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
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.
|Hb, g/L||[115 – 155 g/L]||127g/L|
|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|
|O2 pulse||15||1 – 4|