Cardiac Output Response to Exercise in Chronic Cardiac Failure Patients

Cardiac output measurements during cardiac catheterization were obtained in normal subjects for several grades of treadmill exercise. Femoral venous blood was sampled and the A-V oxygen difference for the exercising leg obtained. Measurements of central and femoral A-V oxygen difference and total oxygen uptake were also obtained in normal subjects during supine rest and during standing. When subjects merely stood, the A-V oxygen difference for the leg increased (whether the leg bore weight or not) much more than did that for the whole body. During treadmill walking femoral A-V oxygen difference was usually no greater than that during standing. Cardiac output was smaller and total body A-V oxygen difference was greater for treadmill walking than for supine bicycle exercise in which comparable levels of oxygen uptake were achieved. It is clear that change in posture alters the cardiac output response to exercise. An important aspect of the altered response was a marked difference in the circulation within the leg for these two postures both at rest and during exercise. Submitted on August 8, 1960

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Non-invasive Measurement of Cardiac Output and Ventricular Ejection Fractions in Chronic Cardiac Failure: Relationship to Impaired Exercise Tolerance

Clinical Science ◽

10.1042/cs0930195 ◽

1997 ◽

Vol 93 (3) ◽

pp. 195-203 ◽

Cited By ~ 8

Author(s):

Ian C. Steele ◽

ANN Moore ◽

Anne-Marie Nugent ◽

Marshall S. Riley ◽

Norman P. S. Campbell ◽

...

Keyword(s):

Cardiac Output ◽

Oxygen Consumption ◽

Oxygen Uptake ◽

Cardiac Failure ◽

Exercise Tolerance ◽

Perceived Exertion ◽

Lactate Concentration ◽

Submaximal Exercise ◽

Chronic Cardiac Failure ◽

And Control

1. The role of cardiac output limitation in the pathophysiology of exercise in patients with chronic failure remains undefined. During steady-state submaximal exercise, oxygen uptake is similar in patients and control subjects, but it is not known if cardiac output is also similar. We wished to determine if the reduced exercise tolerance of patients with chronic cardiac failure during such exercise is related to reduced cardiac output, or to peripheral factors. 2. Ten male patients with stable chronic failure and ten age-matched male normal controls were studied at rest and during exercise. Each subject performed a familiarization exercise test, a symptom-limited maximal exercise test and two submaximal exercise tests. Cardiac output was measured by a carbon dioxide rebreathing method. We also measured oxygen consumption, ventilation, Borg score of perceived exertion and venous lactate concentration, and ejection fractions. 3. As expected, patients had lower peak oxygen consumption [median (range) 1.18 (0.98–1.76) versus 1.935 (1.53–2.31) 1/min; P < 0.001], lower peak venous lactate concentration but a similar overall level of perceived exertion. At the same submaximal workload, patients and control subjects had similar oxygen consumption [0.67 (0.59–0.80) versus 0.62 (0.52–0.82) 1/min] and cardiac output [6.92 (5.79–9.76) versus 7.3 (5.99–10.38) 1/min] but the patients had a greater perceived level of exertion [Borg score: 4 (1–6) versus 3 (1–5); P < 0.005], higher venous lactate concentration [1.6 (1–3.3) versus 1.14 (0.7–1.7) mmol/l; P < 0.05] and higher heart rate [106 (89–135) versus 87 (69–112) beats/min;P < 0.005]. 4. During submaximal exercise at a similar absolute workload, patients with cardiac failure have a similar oxygen uptake and cardiac output but greater anaerobiosis and increased fatigue when compared with normal subjects. These findings appear to relate predominantly to changes that occur in the periphery rather than abnormalities of central cardiac function.

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