Patient description: 33y/o M in ED c/o dyspnea x 6 months. HIV+ and amphetamine user. BP on the low side, loud S2, parasternal heave. BNP and LFTs elevated. Each shows marked RV dilation and TR. RHC shows RA 12, RV 65/7, EDP 19, PA 61/21 with mean 39, PAWP 12, CO 2.43, CI 1.28, SVI 12, PVR 11 Wood units. MvO2 44%. There is no response to inhaled nitric oxide iNO. CT shows no parenchymal lung disease. Diagnosis of PAH made.