CPET

Question 1

What does the CPET measure?

Answer 1

Simultaneous measurement of cardiovascular and ventilatory systems during exercise

Question 2

What is assessed breath by breath?

Answer 2

gas exchange and ventilation

Question 3

What can a CPET show?

Answer 3

The cause of exercise limitation

Question 4

What are the aims of a CPET?

Answer 4

-diagnose cardiopulmonary disease
-grade severity of disease
-quantify exercise capacity and establish cause of limitation
-provide prognostic info
-assess response to clinical therapy
-identify and optimise therapeutic intervention

Question 5

What are the indications for CPET?

Answer 5

-evaluation of exercise limitation
-unexplained dyspnea
-evaluation with known CV/ resp disease
-preop
-exercise prescription for rehab
-evaluation of disability
-assessment for transplant

Question 6

What are some common referrals for a CPET?

Answer 6

-baseline assessment
-?transplant
-?time for valve repair
-increasingly symptomatic
-?athletic heart

Question 7

Advantages of bike?

Answer 7

-have work rate measurement
-blood gas collection easy
-less artefact
-safer
-less weight bearing
-require less leg muscle training
-more appropriate for patients.

Question 8

What type of protocols can you have for CPET?

Answer 8

Incremental and ramp

Question 9

What is the equipment used for CPET?

Answer 9

-ventilation mask
-ECG
-BP cuff
-oximeter on ear
-bike

Question 10

How to prepare for CPET?

Answer 10

-assess if supervision needed
-crash trolley
-previous CPET?
-other recent tests?
-medications?
-equipment check
-conditions are appropriate

Question 11

What needs to be done to the equipment before the test?

Answer 11

Calibration - air flow, gas concentration and conditions (barometric pressure)

Question 12

How to prep the patient for CPET?

Answer 12

-height and weight
-consent
-history
-ECG baseline
-adjust pedals so comfortable for patient
-fit mask so no leak

Question 13

How many mins exercise aiming for with ramp protocol?

Answer 13

8-12 minutes

Question 14

How many mins is rest period for ramp?

Answer 14

2-3 mins

Question 15

What is the equation for work rate(W)?

Answer 15

W= (pred VO2 max-VO2 unloaded)/103

Question 16

Why is spirometry used before CPET?

Answer 16

-estimates predicted MVV
-causes of symptoms
-contraindications
-reproducible efforts
-SOPS

Question 17

What resting values should you check?

Answer 17

ECG, SpO2, HR and BP (see if they’ve changed)

Question 18

What is the respiratory exchange ratio (RER)?

Answer 18

0.7-1.0

Question 19

What can RER be influenced by?

Answer 19

Diet and metabolism

Question 20

What is the textbook value for VO2?

Answer 20

3.5ml/min/kg

Question 21

What is the absolute value of VO2/VCO2?

Answer 21

> 0.2 L

Question 22

What is the BORG scale used for?

Answer 22

to assess breathlessness and leg fatigue throughout the test

Question 23

What is the termination criteria for CPET?

Answer 23

-angina (>2mm ST depression with symptoms, 3mm ST depression without symptoms)
-arrhythmia
-fall in systolic BP >20mmHg
-hypertension >250mmHg systolic and >120mmHg diastolic
-desaturation (<80%)
-loss of coordination
-mental confusion
-dizziness

Question 24

What is meant by peak VO2?

Answer 24

Maximum volume of O2 the body can utilise during physical exertion

Question 25

How is VO2 expressed?

Answer 25

Absolute (ml/L) or relative (ml.min.kg)

Question 26

What is the Fick equation?

Answer 26

VO2= (SVxHR) x (CAO2-CVO2)

Question 27

What is the anaerobic threshold (lactate threshold)?

Answer 27

Normally 50-60% of predicted VO2 max But wide range of normals (35-80%)

Question 28

How does VO2 increase?

Answer 28

Linearly as external work increases

Question 29

What does the slope reflect?

Answer 29

Efficiency of metabolic conversion of chemical potential energy to mechanical work

Question 30

What is the normal value of VO2/work rate?

Answer 30

10.4 ml.min/W

Question 31

What does an RER of >1 indicate?

Answer 31

metabolism of primarily carbohydrate (high intensity exercise)

Question 32

What does RER of 0.7 indicate?

Answer 32

metabolism of primarily fat (rest/ low intensity exercise)

Question 33

What does RER of >1.15 indicate?

Answer 33

Maximal effort

Question 34

What does oxygen pulse reflect?

Answer 34

-ratio of VO2 to HR -amount of O2 extracted per heart beat

Question 35

What is oxygen pulse used for?

Answer 35

estimation of stroke volume during exercise

Question 36

What is assessed in regards to ventilation?

Answer 36

-total minute ventilation (Ve) and breathing pattern (VT and respiratory frequency-FR)

Question 37

What happens to tidal volume (VT) with low level of exercise?

Answer 37

Increased VT

Question 38

What happens after 70-80% max exercise?

Answer 38

FR dominates

Question 39

What is ventilatory equivalent for O2?

Answer 39

Ratio of VE to VO2

Question 40

Ventilatory equivalent for CO2?

Answer 40

Ratio of VE to VCO2

Question 41

what is VE/VCO2 used for?

Answer 41

method of assessing ventilatory efficiency

Question 42

What is RPE?

Answer 42

rating of perceived exertion

Question 43

perceptual assessment?

Answer 43

-effort of patient -reason for stopping exercise -compliant to pre-test instructions?