Sunday, August 23, 2015

Study group discussion: Contraindications of ACE inhibitors

Why ACE inhibitors are contraindicated -
During pregnancy
In CCF due to severe aortic stenosis
Bilateral renal artery stenosis

Please explain.

Pregnancy, because it's teratogenic. Category D drug.

Artery stenosis because it would lead to renal failure.
In renal artery stenosis, renal perfusion is less and hence GFR is low. In such a case, nephrons adapt the filtration by causing efferent arteriolar constriction to maintain the pressure needed for filtration.
If ACEI is given, there is dilation of efferent arteriole and renal perfusion will again decrease further and GFR will become more low. Hence, contraindicated.

In critical aortic stenosis, cardiac output is limited and fixed. ACEI being vasodilator, dilates the arterioles, and causes hypotension and diminished blood pressure. Perfusion pressure diminution causes coronary hypoperfusion and ischaemia and chances of MI and ischaemic damage to vital organ is increased.

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