Case 4

This 75-year-old gentleman is normally independent and self caring.  Attended the CPEX to evaluate his fitness for surgery. He underwent a laparoscopic right nephrectomy uneventfully (2013).  His last episode of angina was on a treadmill over four years ago, which was managed with an angiogram and a single stent insertion.  He has had no further symptoms since then.  He is not diabetic and non-hypertensive.  He has a good exercise tolerance and can walk at least half a mile without having to stop.  He has got one flight of stairs at home that he can climb up easily.

Resting ECG revealed Atrial fibrillation

Exercise Findings:

The patient performed exercise on a cycle ergometer. He pedalled at 60rpm without added load for 3minutes. The work rate was then increased 10W per minute to his symptom-limited maximum. Arm blood pressure was measured with a sphygmomanometer. Arterial oxyhemoglobin saturation was measured with a pulse oximeter on the finger. The test was stopped due to severe SOB.

Measurement Predicted Measured
Age, yr 86
Sex Male
Height, cm 180
Weight, kg 76.2
Hb, g/L [115 – 155 g/L] 127g/L
Measurement Predicted Measured
Exercise duration 5:02
Peak workload 145 51
RER at end 0.88
VO2peak (max) (mL/kg/min) 27.1 8.4 (31%)
VO2 at AT Not achieved
Maximum VE, L.min 127 17.7
Breathing Reserve >30% 86.1 %; 109L
BP (rest, max) 115/80mmHg ; 130/70mmHg
ECG (rest, max) 160 130,  178 (123%)
Vd/Vt 0.35 – <0.25 0.34 – 0.22
VE/VCO2 slope 29.4
O2 pulse 15 1 – 4


9 panel case 4



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