systemic sclerosis presents for annual review to the rheumatology clinic.. Exertional dyspnoea

A 52-year-old female with a known history of systemic sclerosis presents for annual review to the rheumatology clinic. Which one of the following symptoms is most characteristic in patients who have developed pulmonary arterial hypertension?
A. Exertional dyspnoea***
B. Paroxysmal nocturnal dyspnoea
C. Cough
D. Early morning dyspnoea
E. Orthopnoea
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