A 68 year-old man visits his physician for new symptoms arises recently. He has a long history of aortic valve stenosis which is treated with atenolol and he often forgets to take it. Now he complains of frequent chest pains with less exertion. The patient is wondering if he should be considered for an aortic valve replacement. He has a friend who told him that he had the surgery six years ago and he is feeling much better since then. Echocardiogram shows decrease of aortic cusp separation (6 mm). Which of the following is the strongest indication for aortic valve replacement in this patient? A- The patient age (68 years old) B- The patient gender (male) C- Long duration of aortic stenosis (more than 10 years) D- Non-compliance with medical treatment E- Echocardiography findings http://medical-usmle.com/?p=871
