患者，女性，35岁。既往有风湿性心脏病、二尖瓣狭窄病史10余年。因劳累后突发气急、胸闷来院急诊。体检:端坐呼吸，烦躁不安，呼吸40次/分，心率150次/分，律不齐。拟诊“急性肺水肿”。对诊断最具特异性的临床表现是

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