Welcome to the Specialist forum!

I have a 46 year old African American female with past history of SLE, uncontrolled systemic hypertension and Graves disease s/p ablation, OSA(on CPAP). She had a cath done by a cardiologist that revealed MPAP of 55, wedge of 16, LVEDP of 18, stable CO.with no vasoreactivity. Her coronaries were clean.  Interestingly, she was recently noted to have liver cirrhosis with ascites. Clearly there are multiple causes for her PH...SLE, diastolic hear failure, cirrhosis, OSA and hypothyroidism. How would you approach this patient? She was admitted yesterday with worsening renal failure and had to be dialysed.

Thanks for your input.