Document bB949BXmzoaZ6xnjqw04D600O

. 'i- CLINICAL hECORO iCTLi'NS v.'Wl J ! asa.ayaj CONSULTATION SHEET ItQUtSI flOU. #< . w *awn a' , ",__/ ^ . f OATC Of NiOUUT '/ i-.MiL I b.. i'll i'~v 'i M ..i :< '.I 111N : _ .. ii . !. i l roiiu.ch.ni 11 .11 i yi ! i. 11 - .i.i 'lit .nolle Mi-.iauri'.iu nc ih.i'L i r Ji .la nn i> r .w .mas v|iict rjmi'E ir ui-r,i. . ird car i'x iiml 11 k.ird digital ................ 'v ' - J i wll 1 W3 V.ilvll linkman valve __ Mail l led U C. lo-Me Ke r roil v ______NuO|irunu ba;a , f'_ _ _ E . C . C . by il-H ______Minn Safety noiiuxo . / ze r nut..I w.iik ruii-3 to max: mum La lci uticu ; incruiuuiics wen 100 Kilogramiitit3 iini" tuuiucu, work race wu.n i uc return ia 1 each .nlnuie. _,v'ul> i-.iLiiium work race, 6 iuinuU3 c.ich . _ . . fOo L^- 4uo_______600 aoo jOu " 500 ________~70<J 1~_ " _900 PM'il-Nr (.i.O,,LK.UTil(iV' COC`1 S i H J liCT r.VL JUS Eli VAT ION: i --luc~> weak __________cheac p<*ln_shortness of bread: _ Other____________ CO'CltNTS : Initially submaximal constant workrace~t'es"h'3 of 200 aria- dizzy ~m 2 gnrasrce rs per minute were performed. Observations made during~6he 5th and 6th minutes of these tea tSj w tor. an established physiologic steady state^ revealed excessive ventilation, excessive respiratory frequency and abnormally low respiratory exchange ratio. Card:, frequency was normal. The low respiratory exchange ratio va consistent with excess! ventilacicn and partial depletion of body 002 scores prior to initiation of exercise. Just before incrementing the workrata to determine maxiayp 02 consumption the patient was ayain asked to pedal 4 minutes at 200 kg-m/min followed by a 5th ainuts at 300 kg-m/in and * 6th minute at 400 kg-a/min. Of interest ~i% that ventilation and breathing frequency fell significantly cohered Jo that^sssa.during the initial -s^utxmaximal testing. a<.'3Q0 kg-*/iin. Thi^'suggests^eyqfc*5igjjA$- rather than pfeysiologi , pediation of the excessive ventilation. - ****, i- r Vent ilatiixx arid respiratory frequency wepe increased relative to oxygen consumpt and tidal volume was abnormally reduced The heart rate wae normally matched to oxygen oonsuagition. Arterial fclxod ox -uen saturation as eatimatad by ear oximetry wa 96% resting and 96 to 97% througnoui exetrise. This was a normal response. He achie an oxygen consumption of 2000 s.l " ! .innate (the predicted Value-is 2,566 witn a nor: range of 1,768 to 3,J68 ml per tin a -> . He expended only 53% of his breaching capac- (35 X 3.jj * 136.5 liters per nunut i and 34% of cardiac chronotropic capacity. An arterial blood gas drawn withi i 2 seconds of cessation of maximal exercise revealed metabolic ucidenia, PaOi 97 P >CC o4n fvriHttm7.4i1.) bicarbonate 21. ifUNA AN T f LJC W-.'Vi f'NASd , . 0. 6 '2 4/H. .ncMrtncariOM mo. prrLMONARy function lascpatcri i < A*.' tf 0*4 ' mitt t mm mmtnm* 4>*m Wee OKWWN $ eJ sTele. rnmmpmtm t mm %*< at 4TCJ1 MO. 7' ' ctsmuhoe shut i< (*i* til 5 { Jiw* DU? 0933530 i efia**ifar<eiairairiii*ifiaiiiasiisiit.s..v.v.v.v i **i** .'* ' > a **a>a< i . it j i i i i ai ,iii i.aililili.i-i .ia.--t-ifi fI iSViViV** DU 036485 'O . The patient indicated that tiro :"ess of his leQ3 kept him from t.-.o incremental exercise load. This is consistent wi:n lack of srecifiu training and conditioning for the task of pedaling a cycle against in .Teasing resistance. :.T.;.t4ssic": 1' Somal tolerance of heart and longs to exercise i.e. normal aerobic capacity . vhilo neurogenic stimuli from a diseased lung may cause o\.es->'.vc vent i i a 11 on the tenuunoy demonstrated here is more consistent with usycnogenic hyperventilation. Medieai Director ` DU? 0933931 DlJ 036486