CPX testing also guides the development of an exercise prescription and determines the limits on occupational working capacity. Follow-up testing is also indicated to determine if a patient continues to require listing for orthotopic heart transplantation and whether changes in the heart failure medical regimen are required. The patient is prepared for cardiopulmonary exercise testing by placement of electrocardiographic leads and receiving instructions. The patient is seated on a bicycle ergometer. A pneumotach is attached by a mouth piece to the patient to monitor respiratory volume and is connected to a metabolic cart which preforms breath by breath determination of oxygen consumption and carbon dioxide production.
Complete spirometry is preformed with the patient as rest.
All testing is performed with continuous electrocardiographic monitoring for arrhythmias and ST segment monitoring for ischemia. This testing allows determination of exercise capacity, peak heart rate, maximal oxygen consumption, anaerobic threshold, respiratory gas exchange ratio, and ventilatory equivalent for oxygen. All testing is preformed with physician supervision and the results are interpreted by a cardiologist with training in heart failure and exercise physiology. This allow individualized exercise prescriptions, assessment of patients response, and assists with the determination as to when it is safe for the patient to return to work. CPX testing also allows individualized exercise prescriptions and can guide the prescription for supervised cardiac rehabilitation programs.