Cardiopulmonary Functional Capacity Research Articles

Cardiopulmonary Function and Exercise Capacity in Adolescents with Ventricular Septal Defect

Ventricular septal defect (VSD) is the most common defect (50%) among children diagnosed with pediatric congenital heart disease. This study aimed to evaluate the differences of cardiopulmonary function and exercise capacity between normal adolescents and adolescents with VSDs. A cardiopulmonary exercise stress test was performed for the experimental subjects (n = 45) and control subjects (n = 44). The results of the pulmonary function test showed no variation on forced vital capacity (FVC) or forced expiratory volume in one second (FEV1). Neither statistical differences in maximum voluntary ventilation (MVV) nor FEV1/FVC were noticed. In contrast, healthy participants showed significantly higher maximum heart rate compared to adolescents with VSDs, but no significant differences were found in maximal METs and maximal systolic blood pressure. In conclusion, adolescents with VSDs have a normal cardiopulmonary function and exercise capacity, despite a mild chronotropic limitation. We recommend adolescents with VSDs should be encouraged as receive appropriate exercise training, and can participate in sports competitions in order to enhance the quality of life in the future.

21-day Balneotherapy Improves Cardiopulmonary Function and Physical Capacity of Pilots

[Purpose] The purpose of this study was to investigate the effects of balneotherapy on the cardiopulmonary function and physical capacity of pilots. [Subjects] Thirty-six healthy male pilots were recruited. [Methods] All subjects received entire-body immersion bath therapy in thermomineral water for 30 min a day for 21 days. Electrocardiograms, carotid pulse traces, and phonocardiograms were recorded using a cardiac function measuring device. Pulmonary function tests were performed using a Pony FX spirometer. The physical capacity of pilots was examined 1 day before and after balneotherapy. [Results] After 21 days of treatment, isovolumetric contraction time and the ratio of isovolumetric contraction time/left ventricular ejection time were reduced. Forced vital capacity, peak expiratory flow, the ratio of forced expiratory volume in 1 second/ forced expiratory volume and forced expiratory flow at 25–75% were elevated. The exercise numbers of pull-ups and sit-ups in 1 min were boosted. [Conclusion] The findings imply that balneotherapy for 21 days has a significant effect on the cardiopulmonary function and physical capacity of pilots.

PERIOPERATIVE CARE OF ELDERLY SURGICAL PATIENTS

Advancing age is characterized by functional impair ment of the many regulatory processes that provide integration between organs and therefore, may lead failure to maintain homeostasis under conditions of physiological stress. There are two main factors he lping to identify the high risk for surgery. The fi rst relates to the type of surgery and the second to th e scope of cardiopulmonary functional capacity of t he patient. There are major cardiovascular, respirator y, renal and musculoskeletal changes in elderly pat ients. Preoperative assessment of risk in elderly patients must consider patient factors, the surgical proble m and the treatment options. Medical co-morbid conditions are common with age and may markedly increase the risks associated with surgical intervention. Postop erative care of elderly includes respiratory Care, renal function and fluid and electrolyte management, card iovascular Care, management of pain and maintenance of function. In conclusion, health providers should pay attention to the quality of care in elderly pa tients because they are vulnerable surgical and anaestheti c stress. Minimizing perioperative risk in those pa tients requires thoughtful preoperative assessment of orga n function and reserve, meticulous intraoperative management and postoperative care. Management of surgical elderly patients is both complex and different from younger patients. Assessment of the surgical proble ms and physiologic status of elderly persons must t ake into account the changes associated with advancing age, changes in the incidence, prevalence and natural hi story of certain disease processes; and the increased likeli hood of multiple medical diagnoses and polypharmacy.

Impact of training at ventilatory threshold on cardiopulmonary and functional capacity in overweight patients with chronic kidney disease

