IMPRESSION:
AP chest compared to :
 
 Moderate right pleural effusion unchanged.  Moderate cardiomegaly and
 pulmonary vascular engorgement unchanged.  Mild interstitial pulmonary edema
 worsened.  Transvenous right atrial and left ventricular pacer and right
 ventricular pacer defibrillator leads unchanged in standard placements.  No
 pneumothorax.