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A 74-year-old woman presented with chest tightness and progressive dyspnoea for 1 week. She had past history of cardiac surgery for tricuspid annuloplasty and mitral valve replacement 2 years previously. A ventricular rate responsive pacemaker was implanted for atrial fibrillation 3 months previously. Physical examination revealed a grade 3/6 holosystolic murmur at the left heart apex. Lab examination showed elevation of D-dimer level. Chest radiograph showed severe cardiomegaly (figure 1). Chest CT angiography was performed for suspected pulmonary embolism. Chest CT showed a …
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