What are case examples of cardiopulmonary stress testing?

Updated: May 14, 2020
  • Author: Kevin McCarthy, RPFT; Chief Editor: Nader Kamangar, MD, FACP, FCCP, FCCM  more...
  • Print
Answer

Answer

Normal male: This 46-year-old man who previously smoked (smoking history of 30 pack-years) is evaluated as a biological control in the authors' laboratory. He has no health complaints.

Table 3A. Lung Function (Open Table in a new window)

Parameter

Predicted

Measured

Age

 

46

Sex

 

Male

Height (cm)

 

188

Weight (kg)

 

104

Hemoglobin

 

15.4

VC (L)

5.65

6.5

TLC (L)

7.76

9.02

RV (L)

2.17

2

FEV1 (L)

4.47

5.01

FEV1/FEV (%)

79

76

MVV (L/min)

170

212

DLCO (mL/min/mm Hg)

31.6

32.4

Table 3B. Exercise (Open Table in a new window)

Parameter

Predicted

Measured

Peak VO2 (L/min)

3.05

3.03

Maximum HR (beats/min)

174

182

Maximum O2 pulse (mL/beat)

17.5

16.6

AT (L/min)

>1.34

1.5

BP (mm Hg) (rest, maximum)

 

120/68, 188/85

Maximum VE (L/min)

 

129

Ventilatory reserve (L/min)

>15

83

SpO2 (%) (rest, maximum)

 

98, 98

The patient stopped the exercise test citing leg fatigue and dyspnea as the reasons for terminating the test. The results reveal a normal oxygen uptake with a normal cardiovascular limitation to exercise (predicted maximum HR was exceeded). Significant ventilatory reserve existed at the end of exercise.

Ventilatory limitation: A 55-year-old man with a smoking history of 35 pack-years and a diagnosis of emphysema was referred for cardiopulmonary exercise testing to evaluate the complaint of dyspnea upon exertion. The patient uses an inhaled beta-agonist as needed.

Table 4A. Lung Function (Open Table in a new window)

Parameter

Predicted

Measured

Age

 

55

Sex

 

Male

Height (cm)

 

173

Weight (kg)

 

80

Hemoglobin

 

15.6

VC (L)

4.55

4.32

TLC (L)

6.6

7.31

RV (L)

2.04

3.56

FEV1 (L)

3.63

2.68

FEV1/FEV (%)

80

62

MVV (L/min)

134

99

DLCO (mL/min/mm Hg)

23.8

16.7

Table 4B. Exercise (Open Table in a new window)

Parameter

Predicted

Measured

Peak VO2 (L/min)

2.32

1.39

Maximum HR (beats/min)

165

122

Maximum O2 pulse (mL/beat)

14.1

11.4

AT (L/min)

>1.04

1

BP (mm Hg) (rest, maximum)

 

117/85, 170/102

Maximum VE (L/min)

 

93

Ventilatory reserve (L/min)

>15

6

SpO2 (%) (rest, maximum)

 

95/91

The patient terminated the procedure citing dyspnea as the sole reason for stopping the test. The results show moderate impairment of the peak oxygen consumption with a clear ventilatory limitation to exercise. Significant cardiovascular reserve existed at the end of exercise, and the ventilatory reserve was below normal. Pulse oximetry readings are suggestive of exercise desaturation.

Cardiac limitation: This 48-year-old woman was referred for a cardiopulmonary exercise testing to evaluate her shortness of breath upon exertion over the last 6 months. Pulmonary function tests reveal a mild restrictive ventilatory defect with a normal DLCO, suggesting no active parenchymal disease.

Table 5A. Lung Function (Open Table in a new window)

Parameter

Parameter Predicted

Measured

Age

 

48

Sex

 

Female

Height (cm)

 

158

Weight (kg)

 

55

Hemoglobin

 

13.4

VC (L)

3.13

2.1

TLC (L)

4.79

3.57

RV (L)

2.04

3.56

FEV1 (L)

2.6

1.79

FEV1/FEV (%)

83

85

MVV (L/min)

98

85

DLCO (mL/min/mm Hg)

18.9

20.6

Table 5B. Exercise (Open Table in a new window)

Parameter

Predicted

Measured

Peak VO2 (L/min)

1.47

0.79

Maximum HR (beats/min)

172

184

Maximum O2 pulse (mL/beat)

8.5

4.3

AT (L/min)

>0.69

0.62

BP (mm Hg) (rest, maximum)

 

115/89, 165/88

Maximum VE (L/min)

 

49

Ventilatory reserve (L/min)

>15

26

SpO2 (%) (rest, maximum)

 

96, 94

The patient terminated the exercise test citing shortness of breath. The results reveal a moderately reduced oxygen consumption with a cardiovascular limitation (HR maximum exceeded the predicted maximum HR) and adequate ventilatory reserve. The oxygen pulse did not increase normally during the study, with near-peak values observed during unloaded cycling and very little increase during the work phase of the study. Cardiac function studies demonstrated left ventricular failure secondary to mitral insufficiency.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!