60ish male needs cysto w/ biopsies for staging of bladder cancer. 6.4cm ascending thoracic aortic aneurysm found incidentally on CT as part of work-up. 40 pack year smoker, no features that scream Marfan, ehlers danlos, etc. Patient seen by medicine who says “patient is optimized for surgery”. Seen by thoracic who says, patient can proceed under anesthesia and will consider repair if prognosis from cancer is reasonable based on staging, biopsies, etc. You’re assigned the case and despite having not used your stethoscope since residency you for some reason decide to listen to this patients heart and lungs and hear a reasonably loud murmur. Patient has never been told they have a murmur and there is no murmur documented anywhere in this patients chart including recent interactions with thoracic and medicine. Has never seen a cardiologist. No echo. You doing this case today?