Echocardiographic Evaluation of Hypertensive Acute Pulmonary Edema
Echocardiographic Evaluation of Hypertensive Acute Pulmonary Edema
Acute cardiogenic pulmonary edema (ACPE), one of the most severe forms of acute heart
 failure, represents 5% of hospital admissions. One of the most frequent phenomena encountered
 during ACPE is hypertensive crisis (hypertensive ACPE) but the mechanisms and causes of
 hypertensive ACPE are insufficiently understood. Few studies have evaluated the cardiac
 function during hypertensive ACPE, and these studies used only conventional echocardiography
 methods. New methods of evaluation of cardiac function in hypertensive ACPE (such as Tissue
 Doppler imaging) have not been used.

 The objectives of this study are to evaluate presence and role of the following potential
 mechanisms of hypertensive ACPE: 1. acute myocardial dysfunction (systolic and diastolic); 2.
 silent transient myocardial ischemia; 3. acute mechanical left ventricular dyssynchrony; 4.
 dynamic mitral regurgitation; 5. inter-ventricular interaction. Conventional and Tissue
 Doppler echocardiography will be used to assess cardiac function.
Inclusion Criteria:

 -  acute onset of dyspnea within the preceding 8 hours

 -  respiratory distress and pulmonary rales at any level

 -  pulmonary congestion confirmed by chest radiography

 -  systolic blood pressure > 160 mmHg before treatment

 -  sinus rhythm

 -  signed informed consent

 Exclusion criteria:

 -  acute myocardial infarction confirmed by myocardial necrosis markers (either CKMB or
 troponin I). Angina pectoris alone will not be excluded

 -  significant left sided valvular disease (more than moderate). Mitral regurgitation of
 any severity will not be excluded, due to the hypothesis of the role of dynamic mitral
 regurgitation in the pathogenesis of acute hypertensive pulmonary edema

 -  congenital heart disease

 -  cardiac tamponade

 -  rhythm and conduction disturbances that may have precipitated pulmonary edema, like
 sustained ventricular tachycardia and complete heart block