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Angiotensin-Converting Enzyme Inhibitor

ACE Inhibitors


Presentation

  • Time at presentation, presenting symptoms, physical examination findings, treatment, length of hospitalization, and outcomes were examined. Univariate analysis was performed.[ncbi.nlm.nih.gov]
  • Patients with ACE inhibitor-associated angioedema were ascertained through (1) an observational study of patients presenting to Vanderbilt University Medical Center, (2) patients presenting to the Marshfield Clinic and participating in the Marshfield[ncbi.nlm.nih.gov]
  • RESULTS: Eighty-eight patients who presented with ACE inhibitor-related angioedema between January 1, 2012, and December 31, 2012, were identified. They presented anywhere from 1 day to 20 years after starting an ACE inhibitor.[ncbi.nlm.nih.gov]
  • Patients with this disease present with one or more episodes of abdominal pain associated with nausea, vomiting, and/or diarrhea.[ncbi.nlm.nih.gov]
  • Angioedema of the small bowel is a much rarer occurrence; it uniformly presents with abdominal pain of variable duration. A 51-year-old man presented to the emergency department (ED) with generalized abdominal pain, emesis, diarrhea, and bloating.[ncbi.nlm.nih.gov]
Rigor
  • Molecular docking method and rigorously validated model was utilized to search a natural compounds database. Finally, 36 compounds were randomly selected and subjected to in vitro ACE kinase inhibitory assay using fluorescence assays method.[ncbi.nlm.nih.gov]
  • In order to establish noninferiority, a rigorous trial design is required that includes a patient population similar to that in the reference trial, a similar drug regimen, high adherence rates, outcomes that the comparator is known to affect, and high[doi.org]
Ascitic Fluid
  • There were no reported cases of paracentesis or ascitic fluid analysis described in any of the identified case reports.[ncbi.nlm.nih.gov]
Mucosal Edema
  • A computed tomography scan of the abdomen was quickly obtained, which revealed a large amount of simple-appearing free fluid within the abdomen and mucosal edema throughout the small bowel.[ncbi.nlm.nih.gov]
Dry Cough
  • Persistent dry cough is well known as the most common side-effect of angiotensin-converting enzyme (ACE) inhibitors.[ncbi.nlm.nih.gov]
  • Dry cough is a common side effect of ACE inhibitors and has been identified as a possible risk factor for angioedema.[ncbi.nlm.nih.gov]
  • The increase in bradykinin is also believed to be responsible for a troublesome side effect of ACE inhibitors, namely, a dry cough.[cvpharmacology.com]
Chronic Cough
  • CONCLUSIONS: In a patient with chronic cough, ACE inhibitors should be considered as wholly or partially causative, regardless of the temporal relation between the initiation of ACE inhibitor therapy and the onset of cough.[ncbi.nlm.nih.gov]
  • Cough (Chronic, Persistent Cough in Adults and Children) Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic...[medicinenet.com]
  • Pierangelo Geppetti, Marcello Trevisani and Selena Harrison, Pharmacology of Putative Cough Receptors, Acute and Chronic Cough, 10.1201/b14188-7, (105-123), (2013). Sukhjot Kaur, Gurvinder P. Thami, Vadivelu Srinivasan, Ram Singh and Amrinder J.[doi.org]
  • An ACE test is ordered when someone has signs or symptoms that may be due to sarcoidosis , such as: Granulomas A chronic cough or shortness of breath Red, watery eyes Joint pain This is especially true if the person is between 20 and 40 years of age,[labtestsonline.org]
Acute Abdomen
  • In 1 in every 9 patients, operated on for an acute abdomen, laparotomy is negative. In a minority of patients, the acute abdomen is caused by side effects of medication.[ncbi.nlm.nih.gov]
Abdominal Tenderness
  • Due to the presence of significant abdominal tenderness with guarding on examination, a FAST (focused assessment with ultrasound in trauma) examination was performed and revealed free fluid in the abdomen.[ncbi.nlm.nih.gov]
Regurgitation
  • We report a case of a 43-year-old female patient with preoperative lisinopril (2.5 mg per day for a week prior to cardiac surgery), who was diagnosed with severe mitral and tricuspid valve regurgitation.[ncbi.nlm.nih.gov]
Periodontitis
  • This case report involved a 65-year-old African American female who was being treated surgically for localized chronic periodontitis. The procedure was performed without incident, and the patient was alert and stable when released.[ncbi.nlm.nih.gov]
Macroglossia
  • We describe a patient who had recurrent life-threatening episodes of isolated macroglossia due to the use of an angiotensin-converting enzyme (ACE) inhibitor. No associated facial, labial, pharyngeal, or laryngeal edema was noted.[ncbi.nlm.nih.gov]
Toothache
  • Additionally, decreased food intake because of a severe toothache may have contributed to the deterioration of her condition.[ncbi.nlm.nih.gov]
Visual Hallucination
  • Development of visual hallucinations after initiation of ACE inhibitors should prompt discontinuation of therapy. Visual hallucinations have been reported in one case involving an ARB.[ncbi.nlm.nih.gov]
Seizure
  • Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death.[doi.org]
  • […] milder and early forms, the problem may increase in severity with time, progressing to a syndrome variably including neurological abnormalities (headache, muscle cramps, blurred vision, weakness, tremors, restlessness, confusion, lethargy, delirium, seizures[doi.org]
Guillain-Barré Syndrome
  • Secondary hyperkalaemic paralysis is a rare condition often mimicking the Guillain-Barré syndrome. There have been a few case reports of hyperkalaemia caused by renal failure, trauma, and drugs where the presentation has been with muscle weakness.[ncbi.nlm.nih.gov]

