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Systolic murmur in an asymptomatic 70 year old man

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P Paramsothy, CM Otto, Division of Cardiology, University of Washington, Seattle, USA Correspondence to: Professor Catherine M Otto; cmotto{at}

A 70 year old man with hypertension underwent echocardiography for an asymptomatic murmur and was found to have aortic valve sclerosis. Over the next eight years, annual echocardiography showed progressive valve calcification with an increase in transaortic velocity and pressure gradient and a decrease in valve area. He eventually developed decreased exercise tolerance and was referred for aortic valve replacement.

The purpose of this interactive case presentation is to illustrate the diagnosis and clinical implications of aortic valve sclerosis and the progression of sclerosis to significant stenosis, and its appropriate diagnosis and management.

The purpose of this interactive case presentation is to illustrate:

  • The clinical significance of aortic valve sclerosis

  • The clinical factors associated with aortic valve sclerosis

  • The diagnosis of aortic valve stenosis

  • The natural history of aortic stenosis

  • The physical signs and echo cardiographic features of severe aortic stenosis

This interactive case history is hosted on BMJ Learning—the best available learning website for medical professionals from The BMJ Group.

To access the interactive case, please use [Take this module on BMJ Learning] link from the online article content box or table of contents.