Fig. 3

A four-chamber dilative cardiomyopathy with biventricular dysfunction (left ventricular ejection fraction 18%) was diagnosed 13 weeks after the accident. The echocardiography findings showed: enlargement of all the heart cavities; a left ventricular end diastolic diameter 65 mm (normal values 46.8 ± 6 mm); ejection fraction 18% (normal values 50–65%); tricuspid annular plane systolic excursion 1 cm (normal values > 1.6 cm); distinct central mitral insufficiency; and moderate tricuspid insufficiency. There was also a high suspicion of secondary pulmonary hypertension in the context of left ventricular insufficiency (systolic pulmonary artery pressure 45 mm Hg + central venous pressure). LA left atrium, LV left ventricle, RA right atrium, RV right ventricle