患者，女，78岁。突发呼吸困难1h，高血压病史10年。体格检査:半卧位，血压190/124mmHg，心率120次/分，律不齐，双肺满布湿啰音。尿素氮23.1mmol/L,431μmol/L，血钟5.7mmol/L。对该患者的诊断应首先考虑

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