Noah

based on mechanisms and etiologies.

And then on the right hard calf, you classify it based if it's pre-capillary, if it's combined pre and post, or if it's post-capillary.

But all of them are kind of not very intuitive to me because you can have group one having

the same right heart calf as group two and group three and so forth.

So there's kind of like a lot of mixed data.

So that's not the way I approach it.

I have a pretty more management approach to pulmonary hypertension, if that makes any sense.

Once I see that the patient has pulmonary hypertension, I say, okay, do they have left heart disease?

Because that's kind of the first big ideology.

Do they have any pulmonary disease?

Because it's the second one.

Do they have any risk factors for CTF?

And then the VQ scan has great sensitivity for picking up that ideology.

And if not, then I start diving into the serological workup of pulmonary hypertension.

That's the way I think about it.

What about you, Mark?

Are you a fan of the anatomical approach or more like the management approach?

Yeah, this case gets more and more complex.

So before I go into the pattern, just kind of want a brief recap.

So we have a patient that now has kind of cardiogenic shock from right ventricular failure with normal left ventricular function in the background of chronic hypoxemic respiratory failure of unknown etiology and with a normal spiral and technically normal gross lung imaging, right?