Effect of ACE inhibitors and spironolactone on the heart - USMLE Forums
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Old 08-24-2012
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Drug Effect of ACE inhibitors and spironolactone on the heart

What is the effect of ACE, and spironolactone on management of diastolic dysfunction?
*In Kaplan Q bank, spirono= prevent and regress hypertrophy and fibrosis, while ACEI= prevent remodeling and act to regress hypertrophy.
*In MTB spirono=not benefit while ACEI= uncertain.
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Old 08-25-2012
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Quote:
Originally Posted by heartbeat View Post
What is the effect of ACE, and spironolactone on management of diastolic dysfunction?
*In Kaplan Q bank, spirono= prevent and regress hypertrophy and fibrosis, while ACEI= prevent remodeling and act to regress hypertrophy.
*In MTB spirono=not benefit while ACEI= uncertain.
Since no one have answer i will accept the concept from MTB because it seem to be more accurate than Kaplan Q bank
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Old 08-25-2012
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In a diastolic dysfunction (filling defect) spironolactone is not useful since it is an aldosterone antagonist (anti- mineralocorticoid) useful for systolic dysfunction.

http://en.wikipedia.org/wiki/Heart_failure

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  • Reduced perfusion (blood flow) to the kidneys stimulates the release of renin – an enzyme which catalyses the production of the potent vasopressor angiotensin. Angiotensin and its metabolites cause further vasocontriction, and stimulate increased secretion of the steroid aldosterone from the adrenal glands. This promotes salt and fluid retention at the kidneys.
  • The chronically high levels of circulating neuroendocrine hormones such as catecholamines, renin, angiotensin, and aldosterone affects the myocardium directly, causing structural remodelling of the heart over the long term. Many of these remodelling effects seem to be mediated by transforming growth factor beta (TGF-beta), which is a common downstream target of the signal transduction cascade. initiated by catecholamines[19] and angiotensin II,[20] and also by epidermal growth factor (EGF), which is a target of the signaling pathway activated by aldosterone[21]
http://www.aafp.org/afp/2006/0301/p8...060301p841-b29

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The hormone aldosterone promotes fibrosis in the heart and contributes to diastolic stiffness. The aldosterone antagonist spironolactone (Aldactone) has been studied in a large clinical trial of systolic heart failure,29 which showed a reduction in mortality related to heart failure. However, the specific effects of spironolactone on diastolic dysfunction are unclear.

Last edited by Novobiocin; 08-25-2012 at 04:15 PM.
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Stick to qhat MTB has to say..
Spironolactone is beneficial in CHF which mostly is a systolic heart dysfunction
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