PMC8049827_01
Initial electrocardiogram (EKG) demonstrating right bundle branch block, right axis deviation, and sinus tachycardia.
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An electrocardiogram (EKG) demonstrated a right bundle branch block (RBBB), a posterior left fascicular block, and sinus tachycardia (Figure 1).
Transthoracic echocardiogram (TTE) demonstrating right sided ventricular hypertrophy.
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A repeat echocardiogram demonstrated severe right ventricular enlargement (Figure 2).
Initial plain chest film demonstrating acute pulmonary edema and repeat study at four days of hospitalization with improvement in volume overload. Congenital rib deformity and pulmonic valve ring are visible in both images.
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He was extubated after three days of optimizing his volume and respiratory status, and his liver chemistries, INR, and serum lactate normalized.  Figure 3 compares an initial CXR and one performed at day 4.
Cardiac magnetic resonance imaging demonstrating marked right ventricular enlargement.
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A cardiac magnetic resonance image (MRI) showed a normal left ventricular ejection fraction (EF) of 55%, a severely enlarged right atrium and right ventricle (RV) with marked depression in right ventricular function (RV EF: 18%) (Figure 4), and severe bioprosthetic pulmonary regurgitation.