A 44-year-old woman presents with a 6-month history of worsening dyspnea on exertion. She has reduced exercise capacity and has to stop to rest after walking one to two blocks.

On physical exam, her blood pressure is 125/76 mm Hg, and her pulse is 72 beats per minute and regular. Neck veins are flat. Carotid pulses are bounding. Lungs are clear to auscultation bilaterally. Cardiac exam reveals a hyperdynamic apical impulse in the fifth intercostal space, midclavicular line. There is a 3/6 systolic nonradiating ejection murmur in the left upper sternal border. Extremities are warm with no peripheral edema.

Echocardiography is performed to evaluate left ventricular systolic function (Video 26-1).