Is exercise tolerance limited by the heart or the lungs?
This 55-year-old man with known rheumatic mitral valve disease is modestly disabled achieving a VO2max of 72% and a maximal power output of 76% of the predicted normal. His capacity to exercise is limited by dyspnea due to a reduction in his capacity to breathe. Ipratropium bromide was initiated to maximize his expiratory flow and improve his ventilatory capacity. A trial of inhaled steroids produced no improvement. He was referred for rehabilitation and smoking cessation. A decision was made to continue surveillance, postponing mitral valve replacement.
Killian
K J
KJ
Department of Medicine, McMaster University, Hamilton, Ont. killiank@mcmaster.ca
D001769:Blood; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D002637:Chest Pain; D004417:Dyspnea / Q000503:physiopathology; D004562:Electrocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007866:Leg; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D012214:Rheumatic Heart Disease / Q000503:physiopathology*; D012907:Smoking
D002245:Carbon Dioxide; D010100:Oxygen