Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications / Edition 4

Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications / Edition 4

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Lippincott Williams & Wilkins

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Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications / Edition 4

Thoroughly updated in its Fourth Edition, this exceptional resource is the most comprehensive, current text on the physiology and pathophysiology of exercise testing available. It is the only reference to address those disorders that can be diagnosed only through cardiopulmonary exercise testing.

Readers will find...

  • Comprehensive presentation addressing cardiovascular, metabolic, and respiratory responses to exercise—in both health and disease states.
  • Principles and rationale behind exercise testing, commonly used testing protocols, guidelines for normal and abnormal values, and tips for accurate interpretation of test results.
  • Normal test values for a range of patient groups—including children, over- and underweight patients, and the elderly.
  • More than 80 case histories, each accompanied by exercise physiology results, highlight differential diagnosis by applying basic physiological concepts to real-world examples.
  • Coverage of disorders that can be diagnosed only through cardiopulmonary exercise testing.

NEW to the Fourth Edition...

  • New chapter covering regulation of arterial and mixed venous blood gases
  • New nine-panel graphic array illustrating critical aspects of exercise testing
  • Updated flow charts to help with clinical interpretation and differential diagnosis

Product Details

ISBN-13: 9780781748766
Publisher: Lippincott Williams & Wilkins
Publication date: 10/25/2004
Edition description: Fourth Edition
Pages: 568
Product dimensions: 8.76(w) x 11.38(h) x 1.29(d)

