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PHTH 527 > Cardiopulmonary Exercise Testing > Flashcards

Cardiopulmonary Exercise Testing Flashcards

1
Q

What are 3 examples of indications for CPET?

A
  1. Determining causes of dyspnea, chest pain, and exercise intolerance
  2. Exercise prescription
  3. Evaluate level of functional impairment
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2
Q

Do you need to rely on predicted values for exercise prescription after you have performed a CPET?

A

NO

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3
Q

We have a large physiological reserve and therefore our ability to perform ADL’s only _________ when there is a major reduction in physiological capacity.

A

decreases

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4
Q

Resting measurements do not always reflect physiological capacity (T/F).

A

TRUE

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5
Q

_______ may reveal abnormalities at an earlier stage of the cardiopulmonary disease process.

A

CPET

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6
Q

CPET is not effective for objectively quantifying the effectiveness of different therapies (T/F).

A

FALSE

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7
Q

______ helps determine the mechanism of improvement.

A

CPET

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8
Q

CPET provides an index of how well the pt will respond to ____.

A

stress

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9
Q

Pre-operative peak VO2

A

50-60

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10
Q

Can CPET be used to assess the disability for workers compensation?

A

yes

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11
Q

What are 3 components of an effective CPET protocol?

A
  1. Large muscle mass exercise to sufficiently stress the cardiorespiratory system
  2. Should involve measurements of metabolic, cardiovascular, ventilatory and pulmonary gas exchange variance from rest to max/peak exercise
  3. Should involve fixed increments in work rate (magnitude and duration) up to peak exercise
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12
Q

______ specificity for athletes is critical if using CPET for exercise prescription and monitoring training adaptations.

A

sport

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13
Q

What two exercise modalities are recommended for CPET protocol?

A
  1. Cycle ergometer

2. Treadmill

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14
Q

Rest phase of CPET protocol?

A

> or equal to 3 minutes

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15
Q

Warm up phase of CPET protocol?

A

1-3 minutes at very low intensity for patients (athletes will require longer and more intense warm up)

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16
Q

Exercise phase of CPET protocol?

A

Fixed work rate increments (5-25 Watts) and duration (1-2 mins) and continue until patient could no longer continue

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17
Q

Cool down phase of CPET protocol?

A

3 minutes at low intensity

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18
Q

Test duration for CPET should be > or equal to __ minutes and < or equal to ___ minutes in duration.

A

6;20

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19
Q

____ work rate increments and ____ duration risk early fatigue and mainly test muscular strength and anaerobic processes.

A

large; short

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20
Q

_____ work increments and ____ duration risk boredom and suboptimal performance, and mainly test aerobic processes.

A

small; long

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21
Q

What are the 3 components of the Jones approach?

A
  1. choose standardized increments (10 W in disease, 25 W in health)
  2. 1-2 minute stages
  3. Goal is to have a total test duration of 10-20 min for most individuals
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22
Q

What is the formula for work rate increments?

A

(estimated peak VO2 - estimated VO2 of unleaded pedalling) / 100

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23
Q

What is the formula for estimated VO2 of unloaded pedalling (mL/min)?

A

150 + (6 x body mass in kg)

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24
Q

What is the formula for estimated peak CO2 (mL/min)?

A

(height in cm - age in years) x 20 for sedentary men and x14 for sedentary women

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25
Q

What are 3 effort sensations that can help you measure symptom intensity from rest to peak exercise?

A
  1. Breathing discomfort
  2. Muscle fatigue
  3. Chest or muscle pain
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26
Q

Symptom evaluation is often considered to be ________, however, the intraclass coefficient is > ___ during cycle exercise.

A

unreliable; 0.75

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27
Q

Dyspnea grade __: only breathless on strenuous exertion.

A

I

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28
Q

Dyspnea grade __: breathless when hurrying on the level or walking up a straight hill.

A

II

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29
Q

Dyspnea grade __: have to walk slower than most people on the level.

A

III

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30
Q

Dyspnea grade ___: stop for breath after walking about 100 yards on the level.

A

IV

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31
Q

Dyspnea grade __: too breathless to leave the house or breathless after undressing.

