An 80-year-old man presents with exertional syncope. He has suffered worsening chest pain and breathlessness on exertion for some months prior to attending. His echo is shown in Figs 14.1, 14.2, 14.3, 14.4, 14.5, 14.6, 14.7, 14.8, 14.9, 14.10, 14.11, 14.12, 14.13, 14.14, and in Videos 14.1, 14.2, 14.3, 14.4, 14.5, 14.6, 14.7, 14.8 and 14.9.