A 58-year-old woman presents with paroxysmal nocturnal dyspnea for 2 weeks, in a background of worsening exertional dyspnea, vague chest discomfort, and pitting peripheral edema for 1 year. There is no orthopnea. Her New York Heart Association (NYHA) classification is II. Her surgical history is significant for two lower segment cesarean sections (LSCS) performed at the ages of 32 and 36 respectively. Her medical, drug, allergic, and family histories are all unremarkable. She does not smoke, only drinks socially, and does not use recreational drugs. Her basic bloodwork, including a complete blood count, serum electrolyte assay, and liver and renal profiles, are all within normal parameters.