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Eighty-two-year-old man with a systolic murmur
  1. Daniel F Kupsky,
  2. Karthikeyan Ananthasubramaniam,
  3. James Lee
  1. Department of Medicine Division of Cardiology, Henry Ford Hospital Heart and Vascular Institute, Detroit, Michigan, USA
  1. Correspondence to Dr James Lee; jlee24{at}hfhs.org

Abstract

Clinical Introduction An 82-year-old man with a history of coronary artery bypass surgery, hypertension and small bowel gastrointestinal stromal tumour underwent cardiac risk evaluation prior to surgical resection of his tumour. He was asymptomatic from a cardiovascular perspective, but his activity level was less than four metabolic equivalents. Physical examination was notable for a 2/6 systolic murmur at the apex. ECG showed sinus rhythm. A transthoracic echocardiogram was performed (figure 1 and online supplementary video 1).

Supplementary file 1

Figure 1

Transthoracic echocardiography. (A) Mitral valve continuous wave Doppler and (B) tricuspid valve continuous wave Doppler.

QUESTION: The findings in figure 1 are most likely due to which of the following?

  1. Atrioventricular conduction block.

  2. Acute severe aortic regurgitation.

  3. Patent ductus arteriosus.

  4. Atrial flutter.

  5. Severe mitral stenosis.

  • echocardiography
  • valvular heart diseas

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Footnotes

  • Contributors All listed authors participated in the drafting of the submitted work and fulfil criteria for authorship. DFK: case review, manuscript planning and drafting. KA and JL: case review, manuscript drafting and critical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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