MSFinals-0300

MSFinals-0300

A 32-year-old woman with shortness of breath on exercise comes to the clinic some 6 months after the birth of her second child. The recent pregnancy and post-partum period were uneventful. Her general practitioner has diagnosed her with asthma and prescribed a salbutamol inhaler. On examination, she looks unwell and is slightly short of breath at rest. Her blood pressure is 150/80 mmHg and her body mass index (BMI) is 24. There is mild bilateral pitting ankle oedema. Auscultation of the chest reveals no wheeze.
Investigations
Investigation Result Normal value
Haemoglobin 129 g/l 115–155 g/l
White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
Platelets 190 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
Creatinine 110 µmol/l 50–120 µmol/l
Electrocardiogram (ECG) Right axis deviation,
incomplete right bundle branch block
Pulmonary artery systolic pressure 33 mmHg
Which of the following is the most likely diagnosis?