The patient was admitted to our cardiology department for management of acute congestive heart failure.Electrocardiogram showed atrial fibrillation and complete right bundle branch block.Chest X-ray revealed cardiomegaly with signs of atrial enlargement and pulmonary congestion.Transthoracic echocardiogram showed low-gradient severely compromised rheumatic MS.Laboratory results: significantly elevated brain natriuretic peptid. Management of the congestive heart failure and anticoagulation for atrial fibrillation. This evidence concerns the gene NPPB and pulmonary vascular congestion.