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A 54-year-old woman with a history of hypothyroidism, systemic hypertension, and an electrocardiogram showing left ventricular hypertrophy with repolarization abnormality underwent mastectomy and chemotherapy with doxorubicin for carcinoma of the breast with pulmonary metastases. Soon thereafter she became dyspneic, and the dyspnea persisted over the next 6 years despite treatment for cardiac failure.When she was admitted to the hospital at age 60 for worsening cardiac failure, she required inotropic agents for 36 hours. Her neck veins were markedly elevated with large CV waves despite vigorous diuresis. Crackles were heard at both lung bases. Her liver was markedly enlarged and tender, especially the left lobe. She complained that her liver hurt worse when she walked. A huge right ventricular lift was palpable at the left sternal border, and a large dynamic left ventricular impulse could be

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