Case 2

Clinical Findings

This 49 yr old female had been exposed to sandblasting and 25yrs of cigarettes. On questioning,  she admitted to a grinding chest pain, originating in the mid-back and radiating around the left chest into the sub-sternal area. The pain, brought on when walking the dog on cold days and relieved in a few minutes by rest, had not previously been treated or diagnosed. She denied shortness of breath. A physical examination revealed no evidence of peripheral vascular disease, heart murmurs or abnormal heart sounds. The resting 12 lead- ECG was within normal limits.

Exercise Findings

The patient performed exercise on a cycle ergometer. She pedalled at 60rpm without added load for 3 min. The work rate was then increased 10W per minute to his symptom-limited maximum. The patient stopped exercising due to sub-scapular pain and right anterior chest pain. No significant ECG changes. The chest pain resolved within 1 minute of cessation of exercise.

Selected Respiratory Function Data – were all within normal limits

Measurement Predicted Measured
Age, yr   49
Sex   Female
Height, cm   170
Weight, kg   80
Hb, g/L [130-165 g/L] 110
VC, L 2.56 – 3.92 3.63
VC, % Predicted   112
PEF, L 300.84 – 477.96 476
FEV1, L 2.06 – 3.31 2.73

 

Selected Exercise Data

Measurement Predicted Measured
Exercise duration   7:31
Peak workload 99 80
RER at end   1.31
VO2peak (max) (mL/kg/min) 20.9 14.5 (50%)
VO2 at AT   7.5 (36%)
VE/VCO at AT   34
Maximum VE, L.min 118 38.2 (32%)
Breathing Reserve   67%
BP (rest, max)   110/70; 190/90
ECG (rest, max)   91; 178  (104%)
Vd/Vt   0.19 – 0.15
VE/VCO2 slope   32
O2 pulse   3-4

Case 2

 

Answer:

Wasserman et al: Chapter 8 refer to the Principles of Interpretation: A flowchart Approach.

Principles of Exercise Testing and Interpretation: including Pathophysiology and Clinical Applications; p. 183.

Referring to flowchart 1 the VO2 is reduced, whereas the anaerobic threshold in normal, which directs us to flowchart 3.

The breathing reserve branch is high and although the ECG is not abnormal, the 9 panel plot directs us the diagnosis of myocardial ischeamia.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s