Chronic kidney disease (CKD) and obesity are both associated with reduced physical capacity. The potential benefit of aerobic training on physical capacity has been recognized. The exercise intensity can be established using different methods mostly subjective or indirect. Ventilatory threshold (VT) is a direct and objective method that allows prescribing exercise intensity according to individual capacity. To evaluate the impact of aerobic training at VT intensity on cardiopulmonary and functional capacities in CKD patients with excess of body weight. Ten CKD patients (eight men, 49.7 ± 10.1 years; BMI 30.4 ± 3.5 kg/m², creatinine clearance 39.4 ± 9.8 mL/min/1.73 m²) underwent training on a treadmill three times per week during 12 weeks. Cardiopulmonary capacity (ergoespirometry), functional capacity and clinical parameters were evaluated. At the end of 12 weeks, VO2PEAK increased by 20%, and the speed at VO2PEAK increased by 16%. The training resulted in improvement in functional capacity tests, such as six-minute walk test (9.2%), two-minute step test (20.3%), arm curl test (16.3%), sit and stand test (35.7%), and time up and go test (15.3%). In addition, a decrease in systolic and diastolic blood pressures was observed despite no change in body weight, sodium intake and antihypertensive medication. Aerobic exercise performed at VT intensity improved cardipulmonary and functional capacities of overweight CKD patients. Additional benefit on blood pressure was observed. These results suggest that VT can be effectively applied for prescribing exercise intensity in this particular group of patients.

Invited Commentary

Invited Commentary

Cardiopulmonary assessment in primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a rare, usually autosomal recessive disorder of ciliary dysfunction associated with lung involvement, which has a great impact on health. There is limited information concerning the aerobic fitness of children and adolescents with PCD. The aim of this study was to assess cardiopulmonary functional capacity and its relationship with pulmonary function and physical activity (PA) levels in patients with PCD. Ten patients with PCD (age 13·2 ± 2·8 years) underwent spirometry and cardiopulmonary exercise testing. PA was investigated through a questionnaire. Eight age- and body mass index-matched healthy children were enrolled as controls. Main variables were forced expiratory volume at 1 s, peak oxygen uptake (VO(2peak) ) and time spent in PA. Forty per cent of patients with PCD had impaired lung function as expressed by FEV(1) < 85% predicted. Only patients with impaired lung function exhibited reduced VO(2peak) (18·1 ± 7·9 mL/kg/min). Time spent in total daily PA was slightly lower in patients than controls, with no difference between patients with normal or reduced lung function. In multiple regression models, male gender (β = 0·518, P = 0·018), age (β = 0·752, P = 0·035) and time spent in vigorous PA (β = 0·353, P = 0·049) were independent predictors of aerobic fitness. Assessment of resting pulmonary function and cardiopulmonary functional capacity could contribute to the evaluation of pulmonary impairment in PCD. Given the benefit of physical exercise on airway clearance and on general health and quality of life, patients with PCD should be encouraged to adopt an active lifestyle.

From limitation to mastery: exercise experience for adolescents with mild congenital heart disease

To describe the subjective experience of engaging in exercise for adolescents with mild congenital heart disease (CHD). Most children with mild CHD are now expected to survive to adolescence and even into adulthood. With early intervention, cardiopulmonary function and exercise capacity in most are comparable to those of normal peers. However, the exercise behaviours of these adolescent patients and their determinants remain largely undefined. A descriptive phenomenological design was used. Eight adolescents with CHD who perceived no or only mild symptoms after engaging in exercise were individually interviewed using a semi-structured interview. Interviews were transcribed and non-verbal communication recorded within 24 hours of the interview. Transcriptions were analysed and perceptions and attitudes grouped according to theme expressed. The essence of the adolescents with mild CHD engaging in exercise was from limitation to mastery. Four themes emerged: (1) self-awareness: understanding the limitations of their disease and its impact on exercise; (2) perception: focusing on strengths and admitting limitations; (3) transcendence: developing coping strategies and maintaining balance; and (4) living with the disease: mastering oneself and living a normal life. The findings indicated that, when adolescents faced and accepted their exercise limitation, they would assess their condition, develop coping strategies from their accumulated experience and participate in exercise to maintain a healthy body and mind. The findings provide a scientific knowledge base for nursing professionals to instruct adolescents with mild CHD in exercise and help families build the confidence of these adolescents.

E0367 Effect of treatment of hepatocyte growth-promoting factor on improvement of myocardial ischaemia and cardiopulmonary functional capacity during the exercise in patients with severe coronary heart disease

ObjectiveTo test the hypothesis that the treatment of hepatocyte growth-promoting factors (pHGF) by venous injection improves myocardial ischaemia, kinetics of oxygen uptake (VO2) and cardiopulmonary functional capacity during exercise in...

