Case 3

Clinical Findings

This 60 yr old female reported to the clinic because she started to experience shortness of breath (SOB), exercise limitation, and easy fatigability starting about 6 months previously. She had two pillow orthopnoea and paroxysmal nocturnal dyspnoea. She did not experience chest pain with activity. An echo was performed and the interpretation reported a 25% ejection fraction. Her current medical therapy include: Furosemide; Ramipril; Bisoprolol; Simvastatin; and furosemide as needed. She was referred to the CPET lab for quantification of her severity of her heart failure. At the time of referral, she was symptomatically improved on therapy, and pretibial oedema was trace.

Resting ECG revealed sinus rhythm and LBBB with rare premature ventricular contractions.

Exercise Findings:

The patient performed exercise on a cycle ergometer. She pedaled at 60rpm without added load for 3 minutes. The work rate was then increased 10W per minute to her symptom-limited maximum. Arm blood pressure was measured with a sphygmomanometer. Arterial oxyhemoglobin saturation was measured with a pulse oximeter on the finger. She stopped the exercise because of leg fatigue.

Selected Respiratory Function Data – were all within normal limits

Measurement Predicted Measured
Age, yr 60
Sex female
Height, cm 161
Weight, kg 47
Hb, g/L [115 – 155 g/L] 140g/L
VC, L 3.27 3.17
IC, L 2.18 1.98
FEV1, L 2.64 2.17
FEV1/VC, % 81 69
MVV, L/min 97 86
DLCO, ml/mm HG/Min 22.7 17.8

 

 Selected Exercise Data

Measurement Predicted Measured
Exercise duration 4:51
Peak workload 105 49
RER at end 1.27
VO2peak (max) (mL/kg/min) 13.2 (42%)
VO2 at AT 9.9  (31%)
VE/VCO at AT 39 49
Maximum VE, L.min 100 42
Breathing Reserve >30% 57.3 %; 57L
BP (rest, max) 90/60mmHg ; 110/60mmHg
ECG (rest, max) 160 66, 109   (69%)
Vd/Vt 0.35 – <0.25 0.24 – 0.21
VE/VCO2 slope 63
O2 pulse 15 4 – 6

 

Case3-9panel

 

Exercise Case 3

 

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