Q. A 60-year-old woman presents to your primary care clinic with worsening shortness of breath and fatigue over the past few months. Her medical history is significant for chronic obstructive pulmonary disease (COPD) with multiple hospitalizations due to acute exacerbations. She has a smoking history of 40 pack years. Her temperature is 98.6°F (37°C), pulse is 98 beats per minute, blood pressure is 140/90 mmHg and respiratory rate is 18 per minute. Physical examination shows bilateral pitting pedal edema and elevated jugular venous distension at 8 cm above the sternal angle. Hepatomegaly is present. Scattered rhonchi are heard all over the lung fields with normal heart sounds on auscultation. What is the most likely diagnosis for this patient?