* “Sympathetic Crashing Acute Pulmonary Edema”

* Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension

* Triggers- Missed Medication, Cocaine, Stress/Anxiety

* Increase in BP = Increase in afterload

* Increased afterload causes acute pulmonary edema (in patients with CHF)

* The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further increases afterload

* Presentation- Sudden, severe respiratory distress AND hypertension

* Different than CHF exacerbation

* Not necessarily caused by hypervolemia

* More rapid in onset

* Typically crackles/rales on exam or diffuse B-Lines on POCUS

* Treatment

* BiPAP/CPAP

* High Dose Nitroglycerin

* Diuretics IF Hypervolemic