A 62-yeаr-оld mаle presents with а twо-mоnth history of worsening fatigue and shortness of breath. He has a PMH significant for emphysema and 60-pack-year cigarette smoking history. The patient complains of “nearly passing out” while climbing the stairs in his house. He tells you that he feels like his heart races. He reports chronic shortness of breath and cough, but he now feels like his dyspnea is dramatically worse; he can no longer sleep in his bed. He has been trying to sleep propped up in a chair at night. He is also experiencing fatigue. He has gained about 15 pounds, and he notes that he can no longer lace up his shoes because of swelling in his feet. He denies fever, chills, and chest pain. His cough produces some mucus, but no hemoptysis. Pulse ox (room air): 90% Vital signs are: WT: 212 lbs., HT: 69”, BMI: 31.3, HR: 108/min, BP: 140/88, T: 98.2°F On physical exam, the patient appears to be in mild respiratory distress; he is sitting upright and leaning forward, and he uses accessory respiratory muscles for breathing. The exam is significant for reduced air movement and mild rales bilaterally in the lungs; distended neck veins; mild tachycardia with prominent pulmonic component of S2 heart sound; lower extremity edema; and right upper quadrant abdominal tenderness with hepatomegaly. Which of the following conditions is the most likely diagnosis for this patient?
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