RT Journal Article SR Electronic T1 Eighty-two-year-old man with a systolic murmur JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1887 OP 1890 DO 10.1136/heartjnl-2018-313413 VO 104 IS 22 A1 Kupsky, Daniel F A1 Ananthasubramaniam, Karthikeyan A1 Lee, James YR 2018 UL http://heart.bmj.com/content/104/22/1887.abstract AB 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 [SP1.mp4] 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?Atrioventricular conduction block.Acute severe aortic regurgitation.Patent ductus arteriosus.Atrial flutter.Severe mitral stenosis.