Wiggles

Mr. Kaminski had never been seriously ill. He had always taken good care of his health. Didn’t smoke, went regularly to the gym, and walked his dog. At the age of 75years he was a very fit man. He had hypertension - with blood pressure values slightly above normal - but was taking medication for it. Checking his pulse regularly during his workout, he had noted that his heart rate had been lower than normal for several months. He collapsed one day after his workout and was brought to the hospital. A complete AV block was diagnosed. Mr. Kaminski received a DDD pacemaker the same day. Further investigations showed no remarkable features. His coronaries were normal. Mr. Kaminski was happy. The problem was solved and he could go back to the gym. However, he was not the same as he had been earlier. His exercise capacity had dropped. It must be the pacemaker, he thought. Reprogramming the pacemaker on several occasions did not solve the problem.
 
Can the echo help to resolve his problem?
Of course I will show you his echo. Can you see what the problem is?
http://123sonography.com/blog/wiggles