PRINCIPLES OF EXERCISE TESTING AND INTERPRETATION. INCLUDING PATHOPHYSIOLOGY AND CLINICAL APPLICATIONS

CHAPTER 1 Exercise Testing and Interpretation

CHAPTER 2 Physiology of Exercise

CHAPTER 3 Changes in Blood Gases and pH during Exercise

CHAPTER 4 Measurements during Integrative Cardiopulmonary Exercise Testing

CHAPTER 5 Pathophysiology of Disorders Limiting Exercise

CHAPTER 6 Clinical Exercise Testing

CHAPTER 7 Normal Values

CHAPTER 8 Diagnostic Specificity of Exercise Intolerance: A Flowchart Approach

CHAPTER 9 Clinical Applications of Cardiopulmonary Exercise Testing

CHAPTER 10 Case Presentations
Case 1. Normal Man
Case 2. Normal Athletic Man
Case 3. Normal Woman: Air and Oxygen Breathing Studies
Case 4. Normal Man
Case 5. Exceptionally Fit Man with Mild Lung Disease
Case 6. Normal Subject: Cycle and Treadmill Studies
Case 7. Normal Subject: Before and After ß -Adrenergic Blockade
Case 8. Normal Subject: Immediate Effects of Cigarette Smoking
Case 9. Active Normal Man with Suspected Cardiac Disease
Case 10. Normal Sedentary Woman
Case 11. Normal Aging Athletic Man
Case 12. Chronic Heart Failure: Nonischemic Cardiomyopathy
Case 13. Chronic Heart Failure: Before and after Therapy
Case 14. Chronic Heart Failure: Oscillatory Ventilation and Gas Exchange
Case 15. Chronic Heart Failure: Cardiomyopathy with Intraventricular Conduction Delay
Case 16. Myocardial Ischemia: Undiagnosed Angina and Hypertension
Case 17. Myocardial Ischemia: Atypical Chest Pain
Case 18. Myocardial Ischemia: Small Vessel Disease
Case 19. Myocardial Ischemia: Interim Development of Coronary Artery Disease over 3 Years
Case 20. Myocardial Ischemia: Coronary Artery Disease in a Previously Athletic Man
Case 21. Peripheral Arterial Disease
Case 22. Cardiovascular Impairment with Hypertension and Carboxyhemoglobinemia
Case 23. Rate Disturbance due to ß -Adrenergic Blockade for Treatment of Systemic Hypertension
Case 24. Atrial Fibrillation with Rapid Ventricular Response during Exercise
Case 25. Chronotropic Insufficiency with Escape Rhythm
Case 26. Hypertrophic Cardiomyopathy with Postexercise Vasodepressor Syncope
Case 27. Mitral Insufficiency
Case 28. Congenital Heart Disease Surgically Corrected in Infancy
Case 29. Congenital Heart Disease: Surgically Corrected Transposition of the Great Arteries
Case 30. Patent Ductus Arteriosus with Left-to-Right Shunt
Case 31. Patent Ductus Arteriosus with Right-to-Left Shunt (Eisenmenger Ductus)
Case 32. Eisenmenger Complex (Ventricular Septal Defect with Pulmonary Hypertension)
Case 33. Early Onset of Exercise Lactic Acidosis: Differentiating Circulatory from Muscular Impairment
Case 34. Early Onset of Exercise Lactic Acidosis Suggesting Circulatory Impairment
Case 35. Pulmonary Hypertension with Patent Foramen Ovale
Case 36. Idiopathic Pulmonary Hypertension before and after Treatment
Case 37. Long-standing Idiopathic Pulmonary Hypertension: Serial Tests over 17 Years of Treatment
