Pharmacologic: angiotensin-converting enzyme (ACE) inhibitors
Alone or with other agents in the management of hypertension. Reduction of risk of death and heart-failure–related hospitalizations in patients with left ventricular systolic dysfunction or heart failure symptoms following myocardial infarction.
ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation. Therapeutic Effects: Lowering of blood pressure in hypertensive patients. ↑ survival after myocardial infarction.
Adverse Reactions/Side Effects
CNS: weakness. Resp: cough. CV: hypotension. Endo: hyperuricemia. GI: diarrhea, dyspepsia. GU: impaired renal function. Derm: rashes. F and E: hyperkalemia, hypocalcemia. MS: myalgia. Misc: ANGIOEDEMA.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Report these signs to the physician immediately.
Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.
Assess signs and symptoms of CHF, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Document whether drug therapy is effective in reducing these symptoms.
Monitor signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention. Report these signs to the physician.
Watch for signs of electrolyte imbalances (hypocalcemia, hyperkalemia), including headache, lethargy, weakness, cramping, muscle pain, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.
Implement aerobic exercise and cardiac conditioning programs to augment drug therapy and maintain or improve cardiovascular pump function in patients with heart failure and other cardiac conditions.
Use caution during aerobic exercise and other forms of therapeutic exercise in patients recovering from myocardial infarction. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).
Avoid physical therapy interventions that cause systemic vasodilation (large whirlpool, Hubbard tank). Additive effects of this drug and the intervention may cause a dangerous fall in blood pressure.
To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.
Remind patients to take medication as directed to control hypertension and other cardiac conditions even if they are asymptomatic.
Instruct patients with heart failure to weigh themselves every day, and to call their physician if they gain 3 lb or more in 1 day or more ...