11266nam 2200613 a 450 991079426950332120230922163409.01-9751-3646-21-9751-3645-4(CKB)4100000011372871(MiAaPQ)EBC6743416(Au-PeEL)EBL6743416(OCoLC)1273979675(UtOrBLW)bslw09871378(UtOrBLW)9781975136437(EXLCZ)99410000001137287120200812d2021 uy 0engurcnu||||||||txtrdacontentcrdamediacrrdacarrierWasserman & Whipp's Principles of exercise testing and interpretation[electronic resource] /Kathy E. Sietsema ... [et al.]6th ed.Philadelphia Wolters Kluwer20211 online resource (1183 pages)Includes index.1-9751-3643-8 Includes bibliographical references and index.Intro -- Preface -- Acknowledgments -- Contributors -- 1    Exercise Testing and Interpretation -- WHAT IS CARDIOPULMONARY EXERCISE TESTING? -- CELL RESPIRATION AND BIOENERGETICS -- NORMAL COUPLING OF EXTERNAL TO CELLULAR RESPIRATION -- WHY MEASURE GAS EXCHANGE TO EVALUATE CARDIORESPIRATORY FUNCTION AND CELLULAR RESPIRATION? -- CARDIAC STRESS TESTS AND PULMONARY STRESS TESTS -- PATTERNS OF CHANGE IN EXTERNAL RESPIRATION (VO2 AND VCO2) AS RELATED TO FUNCTION, FITNESS, AND DISEASE -- FACTORS LIMITING EXERCISE -- Fatigue -- Dyspnea -- Pain -- EVIDENCE OF SYSTEMIC DYSFUNCTION UNIQUELY REVEALED BY INTEGRATIVE CARDIOPULMONARY EXERCISE TESTING -- Diagnosis of Exercise Intolerance, Especially Exertional Dyspnea and Myocardial Ischemia -- Cardiopulmonary Exercise Testing and Prognosis in Patients With Known Disorders -- Cardiopulmonary Exercise Testing and Preoperative Assessment -- SUMMARY -- 2    Physiology of Exercise -- SKELETAL MUSCLE: MECHANICAL PROPERTIES AND FIBER TYPES -- BIOENERGETICS -- Sources of High-Energy Phosphate and Cellular Respiration -- Phosphocreatine Breakdown -- Substrate Utilization -- Carbohydrates -- Lipids -- Amino Acids -- OXYGEN COST OF WORK -- VO2 Steady State and Work Efficiency -- VO2 Nonsteady State -- ARTERIAL LACTATE INCREASE -- Arterial Lactate Increase as a Function of Work Rate -- Arterial Lactate Increase as a Function of Time -- Mechanisms of Arterial Lactate Increase -- Increasing Glycolytic Flux and Exercise Intensity -- Sequential Recruitment of Type II Muscle Fibers -- Pyruvate Dehydrogenase Activity -- Change in Cytosolic Redox State Limiting Mitochondrial Proton Shuttles -- Lactate Production and Clearance -- Oxygen Supply and Critical Capillary PO2 -- pH Change and Oxyhemoglobin Dissociation Above the Anaerobic Threshold -- BUFFERING THE EXERCISE-INDUCED LACTIC ACIDOSIS.CARDIOVASCULAR RESPONSES TO EXERCISE -- Cardiac Output -- Oxygen Pulse -- Distribution of Peripheral Blood Flow -- Arterial PO2 -- Oxyhemoglobin Dissociation -- Hemoglobin Concentration -- Arterial Oxygen Content -- GAS EXCHANGE KINETICS -- Oxygen Uptake Kinetics -- Moderate Exercise -- Supra-AT Exercise -- Mean Response Time -- Oxygen Deficit -- Oxygen Debt -- Carbon Dioxide Output Kinetics -- Moderate Exercise -- Supra-AT Exercise -- Power-Duration Curve and Critical Power -- VENTILATORY RESPONSES TO EXERCISE -- Arterial and Venous PCO2 and Carbon Dioxide Content -- Ventilatory Determinants -- Carbon Dioxide and H+ Elimination -- Alveolar Ventilation -- Dead Space Ventilation -- Total (or Expired) Ventilation -- Breathing Pattern -- Ventilatory Control -- Moderate Exercise -- Supra-AT Exercise -- SUMMARY -- 3    Measurements During Integrative Cardiopulmonary Exercise Testing -- measurements -- Electrocardiographic Changes With Exercise -- Maximal and Peak Oxygen Uptake -- Oxygen Uptake and Work Rate -- Normal Subjects -- Upward Displacement