Case Presentation 81 yo woman with dyspnoca & oedema* Hlo systemic hypertension & AF* BP 166/84,HR 74, JVD, bilat crepitations* CXR: mild cardiomegaly, pulm congestion* Hb, Creatinine normal; BNP 220» Echo: LVEDVI 94, LVEF 65, mild RVenlargement with normal RV systolic function,flattening of IVS, biatrial enlargement, modTR, mild MR, E/e' 24, PASP 80 mmHg