Desenvolvimento neuropsicomotor

Disponível somente no TrabalhosFeitos
  • Páginas : 22 (5475 palavras )
  • Download(s) : 0
  • Publicado : 13 de outubro de 2012
Ler documento completo
Amostra do texto
Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease*
Sven Gläser, Christian F. Opitz, Ulrike Bauer, Roland Wensel, Ralf Ewert, Peter E. Lange and Franz Xaver Kleber Chest 2004;125;368-376 DOI 10.1378/chest.125.2.368

The online version of this article, along with updated information and services can be found online on the World Wide Web at:

CHEST is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright 2007 by the American College of Chest Physicians, 3300 Dundee Road, Northbrook IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of thecopyright holder. ( ISSN:0012-3692

Downloaded from by guest on July 5, 2009 Copyright © 2004 American College of Chest Physicians

clinical investigations
Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease*
Sven Glaser, MD; Christian F. Opitz, MD; Ulrike Bauer, MD; ¨ RolandWensel, MD; Ralf Ewert, MD; Peter E. Lange, MD; and Franz Xaver Kleber, MD

Objectives: Patients with cyanotic congenital heart disease are generally thought to be limited by hypoxemia. To correlate exercise tolerance to the severity of the cardiac abnormality and to further characterize dyspnea in affected patients, we examined 25 adults with uncorrected cyanotic congenital heart disease. Designand setting: Cohort study at a university hospital. Methods: Symptom-limited cardiopulmonary exercise testing (CPX) was performed on a treadmill. Expiratory gas was analyzed breath by breath for evaluation of maximal exercise performance, ventilation, and ventilatory efficiency in combination with blood gas analysis during rest and exercise. Symptoms were assessed by the ability index and New YorkHeart Association class, and the results were compared to 101 healthy volunteers. Results: PaO2 decreased by 26 8% (mean SD) with exercise (from 49 12 to 36 10 mm Hg), while PaCO2 was only slightly decreased compared to control subjects. Peak oxygen uptake ˙ (VO2) was significantly reduced when compared to control subjects: 16.7 6.6 mL/kg/min vs 36.1 7.7 mL/kg/min. Ventilatory efficiency wasmarkedly impaired at rest (minute ventilation ˙ ˙ [VE]/carbon dioxide output [VCO2] ratio of 70 18; control subjects, 53 11; p < 0.005) and ˙ E vs VCO2 slope, 58 31; control subjects, 26 4; p < 0.005). At rest, ˙ during exercise (V ventilatory efficiency was correlated to resting pH and PaO2, while during exercise it was linked to PaO2. Ventilatory efficiency during exercise had the strongestcorrelation with observed symptoms, ˙ while hypoxemia and peak VO2 were not significantly associated with symptomatic state. Conclusion: CPX in patients with cyanotic congenital heart disease provides helpful parameters that better define the symptomatic state of these patients. The summation of disease-related factors is best reflected by ventilatory efficiency. This parameter offers additional andindepen˙ dent information when compared to peak VO2 and the extent of cyanosis alone. (CHEST 2004; 125:368 –376)
Key words: cyanosis; exercise testing; heart disease, congenital; pulmonary ventilation Abbreviations: AT anaerobic threshold; CPX cardiopulmonary exercise testing; MVV maximal voluntary ventilation; NYHA New York Heart Association; Petco2 end-tidal carbon dioxide partial pressure; Peto2end˙ ˙ ˙ tidal oxygen partial pressure; Vco2 carbon dioxide output; Ve minute ventilation; Vo2 oxygen uptake; ˙ Vo2AT oxygen uptake at anaerobic threshold

mated that 500,000 patients with significant functional cardiac malformations reach adulthood in the United States.2 Supplementing echocardiography and cardiac catheterization data with cardiopulmonary exercise testing (CPX) offers an...
tracking img