of VO2 as a Function of Work Rate in Obesity -- Slope of VO2 as a Function of Work Rate (ΔVO2/ΔWR) -- Linearity of VO2 as a Function of Work Rate -- Can VO2 or METs Be Predicted From the Work Rate? -- Cardiac Output and Stroke Volume -- Cardiac Output Measurement -- Indirect Fick Method Using VCO2 and Estimated CVCO2 -- Direct Fick Method -- Noninvasive Cardiac Output and Stroke Volume by the Fick Principle -- Oxygen Pulse and Stroke Volume -- Anaerobic (Lactate, Lactic Acidosis) Threshold -- Methods of Measurement -- V-Slope Method -- Ventilatory Equivalent Method -- Improving Estimation of the Anaerobic Threshold -- False Positives -- Heart Rate-Oxygen Uptake Relationship and Heart Rate Reserve -- Arterial Blood Pressure -- Breathing Reserve -- Expiratory Flow Pattern -- Inspiratory Capacity.Tests of Uneven VA/Q -- Wasted Ventilation and Dead Space-Tidal Volume Ratio -- Arterial PO2 and Alveolar-Arterial PO2 Difference -- Arterial-End-Tidal PCO2 Difference -- Ventilatory Equivalents as Indices of Uneven VA/Q -- Differentiating Uneven Ventilation From Uneven Perfusion as the Cause of Uneven VA/Q -- Other Measures of Uneven VA/Q -- Arterial Bicarbonate and Acid-Base Response -- Tidal Volume/Inspiratory Capacity Ratio -- Measurements Unique to Constant Work Rate Exercise Testing -- VO2 Response in Phase I -- VO2 Response in Phase II -- VO2 Response Above the Anaerobic Threshold -- The Power-Duration Relationship and Endurance Time -- Noninvasive Estimation of Metabolic Acidosis Buffering -- Carotid Body Contribution to Ventilation -- Detecting Exercise-Induced Bronchospasm -- SUMMARY -- 4    Pathophysiology of Disorders Limiting Exercise -- OBESITY -- PATTERNS OF EXERCISE GAS EXCHANGE COMMON TO CARDIOVASCULAR DISEASES -- VO2 Response to Increasing Work Rate (ΔVO2/ΔWR) in Patients With Cardiovascular Abnormalities -- Why Do Cardiovascular Disorders Impair Gas Transport? -- HEART DISEASES -- Coronary Artery Disease -- Myopathic Heart Disease (Heart Failure) -- Valvular Heart Disease -- Congenital Heart Disease -- PULMONARY VASCULAR DISEASES -- Causes of Increased Ventilation -- Exercise Arterial Hypoxemia -- Effect on Systemic Hemodynamics -- PERIPHERAL ARTERIAL DISEASES -- VENTILATORY DISORDERS -- Obstructive Lung Diseases -- Ventilatory Capacity-Ventilatory Requirement Imbalance -- Oxygen Transport-Oxygen Requirement Imbalance -- Physiological Markers of Inadequate Oxygen Transport -- Restrictive Lung Diseases -- Chest Wall (Respiratory Pump) Disorders -- DEFECTS IN HEMOGLOBIN CONTENT AND QUALITY -- Anemia -- Left-Shifted Oxyhemoglobin Dissociation Curve -- Carboxyhemoglobinemia and Cigarette Smoking -- CHRONIC METABOLIC ACIDOSIS.METABOLIC MUSCLE DISORDERS -- Disorders of Carbohydrate Metabolism -- Disorders of Lipid Metabolism -- Disorders of Mitochondrial Electron Transport Chain -- Toxin- or Drug-Induced Muscle Impairment -- Endocrine Disorders -- NONMETABOLIC CAUSES OF EXERCISE LIMITATION AND DYSPNEA -- Anxiety Reactions -- Poor Effort and Manipulated Exercise Performance -- COMBINATIONS OF DEFECTS -- SUMMARY -- 5    Performance of Clinical Cardiopulmonary Exercise Testing -- EXERCISE LABORATORY AND EQUIPMENT -- General Laboratory Environment -- Gas Exchange Measurement -- Mixing Chambers -- Breath-by-Breath Systems -- Measurement of Volume, Flow Rate, and Ventilation -- Breathing Valves, Mouthpieces, and Masks -- Gas Analyzers -- Elevated Inspired Fractional Oxygen Concentration -- Ergometers: