An 83-year-old man with known severe coronary ar- tery disease, diffuse small vessel disease, and signifi- cant stenosis distal to a vein graft from previous CABG surgery, was admitted when his physician re- ferred him to the hospital after a routine office visit. His symptoms included 3 pedal edema, jugular vein distention, and heart sound abnormalities. Sig- nificant laboratory data obtained upon admission were as follows: