise in VCO2 is higher than rise in VO2 as more CO2 is produced from HCO3 buffering of lactic acid. VE rises at the same rate and in proportion to rise in VCO2. Hence, VE/VCO2 and PETCO2 remain unchanged while PETO2 and VE/VO2 increases. With continued exercise, with worsening lactic acidosis, ventilation increases markedly to compensate for exercise-induced metabolic acidosis. The rise in VE is more than the rise in VCO2. So VE/VCO2 increases while PETCO2 falls.

Bottom Line: It is usually investigated by resting tests such as pulmonary function tests and echocardiogram, which may at times can be non-diagnostic.Cardiopulmonary exercise testing (CPET) measures physiologic parameters during exercise which can enable accurate identification of the cause of dyspnea.Though CPET has been around for decades and provides valuable and pertinent physiologic information on the integrated cardiopulmonary responses to exercise, it remains underutilized.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Pulmonary-Critical Care Medicine, University of CT Health Center, Farmington, CT 06030, USA.

ABSTRACT
Dyspnea on exertion is a commonly encountered problem in clinical practice. It is usually investigated by resting tests such as pulmonary function tests and echocardiogram, which may at times can be non-diagnostic. Cardiopulmonary exercise testing (CPET) measures physiologic parameters during exercise which can enable accurate identification of the cause of dyspnea. Though CPET has been around for decades and provides valuable and pertinent physiologic information on the integrated cardiopulmonary responses to exercise, it remains underutilized. The objective of this review is to provide a comprehensible overview of the underlying principles of exercise physiology, indications and contraindications of CPET, methodology and interpretative strategies involved and thereby increase the understanding of the insights that can be gained from the use of CPET.

No MeSH data available.


Related in: MedlinePlus