Case 38. Idiopathic Pulmonary Hypertension
Case 39. Mixed Connective Tissue Disease with Pulmonary Involvement
Case 40. Pulmonary and Systemic Vasculitis: Air and Oxygen Breathing Studies
Case 41. Scleroderma with Pulmonary and Pulmonary Vascular Involvement
Case 42. Severe Pulmonary Vascular Disease Secondary to Sarcoidosis: Air and Oxygen Breathing Studies
Case 43. Exercise-Induced Pulmonary Hypertension Secondary to Left Ventricular Diastolic Dysfunction
Case 44. Intrapulmonary Right-to-Left Shunt due to Pulmonary Arteriovenous Fistulae
Case 45. Mild Chronic Bronchitis with Normal Exercise Performance
Case 46. Emphysema with Mild Airway Obstruction
Case 47. Severe Emphysema
Case 48. Emphysema with Pulmonary Vascular Disease
Case 49. Severe Emphysema and Bronchitis: Air and Oxygen Breathing Studies
Case 50. Bullous Emphysema: Before and after Bullectomy
Case 51. Chronic Obstructive Lung Disease with a History of Heart Failure
Case 52. Mild Obstructive Airway Disease with Disproportionate Exertional Dyspnea
Case 53. Mild Pulmonary Asbestosis
Case 54. Severe Pulmonary Asbestosis
Case 55. Idiopathic Interstitial Lung Disease
Case 56. Interstitial Lung Disease
Case 57. Sarcoidosis
Case 58. Interstitial Pneumonitis: Before and after Corticosteroid Therapy
Case 59. Interstitial Pulmonary Fibrosis: Air and Oxygen Breathing Studies
Case 60. Obesity Contributing to Ventilatory Limitation
Case 61. Extrapulmonary Restriction: Ankylosing Spondylitis
Case 62. Extrapulmonary Restriction: Scoliosis
Case 63. McArdle Disease
Case 64. Myopathy with Exertional Rhabdomyolysis
Case 65. Congenital Mitochondrial Myopathy
Case 66. Mitochondrial Myopathy
Case 67. Mixed Disorder: Chronic Bronchitis and Obesity
Case 68. Mixed Disorder: Peripheral Arterial Disease, Anemia, Carboxyhemoglobinemia, and Cardiac Dysfunction
Case 69. Mixed Disorder: Mild Interstitial Lung Disease, Obstructive Airway Disease, and Myocardial Ischemia
Case 70. Mild Interstitial Lung Disease, Silent Myocardial Ischemia, and Uncontrolled Systemic Hypertension
Case 71. Mixed Disease: Aortic Stenosis, Mitral Stenosis, and Obstructive Airway Disease
Case 72. Mixed Disorder: Obstructive Airway Disease, Talc Pneumoconiosis, and Pulmonary Vascular Disease
Case 73. Mixed Disorder: Peripheral Arterial Disease and Obstructive Lung Disease
Case 74. Exercise Testing for Staging and Prognosis in Chronic Heart Failure
Case 75. Exercise Testing in Preoperative Evaluation for Lung Cancer Resection
Case 76. Exercise Testing for Evaluation of Work Fitness: Extreme Obesity
Case 77. Exercise Testing for Assessment before and after Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease
Case 78. Evaluation of Unexplained Dyspnea: A Morbidly Obese Asthmatic
Case 79. Evaluation of Unexplained Dyspnea: Thromboembolic Pulmonary Vascular Disease
Case 80. Evaluation of Unexplained Dyspnea: An Obese Woman at Risk for Pulmonary Hypertension

