A 75 year old male patient with a known history of diabetes mellitus and hypertension presented with exertional chest pain. He also had atrial fibrillation (AF) and was on long term anti-coagulation. Electrocardiogram showed AF with T wave inversion over the lateral leads. Serial troponin and cardiac enzymes were normal. Physical examination of the praecordium revealed an ejection systolic murmur of grade 3/6 at the aortic area radiating to the neck. Echocardiogram 2 years ago showed presence of mild aortic stenosis (AS) with mean gradient of16 mmHg, normal left ventricular function and concentric left ventricular hypertrophy (LVH). A repeat echocardiogram was performed this admission which revealed normal left ventricular function with concentric LVH (Fig.1). The aortic valve (AV) was noted to be calcified and thickened with limited opening. The mean gradient across the AV was 19 mmHg but the estimated aortic valve area by continuity equation was 0.9 cm 2 . There was also concomitant mild aortic regurgitation and mild mitral regurgitation. A cardiac catheterization was performed to exclude underlying coronary artery disease. During fluoroscopy, calcification was seen in the region of AV annulus. Coronary angiography revealed obstructive lesions at proximal and mid left anterior descending artery with minor disease in left circumflex and right coronary arteries. Because of the discrepancy in the echocardiographic findings, the decision tocross the AV during cardiac catheterization was made. The aortic valve was successfully crossed using a left Amplatz catheter with the aid of a straight 0.038-in. guidewire which was exchanged for a pigtail catheter. Simultaneous measurement of the systolic pressures of the left ventricle (LV) and right femoral artery was made (Fig. 2) which did not show much pressure difference. There was also no significant pressure difference across AV during pullback of catheter from LV to ascending aorta. The patient's previous echocardiogram reports were evaluated and showed progressive increase in myocardial wall thickness (interventricular septal wall and left posterior wall thickness at diastole were 1.2 cm in 2005, 1.6 cm in early 2007 and 2.2 cm in mid 2008). His blood pressure was well controlled with medications and thus could not account for the