This patient presents with signs and symptoms concerning for an aortic dissection, namely malignant hypertension and mid-sternal “tearing” chest pain radiating to the back. Often, a dissection of the proximal aorta will involve the aortic valve, resulting in the acute development of aortic regurgitation (AR). AR is characterized by an early low-pitched diastolic murmur. Severe jugular venous distention (JVD) and peripheral edema is seen in right-heart failure, which is not a result of acute aortic dissection. A pericardial friction rub is heard in patients with pericarditis, which presents with substernal chest pain that is worse when the patient leans forward. Muffled and distant heart sounds is typically found in patients with cardiac tamponade and presents with acute cardiogenic shock and arrhythmia.