Thoroughly revised and updated for today’s clinicians, Wasserman & Whipp’s Principles of Exercise Testing and Interpretation, Sixth Edition, provides a comprehensive, practical overview of cardiopulmonary exercise testing (CPET) ideally suited for pulmonologists, cardiologists, anesthesiologists, and others with an interest in clinical exercise testing. Written by authors who are uniquely positioned to convey relevant aspects of research and apply them to clinical contexts, this volume offers in-depth coverage of essential information for conducting CPET, or for utilizing data from this discipline in clinical practice or research.

　　　ㆍ　Clearly defines terminology throughout and focuses on the core elements of CPET that are common to all users, ensuring that content is easily accessible to clinicians from a wide variety of backgrounds.
　　　ㆍ　Reviews the central aspects of exercise physiology and metabolism important for understanding measurements used in CPET.
　　　ㆍ　Identifies core procedures and measurements for conducting tests and laboratory quality control.
　　　ㆍ　Outlines systematic, step-by-step approaches to the interpretation of exercise data, including the scientific and technical basis of the methods and analyses.
　　　ㆍ　Includes a new chapter on approach to data and interpretation – focused on practical approaches to viewing, summarizing, and reporting results of a test.
　　　ㆍ　Illustrates normal and abnormal results of exercise tests through discussion of dozens of actual case presentations.
　　　ㆍ　Draws on the extensive experience and expertise of authors from the fields of pulmonary medicine and physiology with experience in research and clinical studies related to cardiology, metabolism, sports medicine, and other areas.

Preface v
Acknowledgments vii
Contributors ix


1 Exercise Testing and Interpretation 1
2 Physiology of Exercise 8
3 Measurements During Integrative Cardiopulmonary Exercise Testing 59
4 Pathophysiology of Disorders Limiting Exercise 91
5 Performance of Clinical Cardiopulmonary Exercise Testing 112
6 Approaches to Data Summary and Interpretation 135
7 Normal Values 159
8 Clinical Applications of Cardiopulmonary Exercise Testing 189
9 Diagnostic Speci? city of Exercise Intolerance: A Flowchart Approach 223
10 Case Presentations 229

