Wasserman & Whipp's: Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications

xi
Contents
Preface v
Kathy E. Sietsema, Darryl Y. Sue, William W. Stringer, Susan A. Ward
Acknowledgments vii
Contributors ix
1 Exercise Testing and Interpretation 1
Kathy E. Sietsema, William W. Stringer, Darryl Y. Sue, Susan A. Ward
2 Physiology of Exercise 8
Susan A. Ward, Harry B. Rossiter
3 Measurements During Integrative Cardiopulmonary Exercise Testing 59
Susan A. Ward
4 Pathophysiology of Disorders Limiting Exercise 91
Darryl Y. Sue, Kathy E. Sietsema
5 Performance of Clinical Cardiopulmonary Exercise Testing 112
William W. Stringer, Janos Porszasz, Harry B. Rossiter
6 Approaches to Data Summary and Interpretation 135
Kathy E. Sietsema
7 Normal Values 159
Darryl Y. Sue
8 Clinical Applications of Cardiopulmonary Exercise Testing 189
William W. Stringer, Darryl Y. Sue
9 Diagnostic Speci? city of Exercise Intolerance: A Flowchart Approach 223
Darryl Y. Sue
10 Case Presentations 229
Kathy E. Sietsema, Darryl Y. Sue
Case 1: Normal Man 231
Case 2: Normal Athletic Man
Case 3: Normal Woman: Air and Oxygen Breathing Studies 234
Case 4: Normal Man 239
Case 5: Fit Cyclist 242
Case 6: Normal Individual: Cycle and Treadmill Studies 246
Case 7: Normal Individual: With and Without ?-Adrenergic Blockade 251
Case 8: Normal Man With and Without Acute Cigarette Smoking 256
Case 9: Active Man With Dyspnea at High Altitude 262
Case 10: Active Woman With Patent Foramen Ovale 267xii Contents
Case 11: Normal Aging Athletic Man: Serial Tests Between Age 66 and 76
Case 12: Mild Air? ow Obstruction and Hyperventilation 270
Case 13: A Submaximal Test 274
Case 14: A Long Test 278
Case 15: Chronic Heart Failure With Reduced Ejection Fraction 282
Case 16: Chronic Heart Failure With Reduced Ejection Fraction 285
Case 17: Chronic Heart Failure With Reduced Ejection Fraction and
Pacemaker Dependence 289
Case 18: Chronic Heart Failure: Oscillatory Ventilation and Gas Exchange 294
Case 19: Chronic Heart Failure With Preserved Ejection Fraction
(Exercise-Induced Pulmonary Venous Hypertension) 298
Case 20: Gas Exchange Evidence of Myocardial Ischemia 302
Case 21: Claudication: Gas Exchange Findings in Peripheral Arterial Disease 307
Case 22: Exertional Chest Pain With Gas Exchange Evidence of
Myocardial Ischemia
Case 23: Exercise-Induced Myocardial Ischemia 310
Case 24: Myocardial Ischemia With Diffuse Distal Coronary Artery Disease 314
Case 25: Myocardial Ischemia: Development of Inducible Myocardial Ischemia Over 3 Years 31 7
Case 26: Atrial Septal Defect and Hemochromatosis 323
Case 27: Symptomatic Chronic Mitral Insuf? ciency 327
Case 28: Congenital Heart Disease: Coarctation and Ventricular Septal Defect
Surgically Repaired 330
Case 29: Congenital Heart Disease: Transposition of the Great Arteries With Surgical Repair 334
Case 30: Patent Ductus Arteriosus With Left-to-Right Shunt, Presurgical Closure 337
Case 31: Patent Ductus Arteriosus With Right-to-Left Shunt
(Eisenmenger Ductus Syndrome) 341
Case 32: Bicuspid Aortic Valve With Aortic Regurgitation 344
Case 33: Surgically Repaired Coarctation of the Aorta With Bicuspid Aortic Valve
Case 34: Fontan Circulation 348
Case 35: Ventricular Septal Defect With Eisenmenger Syndrome 352
Case 36: Tetralogy of Fallot, Surgically Repaired 356
Case 37: Tetralogy of Fallot, Unrepaired 360
Case 38: Amyloid Cardiomyopathy 364
Case 39: Athletic Man With Tachyarrhythmia 368
Case 40: Heart Rate Impairment Due to ?-Adrenergic Blockade for
Treatment of Hypertension 372
Case 41: Atrial Fibrillation With Rapid Ventricular Response During Exercise 378
Case 42: Chronotropic Insuf? ciency With Escape Rhythm
Case 43: Active Older Man With Second-Degree Heart Block 381
Case 44: Active Man With Cardiac Conduction Defects 385
Case 45: Early Onset of Exercise Lactic Acidosis: Differentiating Circulatory From
Muscular Impairment 390
Case 46: Early Onset of Exercise Lactic Acidosis Suggesting Circulatory Impairment 395
