The frontal chest x-ray shows left atrial and left ventricular enlargement.

Left atrial enlargement can be noted from 3 findings on the x-ray:

1. A double right hear border

2. Increased carinal angle (normally should be 60-70 degrees).

3. Distance between the lower border of the mid left main bronchus and the outer margin of the left atrium is 8.5 cm (normally, should be less than 7 cm)

Left ventricular enlargement can be noted by bulging, elongated left heart border.

On the ECHO, this patient was noted to have severe mitral regurgitation with enlarged left atrium and left ventricle.

Reference: Fundamentals of Diagnostic Radiology by Brant and Helms.