Gus is a 46-year-old auto mechanic with an 8-year history of hypertension, which is being treated with a combination of an angiotensin-2 receptor blocker (ARB) and diuretic. He presents to the office because he had diarrhea 2 weeks earlier, followed by troublesome bloating, burping and epigastric discomfort. Examination reveals mild epigastric tenderness, and he's treated with a trial of proton pump inhibitor therapy. 

The patient returns 4 days later feeling "better," but he reports a sense of "pressure" in his chest at night, along with bloating and some difficulty getting "a good deep breath." An upper gastrointestinal series and abdominal ultrasound come back normal with no evidence of gastroesophageal reflux disease, peptic ulcer, abnormal intra-abdominal mass or fluid collection.

Gus is back in the office 10 days later, however, with recurrent complaints of epigastric pain and bloating, which increase with physical activity, so that he occasionally needs to stop for a "deep breath." He awakens at night with a sense of acid coming up into his chest, resulting in a choking sensation. With deep breathing he feels a "gurgling" in the throat, which improves with cough.

Clinical examination reveals a stocky man in no apparent distress and with no evidence of cyanosis. His blood pressure is 130/90 mm Hg, pulse is 96/min and regular, and the chest is clear to auscultation with normal bilateral air entry. His neck veins appear slightly prominent and there's mild bilateral pretibial edema. Some right upper quadrant and epigastric tenderness is noted on abdominal examination with no evidence of ascites. Routine laboratory investigations reveal a hemoglobin of 123 g/L, white blood cell count of 8.6 x 10⁹/L, creatinine at 122 µmol/L and an estimated glomerular filtration rate of 58 mL/min/1.73 m², normal electrolytes and 0.3 g/L proteinuria. A chest x-ray shows cardiomegaly and mild congestive heart failure. An urgent 2D-echocardiogram is performed 2 days later. What do you expect to find?