A 30-year-old female has fatigue and worsening shortness of breath on exertion. BMI is 44 kg/m2. She takes diet pills and lost around 5 kgs in 3 weeks. Blood pressure is 125/85 mm Hg. Cardiac examination shows a loud pulmonary component of the S2. Which of the following is the most likely pathogenesis behind patient's shortness of breath?
Hyperplasia of pulmonary vascular walls
Blockade of the right bundle branch
Hypertrophy of interventricular septum
Permanent enlargement of distal airspaces
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