Fatigue, shortness of breath and light-headedness upon exertion may represent PAH, according to new types of cardiac testing that give more incisive insight into combined heart and lung functioning.  Invasive cardiopulmonary exercise testing (iCPET) gives a more precise view of cardiac function, giving more insight into heart failure.  iCPET can explain more about patient heart/lung condition.  Some PAH occurs because of a viral or severe illness that causes damage to heart and lung arteries and vessels.   These arteries and lung vessels that run across the center of the chest, between the heart and lungs inside the body can be damaged by a virus. 
 
An invasive iCPET test is needed to achieve a definitive diagnosis of this type of heart failure that is estimated to impact 70% of heart failure patients.   Blockages only account for 30% of heart disease, the gold standard stress test for heart failure only detects heart blockages, not PAH.  The invasive cath lab iCPET test is needed to definitively diagnose chronic fatigue syndrome.  The ordinary heart diagnostic tests - stress test, lab tests, bloodwork, pulmonary function testing, echocardiography, cardiac catheterization, radiographic imaging, nuclear imaging,  cardiac stress testing, noninvasive cardio-pulmonary exercise testing (CPET) do not diagnose PAH. 
 
People with chronic farigue syndrome have suffered 20 years or more without a diagnosis or disability insurance because the standard tests miss the PAH problem.    All these tests are unable to detect PAH and the patient is left with exercise difficulties that are unexplained, frequently attributed to faking,  Pulmonary arterial hypertension (PAH), high blood pressure in the lungs, is characterized by exercise intolerance that can only be diagnosed with iCPET in many cases.
 
With long-haul COVID and chronic fatigue syndrome, new diagnostic tools provide a window into PAH.  PAH exercise intolerance caused by lung artery or venous failure can now be definitively diagnosed by the invasive look inside the body at the damaged arteries and veins and the lack of ability to carry adequate oxygen to the organs can be documented definitively. 
 
This disease of intolerance to exercise mimics fatigue often experienced by American football players that use supplemental oxygen on the bench after a stressful sprint on the playing field.  New research that documents how much supplemental oxygen treatment helps heart failure.  Research projects in the leading hospitals worldwide need to be funded by vendors serving the iCPET market to get a better handle on PAH and possible supplemental oxygen treatments for PAH.
 
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