Specific cardiac conditions and sex

Use the Sexual Health Inventory for Men (SHIM) which is the shortened version of the  and reproduced in the Appendix (see page 59). Check the of daily activity compared with the level of exertion during sex using the METs guide page 2). Use exercise electrocardiography if unsure or echocardiography to clarify status or left ventricular function. Always try to involve the partner in the ED a programme—although ED is a man’s problem, it is a couple’s concern.

Hypertension

•    This is not a contraindication to sex when controlled.

•    Controlled patients: antihypertensives (single or multiple) are not a contraindica but use caution with doxazosin (and therefore all alpha-blockers that are non-selec and PDE5 inhibitors.

•    All ED therapies can be utilized.

•    Antihypertensives least likely to cause ED are the angiotensin II receptor antago and doxazosin.

Angina

•    For stable patients, there is minimal risk for sex or ED therapy - Cheap viagra Australia online.

•    Nitrates and nicorandil are contraindications to PDE5 inhibitors. On most occa these can safely be discontinued.

•    Heart rate-slowing drugs are the most effective anti-anginal agents: beta-bloc verapamil, diltiazem.

•    Use an exercise ECG to stratify risk, if unsure.

•    Use pre- or postdischarge exercise ECG to guide advice; no need for delay t resumption if satisfactory.

•    Advise gentle return to allow for losses of confidence by both patient and partner.

•    Rehabilitation programmes are a positive advantage.

•    Avoid sex in first 2 weeks (period of maximal risk).

Post-surgery or percutaneous intervention

•    If successful, risk is low.

•    Sternal scar may be painful; advise side-to-side position or patient on top position

•    Male chest hairs grow back like bristle; advise small pillow between partners to the pain.

•    Use exercise ECG, if unsure of ability. Canada health&care mall - best online store.

Cardiac failure

•    The risk is low, if good ability.

•    If symptomatic, adjust medication accordingly; patient may need to be the more pa partner.

•    If severely symptomatic, sex may not be possible owing to physical limitations an occasionally trigger decompensation.

•    An exercise programme can facilitate the return to sex; physically fit equals sexuall

Valve disease

•    For mild cases, there is no increased risk.

•    Antibiotic prophylaxis is not needed.

•    Significant aortic stenosis may lead to sudden death and can be worsened b vasodilatory effects of PDE5 inhibitors.

 Arrhythmias

•    Controlled atrial fibrillation is not an increased risk depending on cause and exe ability.

•    Warfarin contraindicates vacuum device and requires caution with injections.

•    Complex arrhythmias: arrange for 24–48 hour ambulatory ECG monitoring exercise testing. Treat and retest.

•    Pacemakers are not a contraindication.

Other conditions

•    For pericarditis, await full recovery; there is no specific increased risk thereafter.

•    With peripheral vascular disease, stroke or transient ischaemic attacks (TIAs), th increased risk of myocardial infarct, therefore screen.

•    With hypertrophic obstructive cardiomyopathy, there is increased risk of syncop sudden death on exercise. Exercise ECG advised. PDE5 and alprostadil may inc the degree of obstruction owing to vasodilatory effects. Test dose under ho supervision is recommended.

Stroke

 Stroke is a difficult and sensitive area for the victim and partner. Minimal disability fr transient ischaemic attack (TIA) has been mentioned (see page 43) and here the main is looking for additional cardiovascular risk and minimizing it. Sex should not pres management problem and the couple can be reassured about the minimal risk of a fu stroke with modern management (e.g. statin, ACE inhibitor, aspirin).

Where physical appearance is a problem, then open discussion is essential and s counselling may be needed. Strokes are often followed by fatigue and a decreased li as well as depression, and ED may be the consequence. Depression is very common a stroke but may well respond to specific therapy.

Those sexually active before a stroke are the most likely to be active again; neverth it takes time and support. Touching, kissing and caressing are good starting contact fatigue is often a problem, suggest the morning time after a good night’s sleep.

