January 28, 2022: Medical Equipment Industry Analysis
Letters from WGR:
Heart Disease and PAH: Chronic Fatigue, Exercise Intolerance
Pulmonary arterial hypertension PAH is not the same as high blood pressure most commonly used to determine vital signs. High blood pressure, hypertension in vascular flow through the body can create heart blockages. High blood pressure (hypertension) is a common condition in which the long-term force of the blood against artery walls is high enough that it causes heart disease.
Figure 1. Measuring Blood Pressure
High blood pressure we all know is bad, to be avoided. We do not even know how to avoid pulmonary hypertension. Pulmonary hypertension measuring is different from the common blood pressure measuring. Pulmonary hypertension affects arteries in the lungs and the right side of the heart. It is measured with an invasive Cath lab test iCPET. Shortness of breath, dizziness, and chest pressure are the symptoms that portend the presence of pulmonary hypertension and the need for taking this kind of iCPET measurement. The condition may worsen over time. Medications and oxygen therapy can help lessen symptoms and improve quality of life.
Only extreme cases of pulmonary hypertension have been diagnosed so far, but exercise intolerance is very common. A better understanding of PAH, the conditions that help are expected to come as pulmonary hypertension gets a lot more attention as long-term Covid is diagnosed and treated.
Figure 2. PAH Pulmonary Arterial Hypertension
Exercise intolerance can be diagnosed as chronic fatigue syndrome and that condition can be improved with exercise, nutrition, weight loss, and oxygen, Football players use oxygen to relieve the stress of running a sprint during a game.
PAH pulmonary arterial hypertension is measured by putting catheters inside the chest attached to a metabolic cart to do blood gas oxygen analysis directly from the inside of the body. Having the patient do strenuous exercise while the team of clinicians is watching what is going on inside the body during the strenuous exercise can provide a definitive diagnosis of pulmonary arterial hypertension.
Because there is a lot of unexplained fatigue, particularly after long term Covid takes hold, the relatively uncommon iCPET test needs to get a lot more common. People can and do recover from exercise intolerance all the time, and exercise intolerance is most likely caused by injury to the veins and arteries that go between the lungs and heart. It is just that we have not had a sufficient diagnostic tool so far for physicians to make a reliable diagnosis, opting instead to call chronic fatigue syndrome a phantom disease.
Recently a few iCPET tests have documented chronic fatigue syndrome as a real disease, a medical condition that needs to be reimbursed by disability insurance.
If you cannot diagnose a condition, the doctors and clinicians cannot treat it. Chronic fatigue syndrome has been largely ignored by the medical community – relegated to laziness or something thereabouts.
This is where medical equipment industrial analysts come in. We describe for the clinicians what tools are coming, what treatments are coming, and how to help in treating various conditions. Industry analysts identify what the growth markets are. For PAH, there is a growth market for treating chronic fatigue syndrome and long-term Covid with oxygen.
There is a growth market in the PAH iCPET diagnostic equipment: cath lab catheters, stress testing equipment, metabolic carts, cardiac ICDs. Implantable cardiac defibrillator (ICD) devices are needed for patients even remotely at risk of a heart attack. When the intense exercise is likely to cause a heart attack during the iCPET test, is is better that the patient has an ICD.
Chronic fatigue syndrome simply drains the energy of the person for no apparent reason. With the iCPET diagnostic test, clinicians have been able to determine the reason. They can see that the arteries and veins between the heart and lung, vulnerable to injury from a severe illness, most likely a fever, have been compromised. Severe illness apparently attacks and injures these parts of the body first. When the organs, brain, heart, lungs, kidneys, liver cannot get enough oxygen to function the body shuts down slowly, and the person experiences fatigue, severe fatigue, extreme exhaustion in many cases.
Figure 3. Chronic Fatigue Syndrome
PAH pulmonary arterial hypertension is considered to be incurable by physicians, but that assessment needs serious reconsideration. It may well be that with time, exercise, intermittent supplemental oxygen, and nutritional attention mild cases may resolve favorably, that the physicians are not good enough at diagnosing the condition to have a handle on what helps.
With pulmonary hypertension blood vessels in the lungs are narrowed and injured. The damage slows blood flow through the lungs, and blood pressure rises in the lung arteries. The heart must work harder to pump blood through the lungs. 70% of the heart disease in the world is not adequately diagnosed, properly understood, or treated. This is because the gold standard for heart diagnosis, the standard stress test, diagnoses heart blockages but not PAH.
Same with the blood pressure test. It is able to diagnose blockages, but not to diagnose damage to the arteries and vessels that run between the heart and lungs. Key aspects of oxygenation of the organs are key aspects of managing energy availability inside the body .
WinterGreen Research studies on this topic:
Supplemental Oxygen Can Remedy both Low and High Carbon Dioxide Blood Levels to Improve Endurance White Paper: This is a 2017 white paper that provides the base for the WinterGreen Research PAH studies.
PAH: Pulmonary Arterial Hypertension Equipment
PAH Portable Oxygen Concentrators Treating Pulmonary Hypertension