Review Question - QID 212489

A 41-year-old woman comes to the clinic complaining of progressive shortness of breath and fatigue for the past 2 years. She reports that “it gets difficult to breathe, especially when I try to exercise at the gym.” According to the patient, she first noticed the symptoms several years ago, but it has worsened to the point that 2 minutes of cardiovascular exercise will leave her dyspneic. Past medical history includes hypertension and 1 miscarriage. She reports smoking 1 pack per day for the past 20 years. Physical examination is significant for a loud S2, jugular venous pulse (JVP) of 10cm H2O, and bilateral lower extremity edema. The patient’s skin findings are shown in Figure A. What systemic disease best explains this patient’s presenting condition?