Sexual Dysfunction and Cardiac Risk (the Second Princeton Consensus Conference)

Kostis, John B.; Jackson, Gordon; Rosen, Rachel; Barrett‐Connor, Elizabeth; Billups, Kevin L.; Burnett, AL; Carson, Culley C.; Cheitlin, M.D.; DeBusk, Robert F.; Fonseca, V.; Ganz, Patricia A.; Goldstein, Irwin; Guay, André T.; Hatzichristou, D.; Hollander, Judd E.; Hutter, Adolph M.; Katz, Stuart D.; Kloner, Robert A.; Mittleman, Murray A.; Montorsi, F.; Montorsi, Piero; Nehra, Ajay; Sadovsky, Richard; Shabsigh, Ridwan

doi:10.1016/s0022-5347(05)00878-5

Cited by 49 publications

(75 citation statements)

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“…2,140,145 It can be suggested to patients that they begin with less strenuous sexual activities, such as fondling and kissing, and progress to activities such as mutual masturbation and oral sex, which can allow vital signs to rise more gradually and enable patients to assess their tolerance for sexual activity. If patients can engage in these activities without any adverse effects, such as chest pain, shortness of breath, a rapid or irregular heart rate, dizziness, insomnia after sexual activity, or fatigue the day after sexual activity, they will have more confidence that they can progress to sexual intercourse and are less likely to be fearful of experiencing risk associated with sexual activity.…”

Section: Recommendation For Resuming Sexual Activitymentioning

confidence: 99%

“…137 Patients with mild, stable angina are at low risk for sexual activity-triggered cardiovascular events, whereas patients with unstable or refractory angina are at high risk. 138,140 For patients deemed to be at high risk, sexual activity should be deferred until their condition is optimally managed and stabilized. 2 The relative risk of MI is raised significantly during episodes of physical or sexual activity compared with time not engaged in these activities; however, this association is less evident for physically active people than for sedentary individuals.…”

mentioning

confidence: 99%

“…141 Patients whose cardiac conditions are uncertain, as well as those with multiple risk factors, require further testing or evaluation before they resume sexual activity. 140 Clinically, patients should be advised that heart rate, blood pressure, and respiratory rate normally rise with sexual activity, and this is not a cause for alarm.…”

mentioning

confidence: 99%

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Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners

Steinke¹,

Jaarsma²,

Barnason³

et al. 2013

Circulation

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Section: Recommendation For Resuming Sexual Activitymentioning

confidence: 99%

mentioning

confidence: 99%

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Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners

Steinke¹,

Jaarsma²,

Barnason³

et al. 2013

Circulation

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“…Coadministration of sildenafil and an NO donor but not ANP produced a large rise of cGMP at the membrane, favoring the inhibition via PKG of L-type Ca 2ϩ channels. 53 Interestingly, sildenafil and other new PDE5 inhibitors are contraindicated in men who use nitrate medications 54 because the coadministration of these agents may cause cGMP to accumulate, resulting in marked and unpredictable decreases in blood pressure, accompanied by symptoms of hypotension. Inasmuch as our results in ARVMs apply to vascular smooth muscle, this could be due to a specific role of PDE5 in controlling the soluble pool of cGMP.…”

Section: Castro Et Al Cgmp Compartmentation In Rat Cardiac Myocytes 2225mentioning

confidence: 99%

Cyclic Guanosine Monophosphate Compartmentation in Rat Cardiac Myocytes

et al. 2006

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Background-Cyclic guanosine monophosphate (cGMP) is the common second messenger for the cardiovascular effects of nitric oxide (NO) and natriuretic peptides, such as atrial or brain natriuretic peptide, which activate the soluble and particulate forms of guanylyl cyclase, respectively. However, natriuretic peptides and NO donors exert different effects on cardiac and vascular smooth muscle function. We therefore tested whether these differences are due to an intracellular compartmentation of cGMP and evaluated the role of phosphodiesterase (PDE) subtypes in this process. Methods and Results-Subsarcolemmal cGMP signals were monitored in adult rat cardiomyocytes by expression of the rat olfactory cyclic nucleotide-gated (CNG) channel ␣-subunit and recording of the associated cGMP-gated current (I CNG ). Atrial natriuretic peptide (10 nmol/L) or brain natriuretic peptide (10 nmol/L) induced a clear activation of I CNG , whereas NO donors (S-nitroso-N-acetyl-penicillamine, diethylamine NONOate, 3-morpholinosydnonimine, and spermine NO, all at 100 mol/L) had little effect. The I CNG current was strongly potentiated by nonselective PDE inhibition with isobutyl methylxanthine (100 mol/L) and by the PDE2 inhibitors erythro-9-(2-hydroxy-3-nonyl)adenine (10 mol/L) and Bay 60-7550 (50 nmol/L). Surprisingly, sildenafil, a PDE5 inhibitor, produced a dose-dependent increase of I CNG activated by NO donors but had no effect (at 100 nmol/L) on the current elicited by atrial natriuretic peptide. Conclusions-These results indicate that in rat cardiomyocytes (1) the particulate cGMP pool is readily accessible at the plasma membrane, whereas the soluble pool is not; and (2) PDE5 controls the soluble but not the particulate pool, whereas the latter is under the exclusive control of PDE2. Differential spatiotemporal distributions of cGMP may therefore contribute to the specific effects of natriuretic peptides and NO donors on cardiac function. Key Words: cyclic GMP Ⅲ natriuretic peptides Ⅲ nitric oxide Ⅲ phosphodiesterases Ⅲ sildenafil C yclic guanosine monophosphate (cGMP) is a ubiquitous intracellular second messenger in the cardiovascular system. In the heart, acute elevation of cGMP concentration usually exerts negative metabolic as well as inotropic effects, 1,2 whereas chronic elevation prevents and reverses cardiac hypertrophy. 3-5 cGMP synthesis is controlled by 2 types of guanylyl cyclases (GC) that differ in their cellular location and activation by specific ligands: a particulate GC (pGC) present at the plasma membrane, which is activated by natriuretic peptides such as atrial (ANP), brain (BNP), and C-type natriuretic peptide 6 -8 ; and a soluble guanylyl cyclase (sGC) present in the cytosol and activated by nitric oxide (NO). 8,9 Clinical Perspective p 2228Although NO and natriuretic peptides use cGMP as a common second messenger, there are many instances in which activation of pGC and sGC leads to different functional effects. 10 -14 One explanation for these divergent effects is that cGMP rises in specific subcellular...

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“…After 4 weeks, the patient returns to clinic and reports that, after PDE5-I inges- 8 tion, he is able to maintain an erection and complete satisfactory sexual activity. On questioning, he reports no symptoms with exercise or sexual activity and no cardiac symptoms in general.…”

Section: Casementioning

confidence: 99%