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Advanced Cardiopulmonary Exercise Testing at Brigham and Women's Hospital

Brian Simon

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

B. Simon, RN BSN

Brigham and Women's Hospital, Boston, MA

PURPOSEThere exists a significant proportion of the population that experiences exertional dyspnea and or fatigue of unknown origin. These patients have usually been through a battery of tests to rule out more common diagnoses and are sometimes left with no explanation for the symptoms they are experiencing. This can be physically, emotionally and mentally disruptive to their lives and significantly impact their health status. In the last few years, Advanced Cardiopulmonary Exercise Testing (aCPET) at the Brigham & Women’s Hospital has helped us to identify some of these difficult to diagnose conditions. The fact that aCPET is a relatively new testing procedure leads to a several important questions including how to safely perform and evaluate these tests to determine the outcome on the patient’s dyspnea and well being.

BACKGROUNDIn the past, patients typically undergo a series of tests to determine the cause of dyspnea. These tests may include pulmonary function tests, echocardiogram, cardiac stress, non-invasive exercise testing and right heart catheterization. All of these exams can be useful to rule out well known cardiac and pulmonary disorders. However, they are often inadequate in determining other causes of dyspnea. The development of the invasive or "aCPET" has lead to the diagnosis of Exercise Induced Pulmonary Artery Hypertension, Exercise Induced Heart Failure with preserved Ejection Fraction, Pre-load Failure, and neurologic and muscular disorders such as oxidative myopathies. Each diagnosis is treated differently and, when treatment is available, can lead to improved functional status.

METHODTo utilize a tool, such as the "Pulmonary Functional Status and Dyspnea Questionnaire", to evaluate exertional intolerance pre and post testing and change in treatment. This would involve tracking patients before and 6 months post procedure, as well as any complications from the test including bleeding or infection to see if nursing is being effective with their care of the access sites. An IRB-approved QA survey is done to evaluate patient satisfaction with the test as far as comfort and how they were treated physically and emotionally at our facility with regard to nursing as well as technical and medical staff.

FINDINGSTo date there has been no occurrences of bleeding or infection as a result of this test. QA and patient satisfaction surveys have had very positive results and a database of pt diagnosis and demographics has been established. Many minor changes have been made to the test to improve performance, comfort and time management.

CONCLUSIONaCPET has been shown to provide a safe and effective way to help diagnose unexplained dyspnea in patients with prior negative testing.