Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Erectile dysfunction is more prevalent in patients with cardiovascular disease Leriche’s syndrome and vascular impotence occasionally cause erectile dysfunction Sexual activity is a form of exercise and can precipitate angina or acute coronary syndromes +++ GENERAL CONSIDERATIONS ++ Erectile dysfunction can be primary or secondary to risk factors, such as hypertension, diabetes, cigarette smoking, and hypercholesterolemia Little is known about female sexual dysfunction in cardiovascular disease Erectile dysfunction increases with age New pharmacologic treatments for erectile dysfunction have exposed sexually inactive men to the risks of sexual activities Sexual intercourse increases oxygen demand by about 3–5 metabolic equivalents Any patient who is free of ischemia on submaximal exercise test can safely engage in sexual activity +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Erectile dysfunction Dizziness, syncope after sexual activity Angina with sexual activity Vaginal dryness +++ PHYSICAL EXAM FINDINGS ++ Hypotension Tachycardia S4 +++ DIFFERENTIAL DIAGNOSIS ++ Psychogenic impotence Medication-induced sexual dysfunction Autonomic neuropathy Severe peripheral atherosclerosis Hypogonadism +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Low serum testosterone in some men Low estrogen levels in some women +++ ELECTROCARDIOGRAPHY ++ ECG: may show signs of myocardial ischemia/infarction +++ IMAGING STUDIES ++ Echocardiography: may show left ventricular hypertrophy or dysfunction +++ DIAGNOSTIC PROCEDURES ++ Coronary angiography may be necessary +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Presence of cardiac disease +++ HOSPITALIZATION CRITERIA ++ Acute coronary syndromes Syncope Persistent hypotension +++ MEDICATIONS ++ Oral sildenafil (25–100 mg), vardenafil, and tadalafil are effective for erectile dysfunction (caution with concurrent nitroglycerin use) Give transurethral or cavernosal alprostadil (prostaglandin E1) if nitrates cannot be stopped Testosterone may help some men Topical estrogen creams may help some women +++ THERAPEUTIC PROCEDURES ++ Percutaneous revascularization may be necessary +++ SURGERY ++ Coronary bypass surgery may be indicated +++ MONITORING ++ ECG monitoring in hospital as appropriate +++ DIET AND ACTIVITY ++ Low-fat diet Activity predicted by cardiac disease In general, a negative exercise stress test permits sexual intercourse +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ Resolution of problem Successful revascularization +++ FOLLOW-UP ++ Predicated by cardiac disease status +++ COMPLICATIONS ++ Erectile dysfunction drugs can precipitate dangerous hypotension in certain circumstances, such ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.