Teste ergométrico em portadores de dispositivos cardíacos eletrônicos implantáveis / Exercise testing in patients with cardiac implantable electronic devices

O número de pacientes com dispositivos eletrônicos vem crescendo substancialmente nos últimos anos. Marca-passos com inúmeras programações e desfibriladores com ou sem ressincronizadores, cada vez mais comuns, apresentam-se com traçados eletrocardiográficos confundidores. Assim, é necessária a compreensão de princípios básicos e técnicos pelos clínicos, além da integração entre estes e os eletrofisiologistas. O conhecimento de tais princípios básicos é fundamental na condução desses pacientes, de modo que o ergometrista deve estar ciente do tipo de dispositivo, programação, frequência mínima e máxima de comando, presença de desfibrilador, bem como suas frequências de terapias e desfibrilação. Assim, promover-se-á maior segurança durante provas funcionais (teste ergométrico e ergoespirométrico) e programas de treinamento físico. Este artigo de revisão tem por objetivo descrever diversos pontos de interesse na realização do teste ergométrico em portadores de dispositivos eletrônicos.

The number of patients fitted with cardiac implantable electronic devices has grown substantially over the past few years. Pacemakers with countless programming options and defibrillators with or without resynchronization devices are increasingly more common, with confusing electrocardiographic findings. Consequently, general practitioners must understand their basic principles and techniques, in addition to developing stronger links with electrophysiologists. Knowledge of these basic principles is crucial for managing these patients, meaning that people administering ergometric testing must be aware of the type of device and its programming, minimum and maximum command frequency and defibrillator, as well as its treatment and defibrillation frequencies. This will ensure greater safety during ergometric and ergospyrometric exercise testing and exercise programs. This paper describes several points of interest in ergometric testing for patients fitted with cardiac implantable electronic devices.

Stepping from Belgium to the United States and back: the conceptualization and impact of the Harvard Step Test, 1942-2012.

PURPOSE: This article examines the contribution of the Belgian-American exercise physiologist Lucien Brouha in developing the Harvard Step Test (HST) at the'pioneering Harvard Fatigue Laboratory (HFL) during the Second World War and provides a better understanding of the importance of transnational relations concerning scientific progress. METHOD: Analysis of sources in the University Archives of the State University in Liege (Belgium), the Archives and Documentation Centre of the Sportimonium at Hofstade (Belgium), the Harvard Business School Archives at Baker Library (Cambridge, MA), the Harvard Medical School Archives at Countway Library (Cambridge, MA), and the Brouha and Shaler private family archives (Sutton, VT). RESULTS: The outbreak of the Second World War shifted research at the interdisciplinary HFL toward the field of military physiology and resulted in the transfer of Brouha from Belgium to the HFL. Brouha's personal and academic experiences made him the right man in the right place to develop the HST in 1942. The HST--which has celebrated its 70th anniversary--was of immediate academic and practical significance during and after the war. CONCLUSIONS: Brouha' s case demonstrates the importance of personal experiences, transnational relations, and interdisciplinary research settings for the establishment of scientific (sub)disciplines. Studying internal scientific evolutions in relation to personal and work experiences of "mobile" and therefore often "forgotten" researchers like Brouha is necessary to better understand and interpret evolutions in science and corresponding processes of academic and social mobility.

The stepping test: a step back in history.

The stepping test is a valuable part of the neurological examination that is used to localize labyrinthine pathology. The test is known by two eponyms: the "Fukuda Test" in the United States and Asia and the "Unterberger Test" in Europe. Some controversy exists as to which name is correct. Siegfried Unterberger was an Austrian otolaryngologist who initially described the test in 1939. It was modified in 1959 by Tadashi Fukuda, a Japanese otolaryngologist, who introduced a method to better quantify the test results. Thus, the test should be called the "Unterberger Test," unless Fukuda's methods for measurement are used.

Energetics of swimming: a historical perspective.

The energy cost to swim a unit distance (C(sw)) is given by the ratio E/v where E is the net metabolic power and v is the swimming speed. The contribution of the aerobic and anaerobic energy sources to E in swimming competitions is independent of swimming style, gender or skill and depends essentially upon the duration of the exercise. C(sw) is essentially determined by the hydrodynamic resistance (W(d)): the higher W(d) the higher C(sw); and by the propelling efficiency (η(P)): the higher η(P) the lower C(sw). Hence, all factors influencing W(d) and/or η(P) result in proportional changes in C(sw). Maximal metabolic power E max and C(sw) are the main determinants of swimming performance; an improvement in a subject's best performance time can more easily be obtained by a reduction of C sw) rather than by an (equal) increase in E max (in either of its components, aerobic or anaerobic). These sentences, which constitute a significant contribution to today's knowledge about swimming energetics, are based on the studies that Professor Pietro Enrico di Prampero and his co-workers carried out since the 1970s. This paper is devoted to examine how this body of work helped to improve our understanding of this fascinating mode of locomotion.