Treadmills and Cycles -- Treadmill -- Cycle Ergometer -- Cycle Versus Treadmill -- Work and Work Rate (Power) -- Electrocardiogram and Systemic Blood Pressure -- Exercise Electrocardiogram -- Systemic Blood Pressure -- Oximetry, Blood Sampling, and Arterial Catheters -- Pulse Oximetry -- Single Samples of Arterial Blood by Puncture -- Multiple Samples of Arterial Blood by Catheterization -- Free-Flowing Ear Capillary Blood -- Invasive Cardiopulmonary Exercise Testing With Pulmonary Artery Catheter -- Data Sampling and Computation -- Quality Control, Validation, and Maintenance -- PREPARING FOR THE EXERCISE TEST -- Requesting the Test and Notifying the Patient -- The Patient in the Exercise Laboratory -- Preliminary Tests -- Physician Evaluation -- Equipment Familiarization -- Ending the Exercise -- Arterial Blood Sampling and Use of Catheter -- PERFORMING THE EXERCISE TEST -- Incremental Exercise Test to Symptom-Limited Maximum -- Selecting the Rate of Work Rate Increase -- Resting Measures -- Unloaded Exercise and Cycling Rate -- Incremental Exercise -- Recovery.Postexercise Questioning and Review -- Incremental Tests -- Constant Work Rate Exercise Tests -- Treadmill Test for Detecting Myocardial Ischemia -- Comment -- Treadmill Tests With Even Increments in Work Rate -- Arm Ergometry -- Critique -- Other Tests Suitable for Fitness or Serial Evaluations -- Harvard Step Test and Modifications -- 600-Yard Run-Walk -- 12-Minute Field Test -- 12-Minute Walk Test -- 6-Minute Walk Test -- Incremental Shuttle Walk Test and Endurance Shuttle Walk Tests -- SUMMARY -- 6    Approaches to Data Summary and Interpretation -- CONSIDERATIONS IN FORMATTING AND SUMMARIZING DATA -- Averaging Breath-by-Breath Data -- Formatting Data for Viewing During and After Testing -- Quantifying Peak Values -- Characterizing Submaximal Exercise Patterns -- ORGANIZING DATA: APPROACH TO REVIEW OF A NINE-PANEL GRAPHICAL DISPLAY -- Data Reflecting Cardiovascular and Metabolic Responses -- Cardiovascular and Metabolic Variables: Summary -- Data Reflecting Ventilation Responses to Exercise -- Ventilatory Variables: Summary -- Data Reflecting Efficiency of Pulmonary Gas Exchange -- Pulmonary Gas Exchange Efficiency: Summary -- Graphing Strategies to Facilitate Data Analysis -- Summarizing Key Variables -- EXAMPLES OF FINDINGS IN THE NINE-PANEL DISPLAY IN SELECTED CARDIORESPIRATORY DISORDERS -- Panel 1: VO2, VCO2, and Work Rate as Related to Time -- Panel 3: Heart Rate and Carbon Dioxide Output as a Function of Oxygen Uptake -- Panel 2: Heart Rate and Oxygen Pulse as a Function of Time -- Panel 9: Tidal Volume as a Function of Exercise Minute Ventilation -- Panel 6: Exercise Minute Ventilation as a Function of Carbon Dioxide Output -- Panel 4: Ventilatory Equivalents for Oxygen and Carbon Dioxide Versus Time -- Panel 7: End-Tidal Oxygen and Carbon Dioxide Tensions Versus Time -- Panel 5: Minute Ventilation as a Function of Time.Panel 8: Respiratory Exchange Ratio at Rest, Increasing Work Rate Exercise, and Recovery.Wasserman and Whipp's Principles of exercise testing and interpretationExercise TestPhysical ExertionphysiologyExercise testsHeart function testsPulmonary function testsExercise TestPhysical Exertionphysiology.Exercise tests.Heart function tests.Pulmonary function tests.616.120754Sietsema Kathy E1513854UtOrBLWUtOrBLWBOOK9910794269503321Wasserman & Whipp's Principles of exercise testing and interpretation3748535UNINA