While many people with chronic heart failure lose interest in sex fearing that it will place too great a strain on their hearts, a literature review has now found that with proper screening and treatment, male patients can safely engage in sexual activity.
Writing about their findings in Mayo Clinic Proceedings, Dr. Stacy Mandras and Dr. Mandeep Mehra revealed that they had analysed studies that showed the impact of sexual activity on heart rate, blood pressure and respiratory rates, which typically increase during sexual activity and other forms of exertion.
The review's authors said that in one of the studies, such changes in middle-aged men with and without coronary artery disease were measured. They said that the peak heart rate during intercourse was found to be lower than heart rates measured during the patients' normal daily activities in that study.
Dr. Mandras and Dr. Mehra also addressed how to counsel and treat chronic heart failure patients who are coping with erectile dysfunction, difficulty achieving or maintaining an erection. They said that multiple factors might be responsible for such a problem.
The authors said that in addition to decreased exercise capacity, patients with chronic heart failure have blood vessel and circulation abnormalities that could reduce blood flow into the penis and interfere with the ability to maintain an erection.
They have also observed that many of the medications for chronic heart failure can cause or worsen erectile dysfunction.
Both reviewers said that many health experts have raised concerns over the use of the currently available treatment for erectile dysfunction—such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis)—in patients with chronic heart failure, who also take nitrates or other medications that relax and widen blood vessels.
Such a drug combination has been shown to be dangerous because it can increase the risk for a life-threatening drop in blood pressure, say the authors.
Dr. Mandras and Dr. Mehra reviewed results from a variety of studies in which male patients with congestive heart failure took sildenafil, and observed that more data were required to determine the safety of the newer drugs, vardenafil and tadalafil, for such patients.
"Taken together, these studies show that erectile dysfunction in patients with mild to moderate chronic heart failure can be safely and effectively treated with sildenafil, provided that patients are appropriately screened before therapy," say the authors.
For people who cannot take erectile dysfunction medications, the authors suggests that an exercise training regimen may be an appropriate substitute therapy to enhance sexual function and quality of life.
They strongly feel that clinicians should focus on the sexual activity history of chronic heart failure patients instead of ignoring it, as addressing this element can substantially improve their quality of life.
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