A

V

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32
Q

The reason for stopping ________ provides inside into physiological factors contributing to exercise intolerance.

A

exercise

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33
Q

What are 3 possible reasons for stopping exercise?

A
  1. Dyspnea
  2. Leg fatigue
  3. Combination
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34
Q

________ descriptors of dyspnea provides insight into the causes of dyspnea and exercise intolerance.

A

qualitative

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35
Q

What are 6 measurements taken during CPET?

A
  1. External work
  2. Metabolic gas exchange
  3. Cardiovascular
  4. Ventilatory
  5. Pulmonary gas exchange
  6. Symptoms
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36
Q

Peak ____ and work ____ ultimately reflect the integrated response of several physiological systems.

A

VO2; rate

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37
Q

Reductions in peak VO2 and work rate are indicators of reduced _______ _______.

A

exercise capacity

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38
Q

Values

A

80-85

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39
Q

What is the best evidence of VO2 max?

A

Clear plateau in VO2 with increasing work rate

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40
Q

What is usually used as an estimate of VO2 max in clinical populations?

A

VO2 peak

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41
Q

Reduced VO2 peak reflects problems with what 6 factors?

A
  1. O2 transport
  2. pulmonary limitations
  3. O2 extraction
  4. Neuromuscular limitations
  5. Musculoskeletal limitations
  6. Effort
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42
Q

Reduced ____ ______ is the starting point in the evaluation of reduced exercise intolerance.

A

VO2 peak

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43
Q

What is the equation for VO2?

A

Q x (arterial-mixed venous difference)

44
Q

Q = ?

A

Heart rate x stroke volume

45
Q

What is O2 carrying capacity of arterial blood determined by?

A
  1. Hb [ ]
  2. Partial pressure of O2 in arterial blood
  3. Affinity of Hb for O2 (O2 dissociation curve)
46
Q

What does muscle O2 utilization/distraction depend on?

A
  1. Capillary density
  2. Mitochondrial density and function
  3. Tissue perfusion and diffusion
47
Q

In health arterial-venous difference _______ as VO2 increases, reflecting O2 extraction.

A

widens

48
Q

Increases in VO2 are due to an increase in what two things?

A
  1. Q

2. Arterial VO2 diff

49
Q

In health, HR increases _______ with increasing VO2 and work rate.

A

linearly

50
Q

What is the formula for heart rate reserve?

A

predicted HR max - HR max

51
Q

What are two formulas for predicted HR max?

A
  1. 220-age

2. 210 - (age x 0.65)

52
Q

HR max is _______ in many patients with cardiorespiratory disease due to the disease itself of because of medication use./

A

reduced

53
Q

If a pt reaches his/her predicted HR max then this may suggest what two things?

A
  1. maximal or near maximal effort

2. that cardiovascular function may have contributed to exercise limitation

54
Q

What is the normal HR response at max?

A
  1. HR max > 90% predicted

2. HRR < 15 bpm

55
Q

SV ______ near end exercise.

A

plateaus

56
Q

What 3 things determine SV?

A
  1. EDV or pre load
  2. myocardial contractility
  3. mean arterial blood pressure or after load
57
Q

What is the formula for O2 pulse?

A

VO2 / HR

58
Q

What can be used to estimate SV?

A

O2 pulse

59
Q

And increase in O2 pulse during exercise is ________ and reflects an increase in both SV and arterial venous difference.

A

hyperbolic

60
Q

A low, unchanging O2 pules may reflect _____ SV and/or ______ arterial venous difference due to abnormal O2 extraction/utilization.

A

decrease; decrease

61
Q

Abnormalities in O2 are common (T/F).

A

FALSE

62
Q

How does SBP change with exercise?

A

increases from 120mmHg - 180-200mmHg

63
Q

If SBP does not increase then there is probably a CV limitation or abnormality of sympathetic control of BP (T/F).

A

TRUE

64
Q

The _______ ________ represents the upper limit of exercise intensity that can be accomplished aerobically and the onset of metabolic acidosis during exercise.

A

anaerobic threshold

65
Q

Anaerobic threshold is usually expressed as a % of predicted _____ ____.

A

VO2 max

66
Q

Generally, the AT should be > ___% of predicted VO2 max.

