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Uji Latih Jantung

Cardiopulmonary exercise testing provides a


global assessment of the integrative exercise
responses involving the pulmonary,
cardiovascular, hematopoietic,
neuropsychological, and skeletal muscle systems,
which are not adequately reflected through the
measurement of individual organ system
function. http://www.atsjournals.org/doi/full/10.1164/rccm.167.2.211#.U-HOavldXOA
Indication

Evaluation of exercise tolerance

Evaluation of undiagnosed exercise intolerance

Evaluation of patients with cardiovascular disease

Evaluation of patients with respiratory disease


Patient Preparation

1. The patient should be instructed not to eat or smoke for 2 to 3 h before the test
2. Cessation of medications may be considered
3. A brief history and physical examination should be done to rule out
contraindications to testing or to detect important clinical signs such as murmurs,
gallop sounds, pulmonary bronchospasm, or rales.Patients with a history of
increasing or unstable angina or uncontrolled heart failure should not be have
exercise testing until their condition stabilizes.A cardiac physical examination
should indicate which patients have valvular or congenital heart
disease,particularly adult patients with severe aortic stenosis,who generally
should not undergo exercise testing.
4. A detailed explanation of the testing procedure should be given,outlining risks
and possible complications.The patient should be told how to perform the
exercise test, and the testing procedure demonstrated.
5. A standard resting 12-lead ECG should be obtained since it differ from the
resting pre-exercise
Method
The treadmill and the cycle ergometer
Protocols for clinical exercise testing should include an initial
low load (warm-up), progressive uninterrupted exercise and a
recovery period.
The most popular treadmill protocol is the Bruce one.
It is preferable to require the subject to exercise progressively
through the protocol until it becomes excessively
uncomfortable or impossible to continue
A test is considered maximal when the patient appears to give
a true maximal effort(point of bodily exhaustion) or when other
clinical end-points are reached.
For maximum sensitivity, patients should be supine in the post
exercise period.
Monitoring of Blood pressure and ECG should continue for at
least 6 to 8min after exercise
Bruce Protocol

Stage Minutes % grade Km/h MPH METS

1 3 10 2.7 1.7 5
2 6 12 4 2.5 7
3 9 14 5.4 3.4 10
4 12 16 6.7 4.2 13
5 15 18 8.8 5.5 15
6 18 20 8.8 5.5 18
7 21 22 9.6 6 20
Indication for terminating exercise testing
The test score is the time taken on the test in
minutes (T).
The score can be converted to an estimated
VO2 max:
Women VO2 max (ml/kg/min ) = 2.94 x T + 3.74
Men VO2max (ml/kg/min) = 2.94 x T = 7.65
Young men VO2 max ( ml/kg/min) = 3.62 x T +
3.91
Ref. ACMSs Health Physical Fitness Assessment Manual
Interpretation

Clinical Responses
Evercise intensity and dyspnoe : Borg scale
Classic ischemic chest discomfort induced by the
exercise test is strongly predictive of CAD
A decrease in skin temperature, cool perspiration, and
peripheral cyanosis during exercise inadequate CO.
secondary vasoconstriction
Light headedness, vertigo
Physical examination
Precordial bulge or gallop rhythm left ventricular
dysfunction
Mitral regurgitant murmur suggest papillary muscle
Exercise or Functional Capacity

Decrease in maximum cardiac output CAD

One year survival 94% in heart failure patients with peak


VO2 > 14 ml/kgml

Hemodinamic response

Transient drop in systolic blood pressure at maximum


exercise : ischemic dysfunction of myocardium, increased
risk for ventricular fibrillation

Relatively rapid HR during submaximum exercise:


decreased vascular volume, anemia, metabolic disorder

Relatively low HR during submaximum exercise : drugs


(beta blocker), lack of training

ECG
In normal person:
The PR, QRS, and QT intervals shorten as heart rate increase
P amplitude increases
PR segment becomes progressively more down sloping in
inferior lead
J point at junctional depression will occur
TERIMAKASIH