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ACE inhibitors post-myecotomy


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  • ACE inhibitors post-myecotomy

    I have a new one. I have been prescribed an ACE due to continued high BP after my myectomy 10 weeks ago. I am off beta blockers now but continue to hover at 150/100. My GP prescribed the ACE thinking it would no longer be contraindicated since my surgery was a success. Any thoughts?

    NEMC's (Boston) First Myectomy 7-22-2003

  • #2
    Re: ACE inhibitors post-myecotomy

    Doug, please ask your specialist about this. I have no idea about the contraindications.


    Husband has HCM.
    3 kids - ages 23, 21, & 19. All presently clear of HCM.


    • #3
      Re: ACE inhibitors post-myecotomy

      Hi Reenie,

      I have been doing this a long time (over 20 years) so it goes without saying I would ask my HCM docs. I want to have feedback from anyone who has used ACE inhibitors and if there is anyone who used them post myectomy and what were the results or personal experiences.
      NEMC's (Boston) First Myectomy 7-22-2003


      • #4
        Re: ACE inhibitors post-myecotomy

        Doug, my son did not do well on Ace Inhibitor post myectomy. He had other complications at the same time, so it's hard to tell, but he's glad to not be taking them anymore. I think I understood your message to say you would check with your HCM doc before taking them. Please let us know that doc's viewpoint. Linda


        • #5
          Re: ACE inhibitors post-myecotomy

          Doug,I was on ace inhibitors last fall and winter( for the long term health of my heart) I had nothing but problems then too.I just dont know if it was the drugs ,or the fact i was trying to re-enter the work force, or both .I would talk to whom ever is treating your HCM about it before i would take it .I think there are other ways that will be better for you to bring down your b/p Rich
          Allways remember you cannot control the wind!!
          However you can adjust your sails!!


          • #6
            Re: ACE inhibitors post-myecotomy

            ACE is normally used in HCM.

            This is the Definition of ACE:

            ACE inhibitors, or angiotensin converting enzyme inhibitors (i.e., Enalapril, Captropril) reduce peripheral vascular resistance via blockage of the angiotensin converting enzyme. This action reduces the myocardial oxygen consumption, thereby improving cardiac output and moderating left ventricular and vascular hypertrophy.
            ACE inhibitors are essential for treatment of CHF due to systolic dysfunction (Garg, AHCPR guidelines). Older people may show an exaggerated drop in blood pressure after the first dose of an ACE inhibitor. Therefore, we give a short-acting ACE inhibitor such as Captropril and have the patient's blood pressure observed for several hours. Longer-acting ACE inhibitors are given when the patient's tolerance to Captropril is established. This is another medication which can lead to hypotension. Use ACE inhibitors with care if the patient is on other drugs with hypotensive potential (e.g., antidepressants).

            Angiotensin II receptor antagonists, as their name suggests, block the binding of angiotensin II to the AT1 receptor. These drugs to not inhibit kinin metabolism (e.g., bradykinin). Aspirin may reduce the beneficial CHF effects of ACE inhibitors, but apparently does not alter the efficacy of angiotensin II inhibitors in treating CHF. Cough, a not infrequent side effect of ACE inhibitors, has not been seen with angiotensin II receptor blockers. The limited data available at present suggest that angiotensin II receptor blockers and ACE inhibitors have roughly equivalent beneficial effects on symptoms and hemodynamics of patients with CHF

            HOWEVER: HCM Is more a problem with Diastolic Sysfunction...
            What is diastolic dysfunction?
            The heart contracts and relaxes with each heartbeat. The contraction part of this cycle is called systole (SIS'to-le). The relaxation portion is called diastole (di-AS'to-le).

            In some people with heart failure, the contraction function is normal but there's impaired relaxation of the heart. This affects the heart's lower, pumping chambers (the ventricles) specifically. If the relaxation part of the cycle is abnormal, it's called diastolic (di"as-TOL'ik) dysfunction. Because the ventricle doesn't relax normally, the pressure in it increases and exceeds what's normal as blood for the next heartbeat. (It's harder for all of the blood to go into the ventricle.)

            This can cause increased pressure and fluid in the blood vessels of the lungs. (This is called pulmonary congestion.) It can also cause increased pressure and fluid in the blood vessels coming back to the heart. (This is called systemic congestion.) People with certain types of cardiomyopathy (kar"de-o-mi-OP'ah-the) may also have diastolic dysfunction.

            Hope this helps...
            Knowledge is power ... Stay informed!
            YOU can make a difference - all you have to do is try!

            Dx age 12 current age 46 and counting!
            lost: 5 family members to HCM (SCD, Stroke, CHF)
            Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
            Therapy - ICD (implanted 97, 01, 04 and 11, medication
            Currently not obstructed
            Complications - unnecessary pacemaker and stroke (unrelated to each other)