8th April 2024

A 65-year-old lady presents with bilateral lower leg swelling

A 65-year-old lady presents with bilateral lower leg swelling. On further questioning, she reports occasional shortness of breath but this is not any worse than her baseline. She denies orthopnoea or paroxysmal nocturnal dyspnoea. Her past medical history includes mild left ventricular systolic dysfunction, COPD and Grave’s disease. Her regular medication includes bisoprolol, ramipril, salbutamol inhaler and carbimazole. On examination, her chest is clear and non-pitting oedema is noted in her lower legs bilaterally with scaly thickening and induration of the skin. What is the underlying pathophysiological process?

Select the SINGLE most appropriate option from the list below. Select ONE option only.