What may have been missed? SOB, High BP, exhaustion upon exertion

A 35-year-old female (my wife) was doing workouts 5x a week, losing weight, able to hike up a diamond head in Hawaii in January with no problem. Around March started to find it difficult to keep up in the workout and increased difficulty breathing also notice swelling and weight gain (20-30lbs) with no routine or diet change. In May on a light hike, experienced extreme difficulty breathing, elevated heart rate, and blood pressure. ECG did at the ER and told that she was fine. over the course of the year has tested negative for covid, and had 3 echocardiograms told that her ejection fraction was 40-45% in July and November. Had another and was told it was 60% and she was fine. had a sleep study and was told had apnea and now has a CPAP machine. MRI also has shown nothing. symptoms have worsened as the year progressed. Her body starts to swell, experiences shortness of breath, and an increase in heart rate and blood pressure whenever doing the slightest exertion. symptoms improve when laying down. Hospital says that hormones, lungs, and heart are fine. Is there something that may have been missed and if so where should they be looking? weighs 198lbs is 5"1, has 6 kids, 7 pregnancies, had pre-eclampsia with last pregnancy 3 years ago. has Crohn's disease and pituitary tumor (hasn't had issues with either for past 10+ years). Currently on blood pressure medication and a water pill.

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