Stroke patients with a urinary catheter can be advised to remove it for the sexual ac and insert it after. Avoiding fluids for 2 hours before sex will decrease the bladder vol If the catheter cannot be removed, it can be folded back over the erect penis and cov with a prelubricated condom. Women victims of stroke can tape the catheter t abdomen or thigh. Tell the patients to open their bowels before sex to avoid embarrassing accidents. Sublingual viagra online click here - http://www.sublingualviagra.com

  

Paralysis

Paralysis will inevitably lead to the need to change the person’s usual position. As posi (within the bounds of common sense!) do not increase cardiac stress, experimentati going to be necessary. Pillows can be used to offer support in the side-to-side positio

The most common positions that stroke victims find most useful are:

•    Stroke victim lies on back, partner on top.

•    Side-to-side position. Stroke victim lies on affected side with pillows to support and hips).

•    Sitting position (male victim) in wheelchair or on a sofa or chair.

are ways of expressing feelings.

Self-stimulation, mutual masturbation and oral sex are other alternatives. Fe lubrication problems can be helped with water-soluble lubricants (e.g. KY jelly).

Finally, always be supportive to the couple and try to keep them away from perform issues using lots of humour because they will experience failure where they did not be This must be anticipated and not allowed to become an overwhelming issue.

Impotence Treatment by Drugs from Canadian-healthcaremall.com

The treatment of ED and the awareness of its frequency and importance stem directly the introduction of the oral phosphodiesterase type 5 (PDE5) inhibitor sildenafil (Viagra avaliable at Canadian Health Care Mall Pinterest) tadalafil (Cialis, Cialis Professional Canada) and vardenafil(Levitra)

Its mechanism of action by blocking PDE5’s degradation of c promotes blood flow into the penis (see Figure 3.2, page 9) and the restoration of er function. Vardenafil and tadalafil have recently been added to this family of drugs. Be their mechanism of action is the same, there is no reason to assume there will b significant differences in ED effectiveness; however, their PDE selectivity and half-life be of clinical importance. Potency is not clinically relevant, because it is a way of expre in vitro concentrations of a drug—in short, given in dose equivalents the clinical end-will be the same.

Haemodynamically, PDE5 inhibitors have mild nitrate-like actions (sildenafil viagra australia originally intended to be a drug for mild angina). As PDE5 is present in smooth m cells throughout the vasculature and the NO/cGMP pathway is involved in the regul of blood pressure, PDE5 inhibitors have a modest hypotensive action. In healthy subj a single dose of 100 mg sildenafil transiently lowered blood pressure by an average o 7 mmHg, with a return to baseline 6 hours post-dose. There was no effect on heart ra

As NO is an important neurotransmitter throughout the vasculature and is involv the regulation of vascular smooth muscle relaxation, a synergistic and clinically impo interaction with oral and sublingual nitrates can occur (Appendix 3). A profound f blood pressure can result. The mechanism involves the combination of nitrates incre cGMP formation by activating guanylate cyclase and PDE5 inhibition decreasing c breakdown by inhibiting PDE5. The concomitant administration of PDE5 inhibitor nitrates is a contraindication to their use and this recommendation also extends to NO donors such as nicorandil. Clinical guidelines regarding timing of nitrate use post-P inhibitor or use of a PDE5 inhibitor after cessation of oral or sublingual nitrates ar available, but recent studies are helpful. In a study involving healthy volunteers at 10 dosage, sildenafil, with its short half-life (see later), did not react with sublingual nit 6 hours post-use. Tadalafil, with it long halflife, did not react at 48 hours. No dat available for vardenafil, but as its half-life is similar to sildenafil, a similar result is expected. Oral nitrates are not prognostically important drugs, so they can be disconti and, if needed, alternative agents substituted. After oral nitrate cessation, and pro there has been no clinical deterioration, PDE5 inhibitors can be used safely. recommended that the time interval prior to PDE5 inhibitor use is 5 half-lives, which e 5 days for the most popular once-daily oral nitrate agents.