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Hypertensive acute pulmonary oedema — SCE Acute Medicine MCQ

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HardCardiovascular medicineHypertensive acute pulmonary oedemaSCE Acute Medicine

A 67-year-old woman presents with acute breathlessness and pink frothy sputum. She has basal crackles to the apices, BP 212/118 mmHg and SpO2 84% on air. ECG shows left ventricular hypertrophy without STEMI. ABG shows pH 7.29, PaCO2 6.8 kPa and PaO2 8.1 kPa on high-flow oxygen. What is the most appropriate next step in management?

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Correct answer: B — Start CPAP with nitrates and controlled blood pressure reduction

This is acute cardiogenic pulmonary oedema with severe hypertension and ventilatory failure. CPAP improves oxygenation and work of breathing, while nitrates reduce preload and afterload in hypertensive pulmonary oedema. Fluid boluses and beta-blocker loading would worsen the haemodynamic problem.

Reference: NICE NG106; BTS Oxygen Guideline