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

Selected Exercise Data

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.