LIFE-THREATENING ANGIOEDEMA

Angioedema is a well-recognized edema involving the deeper layers of the skin, subcutaneous tissue, and mucosa. From July 1986 to July 1989 the authors have observed and treated 10 patients admitted to the Medical College of Virginia (MCV) Hospitals in Richmond, Virginia, with life-threatening angioedema as a complication of enalapril or captopril ingestion. Both drugs are angiotensin-converting enzyme (ACE) inhibitors prescribed for antihypertensive activity and the ability to improve symptoms in patients with congestive heart failure. We describe the clinical symptoms, diagnosis, and management of these patients, as well as reasons for each occurrence. Sporadic reports of angioedema secondary to ACE inhibitor therapy have appeared in the literature. This represents the first time a significant series of patients from the same institution have encountered this complication over a short period of time, suggesting that the complication may be much more common than has been thought.