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Hypertensive acute pulmonary oedema — RCPSC EM MCQ

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HardCardiovascular emergenciesHypertensive acute pulmonary oedemaRCPSC EM

A 70-year-old man with known heart failure presents in severe respiratory distress. Blood pressure is 210/118 mmHg, oxygen saturation is 82% on non-rebreather and he has diffuse crackles. Bedside lung ultrasound shows bilateral B-lines; ECG shows sinus tachycardia without STEMI. What is the most appropriate next step?

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Correct answer: C — Start non-invasive ventilation and high-dose nitroglycerin while preparing IV diuresis once perfusion is assessed

Hypertensive acute pulmonary oedema is treated with rapid afterload reduction and non-invasive ventilation. Diuretics are often used but nitrates and ventilatory support are the immediate stabilising measures in severe hypertensive presentations.

Reference: CAEP Acute Heart Failure Best Practices Checklist; Canadian Cardiovascular Society heart failure guidance