Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency Jaenic Lee, MD, Josh Fernelius, MD and William Frick, MD | July 31, 2024

https://psnet.ahrq.gov/web-mm/mismanagement-acute-decompensated-heart-failure-hypertensive-emergency Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency In this WebM&M Spotlight Case with CE/MOC, a 55-year-old woman with a history of panic attacks, obesity, and untreated hypertension experienced syncope after feeling flushed and lightheaded. On arrival at the emergency department, she had severely elevated blood pressure and hypoxemia. Diagnostic tests revealed acute heart failure exacerbation with pulmonary edema, marked elevation of brain natriuretic peptide (BNP), and elevated troponin-I. Despite treatment with diuretics and antihypertensives, her condition deteriorated, leading to intubation due to respiratory failure and subsequent cardiac arrest; cardiopulmonary resuscitation resulted in return of spontaneous circulation. However, she suffered from ischemic stroke and intracranial hemorrhages, ultimately leading to a transition to comfort care and subsequent death. The commentary discusses the contraindications for beta-blockers in the setting of acute decompensated heart failure and appropriate treatment for hypertensive emergencies in the emergency department and intensive care unit.