A 51-year-old male with a history of uncontrolled hypertension presents to the ED with acute onset substernal chest pain that is sharp in nature and radiates to the mid-back. He is short of breath and weak. His temperature is 99.0, blood pressure 80/30 mm Hg, heart rate 130 beats per minute and respirations 30 per minute. Physical examination reveals rales on lung exam and a short, III/IV early diastolic murmur at the right upper sternal border.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Acute pulmonary embolus
C. Acute aortic regurgitation
D. Acute ventricular septal defect