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.