68 year-old female patient with exertional dyspnoea

The case

A 68-year-old female patient (BMI 20.8 kg/m2) complained of exertional dyspnoea:

• She had a history of composite graft replacement of the aortic root because of a bicuspid aortic valve with a dilated annulus 9 months ago.
• A DDD pacemaker was implanted due to postoperative atrioventricular (AV) block.
• A cardiopulmonary exercise test was performed on a treadmill using the modified Bruce protocol.

SPIROMETRY

9 PANEL PLOT OF THE CARDIOPULMONARY EXERCISE TEST

KEY PANELS

EXERCISE ECG

Test findings

The resting spirometry showed a FVC of 3.6 l (116% predicted), a FEV1 of 2.4 l (89% predicted), and a FEV1/FVC of 65%. Estimated maximum voluntary ventilation (MVV, FEV1*40) was 96 l.

Cardiorespiratory fitness was normal with a peak VO₂ of 20.5 ml/min/kg (5.9 MET, 106 % predicted) (Panel 3).

Blood pressure increased from 130/90 mmHg to 160/105 mmHg at peak exercise. Maximum respiratory exchange ratio was 1.04 (Panel 8). The patient was exhausted at the end of the test (Borg 18/20) and complained of exertional dyspnoea.

Maximum ventilation was 69 l (Panel 1). Breathing reserve ((1-VE_max/MVV)*100) was 27% (Panel 8). Respiratory efficiency, determined by the VE/VCO₂ slope was 38 (Panel 4). Peak P_ETCO₂ was 29 mmHg (Panel 9). The O₂ pulse (VO₂/heart rate) increased to 15.8 ml (199% of predicted, Panel 2). At the end of the test, a sudden drop in oxygen uptake (Panel 3) was detected.

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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations.