A 60-year-old male from a rural area in sub-Saharan Africa presents to the emergency department with a 2-day history of worsening shortness of breath, cough, and swelling in his legs. He reports feeling increasingly breathless, particularly when lying flat, and has been waking up at night feeling like he is suffocating. His cough is productive of frothy, pink sputum. He has a past medical history of hypertension, which has been poorly controlled, and has been non-compliant with his antihypertensive medications.

On examination, the patient is tachypnoeic and appears anxious, sitting upright in a tripod position. His blood pressure is 160/90 mmHg, heart rate is 110 beats per minute, and respiratory rate is 28 breaths per minute. He has bilateral crackles at the lung bases and visible jugular venous distension. There is significant bilateral pitting oedema in his lower extremities. An ECG shows signs of left ventricular hypertrophy, and a chest X-ray reveals pulmonary congestion with bilateral alveolar infiltrates, consistent with pulmonary oedema.

The patient is diagnosed with acute pulmonary oedema likely secondary to uncontrolled hypertension leading to left-sided heart failure. He is started on oxygen therapy, diuretics, and intravenous nitro-glycerine for blood pressure control, and is referred for further cardiac evaluation.