A 55-year-old man presents with sudden severe dyspnea, hypotension (80/50 mmHg), and pulmonary edema 5 days after an episode of severe tearing chest pain. Echocardiography shows severe aortic regurgitation with premature closure of the mitral valve and diastolic flow reversal in the descending aorta. What is the definitive management?

• A Emergent surgical aortic valve replacement ✓
• B Intravenous afterload reduction with sodium nitroprusside and diuresis
• C Intra-aortic balloon pump counterpulsation alone
• D Intravenous beta-blocker therapy and observation

Explanation

Acute severe aortic regurgitation is a surgical emergency. Unlike chronic AR, the left ventricle cannot adapt to the sudden volume overload, leading to cardiogenic shock. Medical therapy and IABP are only temporizing measures. Definitive treatment is emergent aortic valve replacement. The clinical picture suggests acute AR complicating aortic dissection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.