Morphine, Midazolam and Dexmedetomidine in the Management of Acute Cardiogenic Pulmonary Edema, Safety and Efficacy

Inclusion Criteria: * Age \>18 year with a clinical diagnosis of ACPE with severe dyspnea and anxiety. * Patients able to verbally acknowledge the risks in receiving midazolam, morphine or dexmedetomidine.- Diagnosis of ACPE was defined by the association of sudden onset of dyspnoea, the presence of bilateral rales on auscultation, respiratory rate \>25 breaths/min and pulse oxygen saturation \<90% in room air. diagnosis will be confirmed by echocardiography and lung ultrasound Exclusion Criteria: * Patients with history of asthma, severe stenotic valvular disease. • Cardiovascular collapse or an impaired level of consciousness (Glasgow Coma Scale score of ≤8 points). Immediate indication for intubation. • Suspicion of ST-segment elevation, acute coronary syndrome needing interventions. • Known severe liver or renal disease, pneumonia, poor chance of survival due to a pre-existing condition. • Psychiatric disorders.