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Indications for Exercise Stress Testing

Dyspnea during exertion is a common complaint, and may indicate pulmonary or cardiac disease. The indications for an exercise stress test are simple. Anyone with unexplained dyspnea may benefit from a stress test. It will help to categorize the source of the dyspnea. The test should place the patient in 1of 5 categories.

 

  1. Normal
  2. Sedentary
  3. Cardiac
  4. Pulmonary
  5. Mixed

 

 

 

 

 

 

 

 

 

 

A normal response to exercise includes:

  • Heart rate (HR) increases linearly with O2 consumption (VO2) until predicted maximum heart rate is reached.
  • Minute ventilation (VE) and CO2 production (VCO2) increases linearly as VO2 or work increases up to the anaerobic threshold. During anaerobic respiration VE and VCO2 increase faster than VO2.
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A sedentary response to a stress test does not imply physiologic dysfunction. It implies that the patient is ‘out of shape’.

    • O2 pulse indicates the rate of O2 consumption by the body during exercise. O2 pulse is calculated as VO2/HR. It is less than predicted since HR is increased at every level of O2 consumed.
    • VO2/kg at maximum exercise is less than predicted.
    • VE increases linearly with work, but at a higher rate than predicted (VE/VO2 > 23-27).

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A cardiac limitation to a stress test implies a problem with the circulatory system.

 

 

 

 

 

 

 

A pulmonary limitation implies that the problem lies with the respiratory system.