A 45-Year-Old Woman Is Evaluated for Progressive Exertional Dyspnea and Fatigue

A 45-year-old woman is evaluated for progressive exertional dyspnea and fatigue.  She also reports episodic pain and bluish discoloration of the fingers and toes on cold exposure that improve with rewarming.  Physical examination shows skin tightening over the fingers.  Cardiac examination reveals an accentuated S2 over the upper left sternal border.  The abdomen is soft with mild hepatomegaly.  There is bilateral lower extremity pitting edema.  Pulmonary function test results are as follows: Which of the following is the most likely cause of this patient's dyspnea?

A) Hypoxia-induced vasoconstriction
B) Intimal thickening of pulmonary arterioles
C) Myocardial amyloid deposition
D) Pericardial thickening and fibrosis
E) Pulmonary interstitial fibrosis
F) Right-sided valvular heart disease

Correct Answer:

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