A 40 year old male with history of Marfan's Syndrome comes in with sudden onset shortness of breath preceded by tearing chest pain. He is tachycardic to 120, blood pressure is 80/40, patient is tachypneic with increased work of breathing. CXR is consistent with widened mediastinum and pulmonary edema and stat bedside ECHO is concerning for acute aortic regurgitation secondary to aortic insufficiency. Cardiothoracic surgery is consulted. What two medical modalities are contraindicated in this patient? 

A. Beta Blocker and Intra-Aortic Balloon Pump

B. Dobutamine and Intra-Aortic Balloon Pump

C. Levophed and Intra-Aortic Balloon Pump

D. Dobutamine and Levophed

E. Beta Blocker and Dobutamine. 

Answer: A - Beta blockade and Intra-Aortic Balloon Pump are contraindicated in acute aortic regurgitation (acute AR). 

-The key factor in acute AR is time in diastole. 

-If there is more time in diastole, there is more blood volume to regurgitate. 

-Beta blocker and Intra-aortic balloon pump both increase diastole time. 

-Beta blocker is the primary treatment in aortic dissection but needs to be avoided in the above situation.