ED Management of Angioedema Induced by ACE Inhibitors: Seeking Doctor’s Assistance for Tongue Swelling

**Title:** Latest Evidence in the Management of Ace Inhibitor Angioedema in Emergency Medicine


Welcome to the Grand Rounds presented at The Ottawa Hospital Department of Emergency Medicine. In this video, Dr. Nathaniel Murray, an expert in emergency medicine, discusses the latest evidence in the management of ace inhibitor angioedema in the emergency department.

**Keywords/Tags:** emergency medicine, foamed, grand rounds, ace inhibitor, ace inhibitor angioedema, acei, icatibant


Dr. Nathaniel Murray, a fourth-year emergency medicine resident, presents the latest evidence in the management of ace inhibitor angioedema in the emergency department. Joined by his supervisor, Dr. Christian New Dad, they delve into the pathophysiology, differential diagnoses, treatment options, and airway management of this condition. By the end of this talk, viewers will feel more confident in their evidence-based approach to treating patients with ace inhibitor angioedema.

**Angioedema and its Mechanisms**

Angioedema is characterized by non-pitting swelling of the subcutaneous or submucosal tissues in various parts of the body, such as the skin, oropharynx, upper respiratory tract, and GI tract. It can be either mast cell-mediated or bradycardian-mediated.

Mast cell-mediated angioedema occurs after sensitization to an allergen, leading to IgE degranulation of mast cells and the release of histamine. On the other hand, bradycardian-mediated angioedema, specifically ace inhibitor angioedema, relies on the kinin-kilocrine system. ACE inhibitors inhibit the angiotensin converting enzyme, which regulates this system. It’s important to note that other drugs, such as TPA and neprolysin inhibitors, can also cause bradycardian-mediated angioedema.

**Significance of Ace Inhibitor Angioedema**

Ace inhibitors are widely prescribed antihypertensive drugs and the most common cause of angioedema. As emergency providers, encountering patients with ace inhibitor angioedema is inevitable. Approximately 30% of all angioedema cases seen in the emergency department are secondary to ace inhibitors. Research shows that 0.7% of patients starting ace inhibitors develop angioedema within the first five years of use.

**Classification of Angioedema**

Angioedema can be classified as hereditary or acquired. Hereditary angioedema, caused by C1 s-rays inhibitor deficiency, and mast cell-mediated angioedema, associated with allergies, fall under the acquired category. In terms of bradycardian-mediated angioedema, it can be caused by drugs, idiopathic factors, or acquired C1 s-rays inhibitor deficiency.

**Differentiating Ace Inhibitor Angioedema**

When faced with a patient presenting with swollen tongue and no allergen exposure, it’s crucial to differentiate between ace inhibitor angioedema and other types. In ace inhibitor angioedema, the absence of allergen exposure, increased involvement of the tongue and upper Airways, and the absence of urticaria and Parietus are important clues. Mast cell-mediated angioedema typically leads to involvement of multiple systems, including cardiovascular and respiratory systems, which ace inhibitor angioedema lacks.

**Investigations in Angioedema Workup**

While various investigations are available for angioedema workup, none of them aid in diagnosis or management. Therefore, it’s important to rely on clinical findings and knowledge for appropriate treatment decisions.

For more information on the latest evidence in the management of ace inhibitor angioedema, be sure to watch the full video presented by Dr. Nathaniel Murray. Stay updated with the Department of Emergency Medicine at the University of Ottawa and The Ottawa Hospital for valuable medical insights and educational resources.

Source: [The Ottawa Hospital Department of Emergency Medicine](

This is a Grand Rounds presented at the The Ottawa Hospital Department of Emergency Medicine. The presenter is Dr. Nathaniel Murray. The presenter has no conflicts of interest to declare.

The views and opinions expressed on this video are those of Dr. Nathaniel Murray and do not necessarily reflect the views and opinions of The Department of Emergency Medicine at the University of Ottawa or The Ottawa Hospital.

This video should not be construed as personal medical advice and is not intended to replace medical advice offered by physicians.

Leave a Reply

Your email address will not be published. Required fields are marked *

GIPHY App Key not set. Please check settings

One Comment

Shivsena Advertisement: Who is Behind the New Announcement Due to Pressure?

Exploring the Influence of Generative AI on Artists: A Controversial Perspective