Summary:
a–e) Physiological and sensorial responses to incremental CPET in a 56-year-old woman with unexplained shortness of breath (Medical Research Council dyspnoea scale score of 3), which was associated with oppressive retrosternal chest discomfort with radiation to the neck, light-headedness and pre-syncope. Note pre-exercise bursts of increased ventilation and increasing dyspnoea scores (a), which were out of proportion to metabolic demand (b). Changes in ventilation were associated with erratic variations in breathing pattern (c) and PETCO2 and PaCO2 decreased in parallel (d). Concomitantly, the patient reported neurological symptoms, which correlated with decrements in pre-frontal cerebral oxygenation as shown by near-infrared spectroscopy (e). The start of exercise was associated with a decrease in dyspnoea (a) and sudden recoupling of ventilation to metabolism (b), which led to a progressive increase in PaCO2 (d). She then reported an improvement in neurological symptoms, which correlated with better cerebral oxygenation (e). The patient increased ventilation near the end of exercise in order to compensate for ongoing metabolic acidosis (respiratory compensation point (RCP)). The pattern of responses is consistent with dysfunctional breathing hyperventilation disorder. See text for further details. Unload: unloaded exercise; rec: recovery; RR: respiratory rate. Reproduced and modified from [87] with permission.
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