The echocardiogram presented a prominent right heart with mild right ventricular hypertrophy, without significant tricuspid regurgitation, and normal right atrial size. No evidence of neoplasia was noted in the right auricle, or elsewhere in the heart. The pulmonary artery was uniformly prominent with mildly depressed pulmonic velocity measured on PW Doppler. No overt heartworms were noted in the main or visible deep pulmonary arteries. Yet, theoretically heartworms could be present in the deep pulmonary vasculature out of visible sonographic range. More likely, however, this prominent right heart is due to excessive intra-thoracic pressures caused by chronic respiratory disease or potentially excessive intra-thoracic fat (Pickwickian syndrome). The left heart demonstrated a linear ventricular septum. . The mitral valve revealed insufficiency with prolapse of the anterior mitral valve leaflet. The left atrium was enlarged. No evident arrhythmic activity was noted during the exam. Mitral insufficiency velocity 6.3 m/sec. Tricuspid insufficiency velocity 3.36 m/sec.