Exertion during a hypoxia altitude simulation test helps identify potential cardiac decompensation

Leigh Seccombe; Matthew Peters; Claude Farah

doi:10.1002/rcr2.450

Exertion during a hypoxia altitude simulation test helps identify potential cardiac decompensation

Leigh Seccombe^*, Matthew Peters, Claude Farah

^*Corresponding author for this work

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Abstract

A 64-year-old female with a history of chronic thromboembolic pulmonary arterial hypertension (CTEPH), moderate airway obstruction (forced expiratory volume in 1 second (FEV₁) 58% predicted), and resting oxygen saturation below the normal range (SaO₂ 94%) underwent a hypoxic challenge test (HCT) to determine suitability for long-haul air travel. The HCT showed only a mild decrease in SaO₂ (89% at 0.15 fraction of inspired oxygen (FIO₂)) at rest. However, a HCT coupled with mild exercise at two metabolic equivalents demonstrated significant hypoxia (SpO₂ 77%) with worsening right ventricular impairment and an inability to increase cardiac output measured with echocardiography. The case highlights the importance of the evaluating cardiac and pulmonary reserve during hypoxic stress. Resting measures alone may not identify risk, and the addition of an exercise component was essential in this case.

Original language	English
Article number	e00450
Pages (from-to)	1-3
Number of pages	3
Journal	Respirology Case Reports
Volume	7
Issue number	7
DOIs	https://doi.org/10.1002/rcr2.450
Publication status	Published - 1 Jan 2019
Externally published	Yes

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Clinical respiratory medicine
environmental and occupational health and epidemiology
pulmonary circulation and pulmonary hypertension
respiratory function tests
respiratory structure and function

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10.1002/rcr2.450

Publisher version (open access)Final published version, 296 KBLicence: CC BY

Cite this

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title = "Exertion during a hypoxia altitude simulation test helps identify potential cardiac decompensation",

abstract = "A 64-year-old female with a history of chronic thromboembolic pulmonary arterial hypertension (CTEPH), moderate airway obstruction (forced expiratory volume in 1 second (FEV1) 58\% predicted), and resting oxygen saturation below the normal range (SaO2 94\%) underwent a hypoxic challenge test (HCT) to determine suitability for long-haul air travel. The HCT showed only a mild decrease in SaO2 (89\% at 0.15 fraction of inspired oxygen (FIO2)) at rest. However, a HCT coupled with mild exercise at two metabolic equivalents demonstrated significant hypoxia (SpO2 77\%) with worsening right ventricular impairment and an inability to increase cardiac output measured with echocardiography. The case highlights the importance of the evaluating cardiac and pulmonary reserve during hypoxic stress. Resting measures alone may not identify risk, and the addition of an exercise component was essential in this case.",

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doi = "10.1002/rcr2.450",

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AU - Peters, Matthew

AU - Farah, Claude

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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AB - A 64-year-old female with a history of chronic thromboembolic pulmonary arterial hypertension (CTEPH), moderate airway obstruction (forced expiratory volume in 1 second (FEV1) 58% predicted), and resting oxygen saturation below the normal range (SaO2 94%) underwent a hypoxic challenge test (HCT) to determine suitability for long-haul air travel. The HCT showed only a mild decrease in SaO2 (89% at 0.15 fraction of inspired oxygen (FIO2)) at rest. However, a HCT coupled with mild exercise at two metabolic equivalents demonstrated significant hypoxia (SpO2 77%) with worsening right ventricular impairment and an inability to increase cardiac output measured with echocardiography. The case highlights the importance of the evaluating cardiac and pulmonary reserve during hypoxic stress. Resting measures alone may not identify risk, and the addition of an exercise component was essential in this case.

KW - Clinical respiratory medicine

KW - environmental and occupational health and epidemiology

KW - pulmonary circulation and pulmonary hypertension

KW - respiratory function tests

KW - respiratory structure and function

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ER -

Exertion during a hypoxia altitude simulation test helps identify potential cardiac decompensation

Abstract

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