Workup

Right Pleural Effusion
  • The patient's heart failure symptoms worsened, including accumulation of right pleural effusion and ascites, after the initiation of ACEI administration. Cessation of ACEI administration dramatically improved his symptoms.[ncbi.nlm.nih.gov]
Lymphocytopenia
  • The elevation of ASO, hypocomplementemia, and endocapillary proliferation suggested acute glomerulonephritis, while lymphocytopenia, positive ANA, the persistent hypocomplementemia, and various deposits detected by IF and EM suggested lupus nephritis;[ncbi.nlm.nih.gov]
Hypercapnia
  • Hypercapnia (PaCO2 45.2 6.7; P 0.046) also identified patients needing ventilatory support. CONCLUSIONS: Ventilatory support was provided for about one-third of those with ACE inhibitor-associated angioedema.[ncbi.nlm.nih.gov]

Treatment

  • Combined treatment with a mineralocorticoid receptor blocker further reduced albuminuria by 23 to 61% compared with standard treatment. Estimated glomerular filtration rate values upon study completion slightly decreased under combined treatment.[ncbi.nlm.nih.gov]
  • ) per QALY gained comparing ACEI-based treatment with diuretic-based treatment (sensitive to the utility value for new-onset diabetes).[ncbi.nlm.nih.gov]
  • Treatment with omega-3 fatty acids, statins or anti-thrombotic therapies has limited benefits in a general heart failure population.[ncbi.nlm.nih.gov]
  • Symptoms in first year of treatment A total of 2569 patients were randomised to enalapril or placebo in the treatment trial.[bmj.bmjjournals.com]
  • Angioedema is an asymmetric non-pitting oedema on face, lips, tongue and mucous membranes; any delay in diagnosis and treatment can be fatal.[ncbi.nlm.nih.gov]

Prognosis

  • This review discusses the disease, prognosis and treatment options.[ncbi.nlm.nih.gov]
  • Although the use of angiotensin-converting enzyme inhibitors should be avoided during pregnancy, patients whose fetuses are inadvertently exposed in utero need not be given a uniformly poor prognosis.[ncbi.nlm.nih.gov]
  • Prognosis. Abstract It is well established that long-term administration of angiotensin-converting enzyme (ACE) inhibitors has a favorable effect in patients with chronic heart failure and dilated cardiomyopathy.[revespcardiol.org]
  • The wasting associated with chronic congestive heart failure (cardiac cachexia) has recently been shown to portend a worse prognosis, and it is an independent predictor of mortality.[doi.org]
  • Angiotensin-converting enzyme inhibitors have become “the cornerstone for the treatment of heart failure” and improve the prognosis in all stages of heart failure (3,4).[content.onlinejacc.org]

Etiology

  • An abdominal computed tomography scan, if it does not identify any other significant etiology, will increase the probability that ACEI-induced visceral angioedema is the diagnosis when there is nonspecific bowel wall thickening or edema.[ncbi.nlm.nih.gov]
  • It was felt that angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema of the small bowel was the most likely etiology of her symptoms.[ncbi.nlm.nih.gov]
  • A majority of angioedema arise from unknown etiologies.[ncbi.nlm.nih.gov]
  • Other potentiating etiologies were also ruled out by the allergist. Angioedema is a recognized possible side effect of ACE inhibitor therapy.[ncbi.nlm.nih.gov]
  • Article INTRODUCTION Numerous studies have been performed on the long-term prognosis of patients with chronic heart failure due to left ventricular systolic dysfunction (dilated cardiomyopathy) of different etiology, and much evidence has been collected[revespcardiol.org]

Epidemiology

  • 5, Jacob A Udell, cardiologist and assistant professor of cardiology 6 7, Laurent Azoulay, associate professor of epidemiology and oncology 1 2 8 1 Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada,[doi.org]
  • Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am J Epidemiol 2004 ;160: 301 - 305 30. Zeger SL, Liang KY, Albert PS.[doi.org]
  • Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000 ; 283 : 2008 -12.[bmj.com]
  • These confounders were adjusted for using advanced epidemiologic methods including propensity score stratification and high dimensional propensity score analyses.[journals.lww.com]
Sex distribution
Age distribution

Pathophysiology

  • Some aspects of the pathophysiology have been elucidated and the vasoactive molecule bradykinin is shown to be one of the main causative agents. The diagnosis is often delayed and traditional treatment usually ineffective.[ncbi.nlm.nih.gov]
  • The case is discussed, and the literature, pathophysiology and treatment of angioedema are reviewed.[ncbi.nlm.nih.gov]
  • Although the pathophysiology of ACEI-induced angioedema is attributable to elevated serum bradykinin, standard management typically includes corticosteroids and antihistamines.[ncbi.nlm.nih.gov]
  • Author information 1 1 Department of Pathophysiology, Chongqing Medical University, Chongqing, China. 2 2 Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, China. 3 3 Hospital of Chongqing University of Arts and[ncbi.nlm.nih.gov]
  • The pathophysiology of ACE inhibitor (ACEi) induced angioedema most likely resembles that of hereditary angioedema (HAE), i.e. it is mainly mediated by bradykinin induced activation of vascular bradykinin B2 receptors (BKR-2).[clinicaltrials.gov]

Prevention

  • Yet the use of angiotensin converting enzyme inhibitor (ACEI) yields conflicting results in the prevention of CIN.[ncbi.nlm.nih.gov]
  • The differences between ARB and ACEI in their effects on the primary prevention of AF remain unclear.[ncbi.nlm.nih.gov]
  • The drug suspension probably prevented other complications.[ncbi.nlm.nih.gov]
  • ACE inhibitors are used for controlling blood pressure, treating heart failure, preventing strokes, and preventing kidney damage in people with hypertension or diabetes. They also improve survival after heart attacks.[web.archive.org]
  • Heart Attack Prevention Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management....[medicinenet.com]

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