Case. Patient is a 44 year old male who presents to VA clinic with symptoms of increasing shortness of breath, chest heaviness, decreased exercise, tolerance and lower extremity swelling. He has no significant PMH or FMH, takes no medications at home, and denies tobacco use. An EKG was done in clinic showing RAE. An echocardiogram was done which revealed an elevated RVSP and right ventricular dilation. .