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This 68-year-old man initially sought medical advice five years prior came to his death. His symptoms at that time were the hospital with complaints of exercise intolerance and occasional peripheral edema. He gave a history of a "heart murmur" that was diagnosed 25 20 years ago during an employment physical. No but no follow up care had been given for this murmur.  The patient's terminal admission was for signs of severe heart failure -- On examination the patient had marked peripheral edema and shortness of breath and a chest x-ray revealed significant cardiac enlargement and pulmonary edema with bilateral pleural effusions. He sustained a cardiac arrest shortly after admission and could not be resuscitated. Autopsy disclosed a markedly enlarged heart weighing 650 grams. The aortic valve was calcified and showed evidence of stenosis and insufficiency. The coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions were found.