Impact of Integrative Cardiopulmonary Exercise Testing (1)
Ambulation and physical activity are essential contributors to quality of life. When a patient complains of reduced exercise capacity due to fatigue or exertional dyspnea, how should the physician most efficiently and effectively investigate the problem? antibiotic levaquin
Two important factors should be considered. First, many commonly encountered medical conditions, such as heart disease, lung disease, obesity, and hypertension, are known to cause or contribute to exercise limitation. Second, because the patients complaints are occurring during exercise, it is likely that a diagnostic test performed during exercise rather than at rest would have an advantage. Therefore, an exercise test that can identify and distinguish between the various causes of exercise limitation has potential to be of particular value (Table 1).
In the last ten years, advances in understanding of physiology and new technologic capabilities have made it feasible to measure gas exchange during exercise in the clinical setting. These measurements of gas exchange, largely noninvasive, form the basis for the integrative cardiopulmonary exercise test. The purpose of this brief review is to describe the physiologic basis for the value of this type of exercise test and to examine its current status as a tool for the evaluation and treatment of cardiopulmonary disease.
Table 1—Disorders Producing Pathophysiologic Limitations to Exercise
|Peripheral vascular disease|
|Coronary artery disease|
|Valvular heart disease|
|Congenital heart disease|
|Thromboembolic and other pulmonary vascular disease|
|Obstructive lung disease|
|Interstitial lung disease|
|Metabolic disorders of skeletal muscle|