Idiopathic pulmonary arterial hypertension

Case history

A 36-year-old woman presents with a 6-month history of gradually progressive dyspnea on exertion and fatigue. On physical exam, her vital signs are normal and she appears not to be in any distress. Her lungs are clear to auscultation. Her cardiac exam shows a prominent jugular V wave, an accentuated pulmonic component to the second heart sound (P2), and a high-pitched holosystolic murmur best heard at the left sternal border.