Cardiopulmonary exercise testing (CPX) is an extension of exercise ECG that includes measurement of oxygen uptake and carbon dioxide production. CPX has applications in the diagnosis and risk Cisplatin of patients with a range of cardiorespiratory disorders, the investigation of unexplained exertional dyspnoea and assessment before major surgery, but is not widely available. The clinical uses of CPX are the subject of a recent review2 and are not discussed further in this article.
Exercise ECG and coronary artery disease
Many tests can be used to diagnose obstructive coronary artery disease, broadly divided into those that show the anatomy of epicardial coronary arteries, and those that reveal the functional effects of CAD. In the presence of flow-limiting CAD, coronary perfusion is insufficient during exercise to match myocardial oxygen demand; substitution results in subendocardial ischaemia and abnormal ventricular repolarization, apparent as ST-segment depression on the surface ECG. As well as its ability to demonstrate inducible myocardial ischaemia and the haemodynamic response to exercise, exercise ECG can also clarify the cause of non-specific exertional symptoms and provide an objective measure of exercise tolerance and symptom burden.
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