Filipina accountant in her late thirties has been complaining of shortness of breath for months, unable to complete her daily activities. She has been diagnosed with asthma and given steroids and inhalers on multiple occasions. Her infertility doctor has been postponing treatment until her shortness of breath resolves. On examination, she is visibly distressed, gasping for air. When she holds her breath, there is a faint murmur that radiates to her carotids. An ultrasound of her heart reveals a congenital bicuspid aortic valve that barely opens. Normally, the aortic valve has three leaflets, but she was born with two. Typically, these valves must be replaced in the fifth decade of life, but in her, the valve area is 0.4 cm2 (1/8th of normal) and the pressure on the valve is 112 mmHg (more than 5 times normal). She does not have asthma. She has heart-failure, because her heart cannot pump the blood out to the rest of her body. Time for surgery to replace her valve and a cure her asthma and possibly fertility issues!