Case Introduction Joe Lombard is an 82-year-old retired carpenter who still does “odd jobs” for friends and neighbors. His wife begged him to relax, but he ignores her. Despite having chest pains (angina) and periods of confusion, Joe doesn't trust doctors and stubbornly refuses to be checked. Recently, however, after several episodes of syncope (fainting) while hauling lumber, Joe reluctantly agreed to see a doctor. On physical examination, the physician noted a murmur during systole (described as a systolic ejection murmur). An ECG was consistent with left ventricular hypertrophy. His carotid pulse was weak and he had a delayed upstroke. The doctor ordered a cardiac catheterization, which showed a pressure gradient. In a normal human, the aortic valve contains three cusps that allow blood to pump silently and smoothly out of the heart. People with congenital birth defects have more or less than three cusps (Mayo Clinic, 2014). As these patients age, complications may arise due to the combination of structural deformity and calcium buildup that occurs with age. The valve loses its ability to open fully due to calcium thickening its structure (Mayo Clinic, 2014). Finally, the consequences of rheumatic fever can affect the heart. As the human body tries to fight fever, it indirectly attacks the valves of the heart. The valves become inflexible due to scarring that occurs (Cleveland Clinic, The heart pumps blood from the left ventricle through the lunate aortic valve and into the aorta. The narrowed aortic valve causes increased pressure in the left ventricle. Typically, the muscles in the ventricles Papillary muscles contract during ventricular contraction, pushing blood through the valves. The left ventricle of a heart with aortic stenosis would have to work harder to pump blood through the narrower valve because left ventricular hypertrophy occurs. in aortic stenosis (Klabunde, 2012, para.