Fig. 2

Patient echocardiogram. An apical, left two-chamber view shows moderately dilated left ventricle, mild concentric left ventricular hypertrophy and severely reduced systolic function. Left ventricular end diastolic diameter Z score 5.59 by M-mode and end-diastolic volume by 5/6 area length method is Z score 4.98. left ventricular dp/dt of 1398. There is also a LV diastolic dysfunction with fusion of E and A waves of inflow doppler pattern. There is moderate to severe mitral valve regurgitation and mild to moderate tricuspid regurgitation. The aortic and pulmonary valves are trivially regurgitant. There is no pericardial effusion