[Ergometric assessment of functional performance deficit in psychosomatic patients]

Patients with marked loss of physical and psychological fitness and cardiovascular symptoms without objective findings often pose diagnostic problems. Fifteen patients hospitalized for general incapacity with normal cardiovascular findings were tested in the ECG laboratory on a conventional bicycle ergometer and in a more natural environment climbing stairs in a windowed staircase. Work capacity in the two tests was compared. Eight out of fifteen patients achieved only 40% of their age and weight adjusted nominal value on the bicycle ergometer, while they were fully efficient on the staircase (= discordant result). Four patients reached their expected nominal values in both tests. The performance of three patients was much lower than expected, more markedly so in the laboratory situation on the bicycle. All patients' performance was limited by central nervous incapacitating cardiovascular symptoms. Diagnosis of psychosomatic situational cardiovascular insufficiency in the absence of pathological findings can be substantiated by comparing exercise tests in a physiological and non-physiological environment. This is helpful to both patient and physician by facilitating a more precise diagnostic process and documentation of therapeutic improvement.