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

Area of Science:

• Cardiology
• Cardiac Imaging
• Valvular Heart Disease

Background:

• Pre-operative cardiac risk assessment is crucial for elderly patients with comorbidities undergoing non-cardiac surgery.
• The patient presented for evaluation prior to resection of a small bowel gastrointestinal stromal tumour.
• He had a history of coronary artery bypass surgery, hypertension, and a low activity level.

Observation:

• Physical examination revealed a 2/6 systolic murmur at the apex.
• Electrocardiogram (ECG) showed normal sinus rhythm.
• Transthoracic echocardiography was performed for further cardiac evaluation.

Findings:

• Echocardiographic Doppler tracings of the mitral valve (Figure 1A) demonstrated findings consistent with severe mitral stenosis.
• Tricuspid valve Doppler (Figure 1B) was also analyzed.

Implications:

• Accurate diagnosis of severe mitral stenosis is critical for surgical planning and patient management.
• This case underscores the importance of echocardiography in identifying significant valvular heart disease in asymptomatic patients.
• Management strategies must address both the oncological and cardiovascular conditions.