Question

A hypertensive patient who is non-compliant with medication presents to you with sudden onset breathlessness. A chest x-ray was done, which is shown below. How will you manage this patient?

• A. Intravenous salbutamol
• B. Intravenous nitro-glycerine
• C. Nebulization with salbutamol
• D. Oxygen and antibiotics

Answer 1

The Correct Option is B

The scenario describes a hypertensive patient who is non-compliant with medication and presents with sudden onset breathlessness. Such a presentation suggests the development of acute pulmonary edema, a condition often linked with heart failure due to hypertension. Appropriate management in this case is crucial.

To manage acute pulmonary edema effectively, the primary goals are to reduce the preload and afterload on the heart, improve gas exchange, and relieve symptoms. The use of intravenous nitro-glycerine is an appropriate treatment because:

• Vasodilation: Nitro-glycerine acts as a vasodilator, predominantly affecting the venous system, which decreases preload by pooling blood in the peripheral veins and reducing the volume of blood returning to the heart.
• Reduced Cardiac Workload: By decreasing the preload and afterload, nitro-glycerine reduces the workload on the heart, allowing it to pump more efficiently even in a compromised state.
• Rapid Symptom Relief: It provides rapid relief from congestion and breathlessness by decreasing the pressure in the pulmonary circulation.

Given these pharmacological effects, the patient should be administered intravenous nitro-glycerine. Other options, such as corticosteroids or bronchodilators like salbutamol, do not address the underlying pathophysiology of acute pulmonary edema due to hypertension.

In conclusion, using intravenous nitro-glycerine is the correct choice for this patient, as it directly targets the cardiovascular causes of the patient's symptoms.