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Hypertensive acute pulmonary oedema — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsHypertensive acute pulmonary oedemaSCE Acute Medicine

A 77-year-old woman with longstanding hypertension presents with acute severe dyspnoea. BP is 224/118 mmHg, SpO2 82% on air, and she has pink frothy sputum with widespread crackles. Chest radiograph shows pulmonary oedema. She is anxious but conscious. What is the most appropriate initial management?

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Correct answer: A — Give titrated intravenous nitrate with non-invasive ventilation

Hypertensive acute pulmonary oedema needs rapid preload and afterload reduction. Titrated nitrates and non-invasive ventilation improve physiology while oxygen, loop diuresis and precipitant treatment are individualised. A large fluid bolus or slow oral antihypertensive treatment is inappropriate.

Reference: https://www.nice.org.uk/guidance/cg187/chapter/recommendations