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?