Eighty-two-year-old man with a systolic murmur.

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).DC1SP110.1136/heartjnl-2018-313413.supp1Supplementary file 1 heartjnl;104/22/1887/F1F1F1Figure 1Transthoracic 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.