An unusual cause of cardiac failure

A 91-year-old woman, with long-standing swelling of both ankles, presented with a 2-month history of increasing swelling of both legs and lower abdomen. She was otherwise asymptomatic. She had undergone a mastectomy for carcinoma of the breast in 1981. At this time, no cardiac murmurs were documented and her electrocardiogram (ECG) showed normal sinus rhythm with a partial right bundle branch block. She remained well at follow-up. There was no history of ischaemic heart disease. Recently her general practitioner had commenced her on digoxin and diuretics for atrial fibrillation and the oedema.