A 68-year-old man presents with acute onset severe dyspnoea, hypotension, and a blowing early diastolic murmur along the left sternal border. Echocardiography confirms severe acute aortic regurgitation with premature mitral valve closure. Which of the following is a characteristic feature distinguishing acute from chronic aortic regurgitation?

• A Wide pulse pressure
• B Peripheral signs of aortic regurgitation (Quincke's pulse, Corrigan's pulse)
• C Soft, short diastolic murmur ✓
• D Left ventricular dilatation on chest X-ray

Explanation

In acute aortic regurgitation, the left ventricle is non-dilated and non-compliant, causing rapid equalisation of aortic and LV diastolic pressures. This results in a soft, short diastolic murmur (unlike the long, blowing murmur of chronic AR). Wide pulse pressure and peripheral signs are features of chronic AR where LV has dilated over time. Premature mitral closure is a hallmark of severe acute AR.

Reference: Braunwald's Heart Disease, 12th ed.

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