Wednesday, July 17, 2019

ACEI and ARBs in congestive heart failure

Hey everyone!

Today, I will be talking about ACEI and ARBs in congestive heart failure (based on ACC and ECS guidelines).

Here are a few points on what the guidelines say:


In all patients with a recent or remote history of MI or ACS and reduced EF, ACE inhibitors should be used to prevent symptomatic HF and reduce mortality.

ACE inhibitors should be used in all patients with a reduced EF to prevent symptomatic HF, even if they do not have a history of MI.

ACE inhibitors can reduce the risk of death and reduce hospitalization in HFrEF.

In patients with type 2 diabetes mellitus, ACE inhibitors and ARBs significantly reduced the incidence of HF in patients

Caution:
If the patient has very low systemic blood pressures (systolic blood pressure <80 creatinine="" hg="" increased="" levels="" markedly="" mm="" of="" serum="">3 mg/dL), bilateral renal artery stenosis, or elevated levels of serum potassium (>5.0 mEq/L).

Adverse effects:
Angioedema (kinin potentiation)
Rash and taste disturbances
ACE inhibitor–induced cough

ARBs are recommended in patients with HFrEF with current or prior symptoms who are ACE inhibitor intolerant, unless contraindicated, to reduce morbidity and mortality.

ARBs do not inhibit kininase and are associated with a much lower incidence of cough and angioedema than ACE inhibitors.

The combination of ACEI/ARB should be restricted to symptomatic HFrEF patients receiving a beta-blocker who are unable to tolerate an MRA, and must be used under strict supervision.

That's all!
-IkaN

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