Bonus Cases Online

Case 81 Apparently Healthy Man with Unexplained Tachycardia: Air and Oxygen Breathing
Case 82 Apparently Healthy Woman with Mitral Valve Prolapse, Tachycardia, and Dyspnea
Case 83 Apparently Healthy Cigarette Smoker
Case 84 Normal Man with Ventilatory Chemore?ex Insensitivity
Case 85 Ischemic Cardiomyopathy
Case 86 Hypertrophic Cardiomyopathy
Case 87 Mitral Stenosis: Before and after ß-Adrenergic Blockade
Case 88 Congenital Heart Disease: Pulmonic Valve Insuf?ciency
Case 89 Peripheral Arterial Disease with Pulmonary Vascular and Obstructive Airway Disease
Case 90 Fatigue and Exercise Intolerance Attributed to Vasoregulatory Asthenia
Case 91 Chronic Bronchitis, Cigarette Smoking, and Obesity
Case 92 Early Asbestosis, Chronic Bronchitis, and Cigarette Smoking
Case 93 Pulmonary Alveolar Proteinosis: Air and Oxygen Breathing
Case 94 Alveolar Proteinosis: Before and After Whole-Lung Lavage
Case 95 Pulmonary Microlithiasis: Air and Oxygen Breathing
Case 96 Abnormal Gas Exchange Due to a Circulatory Disorder in a Man with Systemic Hypertension and Early Asbestosis
Case 97 Pulmonary Vascular Disease Secondary to Interstitial and Obstructive Lung Disease
Case 98 Poor Effort and Hyperventilation
Case 99 Poor Effort
Case 100 Acute Hyperventilation in a Moderately Obese Man
Case 101 Skeletal Disease Limiting Exercise
Case 102 Myasthenia Gravis
Case 103 Circulatory Dysfunction and Mild Obstructive Airway Disease: Cycle and Treadmill Studies
Case 104 ß-Adrenergic Blockade, Systemic Hypertension, Pulmonary Vascular Disease, and Mild Chronic Bronchitis
Case 105 ß-Adrenergic Blockade, Obesity, and Asbestosis
Case 106 Pulmonary Vascular Disease, Chronic Bronchitis, Asbestosis, and Myocardial Ischemia
Case 107 Systemic Sclerosis and Primary Lung Cancer: Preoperative Evaluation
Case 108 Transition from Normal to Left Ventricular Dysfunction
Case 109 Idiopathic Hyperventilation and ß-Adrenergic Blockade
Case 110 Ischemic Cardiomyopathy, Restrictive Lung Defect, and ß-Adrenergic Blockade

Appendix A. Symbols and Abbreviations 542
Appendix B. Glossary 544
Appendix C. Calculations, Formulas, and Examples 549
Appendix D. Placement of a Brachial Artery Catheter 557
Appendix E. Tables and Nomogram

Discover what exercise testing can reveal about cardiopulmonary, vascular, and muscular health. Now in its Fifth Edition, Principles of Exercise Testing and Interpretation continues to deliver timely information on the physiology and pathophysiology of exercise and their relevance to clinical medicine.

The text begins by explaining the processes by which cells receive oxygen and dispose of carbon dioxide produced as a byproduct of exercise and metabolism. By measuring gas exchange, we can better evaluate cardiovascular and cardiopulmonary functioning, as well as cellular respiration. Detailed discussions explore various types of exercise intolerance, their effects on test results, and clinical diagnoses. Using real-world cases, the text illustrates how cardiopulmonary exercise testing can evaluate the functional competency of each component in the coupling of cellular to external respiration, including the cardiovascular system. Expert authors’ comments, analysis, and conclusions for each case, help to improve readers’ interpretive and diagnostic skills.


This in-depth resource provides…

- Updated content and new graphics present the most current information in a reader-friendly format.
- Updated flow charts detail clinical presentations and differential diagnosis
- More than 80 case presentations improve diagnostic accuracy.
- Normal test values for a wide range of patient groups provide a basis for comparison and help to identify abnormalities.
- Companion website includes the complete text, PLUS 30 additional case presentations.

About the Author(s)

James E. Hansen MD
Emeritus Professor of Medicine, David Geffen School of Medicine at UCLA; Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Harbor—UCLA Medical Center, Torrance, CA

Kathy E. Sietsema MD
Professor of Medicine, David Geffen School of Medicine at UCLA; Division of Respiratory and Critical Care Physiology and Medicine, Associate Professor, General Medicine and Health Services, Department of Medicine, Harbor—UCLA Medical Center, Torrance, CA

Brian J. Whipp PhD, DSc
Principal Research Fellow, School of Sport and Exercise Science, University of Leeds, Leeds, United Kingdom

Karlman Wasserman MD, PhD
Professor of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Harbor—UCLA Medical Center, Torrance, CA

Darryl Y. Sue MD
Associate Chair and Director, Internal Medicine Training Program, Department of Medicine, Director, Medical ICU, Division of Respiratory and Critical Care Physiology and Medicine, Harbor—UCLA Medical Center, Torrance, CA; Professor of Clinical Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA

Xing-Guo Sun
Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, St. John's Cardiovascular Research Center, Torrance, CA

William W. Stringer MD
Professor of Medicine, David Geffen School of Medicine at UCLA; Chair, Department of Medicine, Harbor—UCLA Medical Center, Torrance, CA