An elderly man who suddenly lost consciousness

While walking on the beach, a 76 year old man lost consciousness suddenly and woke up to find his family looking over him. He had no convulsions, tongue biting, or urinary or faecal incontinence. He did not recall the event, but his daughter reported that he fell over without warning. He had no history of losses of consciousness, but he did admit to occasional chest pain and breathlessness on exertion. He took no regular drugs. Electrocardiography showed sinus rhythm with no ST/T changes. His pulse rate was regular at 68 beats/min, and his blood pressure was 132/76 mm Hg. Pulses were equal in all four extremities, and pedal oedema was not present. His venous pressure was not raised. On auscultation, his lungs were clear. He had delayed and subdued carotid upstrokes with a loud, late peaking, systolic crescendo-decrescendo murmur over the sternal border near the second intercostal space. The second heart sound was faintly audible. ### Short answers