A 48 year old man presents with progressively worsening dyspnea for 3 months, which is worse when sitting up. There is no history of fever, cough or chest pain and he is otherwise asymptomatic.

He was diagnosed with alcoholic cirrhosis 5 years ago, following which he stopped drinking. An upper GI endoscopy performed 6 months ago showed grade II esophageal varices, which were banded.

A chest x-ray and ECG are performed and found to be normal.