A

40

67
Q

Is AT reached in all populations?

A

No; often not in people with severe CR disease/exercise intolerance.

68
Q

What is the formula for RER?

A

VCO2/VO2

69
Q

______ can be used to estimate fuel utilization because CHO and fat differ in the VO2 and VCO2 during oxidation.

A

RER

70
Q

RER > ____ is often used as an indicator that the pt gave a good or near maximal effort during the test.

A

1.10

71
Q

_______ _______ is tightly coupled to metabolic demands

A

minute ventilation

72
Q

Tidal volume plateaus at ~ ___-___% of vital capacity.

A

60-70

73
Q

Further increase in Ve after the Vt plateau is driven by an increase in _________ _________.

A

breathing frequency

74
Q

What are two formulates for ventilatory reserve?

A
  1. Ve max/MVV%

2. MVV - Vemax (L/min)

75
Q

______ is the maximum amount of air that can be inhaled and exhaled within 60 s.

A

MVV

76
Q

What are two ways to estimate MVV?

A
  1. FEV1 x 35

2. FEV1 x 40

77
Q

A Ve max/MVV > ___-___% or MVV-Ve max < ___L/min = ventilatory limitation.

A

80-85; 11

78
Q

Would a pt with COPD have a large or small ventilatory reserve?

A

small

79
Q

_____ _______ = acute increase in end expiratory lung volume and is a compensatory strategy to overcome the flow limitation.

A

dynamic hyperinflation

80
Q

Would dynamic hyperinflation lead to an increase of decrease in IRV?

A

decrease

81
Q

Vd/Vt is an index of gas exchange efficiency of ______/______ mismatching.

A

ventilation/perfusion

82
Q

As Vd/Vt increases, gas exchange efficiency ________ and vice versa.

A

decreases

83
Q

Normal Vd/Vt at rest is ___-____.

A

0.3-0.4

84
Q

Vd at rest (mL)?

A

150mL

85
Q

Vt at rest (mL)?

A

500mL

86
Q

Normal Vd/Vt at peak exercise?

A

< 0.28

87
Q

Vd/Vt _____ during exercise before Vt increases more than Vd.

A

decreases

88
Q

Vd/Vt is _______ at rest and during exercise in cardiac and pulmonary disease vs. health.

A

higher

89
Q

Ve/VCO2 (ventilatory equivalent for CO2) is an index of _________ efficiency.

A

ventilatory

90
Q

Ve/VCO2 is closely related to what other variable?

A

Vd/Vt

91
Q

In health, Ve/VCO2 _____ early in exercise and then _______ near end exercise.

A

decreases; increases

92
Q

In health, Ve/VCO2 is

A

32-34; 36-40

93
Q

An increase in Ve/VCO2 at the AT or at peak exercise = incase in Vd/Vt = _____/_______ mismatch.

A

ventilation/perfusion

94
Q

Perceptual responses to exercise are ______ in women vs. men for any given submit exercise intensity.

A

higher

95
Q

Patient’s with COPD have a greater perception of effort at any given work rate compared to normal controls during exercise (T/F).

A

TRUE

96
Q

Strong individuals with a respiratory disease can go to higher work rates than a weak normal individual (T/F).

A

TRUE

97
Q

Normal criteria for VO2 and cycle work rate?

A

> 80-85% predicted

98
Q

Normal criteria for AT or CT threshold?

A

> 40% predicted VO2 max

99
Q

Normal criteria for HR ?

A

> 90% age predicted

100
Q

Normal criteria for HRR?

A

< 15 bpm

101
Q

Normal criteria for O2 pulse?

A

> 80% predicted

102
Q

Normal criteria for ventilatory reserve?

A

> 11L/min or <80-85% of MVV

103
Q

Normal criteria for breathing frequency?

A

< 60 breaths per min

104
Q

Normal criteria for Ve/VCO2 ratio at AT and at max?

A

<32-34 and < 36-40

105
Q

Normal criteria for Vd/Vt?

A

< 0.28

106
Q

Normal criteria for SaO2?

A

> or equal to 95% or < or equal to 4% from baseline

PHTH 527 (10 decks)

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