A repeat echocardiogram on day 14 demonstrated marked improvement in her left ventricular systolic dysfunction (mild-moderate systolic impairment) and her heart failure was now NYHA class I. Standard oral heart failure therapies (ACE-inhibitor, betablocker and diuretics) were optimised, hydroxycarbamide was stopped on day 24 and steroids weaned over an 8 week period. The gene discussed is ACE; the disease is heart failure.