How does a hypertensive emergency with acute left ventricular failure differ from other hypertensive emergencies?
These patients typically present with dyspnea, cough, frothy, pink-tinged sputum, and hypoxia. Physical examination nearly always shows distended neck veins, rles in most of the lung fields, and an S 3 . Chest x-ray typically shows pulmonary vascular redistribution, hilar congestion, and diffuse infiltrates in most of the lung fields. Prompt therapy with oxygen, intravenous loop diuretics, morphine, and nitroglycerin are usually effective acutely, although nitroprusside may be added to help lower both preload and afterload if nitroglycerin is an insufficient hypotensive agent. Appropriate evaluation of the reason for the acute decompensated heart failure is appropriate during the intensive care unit stay. Intravenous enalaprilat has been shown in a small study to improve prognosis in these patients, but its hypotensive effect is variable and may lead to acute hypotension that is difficult to reverse.
