Dilated cardiomyopathy. (A) All heart chambers are enlarged. Note mitral ‘tenting’ due to eccentric pull of papillary muscles with apposition of the leaflets displaced into the left ventricle. The dotted line marks the level of the mitral annulus. (B) and (C) Calculation of left ventricular volumes and ejection fraction by modified Simpson’s rule (in this case, monoplane from planimetry of the left ventricle in end-systole and end-diastole). End-systolic volume: 147mL; end-diastolic volume: 191mL; ejection fraction 23% (severely reduced).