This case demonstrates features of severe pulmonary hypertension. This was a case of idiopathic pulmonary arterial hypertension. 

In an exam look for common causes of Pulmonary hypertension such as:

• pulmonary parenchymal disease (pulmonary fibrosis, emphysema, cystic fibrosis)
• pulmonary vessels (chronic pulmonary thromboembolism)
• cardiac (L>R shunts, mitral stenosis)
• connective tissue disorders (Scleroderma with dilated esophagus)

And consequences such as:

• right heart strain