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Patient details

Presets
Male
Female
Non binary
Presets
Dyspnea
Presets
No significant past medical history
Presets
Does not take any medications

Exam details

Presets
Both pre- and post-exercise ABG were collected
Only pre-exercise ABG collected
No ABG was collected
Presets
Leg fatigue
Dyspnea
Chest Pain

Study parameters

Annotations
  • Oxygen consumption (VO2) at rest.
  • Normal resting VO2: Approximately 0.25 L/min (250 mL/min ± 50 mL/min).
Presets
Normal
Elevated
Annotations
  • Normal resting VO2: Approximately 0.25 L/min (250 mL/min ± 50 mL/min).
  • Select 'Normal' for VO2 within the typical range or 'Elevated' for values above the norm.
Annotations
  • Specify in Celsius (°C) or Fahrenheit (°F)
Annotations
  • VO2 max represents the maximum rate at which the body can utilize oxygen.
  • Assessment:
  • Characterized by a plateau in VO2 despite an increase in workload.
  • A VO2 max > 84% predicted is considered normal for healthy individuals.
Annotations
  • Maximum oxygen consumption attained per Body Surface Area (BSA).
  • Normal values are > 20 mL/kg/min (with a range of 20-30).
Annotations
  • Predicted maximum oxygen consumption.
Annotations
  • The ratio of the attained maximum oxygen consumption (VO2 max) to the predicted maximum oxygen consumption, expressed as a percentage.
Presets
Yes
No
Annotations
  • The Anaerobic Threshold (AT) marks the onset of anaerobic energy production during intense exercise.
  • Key Insights on AT:
  • Exercise raises both oxygen uptake (VO2) and carbon dioxide production (VCO2) in active muscles, observable through the analysis of exhaled breath's gas composition.
  • Exercise produces alveolar recruitment, enhancing gas exchange efficiency per volume of exhaled air (i.e: progressively lower VE/VO2 and VE/VCO2 ratios).
  • With sustained exercise, aerobic metabolism is insufficient for energy production and thus relies on anaerobic metabolism for energy, leading to the production of lactic acid.
  • Initially, bicarbonate neutralizes lactic acid, leading to increased CO2 removal in the alveoli (isocapnic buffering phase).
  • As exercise continues, excess lactic acid causes CO2 to build up in the blood, triggering more rapid breathing to stabilize blood pH (Ventilatory Threshold).
  • Methods to Assess AT:
  • V-slope method: Detects AT by analyzing the change in the slope between VCO2 and VO2.
  • Lactic acid buildup increases CO2 in the exhaled gas (VCO2), as CO2 comes from both aerobic utilization and lactic acid buffering.
  • Ventilatory Equivalent method: Identifies AT using the lowest VE/VO2 ratio point (nadir).
  • Before AT: Increased alveolar recruitment causes VE/VO2 and VE/VCO2 ratios to decrease during exercise (improved efficiency).
  • At AT: Lactic acid production increases CO2 elimination needs, raising VE and consequently the VE/VO2 ratio.
Annotations
  • Measures oxygen usage at the Anaerobic Threshold (AT), indicating the transition point where lactate begins to accumulate faster than it can be removed.
  • For most individuals, AT occurs at 50% to 60% of VO2 max, though it can range from 40% to over 80%, reflecting variations in aerobic fitness and endurance training levels.
  • Assessment:
  • The normal value is > 40% of the predicted maximum VO2.
Annotations
  • Heart rate at the point of maximum oxygen consumption (VO2 max).
  • HR is the primary driver for boosting cardiac output at higher work rates.
Annotations
  • Independent of fitness but declines with age (~10 beats/min per decade).
  • Maximum heart rate can be estimated as 220 - Age in years, with a standard deviation of ≥10 beats/min.
Annotations
  • Respiratory Exchange Ratio (RER) at rest.
  • RER is the ratio of Carbon Dioxide produced to Oxygen consumed.
  • Measured at the mouth, used as a surrogate of the Respiratory Quotient (RQ) - the cellular level ratio of CO2 production to O2 consumption.
Annotations
  • Respiratory Exchange Ratio (RER) at peak exercise.
  • Measured at the mouth, used as a surrogate of the Respiratory Quotient (RQ) - the cellular level ratio of CO2 production to O2 consumption.
Annotations
  • Subjective rating of perceived exertion at peak exercise.
