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Hypertensive acute pulmonary oedema — SCE Acute Medicine MCQ

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ModerateCardiovascular medicineHypertensive acute pulmonary oedemaSCE Acute Medicine

A 68-year-old man presents with severe breathlessness, frothy sputum and headache. Blood pressure is 226/128 mmHg, oxygen saturation is 82% on air and chest radiograph shows bilateral alveolar oedema. ECG shows sinus tachycardia without ST elevation. He is agitated but able to cooperate. What is the most appropriate next step in management?

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Correct answer: E — Start CPAP with intravenous nitrate therapy and controlled blood pressure reduction

This is hypertensive acute pulmonary oedema, where non-invasive positive pressure and intravenous nitrates reduce preload and afterload while improving oxygenation. Large fluid boluses would worsen pulmonary oedema. Oral antihypertensives act too slowly for a hypertensive emergency with end-organ compromise.

Reference: NICE NG106 heart failure; ESC acute cardiovascular care guidance