Mark

Pulmonary hypertension doctors are much more aggressive with diuresis than we are.

And really it is because while they are preload dependent, and while if you valve salva and decrease your preload and you syncopize, that usually means that your RV is doing pretty bad and there's pretty high pulmonary pressures.

if your rv is so dilated and so decompensated that rv starts to bow into the lv and then starts to cause you know decreased perfusion to the systemic circulation so that's why really one of the main states of treatment is diuresis because you want to prevent that bowing of the rv into the lv so it's this really delicate balance that's why a lot of times these patients are such a low threshold for these patients to be in the cardiac icu or the medical icu when you know you're having um

you know, the arterial line in them and keeping a really close eye on their pressures.

And so, yeah, they're really tough patients to manage.

But Yusuf, I'm curious, when you think of like a new patient with pulmonary hypertension, really all we have now is the age.

How do you think, how do you stratify the differential diagnosis based on the age?

Does that help you at all?

I think I like both.

Honestly, I love thinking about physiology and anatomy.

But then I think the five groups are more of the management approach helps me kind of get to those etiologies more quickly.

So I probably stick with the five groups more commonly than I do the anatomy and physiology approach.

But I think both are great.

I think one of the things that's really tough about pulmonary hypertension and what can lead to a lot of diagnostic errors, it comes down to the law of proportionality, right?

We talk about this a lot in CP solvers is that left heart disease is really common.

Lung disease like COPD is really common.

pulmonary embolisms are really common, right?

So I think it's really easy to say, oh, this patient has pulmonary hypertension from their HFPEP.

The patient has pulmonary hypertension from their COPD.

Oh, they had a prior PE, maybe they have CTEF and kind of stop the workout, work up there.