The Effects of Short Term Beta-Blockade on Exercise Capacity and Left Ventricular Function in Elderly Patients with Heart Failure

Exercise capacity is correlated with overall cardiac beta receptors density, but effects of ß blockers on exercise ability and capacity in elderly patients with HF remains unclear. In present study we estimated the impact of ß blockers therapy on cardiopulmonary functional capacity and LV function in elderly patients with HF. Methods: Thirty consecutive patients aged over 65 with clinical existence of systolic HF treated with ß blockers during 8 weeks. All patients were in NYHA class II-III. Cardiopulmonary exercise testing (CPET) were performed according to a submaximal test protocol before therapy and after 12 week follow up.

6 Minute Walk Test Outcomes in Sickle Cell Disease

The six-minute walk test (6MWT) is a standardized test use to measure patient cardiopulmonary functional capacity. It is been increasingly used as a measure of overall “functional ability” in chronically ill subjects. The frequent occurrence in sickle cell disease (SCD) of complications such as severe anemia, hypoxemia, and avascular necrosis (AVN) raises questions regarding the capacity of this patient population to perform the 6MWT adequately. This study prospectively evaluated the performance of SCD patients enrolled in a longitudinal prospective study evaluating pulmonary hypertension (pHTN) natural history in a 6MW test. The 6MWT was performed in adult patients with SCD, at steady state. The following 6MWT variables were analyzed: Hemoglobin (Hb) diagnosis, age, Hb level, gender, heart rate (HR) at rest and maximum predicted rate at exercise, distance walked (DW), and percentage (%) of predicted distance walked (%PDW), pulse oxymetry (O2Sat) at rest and at exercise, Wellness scale, Borg scale, reason for resting, and physical limitations in performing the test. In addition, pHTN was evaluated by 2D echo. Patients with a TR jet ≥2.5 m/s were considered to have pHTN. Data from 52 adults (≥ 18 yr, 21 females) were collected and analyzed. Thirty-two (62%) had Hb SS, 13 Hb SC, 6 Hb Sβ+Thal, and 1 Hb SδβThal. TR jet was measurable in 41 patients, and 16 of them (39%) had a TR jet ≥2.5 m/s (range 2.5 – 4.7). Mean age of subjects was 36.5 ± 12.6. Females were older than males. (41.3 ± 2.8 vs. 33.7 ± 2.0; p=0.03). The mean distance walked by all patients was 463.6 meters ± 99.2 (minimum 142, maximum 658). The mean %PDW was 72.07% ± 20.75, range: 24 to 146%. There was no statistical difference in the DW when the different HbS genotypes were compared. As expected, the mean DW was higher in males than females (488 ± 14.4 vs. 427.4 ± 25.1 meters, p<0.5). No gender-related differences were observed in Hb levels (9.4 ± 0.34 and 9.9 ±0.4 for females and males respectively), resting and exercise heart rate, or on the Wellness scale. The mean HR at rest was 75 bpm ± 12; while it was 127 bpm ± 20 at exercise. As anticipated, the HR difference between rest and exercise was statistically significant (p<0.0001, r2= 0.88); when analyzed by gender, this difference remained significant. Mean O2Sat at rest was 98% (SD 1.8, range 93–100%). The mean O2Sat at exercise was 94.9 (SD 3.7, range 82–100%). O2Sat difference between rest and exercise was statistically significant (p<0.0001, 95% CI 2.0 to 3.7, r2= 0.47). No differences were observed when oxygenation was analyzed by gender. Percentage distance walked only correlated with oxygenation at rest (p<0.05; CI 0.00 to 0.52) but not with HR at rest or Hb when data for all patients were evaluated. When only the patients with a measurable TR jet were analyzed, %PDW directly correlated with Hb and inversely correlated with TR jet. Three patients performed the test with supplemental O2. In one patient, the supplemental O2 requirement increased from 2L to 4L during exercise. The Wellness scale scores in the study population ranged from 2 – 5, mean 2.8 ± 0.5. The Borg Dyspnea scale scores ranged from 0.5 to 5, mean 2.20 ± 1.2. The average Borg scale score was found to be lower in males (1.7 ± 1.0) vs. females (2.750 ± 1.4), and that difference was statistically significant (p=0.025). Only one patient required rest during the test due to dyspnea, and 2 patients had physical limitations (one walked with a cane and the other one walked with a limp). No adverse events or arrhythmias were observed during the 6MWT. We conclude that the 6MWT can be efficiently performed by SCD patients. Baseline O2Sat, Hb level and pHTN correlated with a shorter 6-minute walking distance percentage in SCD patients.

