Description 

A 66-year-old man presented with progressive breathlessness for 1 week. Further history was consistent with orthopnoea and paroxysmal nocturnal dyspnoea. He was a known case of ischaemic heart disease, on medical management with poor compliance, for 5 years. On examination, blood pressure was 130/70 mm Hg, pulse rate 94 beats/min and respiratory rate 36 breaths/min with SpO₂ 92% at room air. He had raised jugular venous pressure (12 cm of water), bilateral pitting pedal oedema and bilateral basal crepitation on chest auscultation with gallop rhythm (LVS3). Echocardiography revealed systolic …