She had a history of coronary artery disease and ischemic mitral regurgitation treated with CABG and mitral valve repair three years earlier. On clinical examination a holosystolic apical murmur was noted. Her jugular veins were dilated and lower limb edema was present. Bedside examination with KOSMOS revealed impaired systolic function of both ventricles accompanied by severe residual ischemic mitral regurgitation and significant functional tricuspid regurgitation. Intravenous diuresis was promptly initiated resulting in improvement of her symptoms.