45 year old woman complaining of dizziness with exertion


Patient Chart History: A 45 year old diabetic woman, two pack a day smoker, who has developed right calf pain with exertion.

Physical Exam
High blood pressure (140/80).
Pulse rate 80.
No pulse in right foot.
Marked increase in chest diameter.


Test Results: White blood cell count normal.
Electrolytes normal.
Thyroid function studies normal.
Chest x-ray shows prominent pulmonary artery.


Heart Sounds:


Diagnosis What is your diagnosis?