Cardiovascular risk in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous disease affecting about 5-10% of reproductive-age female population, which is predominantly characterized by chronic anovulation, hyperandrogenism and insulin resistance. PCOS women represent an intriguing biological model illustrating the relationship between hormonal pattern and cardiovascular risk profile, presenting a cluster of cardiovascular features, such as obesity, insulin resistance, hypertension, impaired cardiopulmonary functional capacity, autonomic dysfunction and low-grade chronic inflammation. Metabolic syndrome should be also considered in the clinical evaluation and management of PCOS. The treatment of PCOS and its complications should not be based solely on pharmacological therapies trying to improve hyperandrogenism, hyperinsulinemia and insulin resistance. Although mounting evidence recognizes the beneficial effects of lifestyle modifications, the clinical management of PCOS is not sufficiently focused on long-term maintenance of both exercise and dietary interventions and on further aspects of this syndrome (i.e. psychological status). Taking into consideration the patients' young age and the devastating effects of PCOS on hormonal and metabolic pattern, this complex and multifaceted disease requires a comprehensive approach in order to achieve concrete beneficial effects for PCOS patients. Multidisciplinary programs, including dietary and educational counseling, exercise training, stress management and psychosocial support, might represent the gold standard for adequate reduction of cardiovascular risk in young women with PCOS.

Left ventricular remodelling in patients with moderate systolic dysfunction after myocardial infarction: favourable effects of exercise training and predictive role of N-terminal pro-brain natriuretic peptide

To investigate the effects of exercise training (ET) on left ventricular (LV) volumes, cardiopulmonary functional capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in postinfarction patients with moderate LV dysfunction. Sixty-one postinfarction patients were randomized into two groups: group T [n=30, LV ejection fraction (EF) 41.6+/-11.3%, mean+/-SD] entered a 6-month ET programme, whereas group C (n=31, EF 42.0+/-7.6%, P=NS) did not. NT-proBNP assay, Doppler-echocardiography and cardiopulmonary exercise test were performed upon enrolment and at sixth months. At sixth months, trained patients showed an improvement in workload (+26%, P<0.001), Vo2peak (+31%, P<0.001), LV end-diastolic volume index (LVEDVI; -9%, P<0.001), a reduction in NT-proBNP (-71%, P<0.001) and a significant correlation between changes in NT-proBNP and in LVEDVI (r=0.858, P<0.001). Baseline NT-proBNP correlated with changes in LVEDVI in both trained (r=0.673, P<0.001) and untrained (r=0.623, P<0.001) patients. Group C showed unfavourable LVEDVI dilation (+8%, P<0.001; T vs. C group, P<0.001) and a smaller reduction in NT-proBNP (-40%, P<0.001; T vs. C group, P<0.001). Six month ET induced a favourable LV remodelling and a marked fall in NT-proBNP that could predict LV remodelling in postinfarction patients with moderate LV dysfunction.

Beneficial Effects of a Three-Month Structured Exercise Training Program on Cardiopulmonary Functional Capacity in Young Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is an endocrine disease closely related to several risk factors for cardiovascular disease. An impaired cardiopulmonary functional capacity was previously demonstrated in PCOS women. No data regarding the effects of a structured exercise training (ET) program on cardiopulmonary functional capacity in PCOS women are available. Our objective was to evaluate the effects of a 3-month ET program on cardiopulmonary functional capacity in young PCOS women. A prospective baseline-randomized clinical study was conducted at the University "Federico II" of Naples, School of Medicine (Italy). Ninety young overweight PCOS women were enrolled. Ninety young PCOS women were randomly subdivided into two groups, each composed of 45 subjects. The PCOS-T (trained) group underwent a 3-month structured ET program, whereas the PCOS-UnT (untrained) group did not. Hormonal and metabolic profiles and cardiopulmonary and exercise parameters were evaluated. After 3-month ET, PCOS-T showed a significant improvement in peak oxygen consumption (+35.4%; P<0.001) and in maximal workload (+37.2%; P<0.001). In PCOS-T we also observed a significant reduction in body mass index (-4.5%; P<0.001) and in C-reactive protein (-10%; P<0.001), and a significant (P<0.001) improvement in insulin sensitivity indexes. After 3 months, no changes were observed in PCOS-UnT. A 3-month structured ET program improves cardiopulmonary functional capacity in young PCOS women.

