1. Majid Mirsadraee Associate professor Islamic Azad University

3. Copyright ©2004 American Heart Association Milani, R. V. et al. Circulation 2004;110:e27-e31 Derangements of gas exchange in disease

6. SeverityClass Peak o 2, mL/kg per minute Anaerobic Threshold Maximal Cardiac Index, L/min per m 2 None to mildA>20>14>8 Mild to moderateB16–2011–146–8 Moderate to severeC10–168–114–6 SevereD6–105–82–4 Very severeE<6<4<2 *Data derived from Weber et al. 6 TABLE 3. Functional Impairment During Incremental Treadmill Testing in Heart Failure: Weber-Janicki Classification *

8.  Dyspnea  Fatigue  Evaluate exercise capacity  CHF  Asthma  Preoperative evaluation  Pulmmonary rehabilitation  Disability assessment

9. Evaluation for exertional dyspnea Development of an exercise prescription Direct measurement of Pko 2 (functional capacity) Risk stratification and prognosis in heart failure Optimization of rate-adaptive pacemaker Congenital heart disease: determination of need for surgical repair and response to treatment Disability determination; worksite readiness Assess functional significance of regurgitant valvular heart disease Indication of CPET in Heart disease

10.  After initial work up consists of  Resting ECG  Spirometry  Chest X ray

27. Copyright ©2004 American Heart Association Milani, R. V. et al. Circulation 2004;110:e27-e31 Flow chart for the differential diagnosis of exertional dyspnea and fatigue