Youssef

In general, when I heard about the lower extremity edema, the thing that came up to my mind is this is an evidence of right-sided disease, so right-sided heart disease.

And I would be hesitant to label this just heart failure.

Instead, I would label it specifically as right-sided disease because we only heard about edema so far.

We didn't hear about pulmonary edema, only some in the lower extremities.

And then that makes the pulmonary artery potentially the center of attention of the case here.

The patient is at risk for HFPAF.

And what is HFPAF?

So it's heart failure with preserved ejection fraction.

And

We used to think in the past that high blood pressure causes LV hypertrophy and that alone causes HFPF, but now we think of it as a cardiometabolic disease that occurs in females who are older than 70 with risk factors such as AFib, higher BMI, diabetes, and hypertension, etc.

But the fact that we don't hear about any left-sided symptoms is making me think, is the pulmonary artery the center of attention of the case?

And before I talk about the etiologies, Noah, I would love to hear about how you think about the anatomy of pulmonary arterial disease, and do you have an approach?

And I know you love to take us through the journey of blood vessels, et cetera.

I know you did it last time for our episode.

Yeah, thank you, Mark.

I loved your note on normal intensive shock, really easy to miss.

One thing to note is if you want to, like, if you're listening, you can Google pulmonary hypertension drawing, and that's a quick way, like a mnemonic to remember it.

So group one, if you put two ones next to each other, it looks like an artery.

So it's

pulmonary arterial hypertension.