Youssef

And that is implied, and I would love to just say that out loud.

And the causes of shock, you can spell out shock, so S is in septic, H is hypovolemic or hemorrhagic, O is obstructive, and C is cardiogenic.

So in any patient with syncope, in addition to the big buckets of reflex, orthostatic, and cardiac, you're thinking of any cause of shock.

And there's a big overlap here between cardiac and obstructive, so we're thinking, is this like a

right-sided pressure phenomenon.

And Mark, to answer your question, I think the age is really helpful.

And the other thing that's really helpful is the center of attention.

We didn't hear from Maddy that this patient presented to a heart failure clinic for lower extremity edema.

We didn't hear from Maddy that this patient presented for a COPD to a pulmonologist.

We heard that they presented to a pulmonary hypertension clinic.

And the vast majority of cases are going to be related to cardiac disease or obvious pulmonary disease.

But the fact that they presented to a pulmonary hypertension clinic has me worried about more esoteric causes.

And I'll leave it at that.

And we'd love to hear more from Maddy.

Absolutely.

And great aliquot, Maddy.

And hearing things out loud, I'm still trying to label the problem.

And we heard about a possible diagnosis of pulmonary hypertension.

We heard about lower extremity edema.

And then we heard a lot about cardiometabolic risk factors.