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: Going through a complete cardiac rehabilitation is essential for all cardiac patients undergoing complex surgery, including those who wear intracardiac devices. Determining the effort capacity after the surgical intervention might provide satisfactory results with the improvement of the quality of life. Case presentation:  We present the case of a male patient, 44 years old, known with aortic bicuspid valve, aortic mechanical valve evolved with prosthesis mismatch and aortocoronary bypass (right coronary artery), followed by total atrioventricular block which required cardiac pacemaker VVI, who is admitted in the Cardiovascular Rehabilitation Clinic to continue the second phase of the rehabilitation program. The ergospirometry test (which was performed in order to evaluate the impairment of the effort capacity) showed a moderate-severe decrease of effort capacity (42% of maximal oxygen consumption, class C Weber), effort hypotension and chronotropic incompetence which led to pausing cardiopulmonary test before anaerobic threshold. Stepper exercise or climbing stairs did not cause the lowering of blood pressure and heart rate, which led to the idea of controlling and adjusting the stimulation parameters. Within cardiopulmonary testing in patients with pacemaker special regards should be paid towards: parameters assessment during effort (heart rate during the test in pacemakers without adaptation to exercise, heart rate during the test in pacemakers with adaptation to exercise, evaluation of the effort response in patients undergoing resynchronization therapy) and diagnosis of exercise-induced arrhythmia (atrial fibrillation, ventricular extrasystoles, ventricular tachycardia, as well as identification of arrhythmias in patients with implantable cardioverter defibrillator). Conclusion:  The cardiopulmonary stress test in patients with cardiostimulation should respect certain conditions in conducting the test in order to obtain realistic results of functional capacity. Due to the position of the piezoelectric crystal and the immobilization of the limbs during the cycle ergometer test it is recommended testing using the treadmill.

medicina internă

Particularities in Cardiovascular Recovery by Physical Training in a Patient with Prosthetic Valve, Permanent Electrical Cardiac Stimulation and Aortocoronary Bypass