Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting.   Mr. J’s physican orders a pharmocologic stress test with echocardiography.    What information might Mr. J’s physican be hoping to obtain from this test?

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program   Looking at Mrs. H’s PFT results, do the GOLD criteria for disease severity apply? If so, what is her disease severity?   Pre-bronchodilator: FVC: 70% predicted FEV1:  24% predicted FEV1/FVC: 35% predicted TLC: 120% predicted   Post Bronchodilator: FVC: 79% predicted; 12% change FEV1:  27% predicted; 14% change FEV1/FVC: 43% predicted; 23% change DLCO: 43% predicted

Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting. An EKG from his emergency room visit related to the MI is shown below.       Mr. J meet criteria for a cardiac rehab referral.

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   While reviewing Mrs. H’s medical chart prior to meeting her, you come across recent ABG results as shown below. What is the primary acid-base distrubance?   PaCO2: 48 PaO2: 61 HCO3-:28 SpO2: 91%

Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting. An EKG from his emergency room visit related to the MI is shown below.      What is Mr. J’s NYHA functional class?

Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting.   Mr. J’s physican ordered a pharmacologic stress test with echocardiography.   Identify 5 reasons why it would be contraindicated to perform the pharmacologic stress test with echocardiography using the pharmacologic agent of choice.

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program   Looking at Mrs. H’s PFT results, is the FEV1/FVC ratio normal or abnormal?   Pre-bronchodilator: FVC: 70% predicted FEV1:  24% predicted FEV1/FVC: 35% predicted TLC: 120% predicted   Post Bronchodilator: FVC: 79% predicted; 12% change FEV1:  27% predicted; 14% change FEV1/FVC: 43% predicted; 23% change DLCO: 43% predicted

List 5 ABSOLUTE contraindications to symptom-limited maximal exercise testing

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   Throughly describe the physical examination on day 1 of pulmonary rehab. 

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   List each of Mrs. H’s risk factors for respiratory disease