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A 65-year old male with a history of degenerative aortic stenosis (AS) presented to our department for regular echocardiographic evaluation. He denied any symptoms, but he also emphasized that he is not physically active. The clinical exam revealed no specific abnormalities beside the existence of systolic mormour and blunted second aortic sound, his blood pressure was normal (with antyhipertensive therapy) and his ECG was without ST-T segment abnormalities. Analyzed laboratory parameters (complete blood count and biochemistry analysis) were within referent values, but he was also taking atorvastatin for lipid control. His Brain natriuretic peptide level was 28pg/ml. Echocardiogram confirmed the existence of isolated severe AS (figure 1) with echocardiogaphically observed heavily calcified aortic valve (figure 2) and normal left ventricular ejection fraction (LVEF). To evaluate his symptomatic and functional status we have performed cardio-pulmonary and stressechocardiography testing (as a single test) on semisupine ergobicycle, Ramp 15 protocol. Adequate load was achieved (> 80% of predicted heart rate and 12 minutes of pedalling, and RER has been achieved at cardiopulmonary testing). The stress-echocardiography test revealed

Asymptomatic severe aortic stenosis: Case report and practical application of current ESC and ACC/AHA guidelines