FIG 3: The physical examination did not show any severe problems.  There was no evidence of decompensated heart failure; he had normal heart and breath sounds, and no murmurs.  His serum creatinine was slight increased.  His electrocardiogram (ECG)  showed atrial fibrillation in the mildly reduced frequency.  His echocardiogram showed a left ventricular dilation of 44 mm, and the left ventricular ejection fraction was slightly reduced to 49%.  Chest x-ray showed a mild dilation of the heart, but no pulmonary congestion, effusions, or infiltrates.  His blood gas tests showed hypocapnia, with a partial pressure of CO₂ (pCO₂) of 33.6 mmHg.  During exercise testing, he reached 67% capacity of normal, with oxygen consumption reduced to 56% of normal range.