Therapy with an angiotensin converting enzyme inhibitor (ACEI) may be associated with angioedema.
Patient selection: therapy with an angiotensin converting enzyme inhibitor
Mechanism: accumulation of bradykinin due to decreased degradation
The onset may be during the first week of therapy or sometime later.
Clinical features: swelling of submucosal or deep dermal/subcutaneous tissues, especially of the lips, tongue and face. Other sites may be affected such as gastrointestinal tract (with bowel wall edema).
Risk factors:
(1) female sex
(2) smoker
(3) Black race
(4) chronic heart failure or coronary artery disease
(5) impaired function of aminopeptidase P or other enzymes involved in bradykinin degradation
Therapies include:
(1) discontinuation of the ACE inhibitor
(2) icatibant (bradykinin B2 receptor antagonist)
(3) transfusion of FFP
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