Cardiology · USMLE Step 1 and Step 2

ACE Inhibitors song

ACE Inhibitors - Mechanism & Side Effects, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

ACE Inhibitors

Full song on YouTube ↗Spotify ↗

Key points in this song10

ACE inhibitors block the conversion of angiotensin I to angiotensin II by inhibiting ACE, reducing vasoconstriction and aldosterone secretion, thereby lowering blood pressure and decreasing afterload and preload.
ACE inhibitors also prevent the breakdown of bradykinin, which accumulates and causes the classic adverse effect of a dry, nonproductive cough — the most common reason for switching to an ARB.
The most dangerous adverse effect is angioedema, mediated by excess bradykinin, which can cause life-threatening airway swelling and is an absolute contraindication to continued use.
ACE inhibitors are contraindicated in bilateral renal artery stenosis because efferent arteriolar dilation drops glomerular filtration pressure, precipitating acute kidney injury.
First-line therapy for hypertension in patients with diabetic nephropathy or chronic kidney disease, as ACE inhibitors reduce intraglomerular pressure and proteinuria by dilating the efferent arteriole.
ACE inhibitors are a cornerstone of heart failure with reduced ejection fraction (HFrEF) management, reducing mortality by decreasing afterload and preventing adverse cardiac remodeling.
Hyperkalemia is a key metabolic adverse effect due to reduced aldosterone levels, which decreases urinary potassium excretion — particularly dangerous when combined with potassium-sparing diuretics.
ACE inhibitors are teratogenic (FDA category D/X), causing fetal renal dysgenesis and oligohydramnios, and must be avoided in pregnancy — switch to hydralazine and nitrates or methyldopa.
Captopril, enalapril, and lisinopril are classic examples; most are prodrugs except captopril and lisinopril, which are active in their administered form.
ACE inhibitors reduce mortality post-myocardial infarction, especially in patients with decreased ejection fraction or anterior MI, by limiting ventricular remodeling and reducing wall stress.