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Forum Name: Valvular Heart Diseases

Question: ACEI and Aortic Stenosis

 Anonymous - Fri Dec 27, 2002 7:45 pm

Just want to double check about the the MOA of why ACEI's are not good in aortic stenosis. Is it because ACEI's reduce preload so that there isn't enough filling pressure to overcome the stenosis??
 Dr. Yasser Mokhtar - Sun Feb 09, 2003 9:01 pm

User avatar Dear Gigget,

Thank you very much for using our website.

You got this one right.

If you give a patient with fixed obstructive (stenotic lesion) like aortic stenosis a vasodilator like an ace-i, the patient will have vasodilatation with decrease in blood pressure but he will not be able to increase the cardiac output because the door is closed.

The question is why do you want to give these patients ace-i and the answer is because some of them have heart failure, so ace-i should be given.

Some authorities do not recommend giving people with heart failure secondary to aortic stenosis or with associated aortic stenosis ace-i because of the problem of developing hypotension and syncope. On the other hand some say it could be given in addition to other heart failure medications but you have to be very very cautious.

The best treatment for these patients (of course that is if they can tolerate surgery) is valve replacement once there is an indication.

Once more thank you very much for using our website and sorry for the delay.

Yasser Mokhtar, M.D.

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