Presets
The heart rate increased appropriately with exercise.
The heart rate response to exercise was blunted.
Annotations
  • Assessment:
  • Visualize the Heart Rate curve during exercise (it should increase with workload).
Annotations
  • Oxygen Pulse at peak exercise.
  • Represents the amount of oxygen extracted from the blood with each heartbeat.
Annotations
  • Maximum predicted oxygen pulse.
Annotations
  • The ratio of the attained oxygen pulse to the predicted maximum oxygen pulse, expressed as a percentage.
  • Normal values are ≥ 80% of the predicted maximum oxygen pulse.
Presets
Limited electrocardiographic recording did not reveal signs of ischemia or arrhythmia.
NA: No ECG was obtained.
Annotations
  • Any observed ECG abnormalities during the exercise test.
Presets
The blood pressure response to exercise was normal.
There was a hypertensive response to exercise.
Annotations
  • Assess by inspecting the blood pressure curve during exercise.
  • Systolic pressure typically increases significantly more than diastolic pressure.
  • A decrease in systolic and pulse pressures with increasing work rate suggests significant cardiac dysfunction and are a signal to stop the exercise test.
Presets
NA: ABGs were not obtained
Annotations
  • Acid base status of the available Arterial Blood Gases (both pre- and post-exercise).
Presets
The PaO2 was normal at rest and during exercise.
The PaO2 was normal at rest and abnormal during exercise.
The PaO2 was normal at rest.
NA: ABGs were not obtained
Annotations
  • PaO2 measures arterial blood oxygen levels, directly influenced by the amount of oxygen in the alveoli (PAO2).
  • Ideally, in a perfectly functioning lung, PAO2 should approximate 100 mm Hg (assuming optimal ventilation-perfusion balance, absence of diffusion barriers, a respiratory quotient of 0.8, and arterial CO2 pressure maintained at 40 mm Hg.)
  • Assessment:
  • A PaO2 ≥ 90 mmHg during moderate exercise at sea level is considered normal.
Annotations
  • Maximum minute ventilation (VE) attained during exercise.
  • Measures the maximum volume of air inhaled and exhaled in one minute.
Annotations
  • Maximum Voluntary Ventilation (MVV) is the volume of air that can be breathed per minute at rest with maximal effort.
  • Assessment:
  • Can be directly measured using spirometry.
  • Can be estimated as 35 times the FEV1.
Presets
The tidal volume increased appropriately with exercise.
The tidal volume response to exercise was flat.
Annotations
  • Assessment of the tidal volume response to exercise.
  • Assess by inspecting the tidal volume curve during exercise.
Presets
The ventilatory response to exercise was normal.
The ventilatory response to exercise was abnormal.
NA: no post exercise ABG.
Annotations
  • Proportion of Dead Space ventilation (VD) per Tidal Volume breath (VT) at rest, expressed as a percentage.
Annotations
  • Proportion of Dead Space ventilation (VD) per Tidal Volume breath (VT) at peak exercise, expressed as a percentage.
Presets
The efficiency of gas exchange was normal at rest and during exercise.
The efficiency of gas exchange was normal at rest and abnormal during exercise.
The efficiency of gas exchange was abnormal at rest and during exercise.
NA: no ABGs were taken.
Annotations
  • Calculate A-a gradient (both at rest and peak exercise).
Presets
The VE/VCO2 slope was normal.
The VE/VCO2 slope was abnormal
Annotations
  • The VE/VCO2 Slope represents the efficiency of ventilation in relation to carbon dioxide (CO2) production during exercise.
  • VE: Volume of air ventilated per minute.
  • VCO2: Volume of CO2 produced per minute.
  • Interpretation:
  • Plotted with VE on the y-axis and VCO2 on the x-axis.
  • A lower slope (<30) suggests efficient ventilation: less air is needed to expel CO2.
  • A higher slope (>34) indicates inefficient ventilation: more air is required to expel the same amount of CO2.
  • Normal Range: <30 - 34, indicating optimal ventilation efficiency.
Presets
Intra-exercise flow-volume loops did not demonstrate the presence of dynamic hyperinflation.
Intra-exercise flow-volume loops demonstrated the presence of dynamic hyperinflation.

Study interpretation

Report