[Management of sexual dysfunction in patients with coronary heart disease].
THE CONTEXT: Patients with coronary heart disease are generally males aged more than 55 and in whom the question of sexual activity must be evoked, not only with regard to the risks involved with the sexual act itself but also regarding the management of an eventual erectile dysfunction. POSITIVE DATA: A negative and maximal for the age stress test is of predictive value and can eliminate the hypothesis of recurrent coronary ischaemia during sexual intercourse. Drug-induced effects on the libido and erectile function are known but only led to suspension of treatment in one out 438 patients treated for one year.


CONCLUSIONS
In the case of documented erectile dysfunction, the combination of sildenafil nitrate derivatives or NO suppliers is formally contra-indicated because of the risk of hypotension. Post-marketing registers and specific studies in patients with coronary heart disease demonstrate the good haemodynamic and coronary tolerance to sildenafil in this category of patient, so long as the contra-indications are respected. The Princeton Consensus Panel has proposed a therapeutic strategy adapted to each patient and according to their level of risk and its treatment.
Philippe
François
F
Département de pathologie cardiaque, Institut mutualiste, Montsouris, Paris. francois.philippe@imm.fr
D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines; D018570:Risk Assessment; D012307:Risk Factors; D000068677:Sildenafil Citrate; D013450:Sulfones
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate