Sunday, September 23, 2012

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

The Princeton guidelines define High Risk as patients with:
High risk: defer resumption of sexual activity until cardiological assessment and treatment
Unstable or refractory angina
 -> Increased risk of MI
Uncontrolled hypertension
  -> Increased risk of acute cardiac and vascular events (i.e., stroke)
CHF (NYHA class III, IV)
  -> Increased risk of cardiac decompensation
Recent MI (<2 weeks)
  -> Increased risk of reinfarction, cardiac rupture, or arrhythmias, but impact of complete revascularization on risk is unknown
High-risk arrhythmias
  -> Rarely, malignant arrhythmias during sexual activity may cause sudden death
  -> Risk is decreased by an implanted defibrillator or pacemaker
Obstructive hypertrophic cardiomyopathies
  -> Cardiovascular risks of sexual activity are poorly defined
  -> Cardiological evaluation (i.e., exercise stress testing and echocardiography) may guide patient management
Moderate to severe valve disease
  -> Use vasoactive drugs with caution

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