HTN Management Q - jeanbaptiste

[ArchivalUser]

A 65-year-old man with a history of hypertension, ischemic heart disease and heart failure comes to the emergency room for shortness of breath, progressively worse over the past few hours. He is diaphoretic and cyanotic. Physical examination also reveals jugular venous distention, bilateral rales and bilateral pitting edema of the lower extremities. He is afebrile; heart rate (HR), 110 beats/minute; blood pressure (BP), 210/100 mm Hg; respiration rate (RR), 25 breaths/minute. The electrocardiogram (EKG) does not reveal signs of ischemia. The chest X-ray (CXR) shows cardiomegaly, bilateral basal effusions, and interstitial pulmonary edema. Treatment is initiated with intravenous furosemide. Which agent would also be appropriate in this case?


A. Intravenous hydralazine
B. Intravenous labetalol
C. Intravenous nitroglycerine
D. Intravenous phentolamine
E. Sublingual nifedipine

[ArchivalUser]

a??

[ArchivalUser]

cc

[ArchivalUser]

I don't really agree with the answer of this Q.




The answer written is ©.

Option C (Intravenous nitroglycerine) is correct. Nitroprusside or nitroglycerin plus a loop diuretic are the treatment of choice for hypertension in patients with acute left ventricular failure caused by systolic dysfunction.

Option A (Intravenous hydralazine) is incorrect. Hydralazine increases cardiac work caused by reflex sympathetic stimulation and should not be used in left ventricular failure.

Option B (Intravenous labetalol) is incorrect. Beta-blockers such as labetalol decrease cardiac contractility and should be avoided.

Option D (Intravenous phentolamine) is incorrect. The use of phentolamine is limited to the treatment of severe hypertension caused by increased sympathetic activity (such as in pheochromocytoma).

Option E (Sublingual nifedipine) is incorrect. Sublingual nifedipine rapidly lowers the blood pressure in a nonpredictable way, which can cause coronary ischemia and even myocardial infarction.