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Acute heart failure pulmonary oedema — RCPSC EM MCQ

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HardCardiovascular emergenciesAcute heart failure pulmonary oedemaRCPSC EM

CTAS 1. A 77-year-old with hypertension has sudden severe dyspnoea. BP is 214/116 mmHg, HR 122, RR 34, SpO2 82%, and crackles reach the apices. ECG shows LVH without STEMI. Chest x-ray shows diffuse pulmonary oedema. What is the most appropriate initial management?

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Correct answer: D — Non-invasive ventilation plus IV nitroglycerin

Hypertensive acute pulmonary oedema is treated initially with positive pressure ventilation and vasodilation; intubation is reserved for failure or inability to protect the airway.

Reference: CAEP Acute Heart Failure Best Practices Checklist, 2025