Case 47: Mixed Connective Tissue Disease With Pulmonary Involvement 400
Case 48: Pulmonary and Systemic Vasculitis: Air and Oxygen Breathing Studies
Case 49: Idiopathic Pulmonary Arterial Hypertension 404
Case 50: Severe Pulmonary Vascular Disease Secondary to Sarcoidosis: Air and Oxygen
Breathing Studies 408
Case 51: Pulmonary Arterial Hypertension on Multidrug Therapy 413
Case 52: Pulmonary Hypertension, Patent Foramen Ovale, and
Exercise-Induced Right-to-Left Shunt 418Contents xiii
Case 53: Idiopathic Pulmonary Arterial Hypertension Before and
After Treatment
Case 54: Long-Standing Idiopathic Pulmonary Arterial Hypertension:
Serial Tests Over 17 Years of Treatment 424
Case 55: Intrapulmonary Right-to-Left Shunt Due to Pulmonary
Arteriovenous Fistulae 430
Case 56: Severe Interstitial Lung Disease 434
Case 57: Sarcoidosis 437
Case 58: Interstitial Pneumonitis: Before and After Empiric Corticosteroid Therapy
Case 59: Severe Interstitial Lung Disease : Air and Oxygen Breathing Studies
Case 60: Mild Pulmonary Asbestosis 441
Case 61: Severe Pulmonary Asbestosis 445
Case 62: Pleural and Pulmonary Asbestosis 449
Case 63: Mild Chronic Bronchitis With Normal Exercise Performance 452
Case 64: Emphysema With Mild Airway Obstruction 455
Case 65: Severe Combined Obstructive and Restrictive Lung Disease 458
Case 66: Severe Chronic Obstructive Lung Disease 462
Case 67: Emphysema, Untreated 465
Case 68: Severe Emphysema and Bronchitis: Air and Oxygen Breathing Studies 469
Case 69: Bullous Emphysema: Before and After Bullectomy 475
Case 70: A Runner With Obstructive Lung Disease
Case 71: Mild Obstructive Airway Disease With Disproportionate Exertional Dyspnea 481
Case 72: Obesity Contributing to Ventilatory Limitation
Case 73: Extrapulmonary Restriction: Ankylosing Spondylitis 485
Case 74: Extrapulmonary Restriction: Scoliosis
Case 75: Interstitial Lung Disease and Hemidiaphragm Paralysis 489
Case 76: Active Man With Paralyzed Hemidiaphragm 492
Case 77: McArdle Disease 495
Case 78: Myopathy With Exertional Rhabdomyolysis 499
Case 79: Congenital Mitochondrial Myopathy 502
Case 80: Mitochondrial Myopathy 505
Case 81: Woman With Multiple Sclerosis and Dyspnea 508
Case 82: Congenital Myotonia 512
Case 83: Mixed Disorder: Chronic Bronchitis and Obesity
Case 84: Mixed Disorder: Peripheral Arterial Disease, Anemia, Carboxyhemoglobinemia, and
Cardiac Dysfunction 518
Case 85: Mixed Disorder: Mild Interstitial Lung Disease, Obstructive Airway Disease, and
Myocardial Ischemia 522
Case 86: Chronic Heart Failure With Preserved Ejection Fraction and
Obesity Hypoventilation Syndrome 525
Case 87: Mixed Disease: Aortic Stenosis, Mitral Stenosis, and Obstructive Airway Disease
Case 88: Mixed Disorder: Obstructive Airway Disease, Talc Pneumoconiosis,
and Pulmonary Vascular Disease
Case 89: Mixed Disorder: Peripheral Arterial Disease and Obstructive Lung Disease:
Cycle and Treadmill Exercise 529
Case 90: Morbid Obesity and Aortic Valve Disease 534
Case 91: Morbid Obesity 537
Case 92: Exercise Testing for Staging and Prognosis in Chronic Heart Failure
Case 93: Exercise Testing for Preoperative Evaluation for Lung Cancer Resection 541
Case 94: Exercise Testing for Evaluation of Work Fitness: Morbid Obesity 545xiv Principles of Exercise Testing and Interpretation
Case 95: Exercise Testing for Assessment Before and After Pulmonary Rehabilitation for
Chronic Obstructive Pulmonary Disease
Case 96: Evaluation of Unexplained Dyspnea: A Morbidly Obese Asthmatic 548
Case 97: Evaluation of Unexplained Dyspnea: Chronic Thromboembolic Pulmonary
Vascular Disease 552
Case 98: Evaluation of Unexplained Dyspnea: An Obese Woman at Risk for
Pulmonary Hypertension 555
Case 99: Serial Tests: Active Man With CREST Syndrome 558
Case 100: Serial Tests: Delayed Cardiotoxicity From Chemotherapy 563
Appendices 568
Darryl Y. Sue, Susan A. Ward
Index 582
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