Youssef

Group two, if you flip two twos next to each other, it looks like a heart, so it's left-sided heart disease.

Group three is lung disease.

Group four is CTEF, and group five is the bucket.

And to simplify it even further, you can also think about it anatomically.

Think about the RV, the pulmonary artery, and then going into the arterioles, the capillaries, and then all the way to the left ventricle.

And one way you quickly want to think about this is, is this the lung?

So we hear that the CT of the chest has normal lung findings.

So that's very reassuring.

It could still be like OSA, OHS, but we hear that the patient's gamma is 26, not extremely high.

So that's reassuring as well.

You want to think about the heart.

So whenever you do the right heart cath, you can see how high the left-sided pressures are.

And sometimes you can have a combination.

You can have left-sided heart disease and pulmonary arterial hypertension.

That's also very common.

Group four, so CTPE does not rule out chronic thromboembolic disease.

So you would need CTPE.

a VQ scan.

And I think these three steps, if you rule these out very quickly early on, like a CT, which we already have, a right heart cath to check the left-sided disease, and a VQ scan, you can get the vast majority of cases.

And once you rule these out, you can then jump to group one and group five.