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Saturday, September 8, 2012

Manage Erectile Dysfunction in Patients with Hearth Disease - Low Risk Patients


Erectile dysfunction and cardiovascular disease share similar risk factors, and erectile dysfunction may precede or be a marker for cardiovascular disease.

The Princeton Consensus Conference guidelines for the management of erectile dysfunction in the cardiovascular patient can be used to determine the need for further cardiac evaluation.

The Princeton guidelines define Low Risk as patients with ability to perform exercise of modest intensity without symptoms. These patients do not have any heart related complaints and less than 3 major risk factors (age, hypertension, diabetes mellitus, cigarette smoking, high cholesterol, sedentary lifestyle, and family history of premature CAD).

In addition, low risk patients have controlled blood pressure (it worth mentioning Beta-blockers and thiazide diuretics may predispose to erectile dysfunction). 

In patients with mild, stable angina pectoris, noninvasive cardiac evaluation is recommended. In addition, the anti-anginal drug regimen may require modification.

In patients with post-revascularization (after CABG or cardiac stents) and without significant residual ischemia, exercise tolerance test may be beneficial to assess risk.

If patient is more than six to eight weeks post-revascularization and has no exercise tolerance test-induced ischemia, intercourse may be resumed 3–4 weeks post-

Other low risk patients include those with mild valvular disease, New York Heart Association class I heart failure and left ventricular dysfunction.

If the patient does not respond to an adequate trial of the phosphodiesterase inhibitor, it would be reasonable to obtain a testosterone level. However, a testosterone level does not need to be obtained at the time of the initial evaluation unless there is decreased libido or physical signs suggestive of small testicles.

The full article can be find at:  Click Here

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