A 24-year-old man presents with acute severe aortic regurgitation following infective endocarditis. Blood pressure is 96/60 mmHg, heart rate 118/min. Which bedside finding would argue AGAINST the diagnosis of acute severe AR?
- A Wide pulse pressure with a Corrigan pulse ✓
- B Soft, short early diastolic murmur at the left sternal border
- C Early closure of the mitral valve on echocardiography
- D Premature closure of the aortic valve on M-mode echo
Correct answer: A. Wide pulse pressure with a Corrigan pulse
Explanation
Acute severe AR does not allow time for LV dilation, so total stroke volume stays low and pulse pressure remains narrow; a wide pulse pressure with collapsing pulse is a feature of CHRONIC compensated AR. In acute AR the murmur is soft and short because the regurgitant stream decelerates quickly as LV diastolic pressure rises steeply. Premature mitral and aortic valve closure reflect the rapidly rising LV diastolic pressure and are classic echo signs of acute severe AR.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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