A man in his 60s presented for shortness of breath on exertion for several months. The patient denied any chest pain or palpitations. Medical history included liver transplantation for hepatocarcinoma and chronic kidney disease. Physical examination findings were normal except for tachycardia at 114 bpm. An electrocardiogram (ECG) was obtained (Figure 1).
Transthoracic echocardiography showed a left ventricle ejection fraction (LVEF) of 20% to 25% without regional wall motion abnormalities and a left ventricle end-diastolic diameter (LVEDD) of 60 mm (Figure 2A).