A 59 year-old man with a known history of COPD presents with…

Questions

A 59 yeаr-оld mаn with а knоwn histоry of COPD presents with worsening dyspnea. On examination he is afebrile. He denies productive cough. His breath sounds are decreased bilaterally. He is noted to have jugular venous distension and 2+ pitting edema of the lower extremities. Which of the following is the most likely cause of his increasing dyspnea?

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