Case 14-1990

Presentation of Case A 76-year-old man was admitted to the hospital because of coronary artery disease and staphylococcal sepsis. The patient was well until four years earlier, when he consulted a physician because of "burning" anterior chest pain on exertion. Physical examination showed a Grade 3 systolic ejection murmur and a Grade 1 aortic diastolic murmur. An electrocardiogram revealed atrial fibrillation, with complete right-bundle-branch block and left anterior hemiblock. A Doppler ultrasonographic examination disclosed evidence of aortic stenosis, with an aortic-valve pressure gradient of 75 mm Hg. The patient was referred to this hospital, where cardiac catheterization showed that the . . .