Youssef

And then

idiopathic, which basically means medicine has not reached a point where we know what causes it.

Mark, what would you add to this?

Yeah, Maddy, thank you for presenting this aliquot.

One thing that comes to my mind, we were thinking about group one etiologies and we're thinking of inflammatory versus non-inflammatory symptoms.

And here we don't hear about any inflammatory symptoms so far.

And under the non-inflammatory bucket, we talked about vitamin deficiencies.

We didn't hear about any risk factors and you can develop scurvy just from like avoiding citrus products.

And in this case, we didn't even hear about that.

One telltale sign of pulmonary veno-occlusive disease, which is a disease that acts like heart failure,

but then once acts like left heart failure, and then when you do the cath, you see that the left-sided pressures are normal, and that is how a pulmonary vena occlusive disease presents.

And one telltale sign is that these patients, sometimes their hemodynamics worsen with epiprostanol or vasodilators, because if you think about it,

occluded at the venous side.

So right after the capillary.

So if you vasodilate them, their hemodynamics worsen.

So I'm adding that higher on my list.

So that's one thing I'm considering.

And then we'd love to hear from Noah and Mark as well.

as to could this just be worsening shock?

And is this just the right heart spiral that Mark was alluding to earlier?