A 78-year-old male was admitted with increasing shortness of breath. He had chest pain in the past but was able to continue with normal activities. In the prior year, he experienced two episodes of syncope. On physical examination, a loud systolic murmur could be heard at the left sternal border radiating to the neck. His vital signs were blood pressure 150/90 mm Hg and heart rate 88 beats per minute and irregular. The electrocardiogram (ECG) showed sinus rhythm with atrial premature contractions and left ventricular hypertrophy (LVH) with strain. A transthoracic echocardiogram (TTE) showed a hypertrophied left ventricle (LV), and Doppler echocardiography examination demonstrated severe aortic stenosis (AS) with a mean pressure gradient of 64 mm Hg, mild aortic insufficiency (AI), and moderate mitral regurgitation (MR). He was scheduled for an aortic valve (AV) replacement and a possible mitral valve (MV) repair or replacement.