Table of Contents

1Exercise Testing and Interpretation: An Overview1
Cell Respiration and Bioenergetics2
What Is Cardiopulmonary Exercise Testing?3
Why Measure Gas Exchange to Evaluate Cardiovascular Function and Cellular Respiration?3
Cardiac Stress Test and Pulmonary Stress Test: Nomenclature Fallacies4
Normal Coupling of External to Cellular Respiration4
Patterns of Change in External Respiration (Oxygen Uptake and Carbon Dioxide Output) as Related to Function, Fitness, and Disease5
Factors Limiting Exercise6
Evidence of Systemic Dysfunction Uniquely Revealed by Integrative Cardiopulmonary Exercise Testing7
2Physiology of Exercise10
Skeletal Muscle11
Oxygen Cost of Work18
Lactate Increase19
Buffering the Exercise-Induced Lactic Acidosis28
The Anaerobic Threshold Concept30
Metabolic-Cardiovascular-Ventilatory Coupling42
Control of Breathing50
Gas Exchange Kinetics55
3Changes in Blood Gases and pH During Exercise66
Oxygen, Carbon Dioxide, and H+ Ion Transport67
The Relation Between Cardiac Output and Oxygen Uptake During Exercise69
Carbon Dioxide Transport71
4Measurements During Integrative Cardiopulmonary Exercise Testing76
What Is an Integrative Cardiopulmonary Exercise Test?77
When Should Cardiopulmonary Exercise Testing Be Used?77
Data Display and Interpretation104
5Pathophysiology of Disorders Limiting Exercise111
Peripheral Arterial Diseases114
Heart Diseases114
Pulmonary Vascular Diseases118
Ventilatory Disorders120
Defects in Hemoglobin Content and Quality126
Chronic Metabolic Acidosis127
Muscle Disorders and Endocrine Abnormalities128
Psychogenic Causes of Exercise Limitation and Dyspnea128
Combinations of Defects129
6Clinical Exercise Testing133
Exercise Laboratory and Equipment134
Preparing for the Exercise Test144
Performing the Exercise Test146
Preparing the Report156
7Normal Values160
Peak Oxygen Uptake161
Peak Heart Rate and Heart Rate Reserve168
Relationship of Oxygen Uptake and Heart Rate: The Peak Oxygen Pulse168
Brachial Artery Blood Pressure170
Anaerobic Threshold171
Oxygen Uptake-Work Rate Relationship172
Breathing Reserve, Tidal Volume, and Breathing Frequency at Maximum Exercise172
Ventilatory Efficiency174
Physiological Dead Space-Tidal Volume Ratio175
Arterial and End-Tidal Carbon Dioxide Tensions176
Arterial, Alveolar, and End-Tidal Oxygen Tensions and Arterial Oxyhemoglobin Saturation177
Femoral and Mixed Venous Values and Estimation of Cardiac Output178
Acid-Base Balance179
8Principles of Interpretation: A Flowchart Approach183
Introduction to Flowcharts184
Establishing the Pathophysiological Basis of Exercise Intolerance184
Maximum Exercise Capacity and Anaerobic Threshold (Flowchart 1)184
Exercise Intolerance with Normal Peak Oxygen Uptake (Flowchart 2)186
Low Peak Oxygen Uptake with Normal Anaerobic Threshold (Flowchart 3)190
Low Peak Oxygen Uptake with Low Anaerobic Threshold (Flowchart 4)191
Low Peak Oxygen Uptake with Anaerobic Threshold Not Determined (Flowchart 5)195
9Clinical Applications of Cardiopulmonary Exercise Testing198
Differential Diagnosis of Disorders Causing Exercise Intolerance199
Pathophysiological Responses in Common Disorders200
Diagnoses Uniquely Made by Cardiopulmonary Exercise Testing210
Grading Severity of Heart Disease214
Estimating Peak Cardiac Output During Exercise from Oxygen Uptake at Peak Work Rate215
Cardiopulmonary Exercise Testing for Prognostic Evaluation218
Preoperative Evaluation of Surgical Risk222
Measuring Impairment for Disability Evaluation223
Exercise Rehabilitation226
Assessing the Effectiveness of Treatment232
Screening for Development of Disease in High-Risk Patients235
Graded Exercise Testing and the Athlete235
10Case Presentations242
Case 1Normal Man245
Case 2Normal Athlete248
Case 3Normal Man: Air and Oxygen Breathing Studies251
Case 4Normal Woman: Air and Oxygen Breathing Studies256
Case 5Normal Woman261
Case 6Normal Man264
Case 7Normal Man267
Case 8Normal Man with Ventilatory Chemoreflex Insensitivity270
Case 9Exceptionally Fit Man with Mild Lung Disease273
Case 10Normal Subject: Cycle and Treadmill Studies276
Case 11Normal Subject: Before and After [beta]-Adrenergic Blockade280
Case 12Normal Subject: Immediate Effects of Cigarette Smoking285
Case 13Cardiologic Misdiagnoses in a Man at Ages 65 and 72290
Case 14Obesity, Hypertension, and Cigarette Smoking297
