so there’s a group at Brigham and Women’s doing invasive CPET in ME/CFS - meaning catheters, not just a bike and a mask. Systrom’s team found two things: reduced preload (not enough blood returning to the right heart during exertion) and impaired peripheral oxygen extraction. the reason this matters: both look completely normal on a resting echo.
your cardiologist sees a healthy heart and closes the file. the dysfunction only shows up under exercise load with direct pressure measurements that routine testing doesn’t include. i’ve had two clean echos.
i crash after a 15-minute walk. as a PT i can follow the physiology here - and this is the first mechanistic explanation i’ve read that connects those two facts without routing through “anxiety” or “deconditioning.” anyone actually pushed their cardiologist toward an iCPET, or found another way to document the preload piece on a normal cardiology workup?