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what do you guys think about positive case pressure vs negative? Either way it all has to blow out or in from somewhere, or else the case would explode or implode.

That's slightly an overkill. A passive cooled 5450 for $25 a/r will handle 1080p perfectly and will use less power and be completely silent (no fan). http://www.newegg.com/Product/Product.aspx?Item=N82E16814102922&cm_re=sapphire_5450-_-14-102-922-_-Product (i'm using the 1gb version of this)