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55 year-old male amateur athlete with palpitations during bike rides

Cardiopulmonary Exercise Testing case by Matthias Wilhelm, MD, FESC, Dept. of Cardiology, University Hospital of Bern, Switzerland


Case description

  • This male amateur athlete (55 years, BMI 23.15 kg/m2) presented with palpitations during bike rides
  • He described a rapid increase in heart rate up to 210 bpm, documented by his training monitor, associated with a feeling of loss of performance.
  • The patient has a history of mitral regurgitation secondary to a mitral valve prolapse of the posterior leaflet, for which he underwent mitral valve reconstruction one year ago.
  • The patient used to exercise 3 times per week for 2 to 4 hours per session (skiing and biking). Currently he is not on any medication.
  • A recently performed 24-hour ambulatory ECG revealed some premature ventricular beats.
  • A transthoracic echocardiography showed mildly dilated atria and ventricles, a normal left ventricular ejection fraction and a good mitral valve function without relevant regurgitation.
  • The family history includes a sudden cardiac death of a brother at the age of 57 years.
  • A cardiopulmonary exercise test was performed for further investigation.

Test findings

  • The 9-plot analysis documented an above-average exercise capacity with 278 Watt (135 % predicted), and a peak VO2 of 38 ml/min/kg (120 % predicted) (Panel 3).
  • The O2 pulse (VO2/heart rate) (Panel 2) increased to above average values with a sudden drop at the end of the test. VO2 increased parallel to the work load with a sudden drop at the end of the test (Panel 3).
  • Exercise ECG revealed a sudden increase in heart rate at the end of the test but no exercise-induced ischemia. Blood pressure increased gradually from 130/80 mmHg at rest to 195/80 mmHg at peak exercise.
  • There were no pathologic findings with regard to respiratory efficiency (VE/VCO2 slope, Panel 4), PETCO2 progress (Panel 9), breathing reserve (Panel 8) and resting pulmonary function test.

 ECG during exercise

Test your knowledge


Suggested readings:

Principles of Exercise Testing and Interpretation
Wasserman et al.
Lippincott Williams & Williams 2005.


Of interest:
Other Cardiopulmonary Exercise Testing cases


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