Case 1: Normal Man 231
Case 2: Normal Athletic Man
Case 3: Normal Woman: Air and Oxygen Breathing Studies 234
Case 4: Normal Man 239
Case 5: Fit Cyclist 242
Case 6: Normal Individual: Cycle and Treadmill Studies 246
Case 7: Normal Individual: With and Without - Adrenergic Blockade 251
Case 8: Normal Man With and Without Acute Cigarette Smoking 256
Case 9: Active Man With Dyspnea at High Altitude 262
Case 10: Active Woman With Patent Foramen Ovale 267
Case 11: Normal Aging Athletic Man: Serial Tests Between Age 66 and 76
Case 12: Mild Air? ow Obstruction and Hyperventilation 270
Case 13: A Submaximal Test 274
Case 14: A Long Test 278
Case 15: Chronic Heart Failure With Reduced Ejection Fraction 282
Case 16: Chronic Heart Failure With Reduced Ejection Fraction 285
Case 17: Chronic Heart Failure With Reduced Ejection Fraction and Pacemaker Dependence 289
Case 18: Chronic Heart Failure: Oscillatory Ventilation and Gas Exchange 294
Case 19: Chronic Heart Failure With Preserved Ejection Fraction (Exercise-Induced Pulmonary Venous Hypertension) 298
Case 20: Gas Exchange Evidence of Myocardial Ischemia 302
Case 21: Claudication: Gas Exchange Findings in Peripheral Arterial Disease 307
Case 22: Exertional Chest Pain With Gas Exchange Evidence of Myocardial Ischemia
Case 23: Exercise-Induced Myocardial Ischemia 310
Case 24: Myocardial Ischemia With Diffuse Distal Coronary Artery Disease 314
Case 25: Myocardial Ischemia: Development of Inducible Myocardial Ischemia Over 3 Years 31 7
Case 26: Atrial Septal Defect and Hemochromatosis 323
Case 27: Symptomatic Chronic Mitral Insuficiency 327
Case 28: Congenital Heart Disease: Coarctation and Ventricular Septal Defect Surgically Repaired 330
Case 29: Congenital Heart Disease: Transposition of the Great Arteries With Surgical Repair 334
Case 30: Patent Ductus Arteriosus With Left-to-Right Shunt, Presurgical Closure 337
Case 31: Patent Ductus Arteriosus With Right-to-Left Shunt (Eisenmenger Ductus Syndrome) 341
Case 32: Bicuspid Aortic Valve With Aortic Regurgitation 344
Case 33: Surgically Repaired Coarctation of the Aorta With Bicuspid Aortic Valve
Case 34: Fontan Circulation 348
Case 35: Ventricular Septal Defect With Eisenmenger Syndrome 352
Case 36: Tetralogy of Fallot, Surgically Repaired 356
Case 37: Tetralogy of Fallot, Unrepaired 360
Case 38: Amyloid Cardiomyopathy 364
Case 39: Athletic Man With Tachyarrhythmia 368
Case 40: Heart Rate Impairment Due to -Adrenergic Blockade for Treatment of Hypertension 372
Case 41: Atrial Fibrillation With Rapid Ventricular Response During Exercise 378
Case 42: Chronotropic Insuficiency With Escape Rhythm
Case 43: Active Older Man With Second-Degree Heart Block 381
Case 44: Active Man With Cardiac Conduction Defects 385
Case 45: Early Onset of Exercise Lactic Acidosis: Differentiating Circulatory From Muscular Impairment 390
Case 46: Early Onset of Exercise Lactic Acidosis Suggesting Circulatory Impairment 395
Case 47: Mixed Connective Tissue Disease With Pulmonary Involvement 400
Case 48: Pulmonary and Systemic Vasculitis: Air and Oxygen Breathing Studies
Case 49: Idiopathic Pulmonary Arterial Hypertension 404
Case 50: Severe Pulmonary Vascular Disease Secondary to Sarcoidosis: Air and Oxygen Breathing Studies 408
Case 51: Pulmonary Arterial Hypertension on Multidrug Therapy 413
Case 52: Pulmonary Hypertension, Patent Foramen Ovale, and Exercise-Induced Right-to-Left Shunt 418Contents xiii
Case 53: Idiopathic Pulmonary Arterial Hypertension Before and After Treatment
Case 54: Long-Standing Idiopathic Pulmonary Arterial Hypertension: Serial Tests Over 17 Years of Treatment 424
Case 55: Intrapulmonary Right-to-Left Shunt Due to Pulmonary Arteriovenous Fistulae 430
Case 56: Severe Interstitial Lung Disease 434
Case 57: Sarcoidosis 437
Case 58: Interstitial Pneumonitis: Before and After Empiric Corticosteroid Therapy
Case 59: Severe Interstitial Lung Disease : Air and Oxygen Breathing Studies
Case 60: Mild Pulmonary Asbestosis 441
Case 61: Severe Pulmonary Asbestosis 445
Case 62: Pleural and Pulmonary Asbestosis 449
Case 63: Mild Chronic Bronchitis With Normal Exercise Performance 452
Case 64: Emphysema With Mild Airway Obstruction 455
Case 65: Severe Combined Obstructive and Restrictive Lung Disease 458
Case 66: Severe Chronic Obstructive Lung Disease 462
Case 67: Emphysema, Untreated 465
Case 68: Severe Emphysema and Bronchitis: Air and Oxygen Breathing Studies 469
Case 69: Bullous Emphysema: Before and After Bullectomy 475
Case 70: A Runner With Obstructive Lung Disease
Case 71: Mild Obstructive Airway Disease With Disproportionate Exertional Dyspnea 481
Case 72: Obesity Contributing to Ventilatory Limitation
Case 73: Extrapulmonary Restriction: Ankylosing Spondylitis 485
Case 74: Extrapulmonary Restriction: Scoliosis
Case 75: Interstitial Lung Disease and Hemidiaphragm Paralysis 489
Case 76: Active Man With Paralyzed Hemidiaphragm 492
Case 77: McArdle Disease 495
Case 78: Myopathy With Exertional Rhabdomyolysis 499
Case 79: Congenital Mitochondrial Myopathy 502
Case 80: Mitochondrial Myopathy 505
Case 81: Woman With Multiple Sclerosis and Dyspnea 508
Case 82: Congenital Myotonia 512
Case 83: Mixed Disorder: Chronic Bronchitis and Obesity
Case 84: Mixed Disorder: Peripheral Arterial Disease, Anemia, Carboxyhemoglobinemia, and Cardiac Dysfunction 518
Case 85: Mixed Disorder: Mild Interstitial Lung Disease, Obstructive Airway Disease, and Myocardial Ischemia 522
Case 86: Chronic Heart Failure With Preserved Ejection Fraction and Obesity Hypoventilation Syndrome 525
Case 87: Mixed Disease: Aortic Stenosis, Mitral Stenosis, and Obstructive Airway Disease
Case 88: Mixed Disorder: Obstructive Airway Disease, Talc Pneumoconiosis, and Pulmonary Vascular Disease
Case 89: Mixed Disorder: Peripheral Arterial Disease and Obstructive Lung Disease: Cycle and Treadmill Exercise 529
Case 90: Morbid Obesity and Aortic Valve Disease 534
Case 91: Morbid Obesity 537
Case 92: Exercise Testing for Staging and Prognosis in Chronic Heart Failure
Case 93: Exercise Testing for Preoperative Evaluation for Lung Cancer Resection 541
Case 94: Exercise Testing for Evaluation of Work Fitness: Morbid Obesity 545
Case 95: Exercise Testing for Assessment Before and After Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease
Case 96: Evaluation of Unexplained Dyspnea: A Morbidly Obese Asthmatic 548
Case 97: Evaluation of Unexplained Dyspnea: Chronic Thromboembolic Pulmonary Vascular Disease 552
Case 98: Evaluation of Unexplained Dyspnea: An Obese Woman at Risk for Pulmonary Hypertension 555
Case 99: Serial Tests: Active Man With CREST Syndrome 558
Case 100: Serial Tests: Delayed Cardiotoxicity From Chemotherapy 563


Appendices 568
ndex 582