ACE Inhibitors: Congestive Heart Failure

Original Editor - Lauren Pulliam Southern Top Contributors - Lucinda hampton, Lauren Pulliam Southern, Kim Jackson, Lauren Lopez, Beau Lawrence and Joseph Ayotunde Aderonmu

Introduction

Angiotensin Converting Enzyme (ACE) Inhibitors are a important class of drugs used in the management of cardiovascular and renal diseases, including Congestive Heart Failure (CHF), acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension.

Using an angiotensin-converting enzyme (ACE) inhibitor drug is an important part of treating heart failure. ACE inhibitors are strongly recommended as first-choice therapy in patients with heart failure.

Effects

Angiotensin-converting enzyme inhibitors (ACEIs) improve heart failure by decreasing afterload, preload, and systolic wall stress, which results in increased cardiac output without any increase in heart rate.

ACE inhibitors play an important role in:

• Promoting salt excretion by augmenting the renal blood flow and reducing aldosterone and antidiuretic hormone production.
• Reducing cardiac myocyte hypertrophy (angiotensin II is also responsible for hypertrophy of vascular tissues)
• Increasing bradykinin levels in the blood by decreasing their breakdown.  Bradykinin is responsible for vasodilation.  

Since the 1980s, several large, prospective, randomized, placebo-controlled trials have proved that treatment with ACE inhibitors reduces overall mortality, especially in patients with heart failure with reduced ejection fraction.  

Common Ace Inhibitors

Several ACE inhibitors are on the market, and it is generally thought that they are equally beneficial in the treatment of heart failure. Commonly used ACE inhibitors include:

• Accupril (quinapril)
• Altace (ramipril)
• Capoten (captopril)
• Mavik (trandalopril)
• Monopril (fosinopril)
• Vasotec (enalapril)
• Zestril (lisinopril)

Implications for Physiotherapy

Syncope AKA Fainting, swooning

ACE inhibitors cause a reduction in blood pressure, this coupled with the naturally occurring post-exercise hypotension can result in excessive reductions in blood pressure. This can lead to dizziness and, in rare instances, syncope.

Post-exercising clients on ACE inhibitors may need education in adhering to a gradual cool-down after each and every exercise session to prevent these symptoms and benefit the body by enhancing venous return and the prevention of blood pooling in the skeletal muscle. A gradual cool-down of five to 10 minutes of light aerobic activity allows the body to return to homeostasis and prevents excessive reductions in blood pressure.