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Cardiovascular Images
November 18, 2020

A Patient in Their 70s With an Unusual Case of Heart Failure

Author Affiliations
  • 1Department of Cardiology, Blacktown Hospital, Blacktown, Australia
  • 2School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
JAMA Cardiol. 2020;5(11):e205609. doi:10.1001/jamacardio.2020.5609

What is the most likely diagnosis on this transthoracic echocardiogram? A patient in their 70s, with a remote history of dilated cardiomyopathy (which was lost to follow-up), permanent atrial fibrillation, and hypertension, presented with dyspnea and signs suggestive of decompensated heart failure. A transthoracic echocardiogram revealed severe biventricular dilatation with severe functional mitral and tricuspid regurgitation. The forward left ventricular ejection fraction was severely reduced and measured 25%. Strikingly, there was evidence of marked biatrial dilatation, with a measured indexed left atrial volume of 438.3 mL/m2 (Figure).

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