FINDINGS:
PA and lateral views of the chest were provided.  Tripolar pacer is
 unchanged with leads extending to the region of the right atrium, right
 ventricle and coronary sinus.  The heart is mildly enlarged.  There is
 pulmonary vascular congestion which is new from prior exam.  The lungs appear
 clear without definite signs of pneumonia or alveolar edema.  Right CP angle
 is excluded.  No pneumothorax.  Mediastinal contour is stable.  Bony
 structures are intact.

IMPRESSION:
Cardiomegaly with central pulmonary congestion.