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.
The ECG appears normal.
The x-ray appears normal.
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 shows a pristine coronary vasculature, with a right dominant circulation.