Cardiopulmonary Impairment in Young Women with Polycystic Ovary Syndrome

Insulin resistance is a feature of polycystic ovary syndrome (PCOS), and it is related to mitochondrial function, particularly with maximal oxygen consumption (VO(2max)). At the moment, no evaluation of cardiopulmonary functional capacity in young patients with PCOS has been performed. Our objective was to assess cardiopulmonary functional capacity in young PCOS overweight patients. We conducted a prospective baseline-controlled clinical study at University Federico II of Naples, School of Medicine (Naples, Italy). Forty-five PCOS patients were matched with 45 healthy women for age (mean +/- sd, 21.3 +/- 2.0 vs. 21.6 +/- 1.9 yr, respectively) and body mass index (29.4 +/- 3.6 vs. 29.0 +/- 3.4 kg/m(2), respectively). We assessed hormonal and metabolic pattern and functional capacity by cardiopulmonary exercise testing to evaluate maximal oxygen consumption (VO(2max)), oxygen consumption at anaerobic threshold (VO(2AT)), and the maximal workload at peak exercise. VO(2max) (17.0 +/- 3.7 vs. 26.8 +/- 3.5 ml/kg.min), oxygen consumption at anaerobic threshold (13.9 +/- 3.0 vs. 21.2 +/- 3.8 ml/kg.min), and maximal workload at peak exercise (101.3 +/- 25.2 vs. 135 +/- 22.6 W) were significantly (P < 0.001) reduced in PCOS subjects compared with healthy women. The multiple linear regression analysis showed that only homeostasis model assessment appears to have a strong negative linear relation with VO(2max) in PCOS. No relation was found in controls. Our data demonstrate a reduced cardiopulmonary functional capacity in young PCOS patients.

A study of cardiopulmonary function and working capacity of sojourners acutely exposed to different altitude levels in Ethiopia

Forced vital capacity (fvc, L/sec), forced expiratory volume (fev1, L/sec), fev1%, forced expiratory flow rate (fef 200—1200 ml,. L/sec), forced mid-expiratory flow rate (fmf 25—75 %, L/sec), peak expiratory flow rate (pefr, L/min), minute ventilation (ve, L/min), oxygen saturation of arterial blood (SaO2%), working capacity (Kgm/min/m2 body surface area), pulse rate (beats/min) and arterial blood pressure (mmHg) were studied in eight male sojourners descending to 1370—490 m and ascending to 2550—3300 m from their altitude of residence (2440 m). Of the lung function indices, mean fef 200—1200 ml increased from 6.54 L/sec at 2440 m to 7.18 L/sec and 8.33 L/sec, respectively, at 2550 m and 3100 m. It was not measured at 3300 m for lack of electric power supply. Mean values of fef 200—1200 ml were found to be correlated to the altitudes of investigation significantly (r=0.7316). The increase in fef 200—1200 ml probably reflects that large airways tend to open up more widely perhaps concomitant with enlargement of alveolar spaces at 2550 m and above to compensate for the reduced pao2 and reduced O2 uptake. Mean ve showed a 4—5-fold increase with exercise essentially at all levels of altitude. Acute altitudinal effect became quite evident at 3300 m. At rest, ve increased from 5.62 L/min at 2440 m to 7.78 L/min at 3300 m. During exercise, increase in ve with ascent apparently protects the low O2 saturation (91.9% at rest and 86.9% in this study). Although the mean of exercise ve was markedly increased only at 3300 m, its overall correlation with altitude (r=0.6698) and mean working capacity (r=-0.6426) was quite significant (two-tailed P=0.0236). SaO2% was found to be correlated with mean (r=0.7955) and individual measurements (r=0.7628) of working capacity. Mean working capacity was reduced by about 20% with ascent and increased by about 9% with descent. It was negatively correlated with ascent (r=-0.9101). This signifies that physical performance is quite limited by hypoxia with ascent. Mean pulse rate, which was 75 beats /min at 2440 m increased to 82 beats/min at 490 m. It decreased to 72 beats/min at 3300 m. This is probably attributable to the decrease in ambient temperature and relative humidity with ascent and to the increase with descent. Arterial blood pressure (mean systolic/diastolic) was found to be 100.1 / 62.13 mmHg at 2440 m, 93.1/59.4 mm Hg at 490 m, 99.6/59.4 at 1370 m and 101.46—102.5/62.5—63.1 mmHg at 2550–3300 m. This pattern of change seems to be attributable to changes in peripheral vascular resistance which is apparently secondary to changes in ambient temperature and relative humidity. One of the sojourners experienced only generalised fatigue. This suggests that physiological alterations occurring at 3300 m cannot apparently induce acute mountain sickness in residents of medium altitude. Key words/phrases: Cardiopulmonary functions, high altitude, Sojourners, working capacity SINET: Ethiopian Journal of Science Vol.25(1) 2002: 71-82

