Video 4-3-4 (AB): (A) Apical 4 chamber view taken from the initial echocardiogram of this patient. The echo shows LV dilation, tachycardia, and marked diminution of global systolic function. Note, also, biatrial enlargement, severe mitral annular calcification and myxomatous degeneration of the mitral valve. (B) Apical 2 chamber view taken from the initial study of this patient, with color flow Doppler mapping demonstrating a broad area of flow turbulence in the left atrium in systole, indicative of severe mitral regurgitation. There is a large area of flow convergence in the left ventricle. Note also the rapid heart rate and severe systolic dysfunction.