Bottleneck

A 68 year old man is referred for evaluation of a heart murmur discovered at a routine checkup.

Initially, he claims to be asymptomatic. However, further questioning reveals a slight decrease in exercise capacity which he attributes to "old age".

His medical and drug histories are unremarkable.

Select Relevant Investigations
ECG

Performed

The ECG appears normal.
Chest X ray

Performed

The x-ray appears normal.
Echocardiography

Performed

There is moderate aortic stenosis with an increased transvalvular pressure gradient and decreased transaortic flow velocity. Left ventricular hypertrophy is noted, while the ejection fraction is 60%.
Coronary Angiography

Performed

Coronary angiography shows a pristine coronary vasculature, with a right dominant circulation.

Select Relevant Management
Statins
Aspirin
Aortic Valve Replacement
Endocarditis Prophylaxis