Approach to the Patient with Dyspnea

2016 ◽  
Author(s):  
Roza Badr Eslam ◽  
Aaron B Waxman
Keyword(s):  
Exercise Testing ◽  
Subjective Experience ◽  
Consensus Statement ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Flow Diagram ◽  
Cardiopulmonary Exercise ◽  
Patient Complaints ◽  
Common Causes ◽  
The Common

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular disease. In a consensus statement, the American Thoracic Society defined dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a nonspecific complaint and is one of the most frequent patient complaints. This review discusses the definition, epidemiology, etiology, pathophysiology, peripheral mechanisms, and evaluation of dyspnea. Figures depict cellular metabolism and exercise physiology, and an invasive cardiopulmonary exercise testing (iCPET) flow diagram. Tables list the common causes of dyspnea, invasive cardiopulmonary exercise testing (iCPET) diagnosis, and iCPET characteristics of pulmonary hypertension. This review contains 2 highly rendered figures, 3 tables, and 51 references.

Approach to the Patient with Dyspnea

2018 ◽  
Author(s):  
Roza Badr Eslam ◽  
Aaron B Waxman
Keyword(s):  
Exercise Testing ◽  
Subjective Experience ◽  
Consensus Statement ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Flow Diagram ◽  
Cardiopulmonary Exercise ◽  
Patient Complaints ◽  
Common Causes ◽  
The Common

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular disease. In a consensus statement, the American Thoracic Society defined dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a nonspecific complaint and is one of the most frequent patient complaints. This review discusses the definition, epidemiology, etiology, pathophysiology, peripheral mechanisms, and evaluation of dyspnea. Figures depict cellular metabolism and exercise physiology, and an invasive cardiopulmonary exercise testing (iCPET) flow diagram. Tables list the common causes of dyspnea, invasive cardiopulmonary exercise testing (iCPET) diagnosis, and iCPET characteristics of pulmonary hypertension. This review contains 2 highly rendered figures, 3 tables, and 51 references.

Cardiopulmonary Exercise Testing

2018 ◽  
pp. 413-436
Author(s):  
Andrew Kao
Keyword(s):  
Exercise Testing ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Gas Analysis ◽  
Peak Oxygen Consumption ◽  
Normative Values ◽  
Cardiopulmonary Exercise ◽  
Expired Gas Analysis ◽  
Expired Gas

The chapter Cardiopulmonary Exercise Testing focuses on the opportunities provided by cardiopulmonary exercise (CPX) testing. The coordination of 5 organ systems is described in normal exercise physiology to understand abnormal exercise findings. From a few measured expired gas analysis parameters, most of the important exercise variables can be derived, including the peak oxygen consumption (peak VO2). The contribution of both the aerobic and anaerobic phases of exercise to total exercise capacity are described, including the methods for determination of the anaerobic threshold. The calculation of the normative values of peak VO2 are included, and a suggested template of a CPX report is included. The use of CPX testing in the determination of prognosis in heart failure patients is included.

scholarly journals Summary Statement on Cardiopulmonary Exercise Testing in Chronic Heart Failure due to Left Ventricular Dysfunction Recommendations for Performance and Interpretation

2016 ◽  
Vol 68 (1) ◽  
Author(s):  
Ugo Corrà ◽  
Massimo F. Piepoli
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular Dysfunction ◽  
Exercise Testing ◽  
Ventricular Dysfunction ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Relevant Information ◽  
Left Ventricular ◽  
Cardiopulmonary Exercise

Cardiopulmonary exercise testing (CPET) is a non-invasive tool that provides the physician with relevant information to assess the integrated response to exercise involving pulmonary, cardiovascular, haematopoietic, neuro-psychological, and skeletal muscle systems. Measurement of expiratory gases during exercise allows the best estimate of functional capacity, grade the severity of the impairment, objectively evaluate the response to interventions, objectively track the progression of disease, and assist in differentiating cardiac from pulmonary limitations in exercise tolerance. To achieve optimal use of this test in every day clinical practice, clarification of conceptual issues and standardization of CPET practices are necessary. Recently, a Statement on Cardiopulmonary Exercise Testing in Chronic Heart Failure due to Left Ventricular Dysfunction, by the Gruppo Italiano di Cardiologia Riabilitativa and endorsed by the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology, has been published. Here are resumed the cardinal points of the Statement: (1) Definition of Cardiopulmonary Exercise Testing Parameters for Appropriate Use in Chronic Heart Failure, (2) How to Perform Cardiopulmonary Exercise Testing in Chronic Heart Failure, (3) Interpretation of Cardiopulmonary Exercise Testing in Chronic Heart Failure and Future Applications.

scholarly journals Cardiopulmonary Exercise Testing in Patients with Asymptomatic or Equivocal Symptomatic Aortic Stenosis: Feasibility, Reproducibility, Safety and Information Obtained on Exercise Physiology

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 147-156 ◽  
Author(s):  
Douet van Le ◽  
Gunnar Vagn Hagemann Jensen ◽  
Steen Carstensen ◽  
Lars Kjøller-Hansen
Keyword(s):  
Aortic Stenosis ◽  
Stroke Volume ◽  
Valve Replacement ◽  
Exercise Testing ◽  
Comprehensive Evaluation ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Aortic Valve Area ◽  
Cardiopulmonary Exercise ◽  
O2 Pulse

Objective: The aim of this study was to determine the feasibility, reproducibility, safety and information obtained on exercise physiology from cardiopulmonary exercise testing (CPX) in patients with aortic stenosis. Methods: Patients with an aortic valve area (AVA) <1.3 cm2 who were judged asymptomatic or equivocal symptomatic underwent CPX and an inert gas rebreathing test. Only those where comprehensive evaluation of CPX results indicated haemodynamic compromise from aortic stenosis were referred for valve replacement. Results: The mean patient age was 72 (±9) years; an AVA index <0.6 cm2/m2 and equivocal symptomatic status were found in 90 and 70%, respectively. CPX was feasible in 130 of the 131 patients. The coefficients of repeatability by test-retest were 5.4% (pVO2) and 4.6% (peak O2 pulse). A pVO2 <83% of the expected was predicted by a lower stroke volume at exercise, lower peak heart rate and FEV1, and higher VE/VCO2, but not by AVA index. Equivocal symptomatic status and a low gradient but high valvulo-arterial impedance were associated with a lower pVO2, but not with an inability to increase stroke volume. In total, 18 patients were referred for valve replacement. At 1 year, no cardiovascular deaths had occurred. Conclusions: CPX was feasible and reproducible and provided comprehensive data on exercise physiology. A CPX-guided treatment strategy was safe up to 1 year.

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