Fig. 4

a In a right ventricle-centered view, a thickened right ventricular wall and a small amount of pericardial effusion next to the right ventricular apex (arrow) are apparent (patient 7, age 68). Among the serial echocardiographic studies this patient received, this is the earliest echo image in which the combination of ventricular wall thickening and pericardial effusion can be identified. b In this parasternal long-axis view, a thickening of the right ventricular free wall at 0.74 cm (dashed line) and very thick left ventricular walls (asterisk) are apparent (patient 7, age 69). c The ECG of this patient shows a normal sinus rhythm and a complete left bundle branch block (age 69)