Case 15Extreme Obesity300
Case 16Coronary Artery Disease303
Case 17Coronary Artery Disease306
Case 18Small Vessel Coronary Artery Disease309
Case 19Coronary Artery Disease Developed Over a Three-Year Interval312
Case 20Myocardial Ischemia with Mild Interstitial and Obstructive Airway Disease317
Case 21Silent Myocardial Ischemia, Systemic Hypertension, and Mild Interstitial Lung Disease320
Case 22Ischemic Cardiomyopathy323
Case 23Cardiomyopathy326
Case 24Cardiomyopathy, Hypertrophic Type329
Case 25Chronic Heart Failure: Before and After Therapy333
Case 26Cardiomyopathy with Oscillatory Function338
Case 27Mitral Insufficiency342
Case 28Mitral Stenosis: Before and After [beta]-Adrenergic Blockade345
Case 29Congenital Heart Disease349
Case 30Peripheral Arterial Disease354
Case 31Peripheral Arterial Disease with Pulmonary Vascular and Obstructive Airway Disease357
Case 32Heart Failure-Dominant Mixed Cardiovascular Disease in an Anemic Smoker360
Case 33Hypertensive Cardiovascular Disease and Carboxyhemoglobinemia363
Case 34Patent Ductus Arteriosus366
Case 35Vasoregulatory Asthenia369
Case 36Mild Chronic Bronchitis with Normal Exercise Performance372
Case 37Chronic Bronchitis and Obesity375
Case 38Chronic Bronchitis, Cigarette Smoking, and Obesity378
Case 39Emphysema with Mild Airway Obstruction381
Case 40Severe Emphysema384
Case 41Emphysema with Pulmonary Vascular Disease387
Case 42Severe Emphysema and Bronchitis: Air and Oxygen Breathing Studies390
Case 43Lung Cancer and Chronic Bronchitis: Preoperative Evaluation395
Case 44Bullous Emphysema: Before and After Bullectomy398
Case 45Obstructive Airway Disease: Before and After Rehabilitation403
Case 46Early Asbestosis and Chronic Bronchitis408
Case 47Mild Asbestosis411
Case 48Restrictive Lung Disease (Asbestosis)414
Case 49Idiopathic Interstitial Lung Disease417
Case 50Mixed Connective Tissue Disease with Interstitial and Pulmonary Vascular Disease420
Case 51Interstitial Lung Disease423
Case 52Sarcoidosis426
Case 53Severe Sarcoidosis: Air and Oxygen Breathing Studies429
Case 54Interstitial Pneumonitis: Before and After Corticosteroid Therapy433
Case 55Interstitial Pulmonary Fibrosis: Air and Oxygen Breathing Studies438
Case 56Pulmonary Alveolar Proteinosis: Air and Oxygen Breathing Studies443
Case 57Alveolar Proteinosis: Before and After Whole-Lung Lavage447
Case 58Pulmonary Microlithiasis: Air and Oxygen Breathing Studies452
Case 59Thromboembolic Pulmonary Vascular Disease456
Case 60Pulmonary Vasculitis: Air and Oxygen Breathing Studies459
Case 61Pulmonary Hypertension with Patent Foramen Ovale464
Case 62Left Ventricular Failure with Accompanying Lung Function Changes468
Case 63Pulmonary Vascular Disease Secondary to Interstitial and Obstructive Lung Disease471
Case 64Pulmonary Arteriovenous Fistulae474
Case 65Poor Effort477
Case 66Poor Effort480
Case 67Acute Hyperventilation and Anxiety in a Moderately Obese Man483
Case 68Skeletal Disease Limiting Exercise486
Case 69Ankylosing Spondylitis489
Case 70Myasthenia Gravis492
Case 71Aortic and Mitral Stenosis and Obstructive Airway Disease495
Case 72Left Ventricular Failure and Mild Obstructive Airway Disease: Cycle and Treadmill Studies498
Case 73[beta]-Adrenergic Blockade, Systemic Hypertension, Pulmonary Vascular Disease, and Mild Chronic Bronchitis502
Case 74[beta]-Adrenergic Blockade, Obesity, and Asbestosis505
Case 75Pulmonary Vascular Disease, Chronic Bronchitis, Asbestosis, and Myocardial Ischemia508
Case 76"CHF," "COPD," Obesity, and Anemia511
Case 77Mild Obstructive Airway Disease Complicated by Systemic Hypertension and Pulmonary Vascular Disease514
Case 78Pulmonary Vascular Disease, Obstructive Airway Disease, and Talc Pneumoconiosis517
Case 79Systemic Sclerosis and Primary Lung Cancer: Preoperative Evaluation520
Case 80Primary Pulmonary Hypertension Before and After Treatment523
Case 81Cardiomyopathy Due to Diastolic Dysfunction528
Case 82Transition from Normal to Left Ventricular Failure532
Case 83Psychogenic Dyspnea537
Case 84Hypertension Treated with [beta]-Adrenergic Blockade540
Case 85Ischemic Cardiomyopathy, Restrictive Lung Disease, and [beta]-Adrenergic Blockade545
ASymbols and Abbreviations548
CCalculations, Formulas, and Examples556
DPlacement of a Brachial Artery Catheter566
ETables and Nomogram568

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