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Cardiopulmonary Exercise PowerPoint Presentation

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Cardiopulmonary Exercise Presentation Transcript

Slide 1 - CARDIOPULMONARY EXERCISE TESTING Historical Perspective, Principles & Applications
Slide 2 - JOSEPH PRIESTLY (1733-1804) Discovers Oxygen
Slide 3 - LAVOISIER’S EXPERIMENTS ON OXYGEN IN THE ATMOSPHERE
Slide 4 - ANTOINE & MADAME LAVOISIER
Slide 5 - ADOLPH FICK (1829-1901) AND CARDIAC OUTPUT
Slide 6 - NATHAN ZUNTZ (1847-1920) COLLECTING EXPIRED AIR
Slide 7 - CARDIOPULMONARY EXERCISE LAB AT THE UNIVERSITY OF PENNSYLVANIA Collecting Expired Air
Slide 8 - DICKINSON RICHARDS AND THE CARDIOPULMONARY UNIT “The foundation upon which the work of Dr. Cournand and myself chiefly rests is that of Laurence J. Henderson…he was a general physiologist in the broadest sense. It was from Henderson that we derived the simple but essential concept that lungs, heart, and circulation should be thought of as one single apparatus for the transfer of respiratory gases between outside atmosphere and working tissues.”
Slide 9 - THE GAS TRANSPORT SYSTEM
Slide 10 - CARDIO-PULMONARY EXERCISE TESTING Breath-by-Breath Respiratory Gas Exchange Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986
Slide 11 - CARDIO-PULMONARY EXERCISE (CPX) Modified Naughton Protocol for Incremental Treadmill Exercise Patterson JA, et al. Am J Cardiol 1972;30:757
Slide 12 - THE PRINCIPLE OF ADOLPH FICK O2 Uptake (VO2) Arterio-Venous O2 difference = Cardiac Output VO2 = cardiac output • A−VO2 difference
Slide 13 - OXYGEN UPTAKE AND INCREMENTAL MUSCULAR WORK Maximal O2 Uptake
Slide 14 - MAXIMAL O2 UPTAKE Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986
Slide 15 - CLASSIFICATION OF FUNCTIONAL IMPAIRMENT FOR PATIENTS WITH CARDIAC OR CIRCULATORY FAILURE Weber KT, et al. N Engl J Med 1980;303:242
Slide 16 - RESPONSE IN ARTERIO-VENOUS O2 DIFFERENCE TO UPRIGHT ISOTONIC EXERCISE Weber KT & Janicki JS. Am J Cardol 1985;55:22A
Slide 17 - Weber KT & Janicki JS. Am J Cardol 1985;55:22A CARDIAC OUTPUT RESPONSE TO UPRIGHT ISOTONIC EXERCISE
Slide 18 - Weber KT & Janicki JS. Am J Cardol 1985;55:22A RELATIONSHIP BETWEEN CARDIAC OUTPUT AND LEFT VENTRICULAR FILLING PRESSURE DURING UPRIGHT ISOTONIC EXERCISE
Slide 19 - RESPONSE IN MIXED VENOUS LACTATE TO UPRIGHT ISOTONIC EXERCISE Weber KT & Janicki JS. Am J Cardol 1985;55:22A
Slide 20 - CARDIO-PULMONARY EXERCISE Anaerobic Threshold Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986
Slide 21 - CARDIO-PULMONARY EXERCISE Gas Exchange, VE and HR
Slide 22 - CPX AND GRADING THE SEVERITY OF IMPAIRED AEROBIC CAPACITY Weber KT, et al. Clin Chest Med 1984;5:173
Slide 23 - AEROBIC CAPACITY AND SYMPTOMATIC STATUS Patients with cardiac disease begin to experience limiting symptoms when VO2 is <22 mL/kg/min They consider themselves severely limited with VO2 <16 mL/kg/min Patterson JA, et al. Am J Cardiol 1972;30:757
Slide 24 - Pardy RL, et al. Clin Chest Med 1984;5:35 NORMAL VENTILATORY RESPONSE TO INCREMENTAL ISOTONIC EXERCISE
Slide 25 - Weber KT & Janicki JS. In: Cardiopulmonary Exercise Testing. Philadelphia: Saunders. 1986 CARDIO-PULMONARY EXERCISE Predicting Cardiac Index and VE
Slide 26 - THE PROPORTION OF THE MAXIMUM VOLUNTARY VENTILATION (VENTILATORY RESERVE) USED DURING INCREMENTAL ISOTONIC EXERCISE BY PATIENTS WITH CHRONIC CARDIAC FAILURE Weber KT, et al. Circulation 1982;65:1213 Class B 52% Class A 43% Class C 34% Class D 37% VE max MVV MVV=FEV1×35
Slide 27 - EXERCISE VE AND VENTILATORY RESERVE (MVV) Cardiac vs. Ventilatory Limitation
Slide 28 - ARTERIAL O2 IN EMPHYSEMA AND BRONCHITIS Jones NL. Clin Sci 1966;31:39
Slide 29 - CRITERIA USED TO IDENTIFY CARDIAC FROM VENTILATORY CAUSE OF EXERTIONAL DYSPNEA Achieve anaerobic threshold and VO2max Exercise VE is <50% of MVV Do not develop arterial O2 desaturation Cardiac Do not achieve anaerobic threshold or VO2max Exercise VE is >50% of MVV Propensity to develop arterial O2 desaturation Ventilatory Weber KT. In: Fishman’s Pulmonary Diseases and Disorders. New York: McGraw-Hill. 1998
Slide 30 - INDICATIONS FOR CPX TESTING IN THE EVALUATION AND MANAGEMENT OF CARDIOPULMONARY DISEASE Identify the nature of the disease Identify the severity of the disease Monitor the natural course of the disease Select therapy Monitor response to therapy
Slide 31 - ASSESSING THE SEVERITY OF CHRONIC CARDIAC FAILURE By CXR
Slide 32 - ASSESSING THE SEVERITY OF CHRONIC CARDIAC FAILURE By CXR, Hemodynamic Data, and Ejection Fraction Resting Resting CI (L/min/M2) 1.80 1.85 PCW (mmHg) 28 27 EF (%) 24 26
Slide 33 - ASSESSING THE SEVERITY OF CHRONIC CARDIAC FAILURE By Response to Exercise Resting Exercise Resting Exercise CI (L/min/M2) 1.80 3.43 1.85 6.00 PCW (mmHg) 28 42 27 40 EF (%) 24 -- 26 -- Exerc. capac. (sec) -- 492 -- 924
Slide 34 - ppt slide no 34 content not found
Slide 35 - SIX- AND 12-MONTH SURVIVAL Chronic Cardiac Failure Likoff MJ, et al. Am J Cardiol 1987;59:634
 

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