A 50-year-old man who is usually fit and well and cycles 100km every week presented with increasing fatigue and breathlessness over a few weeks. He has no history of cardiovascular disease or any traditional risk factors. Auscultation revealed a pan-systolic murmur in his left sternal region. There were no signs of heart failure and his ECG and baseline blood tests were normal. The echo images are shown in the figure above (parasternal long axis view- MV= mitral valve, LA- left atrium).
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