Review Question - QID 214400

A 33-year-old woman presents to the emergency department with shortness of breath. She states that she has always been short of breath with exertion but that it has been gradually worsening over the past month. She denies any chest pain or recent travel. She had a cold recently from which she recovered The patient does not regularly see a physician and has a past medical history of asthma. Her temperature is 98.7°F (37.1°C), blood pressure is 129/84 mmHg, pulse is 113/min, respirations are 19/min, and oxygen saturation is 94% on room air. Physical exam is notable for bilateral lower extremity pitting edema and jugular venous distension that increases when palpating the patient’s right upper quadrant. Her breath sounds are clear, and heart sounds reveal an S4. A radiograph is performed as seen in Figure A. Laboratory studies are ordered as seen below.

Serum:
Na+: 143 mEq/L
Cl-: 103 mEq/L
K+: 4.7 mEq/L
HCO3-: 23 mEq/L
BUN: 28 mg/dL
Glucose: 113 mg/dL
Creatinine: 1.4 mg/dL
Ca2+: 12.0 mg/dL

Which of the following is the most likely etiology of this patient’s symptoms?