Cardiac risks of hyperthyroidism in the elderly.

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation (AF) may dominate the clinical picture and mask the more classic endocrine manifestations of the disease. Impaired cardiopulmonary function and exercise capacity, significantly more marked in older patients, is observed in hyperthyroidism. Thyrotoxicosis can aggravate pre-existing heart disease and can also lead to AF, congestive heart failure, or worsening of angina pectoris. Regarding the high incidence of AF in older patients with hyperthyroidism, it is also important to detect subclinical hyperthyroidism in older patients with AF, thus warranting the measurement of the serum thyrotropin (TSH) concentration for early recognition and treatment. Most cardiac abnormalities return to normal once a euthyroid state has been achieved, although AF may persist in a minority. Optimal treatment requires rapid and definitive antithyroid therapy. Furthermore, anticoagulation is recommended for thyrotoxic patients with AF older than 50 years, those who have histories of previous emboli, hypertension, or with echocardiographic evidence of left atrial enlargement and/or myxomatous valves.

Are the patients who become organ donors under the Pittsburgh protocol for "non-heart-beating donors" really dead?

The University of Pittsburgh Medical Center (UPMC) "Policy for the Management of Terminally Ill Patients Who May Become Organ Donors after Death" proposes to take organs from certain patients as soon as possible after expected cardiopulmonary death. This policy requires clear understanding of the descriptive state of the donor's critical cardiopulmonary and neurologic functional capacity at the time interventions to sustain or harvest organs are undertaken. It also requires strong consensus about the moral and legal status of the donor during dying and confirmation of death. There has been no need for the clarity and precision that this policy relies upon, and thus the needed research and conceptual work has not previously been generated. The empiric base and societal consensus are both too frail to provide justification for this policy at this time.

Estimation of cardiopulmonary functional capacity by means of oxygen debt studies

The response of forty-five persons with, or without, cardiac, pulmonary and combined cardiopulmonary disease to a modified stairclimbing exercise test has been studied, and the “oxygen debt” measured. The results have been compared with those of other types of function tests, and the limitations of interpretation pointed out. Although the series of cases is small, the results indicate that the test is important as an objective method of evaluating diminution in cardiopulmonary reserve.

THE ESTIMATION OF CARDIAC FUNCTION BY SIMPLE CLINICAL METHODS

Article1 January 1937THE ESTIMATION OF CARDIAC FUNCTION BY SIMPLE CLINICAL METHODSEMANUEL MESSINGER, A.B., M.D.EMANUEL MESSINGER, A.B., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-10-7-986 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe problem of determining the functional impairment, or conversely the cardiac reserve of ambulatory cardiac patients has always been a baffling one. Even with the use of all our modern laboratory adjuncts—the fluoroscope, roentgen-ray measurements of the heart, and lastly the electrocardiogram, in addition to all available clinical methods, one is often at a loss to decide just where in the scale of impairment of cardiovascular function a particular patient belongs. This difficulty of course arises chiefly in the case of the strictly ambulatory cardiac patient, since those patients who show evidences ofdecompensationeither at rest or after moderate... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: St. Cloud, Minnesota*Received for publication September 14, 1936.Published with the permission of the Medical Director of the Veterans Administration, who assumes no responsibility for the opinions expressed or the conclusions drawn by the writer. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEstimation of cardiopulmonary functional capacity by means of oxygen debt studies 1 January 1937Volume 10, Issue 7Page: 986-999KeywordsElectrocardiographyHeartResearch laboratories Issue Published: 1 January 1937 PDF downloadLoading ...