The 20 year evolution of dobutamine stress cardiovascular magnetic resonance.

Over the past 20 years, investigators world-wide have developed and utilized dobutamine magnetic resonance stress testing procedures for the purpose of identifying ischemia, viability, and cardiac prognosis. This article traces these developments and reviews the data utilized to substantiate this relatively new noninvasive imaging procedure.

1958-2008: 50 years of youth fitness tests in the United States.

The AAHPER Youth Fitness Test, the first U.S. national fitness test, was published 50 years ago. The seminal work of Krause and Hirschland influenced the fitness world and continues to do so today. Important youth fitness test initiatives in the last half century are summarized. Key elements leading to continued interest in youth fitness testing at the start of the 21st century include (a) concerns about children and youth fitness levels, (b) AAHPER(D)-led youth fitness battery development, (c) differentiation between performance-related and health-related fitness testing, (d) the numerous youth fitness tests developed, (e) collaborative discussions on development and adoption of a unified national youth fitness battery, (f) computerization of youth fitness test results, (g) differentiation between norm-referenced and criterion-referenced evaluation of student results, and (h) concern about youth fitness levels (again, but with a focus on health). We have come full circle on youth fitness interests. This article summarizes the key youth fitness tests in the second half of the 20th century and projects future considerations.

Indicações e avanços do teste de esforço no diagnóstico de doença arterial / Indications and advances in diagnose of coronary artery disease through exercise stress testing

o teste de esforço tem por objetivo submeter o paciente a estresse físico programado e personali-zado, com a finalidade de avaliar a resposta clínica, hemodinâmica, eletrocardiográfica e metabólicaao esforço. Essa avaliaçäo permite: a detecçäo de isquemia miocárdica, arritmias cardíacas e distúrbi-os hemodinâmicos esforço-induzidos; a avaliaçäo da capacidade funcional; a avaliaçäo diagnóstica eprognóstica das doenças cardiovasculares; a prescriçäo de exercícios; a avaliaçäo objetiva dos resul-tados de intervenções terapêuticas; e a demonstraçäo ao paciente e familiares de suas reais condi-ções físicas e perícia médica. O teste é de grande valia no estabelecimento do diagnóstico e orienta-çäo das condutas a serem tomadas, participando especialmente no processo de prevençäo tantoprimária como secundária da doença arterial coronária.A interpretaçäo moderna do teste de esforço e as implicações para a tomada de decisäo sobre otipo de terapêutica a ser empregado baseiam-se na análise multifatorial, que compreende a avaliaçäodas respostas clínicas, hemodinâmicas e eletrocardiográficas frente ao esforço. As modificaçõeseletrocardiográficas relacionadas à isquemia que ocorrem durante a realizaçäo do teste säo expres-sas nos segmentos Ta, ST e onda T, sendo difícil, por vezes, a diferenciaçäo com outras condiçõesque podem mimetizar os padrões morfológicos. Assim, torna-se necessária a avaliaçäo adicional econjunta dos outros parâmetros clínicos, durante o exercício e mesmo até a utilizaçäo de escoresdiagnósticos, na caracterizaçäo da probabilidade pós-teste de doença coronária, de fundamental im-portância no processo da decisäo clínica

[The history and clinical importance of cardiopulmonary assessment of working fitness with special reference to spiroergometry]. / Zur Geschichte und klinischen Bedeutung der kardiopulmonalen Arbeitsuntersuchung unter besonderer Berücksichtigung der Spiroergometrie.

Spiroergometry-a synonym for ergospirometry or ergospirography - is a diagnostic procedure to continuously registrate respiration and gas metabolism during ergometer exercise. It enables to judge function and performance capacity of the cardiopulmonary system and metabolism. Spiroergometry is made up of the two components spirometry and ergometry. The first attempts to measure human gas metabolism while performing a quantified physical work can be traced back to the year 1789. The development of procedures to measure gas metabolism and respiration as well as the construction of ergometers in the 19th and 20th century are described. 1929 saw the introduction of spiroergometry and routinely performed clinical performance diagnosis. But not until the 1950s was the first spiroergometric apparatus which met all scientific requirements developed. In a historical frame, the used parameters and the physiological and pathophysiological findings by spiroergometry are given. Numerous medical fields have profited from the technique of spiroergometry: cardiology, pulmonology, sports medicine, performance physiology, biochemistry, clinical pharmacology, surgery, orthopedics, pediatrics, gerontology, etc. besides such global disciplines as preventive medicine, exercise therapy, and rehabilitative medicine.