A 49 year old man was referred to the cardiology clinic for a loud systolic murmur. He was an ex-smoker and had a past history of thyrotoxicosis for which he had radioactive iodine treatment followed by current oral thyroxine replacement. His co-morbid problems included hypertension and hyperlipidaemia. He complained of having retrosternal chest discomfort for two years with a recent onset of exertional …