-4 -2 0 2 4 6 8 10 12 14 Right atrial pressure (mm Hg)

Cardiac reserve in different conditions, showing less than zero reserve for two of the conditions.

and the cardiac output soon fails to rise high enough to sustain the body's new level of activity. The acute effects are as follows:

1. Immediate and sometimes extreme shortness of breath (dyspnea) resulting from failure of the heart to pump sufficient blood to the tissues, thereby causing tissue ischemia and creating a sensation of air hunger

2. Extreme muscle fatigue resulting from muscle ischemia, thus limiting the person's ability to continue with the exercise

3. Excessive increase in heart rate because the nervous reflexes to the heart overreact in an attempt to overcome the inadequate cardiac output

Exercise tests are part of the armamentarium of the cardiologist. These tests take the place of cardiac output measurements that cannot be made with ease in most clinical settings.

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