LEADER 13346nam 2200673 a 450 001 9910965719203321 005 20251116190313.0 010 $a9781975136468 010 $a1975136462 010 $a9781975136451 010 $a1975136454 035 $a(CKB)4100000011372871 035 $a(MiAaPQ)EBC6743416 035 $a(Au-PeEL)EBL6743416 035 $a(OCoLC)1273979675 035 $a(UtOrBLW)bslw09871378 035 $a(UtOrBLW)9781975136437 035 $a(BIP)70317965 035 $a(EXLCZ)994100000011372871 100 $a20200812d2021 uy 0 101 0 $aeng 135 $aurcnu|||||||| 181 $ctxt$2rdacontent 182 $cc$2rdamedia 183 $acr$2rdacarrier 200 10$aWasserman & Whipp's Principles of exercise testing and interpretation /$fKathy E. Sietsema ... [et al.] 205 $a6th ed. 210 $aPhiladelphia $cWolters Kluwer$d2021 215 $a1 online resource (1183 pages) 300 $aIncludes index. 311 08$a9781975136437 311 08$a1975136438 320 $aIncludes bibliographical references and index. 327 $aIntro -- 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. 327 $aCARDIOVASCULAR 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 (?VO2/?WR) -- 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. 327 $aTests 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 (?VO2/?WR) 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. 327 $aMETABOLIC 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. 327 $aPostexercise 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. 327 $aPanel 8: Respiratory Exchange Ratio at Rest, Increasing Work Rate Exercise, and Recovery. 330 $aSelected as a Doody's Core Title for 2025! Thoroughly revised and updated for today's clinicians, Wasserman & Whipp's Principles of Exercise Testing and Interpretation, Sixth Edition, provides a comprehensive, practical overview of cardiopulmonary exercise testing (CPET) ideally suited for pulmonologists, cardiologists, anesthesiologists, and others with an interest in clinical exercise testing. Written by authors who are uniquely positioned to convey relevant aspects of research and apply them to clinical contexts, this volume offers in-depth coverage of essential information for conducting CPET, or for utilizing data from this discipline in clinical practice or research. Clearly defines terminology throughout and focuses on the core elements of CPET that are common to all users, ensuring that content is easily accessible to clinicians from a wide variety of backgrounds. Reviews the central aspects of exercise physiology and metabolism important for understanding measurements used in CPET. Identifies core procedures and measurements for conducting tests and laboratory quality control. Outlines systematic, step-by-step approaches to the interpretation of exercise data, including the scientific and technical basis of the methods and analyses. Includes a new chapter on approach to data and interpretation - focused on practical approaches to viewing, summarizing, and reporting results of a test. Illustrates normal and abnormal results of exercise tests through discussion of dozens of actual case presentations. Draws on the extensive experience and expertise of authors from the fields of pulmonary medicine and physiology with experience in research and clinical studies related to cardiology, metabolism, sports medicine, and other areas. Enrich Your Ebook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. 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