A 63-year-old man presents with worsening breathlessness over 4 weeks culminating in his admission with pulmonary oedema. His echo is shown in Figs 15.1, 15.2, 15.3, 15.4, 15.5, 15.6, 15.7, 15.8, 15.9 and 15.10, and in Videos 15.1, 15.2, 15.3, 15.4, 15.5, 15.6, 15.7, 15.8, 15.9, 15.10, 15.11, 15.12, 15.13, 15.14 and 15.15.