{
  "abstract": "Introduction A normal blood pressure response during exercise is characterized as a progressive increase in systolic blood pressure with increasing workload, typically reflecting an appropriate increase in cardiac output. Diastolic blood pressure can remain stable or alter minimally due to peripheral resistance. A significant increase or fall in blood pressure in response to exercise can suggest underlying cardiac dysfunction. This case presentation demonstrates two patients who attended as part of the Unexplained Breathlessness Clinic, performing Cardiopulmonary Exercise Tests (CPET) resulting in a hypotensive response to exercise.Case Presentation Two patients attending for CPETs with respective clinical backgrounds of acrocyanosis and post COVID symptoms presented with mutual complaints of reduced exercise capacity. Both patients performed near-maximal tests which were suspended due to hypotensive blood pressure responses, evidenced by a fall in systolic blood pressure (>20mmHg) from the prior peak measurement (Pritchard A et al. BMJ 2021; 8) ( figure 1).The 9-Panel plot for one patient demonstrated a rising and above normal oxygen pulse (O2pulse) with linear increase in oxygen uptake (VO2) whilst the other showed a reduced O2pulse and VO2max (due to peripheral muscle dysfunction as a result of Long COVID and deconditioning). These findings paired with normal pulmonary function tests and blood tests resulted in referrals for further autonomic testing. One patient also underwent a Stress Echocardiogram.Discussion Extensive autonomic testing for both patients demonstrated no evidence of cardiovascular autonomic failure, normal catecholamine levels, evidence of venous pooling and Initial Orthostatic Hypotension (IOH) with spontaneous recovery. One patient was provided with diagnosis and no further management for the benign and non-progressive physiological phenomenon whilst the other received pre-syncope and syncope management and education. The overall clinical pathway from symptom presentation, initial hypotensive response during CPET to subsequent autonomics testing, evidenced blood pressure responses due to venous pooling rather than cardiac dysfunction.Abstract P57 Figure 1Table and graph demonstrating incremental systolic and diastolic blood pressure measurements against time recorded throughout CPET, demonstrating a >20mmHg foll in systolic blood pressure at 13:24",
  "authors": [
    {
      "affiliations": [
        "University College London Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Jahida Begum"
    },
    {
      "affiliations": [
        "University College London Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Helen Purcell"
    },
    {
      "affiliations": [
        "University College London Hospital NHS Foundation Trust, London, United Kingdom",
        "National Hospital for Neurology and Neurosurgery, University College London Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Ronan Astin"
    }
  ],
  "title": "P57 Abnormal response in blood pressure during exercise",
  "uid": "974bcb19-f161-5621-ab1f-3a1518720ee6"
}