A 24-year-old woman with no cardiac history is referred to your clinic for further evaluation of shortness of breath. She had twins two months ago and said she did fine after delivery. Since then, she has noticed progressive shortness of breath with mild exertion, the need for three pillows to sleep at night, and increased lower extremity swelling.
On physical examination, her blood pressure is 145/90 mm Hg, her pulse is 95 beats per minute, respiration rate is 20 breaths per minute, and she has an oxygen saturation of 93% on room air. She has evidence of jugular venous distention; normal S1, S2; and an S3 is heard on cardiac examination. In addition, she has bibasilar crackles and lower extremity edema.
