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  • The acute onset of dyspnea with a muffled S1and a brief early diastolic murmur at the base should always raise the suspicion of acute aortic regurgitation (AR).
  • The large regurgitant flow into a normal sized left ventricle (LV) precipitously raises the LV end-diastolic pressure (LVEDP) which in turn tends to close the mitral valve in early diastole and produces the muffled S1.
  • The markedly elevated LVEDP decreases the diastolic gradient across the aortic valve in late-diastole and reduces the intensity and duration of the AR murmur.

    Other relevant issues:
  • Of untreated patients with Type dissection 50% are dead within 48 hours and 90% at one month.
  • Death is usually due to rupture of the aorta into the pericardial sac or pleural space or due to acute AR with LV failure.
  • Classic findings of wide pulse pressure and bounding pulse of chronic AR are usually absent in acute cases.
  • The patients BP was normal in the right arm and 190/130 mm Hg in the left arm.
  • In the setting of early interstitial pulmonary edema, the lungs may be clear.
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