Erectile dysfunction cardiovascular disease

First- and second-trimester abortion Cervical reopening Induction of labor Augmentation of labor Postpartum hemorrhage Ectopic pregnancy Lactation suppression In gastrointestinal disease Peptic ulceration Liver transplantation Chemotherapy-induced mucosal lesions In cardiovascular disease Congenital cardiac malformations Raynaud s syndrome Chronic obstructive pulmonary disease Adult respiratory distress syndrome Pulmonary hypertension Arterial occlusive disease Extracorporeal circulation In urology Erectile dysfunction... 

Abbrevations. CAD. coronary artery disease CHF, congestive heard failure CV, cardiovascular CVA, cerebrovascular accident ED, erectile dysfunction ETT, exercise tolerance test LVD, left ventricular dysfunction MI, myocardial infarction NYHA. New York Heart Association. 

Billups KL, Endothelial dysfunction as a common link between erectile dysfunction and cardiovascular disease. Sex Health Rep 2004 1 137-141. 

Kaiser DR, Billups K, Mason C, et al, Impaired brachial artery endothelium-dependent and -independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease, J Am Coll Cardiol 2004 43 (2) 179-1 84,... 

Kirby M, Jackson G, BetteridgeJ, etal. Is erectile dysfunction a marker for cardiovascular disease Int J Clin Pract 2001 55 614-618. 

Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005 294 2996-3002. 

Thadani U, Smith W, Nash S, et al, The effect of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease, J Am Coll Cardiol 2002 40 2006-2012. 

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39% in those of 40 years. Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14%). While the evidence is not conclusive, drug therapy is thought to underlie 25% of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H -receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly adrenoceptor blockers and thiazide diuretics. 

Sildenafil citrate (Viagra) has been found to be safe and effective for managing erectile dysfunction in PD, but can unmask orthostatic hypotension in patients with multiple system atrophy (Zesiewicz et al., 2000 Hussain et al., 2001). Sildenafil is also effective for erectile dysfunction in other neurodegenerative disorders, but it should be used cautiously in those with cardiovascular disease. 

The interpretation of these sporadic cases is controversial, although some have argued that the reported cardiovascular adverse effects occur more often with sildenafil than with other pharmacological treatments of erectile dysfunction. It is at present unclear whether there is an increased risk with sildenafil. For example, in placebo-controlled trials there have been no differences in the incidences of myocardial infarction, angina, or coronary artery disorders between sildenafil and placebo (9). Exclusion criteria in clinical trials may have prevented the inclusion of patients who are at increased risk of adverse events. On the other hand, sexual activity itself increases cardiac workload and the risk of myocardial infarction. Patients with cardiovascular disease should be cautious in their use of sildenafil. 

Israilov S, Niv E, Livine PM, et al. Intracavernosal injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate. Int J Impot Res 2002 14 38 3. 

The nurse should assess how the client has been controlling his HTN and ask specifically about erectile dysfunction related to hypertensive medication. HTN is a risk factor for developing other cardiovascular diseases, including stroke. This client has two risk factors for developing a stroke HTN and his racial background. 

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