Podcast #4 - A 72F with ankle swelling

A 72-year-old woman comes to the physician for an 18-month history of ankle swelling and shortness of breath. She has smoked two packs of cigarettes daily for 45 years. Her vitals are: HR 76, RR 22, BP 160/90. Physical examination shows pedal edema. Chest auscultation reveals bilateral diffuse wheezes. Cardiac examination shows a 2/6 holosystolic murmur along the left sternal border that is accentuated with inspiration. Heart sounds are distant. The point of maximal impulse is palpated in the sub-xiphoid area. Abdominal examination shows a liver edge palpable a few centimeters below the costal margin. What's the most likely diagnosis? Aortic regurgitation Congestive heart failure Cor pulmonale Mitral regurgitation Primary pulmonary hypertension