In some ways it is hard to beat this case. Not because of the complexity of the diagnosis, but because of its classic nature. This case was from one of our recent residency graduates. It was literally the first case he was scheduled to do on his first day as an attending anesthesiologist. The patient is a 72 year-old woman scheduled to undergo a laparoscopic hernia repair. She has chronic pain which significantly limits her mobility, but she does not report symptoms of heart failure. On physical exam, she has a harsh 4/6 systolic murmur. The image below is the first one obtained…need I go on?

If that isn’t enough, look at the next 3 images and quantify the severity based on 4 criteria. Then read this article and remember that ultrasound is the stethoscope of the future!